Recovering From Covid? Do This Before Hiking at Altitude

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High-altitude trekking stresses our bodies in unique ways, even for hikers in the best of shape. A trip to elevation on the heels of a Covid-19 infection poses an even bigger challenge, and the effects of the coronavirus on long-term performance remain uncertain.

Estimates of the number of people with “long Covid-19”—health problems lasting four or more weeks after infection—vary widely, but studies indicate that anywhere between 10 and 50 percent of those recovered from the acute phase of the illness will have persistent symptoms like fatigue, shortness of breath, and problems with cognition. With the total number of US cases topping 75 million, the numbers add up fast. Millions of travelers with long-haul symptoms could be trekking at altitude this spring and summer.

Scientists don’t know for sure how ongoing symptoms impact performance at elevation, or if long-haul Covid makes altitude illness more likely, or even more dangerous. But we do know that some persistent post-illness symptoms are accompanied by decreased exercise capacity and lung function.

Altitude experts Andrew Luks and Colin Grissom recently proposed guidelines for safe high-altitude travel after recovery from the virus. In an article in High Altitude Medicine and Biology, the two physicians outline a somewhat rigorous screening program for travelers who continue to have Covid symptoms when heading to the mountains.

“There was nothing in the literature to guide people who are returning to altitude,” Grissom told me, although climbers could borrow from guidelines for athletes returning to other sports.

Even trekkers who were fully vaccinated against Covid and never hospitalized—who exercised right through their illness—may not perform at their peak. The authors suggest that before traveling to high altitude, anyone with persistent symptoms—or even fully recovered patients who had an ICU stay, myocarditis, or blood clots—undergo testing including measurement of blood oxygen levels during exertion, an echocardiogram, lung function tests, cardiac stress tests and blood tests to screen for cardiac damage.

That sounds like a lot, but Grissom says it’s not a one-size-fits-all approach. Post-Covid travelers may be casual visitors to mountain towns or extreme alpinists eyeing 8,000-meter peaks. Climbers who aim to test the limits of their performance should do so with a clear sense of how their heart and lungs have recovered. Full recovery can take weeks or months, but thankfully most symptoms resolve with time.

Backpackers experiencing long Covid-19 symptoms don’t need to be home sitting on the couch—it’s just about time for all of us to get out and enjoy the world a bit more. But if you have persistent symptoms, reviewing your performance goals with a physician versed in altitude travel can help make your experience in the mountains a positive one. Having as much information as possible about your own recovery can boost the odds for a successful and well-deserved adventure.