CORONAVIRUS

What does it mean to be recovered from the coronavirus?

State tracks recovery rate, but some Iowans show symptoms beyond 28-day marker

Darcy Havel-Sturdevant resting at her Iowa City home with the dogs on May 7, 2020 in a photograph by Gabe Havel. She had
Darcy Havel-Sturdevant resting at her Iowa City home with the dogs on May 7, 2020 in a photograph by Gabe Havel. She had tested positive for COVID-19 on April 29, but Havel-Sturdevant has still felt symptoms weeks after the diagnosis. (Photo submitted by Gabe Havel)
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Darcy Havel-Sturdevant has been counting the days since she first felt the effects of COVID-19.

Now more than 160 days later, the Iowa City woman’s health still is suffering the toll of the novel coronavirus, which has infected tens of thousands of Iowans since early March.

“I definitely don’t consider this as recovery,” Havel-Sturdevant said. “If it was, I would be able to resume daily life and I definitely am not able to, between the brain fog and cognitive issues and windedness.

“I’m nowhere near my baseline.”

The 33-year-old first came down with coronavirus-like symptoms in March, but her test came back negative for COVID-19.

It could have been lingering effects of pneumonia she had back in November, but the persistent symptoms — including high fever, shortness of breath and an elevated blood pressure — prompted Havel-Sturdevant to get another test.

Her third COVID-19 test came back positive on April 29.

The virus still didn’t seem to go away after 14 days. In the weeks that followed, Havel-Sturdevant said she continued to have trouble breathing, began having issues remembering and felt what she described as a “brain fog.”

Despite her lingering symptoms, Havel-Sturdevant is considered to be recovered from COVID-19 under state officials’ tracking of the virus within Iowa. Public health experts say infected individuals are not transmitting the novel coronavirus after 14 days — a key metric to help others understand when they may be at risk for exposure.

However, when it comes to understanding how this virus could affect Iowans’ overall health and the long-term implications for their well-being, that knowledge could be lacking under current tracking systems.

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Beyond deaths and hospitalizations, there’s no data to track the outcomes of COVID-19 patients.

State classifies recovery after 28 days

In late June, Gov. Kim Reynolds announced a change to the state’s classification of “recovered” from COVID-19 in a way that counts more Iowans as recovered from the virus using state data.

Iowans are considered recovered 28 days after a positive test, or two incubation periods of the virus. An individual will not be counted as recovered if state public health officials receive information that the individual in question still is ill.

Until that stage, an individual was only considered fully recovered once public health officials confirmed that fact in a phone call made to the individual about 10 days after that positive test result.

However, many of these phone calls had gone unanswered or unreturned — meaning these individuals were not considered recovered — Reynolds said during a news conference announcing the change.

Before the change, Iowa’s recovery rate was a little more than 60 percent. The new process brings Iowa’s recovery rate to about 80 percent.

Dr. Caitlin Pedati, state epidemiologist and medical director for the Iowa Department of Public Health, said in an interview with The Gazette this past week that long-term follow-up with COVID-19 patients is between the individual and his or her clinician.

“There are some people for whom there may be long-term effects. It depends a little bit on the individual, but it may take some time for some symptoms to resolve,” she said.

But the state’s process of counting Iowans as recovered 28 days later “does not necessarily mean that we don’t think there’s follow-up that needs to happen clinically or that there may not be long-term implications,” Pedati said. “Those are things we continue to look at for increased knowledge and guidance and information.”

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Under this new approach to the state data, individuals such as Melissa Erbes, a 43-year-old Marion resident, also would be considered recovered from COVID-19.

She tested positive on July 19, and 10 days later a contact tracer from the Iowa Department of Public Health said she no longer had to self-quarantine, which matches guidance from federal officials.

However, Erbes still was experiencing symptoms — including difficulty breathing and pain in her chest — at that stage. She said the contact tracer did not ask about that.

Her doctors at the Mayo Clinic in Rochester, Minn., where Erbes receives treatment for her thyroid cancer that metastasized into her lungs, told her to remain in quarantine for another two weeks.

“I was surprised. They didn’t ask to try to find out if I was still having symptoms. They seemed like they were in a hurry,” Erbes recalled of the contact tracer.

Long-haulers

A growing number of COVID-19 patients in the United States are experiencing symptoms — ranging from fatigue and trouble breathing to even neurological or cardiac issues — for weeks or even months after their initial diagnoses.

Research on these so-called long-haulers still are limited. One study of more than 140 COVID-19 patients in Italy, which was published in JAMA Network, reported that 87 percent reported at least one remaining symptom, usually fatigue and trouble breathing.

It’s worth noting that the average COVID-19 patient recovers after two weeks, and experts believe they no longer are spreading the virus, according to the World Health Organization. About 80 percent of those infected worldwide have reported mild symptoms, or no symptoms at all.

Some counties take different approach

Some counties still are following the process recommended by federal public health officials — which is different from the state’s process — including those that have resources to fund their own contact tracers, such as Linn County Public Health.

The county public health department continues to follow up with COVID-19 patients after 10 days, and will not classify individuals as recovered in reports to the state if they do not meet the criteria followed by the agency, said Heather Meador, clinical branch services supervisor.

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Meador could not speculate why the state chose the 28-day period to consider patients recovered, as it does not fit within guidelines by the U.S. Centers for Disease Control and Prevention.

Local contact tracers consider three metrics recommended by federal public health officials. They consider if the patient:

• Is 10 days from onset of the illness

• Is fever-free for 24 hours

• Has seen a general improvement in overall symptoms.

People can hit the federal metrics at different stages, and they often are individualized to that person, Meador said. And it could take some time for some individuals to see symptom improvement, especially if they experienced a severe illness.

Pedati pointed out that those federal guidelines refer to isolation, which comes from early research on how long viruses can transmit to others.

But because the virus is new and research remains lacking, Meador said there’s still some uncertainty as to whether a COVID-19 patient could be infectious beyond 10 days.

“If you have mild to moderate symptoms, after 10 days you can’t transmit to others,” Meador said.

“But if you’re really sick and in the hospital, how long are you truly infectious for if you’re highly symptomatic? There’s no good answer for that yet.”

Comments: (319) 398-8469; michaela.ramm@thegazette.com

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