FOR TWO WEEKS last summer, Justin Foster puttered around his Clemson apartment, working out as best he could, waiting for the 14 days of his COVID-19 quarantine to pass. He was one of more than 40 Clemson football players to test positive, and, like most of them, his symptoms were barely noticeable.
The 14 days passed, and he headed back to the field, officially recovered.
Something wasn't right. From the first workout, he struggled for breath while he ran, and after practices he collapsed in bed. No amount of sleep was enough.
"Even when you feel your best day, you're still so tired," he says. "You can't really keep up. You can't do anything."
As it became harder to function, doubt seeped in. Maybe something was happening to him, or maybe it was something else. Despite a lifetime of evidence to the contrary, "it was almost to the point where I just felt lazy," he says.
What Foster did not know, and would not know for months, was that he was a part of the COVID-19 population that was only beginning to reveal itself. He was a long-hauler, someone whose symptoms persevere for more than four weeks after the initial infection, according to the Centers for Disease Control and Prevention.
Beyond the fatigue, long-haulers have reported an odd collection of symptoms -- headaches, sore joints, shortness of breath, itchy skin, sore teeth, strange rashes, muscle spasms, mental fog -- but for many people, there is another side effect that's harder to deal with: You feel like you're losing your mind.
You feel like you're supposed to will your way out of it, show some gumption or get-up-and-go, and your body just ... won't. And like Foster, you start to think you're just lazy, and you worry that people don't believe you. Because often you don't believe yourself.
I didn't. I caught COVID-19 in March 2020, and by June I couldn't understand why I couldn't get myself together. I haven't felt like myself for a single day since.
He's a 22-year-old athlete from North Carolina who had aspirations for the NFL. I'm a 52-year-old journalist who lives in New Jersey and likes to run.
From our first conversation, we connected about what it was like to suddenly no longer be yourself, and the constant self-doubt that came with it. If we can't do the things we used to do, then who are we?
You spend your life running into limits and defining yourself by how you react to them. Then long-haul COVID hits you with limits that you don't know how to deal with, or didn't expect to deal with for years. And no one can tell you whether it will be one more week of this or the rest of your life.
JUSTIN FOSTER IS a "yes, ma'am/yes, sir" sort of Southern kid who grew up in Shelby, North Carolina, a town of about 20,000 just west of Charlotte.
He was quiet, he says, like his parents. He's still pretty quiet. He wasn't a natural athlete, and he wasn't one of those kids driven to play sports.
"Most of the time I was forced to play, just because I was larger than everyone else. I was very clumsy, not coordinated at all," he says. "I was pretty good at football, just because they'd just tell me to tackle the person with the ball."
In high school he was a linebacker, gaining national attention as a junior when he had 67 tackles during Crest High School's perfect 2015 season. (He had 10 tackles in the state championship.) One day his coach, Mark Barnes, handed him a phone and said someone wanted to speak to him. It was Dabo Swinney, who offered him a scholarship.
Only one member of Foster's immediate family had gone to college, he says, and it hadn't occurred to him that football could make him the second. He had been thinking about trade school or the military, some arena where he could use his skill to take any machine, figure out what was wrong with it and then put it back together.
"Everyone else looked at me as a ballplayer, but for me personally it really hadn't set in that that was my identity and that's what I really wanted to do," he says.
Clemson moved him to defensive end, and for his first three seasons, Foster was mostly a role player on a stacked team, showing ability as a pass rusher. The possibility of the NFL was becoming real, though. In 2019 he was honorable mention All-ACC and made the All-ACC Academic Team. (In December 2020, he graduated with a degree in construction sciences with a 3.24 GPA.)
His teammates describe the two sides of Foster they've come to know. There's "Mater," named for the rusty tow truck in the animated movie "Cars." "Mater" Foster fixes their vehicles and changes flat tires and is, in their words, an easygoing country boy.
Then there's the Foster who takes his place on the edge of the defensive line.
"He's a straight power rusher," teammate Myles Murphy says. "Loves to go through the tackle, go through people. Very aggressive player. We like that on the edge."
Before the 2020 season, a number of scouting websites said Foster was a credible "Day 3" NFL draft pick, meaning somewhere between the fourth and seventh rounds. A solid season could push him up the list.
On June 25, 2020, Foster was at his home in Clemson when the text came from the team training staff saying he had tested positive for COVID-19. All he felt at the time was a runny nose that he assumed was allergies.
When he returned to practice two weeks later, the struggle began. He'd had asthma his whole life but felt like it was always under control -- he rarely used an inhaler. Now, he was short of breath all day long. And he felt like he had to do something that went against every part of his personality: ask for help.
"There's some guys that maybe have a little something that's wrong with them and they drag it out for a period of time," says Danny Poole, the team's director of sports medicine, and an athletic trainer for 40 years. "With Justin, he's one of those guys that if he comes and tells you there's something going on, you better believe it."
EVERY DISCUSSION OF long-haul COVID has to start with the caveat that no one fully understands it. Almost two years into the pandemic, experts still have multiple theories about what long-haul COVID is and how to define it.
When Foster and I realized more than a year ago we weren't recovering, there was no consensus that there even was such a thing as long-haul COVID. Some doctors thought their patients were still sick with the disease but that the virus was somehow avoiding detection; some doctors thought patients were suffering from PTSD.
Researchers from the University of Washington estimate that roughly 30% of people infected with COVID-19 develop long-haul syndrome. The severity and symptoms range wildly. Some people feel a little off, while others are unable to get out of bed for days at a time.
What experts have come to believe is that for some unknown reason, long-haulers' immune systems act as though they're still under attack from the virus. Physical or emotional stress, even good stress, disturbs the entire system like a hornet's nest. Doctors want their patients moving so they don't become completely sedentary. But if you have the driven personality of, say, a college football player, accustomed to ignoring pain and fatigue, that drive can make the symptoms worse.
How it all happens and how to treat it, however, are still the subject of widespread debate.
"We all would agree that something is wrong with the immune system," says Dr. Daniel Griffin, an infectious disease physician and researcher at Columbia University. "To this day I still don't think we've gotten to why the immune system hasn't reset itself."
When I was infected, I was never hospitalized, never had problems breathing or with my heart. I was sick for three weeks, the worst of it a four-day period when I slept about 18 hours a day. A couple of weeks after I had been sick, I assumed that as soon as I could get my running legs back, I'd feel like myself. On my first run, I felt out of shape, but no more than that. Then, about 36 hours later, my lungs began to ache as though I had been breathing smoke. I was exhausted. I spent the better part of the next couple of days in bed, wondering why I was so tired, wondering if I had grown too comfortable being in bed all day. I began a pattern of recovering, trying to run, then having the same delayed reaction that shut me down all over again. I tried going for walks, but the result was the same.
A friend who survived the virus after 35 days on a ventilator had returned to his pre-COVID strength, but I hadn't. It made no sense. I just need to get back into shape, I repeated. I need to push through it. And that's one of the first things that sets in with long-haul, the question of whether you're imagining everything, or if, mentally, you're too weak to cope.
CLEMSON PLAYERS WHO had COVID-19 followed a series of steps before they returned to full workouts. They started with light jogging, then sprinting, then practicing in a green jersey, which signified no contact, always checking in with the trainer at the end of the day.
The main concern, Poole says, was making sure players hadn't contracted myocarditis, a rare but potentially fatal heart inflammation that doctors at the time were concerned was linked to COVID-19. Usually, players were back to full speed a month after being infected. Of the players who were infected, all reported complete recoveries. Except for Foster.
Teammates noticed that Foster was raising his hand during drills, asking coaches to rotate him out so he could catch his breath. They hadn't seen that before.
"If he takes the time to step out, that means something serious," teammate K.J. Henry says. "He has a great grasp on the difference between pain and injury."
Foster says the harder he drove himself, the worse it got.
"I didn't want to be the one that wasn't working out or the one that's always having a problem and having to go to the training room and deal with it," he says. "It was just a lot mentally, pretty much just being down all the time. And I didn't know what was going to happen."
Foster and Swinney shared a shorthand to monitor how he felt. Swinney would wave his thumb in three positions -- up, sideways, down -- and Foster would respond with his own thumb to reflect where he was. Too often it was sideways or down.
After a couple of weeks, he wasn't able to practice at all. Day after day, when his teammates came into the training room to get taped up or treated, they saw Foster sitting in the corner with a nebulizer strapped to his face.
"I just remember him coming to me and he just was kind of was broken down. He said, 'Coach, I can't do it,'" Swinney says. "As an athlete and especially as a football player, we're kind of all wired to go and [be] like, 'Hey, snap out of it.' But this was something you couldn't see. It's not like you got a torn ACL, or you got a broken bone or something like that."
Foster says he worried his teammates thought he was lazy. No, they say. Quite the opposite. The fact that it was Foster who was struggling unnerved them. "No one thought he was lazy at all. We knew that he does what he needs to do every day to prepare," Murphy says.
"The entire team had no idea what was happening: 'Am I going to be next? Why did he react like that to COVID? And if I get COVID, am I going to react the same way?'"
Foster got to the point at which walking up the stairs in the football facility was too much. "It was just a very dark place for a long time," Foster says.
One night during the summer of 2020, Foster went to lie down a little after 11 p.m., when he felt an asthma attack coming on. He did what he usually does during an episode and took a puff from his inhaler. It didn't work.
He didn't want to call 911 and go to an emergency room in the middle of a pandemic, so he called Poole, the trainer.
Poole says he was struck by the fear in Foster's voice and told him to get to the team facility. Poole and the team physician put Foster on a nebulizer and talked him through breathing drills until, finally, a few hours later, the attack subsided.
In the weeks that followed, the training staff took Foster to several local doctors, each of whom came to the same conclusion, that there was no medical problem they could identify.
"It's like, am I crazy?" Foster says. "Is something going on with me mentally that I just can't push through this?"
IT WASN'T JUST his body. Foster took summer classes, and when he sat at a computer or tried to read a book, his mind couldn't grasp what was in front of him. This from someone who was an All-ACC Academic Team selection.
"There was a time where I was probably three weeks behind in class. I'm never a person not to do my work," he says.
The mental fog can be more destabilizing for some people than the physical symptoms. You don't recognize yourself, but you look normal to everyone else. I had plenty of evenings with friends or family when I could rally for a few hours, but I knew I'd be wiped out for the next two days. In my lower moments, it became too difficult to read because simple words didn't make sense. When I wrote, I might forget what I was writing in the middle of a sentence.
Over and over, I went through the process of researching something for an article, writing that portion, polishing it and then discovering that I had already done all that hours earlier. I had no memory of writing the same material. I learned to use outlines and checklists to do what I'd relied on my mind to do for 30 years. I had to lean heavily on colleagues to make sure that my work was clean.
In conversation, I frequently lost thoughts in mid-sentence, and then worried people thought I was being melodramatic. There were times watching TV when my mind couldn't keep up with the dialogue and I had to hit pause. Twice I got lost driving near my home and had to use Waze to get back.
And many nights I hit that wall and had to leave the dinner table as my family watched knowingly, not saying anything because they knew I didn't want the attention. I'd be in bed the rest of the night.
Most of the time I felt like I was possessed by someone dumber and more irritable. The cuts to my sense of self were relentless, with the wild, vivid dreams I had every morning, my inability to smell or taste, the strange things I found myself saying, the words I couldn't come up with, the loss of desire for longtime passions, the difficulty of small talk. Experiencing the minutiae of the day and thinking, "This just isn't me," over and over for months.
When I shared that with Foster he nodded and said, "Exactly."
My low point might have come after a weekend in November visiting my daughter in Washington, D.C., the most active two days I'd had in months. When I got home that Monday night, I saw a story from my colleague Jeff Passan about Tony La Russa's DUI. Something was vaguely familiar about it, and it hit me that Jeff and I had spoken three days earlier. I called him and was blunt. "I need to know, did I f--- something up? Was there something you asked me to do?"
"Actually," he said, "there was."
It turned out to be inconsequential, and Jeff couldn't have been better about it, but I had no memory of the conversation. It was like being told about a drunken blackout. And then the thought hit me that I had no way of knowing how many times this had happened over the previous eight months.
I felt like a writer who couldn't write, a reader who couldn't read, a runner who couldn't go for a walk, a father and husband who disappeared into his own head every night. Lesser in every way I could measure. I kept repeating to myself, "Useless."
THE FIRST TIME Foster heard the term "long haul" was in August 2020, from head trainer Poole. Foster then went to the Medical University of South Carolina in Charleston, where, finally, a doctor said his issues were indeed probably related to his COVID-19 infection, and they were real. No one could explain why his asthma attacks had become so intense, and no one could say when or if he would get better. But just hearing about "long haul" was a massive relief.
"Someone telling me that I'm not crazy and that there's actually something going on, that was the first time that I realized that I could relax," he says. "I knew that there was actually something going on that was causing me to be like this."
For the first two months after I'd been sick, convinced I had fallen into some rut of laziness that I couldn't break out of, I wondered if I'd even had COVID at all. In those early pandemic days in North Jersey, you couldn't get a test unless you needed to be hospitalized. I might be imagining this whole thing, I thought.
Ultimately, I took my sons with me to get antibody tests, and even as the nurse drew blood from my arm, I felt like I was on a path to being exposed as a fraud. A few days later the call came and someone read me results. Michael Quinn ... negative. Liam Quinn ... negative. Thomas Quinn ...
As I waited to hear my result my heart was pounding so violently my shirt was moving. "Positive," she said.
The wave of relief that went through me felt like anesthesia. I teared up. I wasn't crazy. I had no idea what would happen, but for the moment it was enough to know it was all real. She sent me a copy of the test result, and I pinned it to the wall next to my desk.
AS THE 2020 football season began, knowing he was fighting an illness and not his own mind, Foster still had hopes of rallying. But week by week, nothing changed, and his nights became lessons in terror.
"There were multiple nights where I would lay down and I would be choking in my sleep. And I would wake up in the middle of the night and I could barely breathe," he says. "That's when I was at my lowest point because I just didn't know what was going to happen. ... If I was going to go to sleep one day and not wake up."
Midway through the season, Foster and Swinney agreed that he needed to focus on his health. There was always next year. Foster went to practices and home games but didn't dress, speaking up when the defensive line gathered, maybe sharing a certain move that would work against an offensive tackle.
"At practice, even in games, he'd be right there, pretty much just coaching us up," Murphy says.
And when the defense was on the field, Foster found a spot on the sideline where he was unlikely to encounter players tumbling out of bounds. "I knew if something did happen I couldn't run fast enough to get out of the way, and I didn't want to cause a scene," he says.
But he says it was killing him not to participate or know whether he might play again. The idea began to sink in that he had to walk away from football altogether, just to be able to move on mentally and emotionally to the next part of his life. To become whatever he was going to be after football. There was always going to be an end to his career; maybe this was it.
He says he made the decision in December but didn't make it official for two months. "I couldn't really bring myself to do it, just because of all the work I'd put in," he says.
On Feb. 24 this year, Foster went to the Clemson football facility and sat outside Swinney's office for 90 minutes until the coach was free. Foster told him he needed to step away from football. Swinney said he understood and told Foster he would have a place on the team if he wanted to come back.
Foster told the rest of the world that day on social media.
"Today is a difficult day for me, but it is also a day of reflection and gratitude," he wrote. "With sadness but no regret, I have decided it is in my best interest to call it a career and hang up football."
A week later, Foster told me about the frustration he felt.
"The question I would ask when I went to the doctor is, 'You guys say you don't see anything; you guys say that things are getting better. I don't feel better. So is this a new life for me? Is this my life now?' And if it is, just tell me that. And I will be fine what that, and I'll just have to deal with it.
"I don't want to get my hopes up and keep hoping and hoping and hoping that I'm going to be back to normal."
We were experiencing something akin to sudden aging, leaping past what we saw as the coming vital years. You had to fight the urge to dwell on what had been lost or whether you could ever get it back. You had to learn that patience and acceptance weren't weaknesses, they were the only strengths you had left at times. This is what I can do today. Let's see what happens tomorrow.
THE SAME DAY Foster announced his retirement, Dr. Anthony Fauci, the director of the U.S. National Institute of Allergy and Infectious Diseases, announced a new federal initiative to study long-haul COVID, and dubbed the syndrome with an official name: Post-Acute Sequelae of SARS-CoV-2.
By that point, several prominent hospitals had established post-COVID clinics to both treat patients and gather data. Foster attended one at Duke, and I went to the one at Mt. Sinai Hospital in Manhattan -- an appointment I had to make five months in advance.
I met with a "functional medicine" doctor, who said the goal was to get my body's inflammation down so my autonomic nervous system would switch back to its normal state. I later learned not all experts believe the nervous system is even involved, but I was advised to adopt an anti-inflammatory diet, take a number of supplements to boost the immune system and decrease inflammation, wear compression clothing to help circulation, get a lot of rest when I needed it. I couldn't tell you if any of it has helped, but I do it.
Before COVID, I was in obnoxiously good health. But like many long-haulers, my blood pressure and cholesterol hit inexplicably high levels after I got sick.
Part of the Mt. Sinai program is visiting with a cardiologist, and the day I saw her in March my blood pressure was 155/110, a fairly alarming number. I hadn't had any cardiac symptoms, but as she listened to my chest she said, "I think I hear a murmur."
An echocardiogram showed that she was right. The aortic valve in my heart was slightly dilated, allowing some blood flow back into the chamber. The good news was the condition is mild and completely manageable. It's possible it had been there for years but eluded detection. But it's possible, she said, that the elevated blood pressure I'd had for a year at that point caused it to dilate. However it got that way, I needed to get my blood pressure under control and will have to control it for the rest of my life to prevent more serious problems.
When Foster went to Duke's clinic for the first time, most of the focus was on his lungs. His pulmonologist there, Dr. Loretta Que, said during one test he was using only 49% of his lung capacity. She and the team there put him on a regimen of new medications.
"Prior to COVID, he hardly ever had to use an inhaler, and now he's on a chronic medication," she says. "I can't predict whether or not he's going to be able to come off of those in the future, but that's something that we're going to need to evaluate for."
THERE WAS A ray of hope out there for both of us in early 2021. At first the results were anecdotal, but long-haulers around the country were reporting dramatic recoveries after getting vaccinated. As data began to roll in, Columbia's Griffin estimated that 40% of long-haulers were seeing improvement.
I got my first shot in March and didn't notice any difference. A couple of weeks later, Foster got his. When I was headed to get my second injection, I texted him to see how he was doing. He wrote back, "1.5 mile jog this morning."
I woke up the day after my second shot feeling the sickest I'd ever felt in my life. The worst of it passed after two days, and over the course of the next two weeks I realized I might be feeling worse overall than I had before the shot.
But something had changed for Foster. Maybe it was the vaccine and maybe it was the progress he had felt since changing medications. Maybe it was just the passage of time. But suddenly a comeback seemed possible.
He began to push himself. His runs got a little longer, and he started to lift weights again. In April, he went back to Duke and got more good news. That 49% lung output was now 102%. Dr. Que put him on a new inhaler and said he was ready to attempt a comeback.
"She was telling me, what do I have to lose? She's like, 'You go back, you try to play again, and if you can't play, you just can't play.' And I was like, 'It's not a bad option,'" he says.
As Foster walked out of the appointment, his phone rang. It was Swinney, just checking on him. That was the moment, Foster says, when he decided he was ready to try, although he didn't share that on the phone call. He wanted to take some time to be sure.
A few days later, he called Swinney. He was ready, he said. Swinney beamed and told Foster he could go at his own pace, and if he's able to play only 10 snaps a game, so be it. Foster had a place on the team.
He started out doing drills at half speed, then continued to build until he was able to complete full workouts. Sometimes he has to take long naps when he finishes, but he's able to do the work. Occasionally during a sprint, he says, his throat will start to close up, but he keeps his inhaler handy and knows to drop out if he needs to.
"You break it down to almost every hour of the day: This is what I do now, this is what I do in an hour. It takes a lot of the mental stress out of it," he says. "When you look at goals that are maybe a year down the line, and you look at your situation, it puts a lot of mental stress on you."
He says he's ready to play, and his coach agrees, without hesitation. "He's back," Swinney says.
But Foster is still a long-hauler, still missing a sense of smell, still struck by occasional shortness of breath or pains in his chest, still prone to brain fog when he's tired. Since COVID-19, he has intense reactions to any bug bites. Last week during practice, he started to feel lightheaded and his throat started to close. He used an EpiPen -- one he's carried since a pre-COVID allergy to bees -- to make it stop. He and the medical staff couldn't figure out if it was related to food or a bug bite, but Foster chalks it up to "the new normal."
"When I get setbacks I stay positive about them," he says. "It could be worse: I could not be playing. I could be struggling a lot worse than I am, but I keep getting better."
And he still has a full season ahead of him, with another chance at the NFL.
"It's almost like it's not real," he says. "I mean, most of the time you get one shot, one chance, and once it's done, it's done."
Yet on Saturday night, 436 days after he was diagnosed with COVID-19, Foster will take the field with his teammates to play the University of Georgia.
IN MID-JULY, I was feeling out of options. The vaccine hadn't done the trick, and I didn't know what else to try. I remembered I had a methylprednisolone prescription that a doctor had written for me nine months earlier, but for whatever reason I hadn't taken it. I decided to give it a try, a medical Hail Mary, thinking another assault on my body's inflammation couldn't hurt.
I discussed it briefly with my cardiologist, and she agreed it was worth trying. I began the six-day steroid pack, and for the next six days I had a migraine every day. When it was over, something had changed.
I drove to North Carolina to meet with Foster in person for the first time. The trip from New Jersey should've laid me out for days. It didn't. I still hit the wall in the evenings, but later and not as badly. Maybe it was the methylprednisolone, maybe it was the supplements, maybe it was the meditation or the acupuncture, maybe it was time. On the Saturday after I met Foster in person, I went for a run.
On July 19, I texted him and said I had completed my fifth run in eight days. They were slow and short and ugly and I was fatigued and sore at night, but I was doing it. He wrote back, "That's what's up."
I took a chapter from the same book he did: Let go of expectations. Do what you can right now. Don't get ahead of yourself. Walk a quarter mile, run a quarter mile, repeat until you can do more. Keep going.
When I went back to my cardiologist with the news, she beamed. "I think I'm more excited than you are," she said. I told her I was just trying to keep an even keel after 16 months of hope and setbacks.
"You're going to get there," she said. "It might take you another year, but you're going to get there."
A year and a half after the long haul began, after wondering if this is what the rest of my life will be, "one more year" sounds like early parole. There are no promises. I still have days when I feel like hell, and I don't know what to make of them. But I get up each day and check my blood pressure, I take my supplements, I eat my heart-healthy diet, I exercise when I can and I'm starting another course of steroids.
Today, I finished this story. Tomorrow, I'll do something else. On Saturday, I'll watch Justin. And then we'll both see what's next.
ESPN feature producer Damien Esparza and researcher John Mastroberardino contributed to this report.