Covid-19 and Post-viral Fatigue Syndrome by Dr Charles Shepherd | 30 April 2020


Dr Charles Shepherd, Hon. Medical Adviser, ME Association.

We are starting to receive reports about previously healthy people who have had (or probably had) coronavirus infection and have not been able to return to their normal level of health and energy levels in the weeks following the onset of symptoms.

These reports are largely from people who have managed at home and not had a more serious infection that required hospital admission.

Some reports are from health professionals. It seems likely that some of them are experiencing what is called post viral fatigue (PVF), or a post viral fatigue syndrome (PVFS).

We are also receiving reports from people with ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome) who have had this infection and now have a significant exacerbation of their ME/CFS symptoms – especially a further reduction in energy levels.

The ME Association has a lot of experience in dealing with people who develop prolonged and debilitating fatigue (sometimes with other symptoms as well) following a viral infection – as well as people with ME/CFS who relapse following another infection.

We are now expecting to see a number of new cases of ME/CFS that follow coronavirus infection fatigue.

This is why we have produced some guidance on how we feel that convalescence and good basic management of post-infection fatigue can lessen the chances of this turning into a more permanent and debilitating illness.

Leaflet Contents:

  • What is PVF and PVFS?
  • What are the symptoms of PVF and PVFS?
  • PVFS and possible progression to ME/CFS
  • Management of PVF and PVFS
    • convalescence
    • activity management
    • mental wellbeing
    • nutrition
    • sleep
    • work and education
    • finances
    • drug treatments
  • When to check with your GP
  • Research into PVF and PVFS
  • Further information

Leaflet Extract:

What is Post-viral Fatigue (PVF) and Post-viral Fatigue Syndrome (PVFS)?

Some degree of post-viral fatigue (PVF) or debility is a fairly common occurrence after any type of viral infection.

Fortunately, in most cases, this is short lived and there is a steady return to normal health over a period of a few weeks.

However, in some cases, a full return to normal health takes months rather than weeks.

Additional symptoms may also develop, where the term post-viral fatigue syndrome (PVFS) may be a more appropriate diagnosis.

The situation with persisting fatigue following coronavirus infection appears to be rather more complicated than what happens with other viral illnesses. It could also be more serious – as fatigue and lack of energy are turning out to be a very characteristic symptom of coronavirus infection.

The precise explanation for what causes post-infection/viral fatigue remains uncertain. But one of the reasons why people have fatigue, loss of energy, muscular aches and pains, and generally feel unwell, when they have an acute infection is the production of chemicals called cytokines by the body’s immune system.

These immune system chemicals form part of the front-line attack on any viral infection. And it is interesting to note that in people who develop serious respiratory complications from coronavirus infection, this may be due to an overactive immune response involving what is being termed a ‘cytokine surge’.

When fatigue and flu-like symptoms persist for a longer period of time once the acute infection is over, as they do in ME/CFS, there is research evidence to indicate that what is a perfectly normal immune system response to the acute infection has not returned to normal.

It is also possible that, as happens with ME/CFS, there is a problem with the way that energy production is taking place at a cellular level in structures called mitochondria.

We are still on a very steep learning curve when it comes to understanding how the coronavirus behaves. However, there is no evidence to indicate that it persists like hepatitis C infection or HIV.

So, the continuing fatigue does not appear to be due to a persisting viral infection. Consequently, people who have continuing fatigue, but no other coronavirus symptoms, are no longer infective to others in our current state of knowledge.

While most people with post-infection fatigue will improve and return to normal health, good management during the very early stage is an important factor in trying to help any natural recovery process take place. And patient evidence also indicates that good initial management of post-infection fatigue lessens the chances of this turning into an ME/CFS-like illness.

Related information:

Physios 4 ME

You might also be interested in reading the latest statement from a group of physiotherapists who are working to make others in their profession more aware of the challenges faced by people with M.E.

This statement appeared on their website yesterday and the content was produced in association with The ME Association.

Extract:

“During this national crisis many physiotherapists have been redeployed to front-line services, but as time goes on our attention will shift to the rehabilitation of survivors.

“COVID-19 is a new virus so rehabilitation can only be based on generalised experiences. Universal presentation after a period of critical illness includes significant muscle loss and impaired cognitive function, with the standard approach to addressing such deconditioning involving mobilisation and exercise.

“Once medically fit many patients will be discharged home as quickly as possible, with community teams picking up the remainder of the rehabilitation process.

​”It is vital for physiotherapists (and any other treating health professional) to understand a potential complication of a viral infection – Post Viral Fatigue Syndrome (PVFS)…”

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