As we enter the second year of the COVID-19 pandemic, many questions remain unanswered. The answers to some questions continue to change. Certainly, as we learn more, science often generates additional questions. Our understanding of COVID-19 sometimes seems like a game of whack-a-mole as new information modifies what we thought we already knew.

This virus is associated with long-lasting symptoms bundled into a condition called COVID-19 long-hauler syndrome. About a third of those who were not hospitalized and experienced only mild to moderate infections are still dealing with various symptoms months after their initial illness. These long-hauler symptoms range from physical to psychological and could be a result of inflammation.

Question: What are the most common long-haul symptoms?

Answer: According to the U.S. Centers for Disease Control and Prevention, the most common long-haul symptoms reported include fatigue (without apparent cause), shortness of breath, cough, joint and chest pains. Less common is a long list of symptoms, including brain fog or mental cloudiness, anxiety and depression, muscle pain, hair loss, headache, elevated heart rate, heart palpitations, numbness and tingling throughout the body, rashes, and loss of the sense of taste or smell.

Also, some individuals are experiencing post-traumatic stress disorder symptoms of anxiety and depression, and minor irritations might even cause rapid heart rate.

Q: Can someone with asymptomatic COVID-19 also have long-haul symptoms?

A: Although less common, a growing number of young, healthy people (before COVID-19) are experiencing long-haul symptoms. These individuals are not necessarily in a high-risk group.

Q: How long do the symptoms last?

A: No one knows how long the symptoms will persist. Some experience continuous long-haul symptoms for weeks or months. In contrast, others feel better for a few weeks and then relapse with old or new symptoms.

Q: Are there things to help prevent, reduce or shorten long-haul symptoms?

A: At this time there are many more questions than answers.

Many of the long-hauler symptoms are similar to those related to the underconsumption of iron and zinc. Increasing vitamin D intake has been widely publicized. However, at least 12 other vitamins and minerals should be adequate for immune health. Therefore, a basic one-a-day, low-cost multivitamin-mineral may help meet the increased nutrient needs of infection and inflammation.

Keeping hydrated is also critical to normal functioning, and adequate hydration will become more important as the weather heats up.

Some long-haulers indicate a certain level of symptom relief after they were vaccinated. Currently, it is unclear whether this symptom relief is related to a direct effect of the vaccine or due to the psychological comfort of returning to safety.

The diverse nature of long-hauler symptoms requires doctors to consider other causes, making the diagnosis and treatment challenging.

Alan Titchenal, Ph.D., C.N.S., and Joannie Dobbs, Ph.D., C.N.S., are nutritionists in the Department of Human Nutrition, Food and Animal Sciences, College of Tropical Agriculture and Human Resources, University of Hawaii at Manoa. Dobbs also works with University Health Services.