Is it post viral fatigue, as some suggest, or an ongoing symptom of Covid-19 and signs of a longer recovery time?
It’s been four months since the first official cases of coronavirus came to light in the UK. Since then, there have been more than 200,000 confirmed cases – although this figure is likely to be a higher, given the current limits on testing.
Some of those who’ve been diagnosed with the illness, or suspect they have it, are finding that three or four weeks into their recovery, they are experiencing intense fatigue and an inability to return to their normal levels of activity.
“You certainly can’t exercise your way out of this,” Dr Charles Shepherd, Hon. Medical Adviser, ME Association.
Professor Paul Garner, an expert in global health at the Liverpool School of Tropical Medicine, is one of them. He had what he heavily suspects was Covid-19 and suffered seven weeks of ill health and exhaustion as a result.
“Sometimes I felt better and became optimistic,” he wrote of his fatigue in a BMJ Opinion piece, “but then the next day I felt as though someone had hit me around the head with a cricket bat.”
Recovery from the virus can take weeks, sometimes even months, Prof Garner went on to stress. “Symptoms come and go, are strange and frightening,” he wrote. “The exhaustion is severe, real, and part of the illness.”
The ME Association has also received reports of extreme fatigue from previously healthy people who have had – or suspect they had – coronavirus and have not returned to their normal level of health and energy in the weeks following the onset of symptoms.
Dr Charles Shepherd, honorary medical adviser to the ME Association, suggests some of these people might be experiencing post viral fatigue (PVF) or even post viral fatigue syndrome (PVFS).
The first is a temporary tiredness and weakness that lingers after a person has had a viral infection, the second a longer-term illness with a wide range of symptoms, the most common of which is extreme tiredness.
This is also diagnosed as chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME).
The number of people citing intense fatigue as an issue after having coronavirus symptoms has been “steadily increasing” in the past few weeks, Dr Shepherd tells HuffPost UK.
“We’re just starting to get to the point now where lots of people have it [Covid-19] and they’re now three or four weeks after they’ve had their initial symptoms, but they’re not getting better,” he says. “So, they’re starting to ask questions and doctors are starting to ask questions.”
The issue is mainly impacting people who have managed the illness at home, Dr Shepherd notes – although this self-reporting could be because people returning home from hospital are already expecting a longer recovery time.
While it’s possible some people with the virus will go on to have post-viral fatigue syndrome, it’s too early to be sure of a link. However, studies have suggested this has happened before in past outbreaks.
One study from 2011 looked at 22 people who had ongoing health problems after the SARS outbreak in Toronto, Canada, and couldn’t return to work.
The participants tended to have disturbed sleep, daytime fatigue, pain and weakness in the muscles, and depression, which researchers concluded were symptoms of a chronic post SARS infection syndrome.
“These symptoms were very reminiscent of CFS/ME,” one of the lead researchers, Dr Harvey Moldofsky, told New Scientist.
Another study of 233 SARS survivors, a year after the outbreak in Hong Kong, found 40% reported some degree of chronic fatigue and 27% met diagnostic criteria for chronic fatigue syndrome.
While we don’t know for sure the causes of CFS/ME, there are a number of theories about what might trigger it – one of which is viral infections.
The ME Association has noticed that people with diagnosed CFS/ME are experiencing a “significant exacerbation” of their CFS/ME symptoms after having the coronavirus.
However, Professor Garner believes we should be cautious about calling it post-viral fatigue syndrome for now.
“The virus, and the body’s response to it, clearly causes a myriad of symptoms,” he tells HuffPost UK in an email – some are similar to symptoms of other viral infections, some are unusual, and some are similar to the symptoms of CFS/ME.
“As things stand, by the UK definition, this is not chronic fatigue syndrome or ME because a) we know the cause and b) it hasn’t gone on for four months.”
This matters, says Prof Garner, because “some doctors and families are dismissing people who are quite unwell with ‘post-viral exhaustion’” when fatigue could still be a symptom of the coronavirus itself.
“If you have people at home assuming they have a diagnosis of ‘post viral exhaustion’, with weird symptoms that may actually be an indicator of the development of severe disease, they may discount them and not seek care that could be important to save their lives,” he says.
What experts do agree on is that people experiencing fatigue after suspected coronavirus need to listen to their bodies – if you push yourself too hard too soon, this may slow your recovery.
Key to all this, says Dr Shepherd, is activity management. This doesn’t mean going to bed and staying there, nor does it mean going on a 5k run.
It’s about not doing too much or too little, but instead small chunks of physical activity – a five-minute walk around the garden, a rest, some mental activity, and a rest.
“You certainly can’t exercise your way out of this,” he adds.
Most people who do develop coronavirus do go on to recover – but that recovery is gradual. Dr Shepherd advises a staged return to work to build your capacity, avoiding stressful situations and taking care of your mental health.
People whose health is deteriorating after 14 days of coronavirus symptoms should seek medical help. And while it can take months to recover fully, if you have persistent fatigue symptoms after four months which interfere with your capacity to carry out normal day-to-day activities, visit your GP for further tests.
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