Q: It’s been a week since I tested negative for Covid, but I don’t feel totally better. Why am I still sick?
The rapid test is finally, blissfully, negative after a week of dark red positives. You’re technically over Covid — but the virus doesn’t seem to be over you, as fatigue, coughing or a general sense of “blah” persists.
If symptoms linger for four or more weeks after a negative test, that’s the point at which they could first be identified as long Covid, according to the Centers for Disease Control and Prevention.
But for some people, there’s a murky middle stage: Your Covid test is negative and you still feel sick, but you aren’t technically in long Covid territory yet, said Dr. Peter Chin-Hong, an infectious disease physician at the University of California, San Francisco.
“A lot of people bounce back really quickly” after a Covid infection, said Dr. Ziyad Al-Aly, a clinical epidemiologist at Washington University in St. Louis. But for many people, “it takes them two, three, four weeks to fully recover,” he said.
Here’s what might be going on.
Why do I still feel sick?
For most people, the immune system quiets down quickly after it fights Covid. For some, though, it stays active.
Researchers are not entirely sure why this happens. It could be because low levels of the virus are still lingering, or because the immune system is acting as if the virus is still there, even if it’s gone, Dr. Chin-Hong said.
Either way, it’s not unusual for certain symptoms to stick around after any viral infection, said Dr. Joseph Khabbaza, a pulmonary and critical care physician at the Cleveland Clinic. Inflammation can linger — people’s airways might swell, causing wheezing or coughing, or their sinus passages might puff up, causing congestion.
Covid fatigue can drag on for weeks in some people, even after they test negative. Covid can also continue to disrupt your sleep, which can leave you feeling even more depleted.
“You’re left with this almost paralyzing exhaustion,” Dr. Chin-Hong said. “You’re not completely right, and you’re just dragging yourself, and you’re trying to go to the gym and you can’t go.”
The more severe your symptoms were during your illness, the longer they might last, Dr. Chin-Hong said.
And Covid symptoms that had previously resolved can return — or “rebound” — during the week or so after a negative test, a phenomenon that is also sometimes linked with the antiviral therapy Paxlovid. But even if you didn’t take Paxlovid, exhaustion, coughs and aches can crop up again, Dr. Chin-Hong said, potentially because your immune system is still in defense mode.
Not everyone with persistent symptoms, however, will go on to develop long Covid, Dr. Al-Aly said — most people will recover before they hit that month mark.
How can I feel better?
There’s no simple fix for healing after Covid — mostly, it’s just a matter of time. But experts said there are a few things you can do to make the recovery process more manageable.
Try to rest as much as you can, Dr. Al-Aly said. Your body may still be trying to preserve the energy it needed to fight the virus, he said. So getting enough sleep can help you feel less worn out throughout the day.
Likewise, you should start slow if you’re eager to return to exercise, Dr. Chin-Hong said — especially if you are still feeling worn out or your other symptoms get worse when you work out. Listen to your body and don’t try to push through, he said.
If you’re still feeling poorly after 30 days, reach out to a primary care doctor, who may be able to offer strategies for managing your symptoms. You may also want to see if there is a medical facility, like a research hospital, that specializes in long Covid recovery near you, advised Dr. Marc Sala, co-director of the Northwestern Medicine Comprehensive Covid-19 Center in Chicago.
For many people, though, symptoms will abate in a matter of days or weeks, Dr. Chin-Hong said. Unfortunately, he said, they may not go “away immediately.”
