May 3, 2022 -- Symptom timelines surrounding COVID-19 infections tend to center on either the immediate 5-day quarantine guidelines or the long-COVID symptoms that can last a month or potentially far longer.

But some patients report a middle-range COVID that goes away before it becomes long COVID but lasts longer than is typical for viral infections. People may return to work or daily routines, but something is off: What had been simple exercise regimens become onerous. Everyday tasks take more effort.

Does this ill-defined subset point to a “medium COVID?”

Farha Ikramuddin, MD, a physiatrist and rehabilitation specialist at the University of Minnesota points out there is no definition or shared official understanding of a middle category for COVID.

“But am I seeing that? Absolutely,” she says.

“I have seen patients who are younger, healthier, with not so many comorbidities have either persistence of symptoms or reappearance after the initial infection is done,” she says.

Some patients report they had very low infection or were non-symptomatic and returned to their normal health fairly quickly after infection. Then a week later they began experiencing fatigue, lost appetite, loss of smell, feeling full after a few bites, Ikramuddin says..

Part of the trouble in categorizing the space between returning to normal after a week and having symptoms for months is that organizations can’t agree on a timeline for when symptoms warrant a “long COVID” label.

For instance, the CDC defines it as 4 or more weeks after infection. The World Health Organization say it means starting 3 months after COVID-19 symptoms begin.

“I’m seeing ‘medium COVID’ —as one would call it – in younger and healthier patients. I’m also noticing that these symptoms are not severe enough to warrant stopping their job or changing their job schedules,” Ikramuddin says.

“I discharge at least two patients a week from my clinic because they have moved on and no longer have symptoms,” Ikramuddin says.

Public radio reporter Nina Feldman wrote about her experiences with not-short, but not-long COVID recently for Kaiser Health News.

“[W]hat I've come to think of as my ‘medium covid’ affected my life. I couldn't socialize much, drink, or stay up past 9:30 p.m. It took me 10 weeks to go for my first run — I'd been too afraid to try,” she said.

Feldman described a dinner with a friend after quarantining.: “One glass of wine left me feeling like I'd had a whole bottle,” she said. “I was bone-achingly exhausted but couldn't sleep.”

Medical Mystery

Ikramuddin notes that what causes extended COVID-19 symptoms is still a medical mystery.

“In one scenario,” she says, “the question is being asked about whether the virus is staying dormant – similar to herpes zoster or HIV.”

“Right now, instead of getting more answers, we’re getting more questions,” Ikramuddin says.

Mouhib Naddour, MD, a lung specialist with Sharp HealthCare in San Diego, says he’s sees some patients who have had COVID take longer to recover than is typical for other viral infections.

Some patients fall between those recovering within 2-3 weeks and patients having long COVID. Those patients in the gap could be lumped into a middle-range COVID, he says.

“We try to put things into tables and boxes but it is hard with this disease, “ Naddour says.

He agrees there’s no medical definition for “medium” COVID, but he says the idea should bring hope for patients to know that if their symptoms are persisting they don’t necessarily have long COVID and their symptoms may still disappear.

“This is an illness that may take longer to completely recover from,” he says.

“The majority of patients we’re seeing in this group could be healthy young patients," Naddour says, "who get COVID, then 2-3 weeks after they test negative, still have lingering symptoms.”

Common Symptoms

Some commonly reported symptoms of those with enduring illness, which often overlap with other stages of COVID, are difficulty breathing, chest tightness, dry cough, chest pain, muscle and joint pain, fatigue, difficulty sleeping, and mood swings, Naddour says. 

“We need to do an extensive assessment to make sure there’s no other problem causing these symptoms,” he says.

Still, there is no set timeline for the medium COVID range, he says, so checking in with a primary care doctor is important for people experiencing symptoms. 

It’s a Range, not a Category

Fernando Carnavali, MD, coordinator for Mount Sinai’s Center for Post-COVID Care in New York City, says he is not ready to recognize a separate category for a “medium” COVID-19.

He says science can’t even agree on a name for lasting post-COVID symptoms, whether it’s “long COVID” or “long-haul COVID,” “post-COVID syndrome” or “post-acute sequelae of COVID-19 (PASC ).” 

“That creates these gaps of understanding on where we are,” Carnavali says.

He says he understands people’s need to categorize symptoms, but rather than a middle ground he sees a range.

It doesn’t mean what others may call COVID’s middle ground doesn’t exist, Carnavali says: “We are in the infancy of defining this. Trying to classify them may create more anxiety.”