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Post-COVID Fatigue Is More Than Just Tiredness; Could It Be Chronic Fatigue Syndrome, Or Long COVID?
People are often surprised by how fatigued they are during a COVID infection. Fatigue is more than being worn out or sleepy. It's excessive tiredness that persists despite resting or good sleep. It's likely a result of our body's strong immune response to the virus. But in some people, the fatigue drags on even when the infection is gone. This can be debilitating and frustrating. Simply resting more makes no difference.
Here's what we know about post-COVID fatigue, and what can help.
Fatigue or tiredness? What's the difference?
The term fatigue can mean different things to different people. Some people mean their muscles are easily weakened. Walking to the mailbox feels like they have run a marathon. Others describe generalised exhaustion, whether they are moving or not. People can experience physical, mental or emotional fatigue or any combination of these. The difference between tiredness and fatigue is this: tiredness can get better with enough rest, while fatigue persists even if someone is sleeping and resting more than ever.
How big a problem is this?
Because there is no agreed definition of post-COVID fatigue, it is impossible to give exact numbers of how many people experience it. Estimates vary considerably worldwide. One review of 21 studies found 13-33% of people were fatigued 16-20 weeks after their symptoms started. This is a worryingly widespread problem.
When should I see my GP?
There are many potential causes of fatigue. Even before the pandemic, fatigue was one of the most common reasons to see a GP (general practitioner). Most serious causes can be ruled out when your GP asks about your symptoms and examines you. Sometimes your GP will investigate further, perhaps by ordering blood tests.
Symptoms that should raise particular concern include fevers, unexplained weight loss, unusual bleeding or bruising, pain (anywhere) that wakes you from sleep or drenching night sweats. If your fatigue is getting worse rather than better, or you cannot care for yourself properly, you really should seek medical care.
Is it like long COVID?
Early in the pandemic, we realised some patients had a cluster of debilitating symptoms that dragged on for months, which we now call long COVID. Some 85% of long COVID patients experience fatigue, making it one of the most common long COVID symptoms. However, people with long COVID have a range of other symptoms, such as "brain fog", headaches and muscle aches. Patients with long COVID, therefore, experience more than fatigue, and sometimes don't have fatigue at all.
Is this like chronic fatigue syndrome?
We knew about chronic fatigue syndrome, otherwise known as myalgic encephalomyelitis, well before COVID. This often develops after a viral infection (for instance after infection with Epstein-Barr virus). So, understandably, there has been concern around the coronavirus potentially triggering chronic fatigue syndrome.
There are striking similarities between chronic fatigue syndrome and long COVID. Both involve debilitating fatigue, brain fog and/or muscle aches. But at this stage, researchers are still untangling any link between post-COVID fatigue, long COVID and chronic fatigue syndrome.
For now, we know many people will have post-COVID fatigue but thankfully do not go on to develop long COVID or chronic fatigue syndrome.
What helps me manage my fatigue?
Expect you or a loved one may develop post-COVID fatigue, regardless of how unwell you or they were during the actual infection.
Vaccines help reduce the risk of post-COVID fatigue by lowering the chance of catching COVID in the first place. Vaccinated people who do catch COVID are less likely to report fatigue and are less likely to develop long COVID.
However, vaccination is not 100% protective and there are plenty of fully vaccinated people who go on to develop longer-term fatigue. The evidence for what helps you recover from post-COVID fatigue is in its infancy. However, a few things do help, like the following:
1.
Pace
yourself:
Adjust
the
return
to
normal
activities
to
your
energy
levels.
Choose
your
priorities
and
focus
on
what
you
can
do
rather
than
what
you
can't.
2.
Return
to
exercise
gradually:
A
gradual
return
to
exercise
may
help
your
recovery,
but
you
may
need
some
support
about
how
to
manage
or
avoid
fatigue
afterwards.
Some
therapists
-
occupational
therapists,
physiotherapists
and
exercise
physiologists
-
specialise
in
this.
So
ask
your
GP
for
a
recommendation.
3.
Prioritise
sleep:
Rather
than
feeling
guilty
about
sleeping
so
much,
remind
yourself
that
while
you
sleep,
your
body
conserves
energy
and
heals.
Disrupted
sleep
patterns
are
an
unfortunate
COVID
symptom.
Having
a
strict
bedtime,
while
also
resting
when
you
feel
tired
during
the
day,
is
important.
4.
Eat
a
range
of
nutritious
foods:
Loss
of
smell,
taste
and
appetite
from
COVID
can
make
this
tricky.
However,
try
to
view
food
as
a
way
of
fuelling
your
body
with
both
energy
and
the
micronutrients
it
needs
to
heal.
Be
careful
not
to
spend
a
fortune
on
unproven
"remedies" that
often
look
good
in
small
studies,
but
more
robust
research
finds
make
little
difference.
5.
Monitor
your
fatigue:
Keep
a
diary
to
monitor
your
fatigue,
and
look
for
a
gradual
improvement.
You
will
have
good
days
and
bad
days,
but
overall
there
should
be
a
slow
trajectory
towards
recovery.
If
you
are
going
backwards,
get
input
from
a
health
professional,
such
as
your
GP.
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