Post Covid Fatigue

In “Characterising Long Covid in an International Cohort: 7 months of symptoms and their impact” Davies et al * one of the most prevalent long term symptoms is excessive fatigue.

Fatigue occurred most frequently in the first 2 months of illness before plateauing - ie it was a persisting feature. Up to 80% of long covid sufferers still had fatigue at 6 months. Fatigue was the top most debilitating symptom described by patients occurring in 2652 respondents.

This was supported by the research paper “Long COVID in the Faroe Islands - a longitudinal study among non-hospitalized patients” * who followed 180 patients non-hospitalised covid-19 patients. 53.1 % still had fatigue at 125 days and again it was the most frequently occurring symptom.

What is post- viral fatigue (PVF)?

PVF is when you have an extended period of feeling unwell and exhausted after a viral infection.

It is important to know that fatigue is completely different to 'normal' tiredness. It is an almost total lack of energy and exhaustion. This is combined with feeling generally unwell.

Post viral fatigue is sometimes seen after viral illnesses such as influenza, mumps, Epstein Barr virus, Human Herpes Virus 6, enterovirus, HIV and now of course Covid-19. Sometimes the virus is never identified.

There can be associated:

  • unexplained muscle and joint pain

  • poor concentration

  • memory problems

  • sore throat

  • headaches

  • swollen lymph nodes

  • increased need for sleep

  • non restorative sleep - waking up feeling unrefreshed

  • unsteadiness whilst standing

  • physical and mental exertion can intensify it

Fatigue can occur after the acute Covid-19 infection regardless of whether the initial infection was mild or severe. It is likely to continue for some time after the initial infection has cleared.

Why does it occur?

Fatigue is a normal part of the body’s response to fighting a viral infection.

The trigger for post-viral fatigue seems to be a reaction to the virus itself and the symptoms are very similar, or identical, to those of people with chronic fatigue syndrome (CFS) and myalgic encephalomyelitis (ME).

It is not fully understood why post-viral fatigue might occur. Some current theories are:

  1. It may have something to do with the body's immune response to the initial infection. When you are fighting off a virus, the immune system releases chemicals called cytokines, which promote inflammation and cause many of the classic symptoms of viral infection (eg, tiredness, aches and pains, malaise). This is part of its frontline attack on the invading virus, and normally it stops once the virus itself has been dealt with. But recent studies suggest that in some cases, levels of cytokines fail to return to normal, causing ongoing symptoms.

  2. It may be due inflammation of the nervous systems

  3. It may be due to individual's own unusual response to the virus which has remained dormant within their body for some time.

How is it diagnosed?

It is difficult to diagnose as fatigue can be a symptom of many illnesses.

Your family doctor should screen you for other common causes of fatigue such as anaemia, hypothyroidism, diabetes, vitamin D and vitamin B12 deficiency and coeliac disease.

They should take note of your other symptoms and make sure these are not the cause of the fatigue. They should screen for dysautonomia - you can do a NASA lean test at home

They should screen you for anxiety and depression too, including alcohol and recreational drug use.

I have hyperlinked here to other causes of fatigue which may need to be excluded -

It is useful to keep a diary of your fatigue symptoms - when they started, what they feel like, what makes them worse or better and if possible a severity score. There are some useful apps for this - Balance if perimenopausal, People With, etc.

Ways to help deal with fatigue:

  1. Paracetamol - this may help ease any lingering pain. By managing pain, you may also be able to improve the quantity and quality of your sleep at night, thereby reducing fatigue throughout the day,

  2. Sleep routine - going to bed at the same time each night and setting your alarm for the same time each morning will help your body slowly ease into a sleeping schedule.

  3. Take small frequent rest breaks throughout the day as your body needs.

  4. Take small, frequent naps as needed. Note prolonged day time sleeping can make you feel more fatigued.

  5. Pacing - keeping with your energy envelop, use the Spoon Theory, Aggressive rest - lying still, eyes closed, and doing nothing (no listening to music, watching a movie, or looking at your phone), keeping within your anaerobic threshold

  6. Prioritize - only do errands and activities that are necessary or help your mood and ignore the rest.

  7. Delegate when you can

  8. Break up longer activities into smaller units; for example, load the washing machine in the morning, put the clothes in the dryer in the afternoon, then put things away the next day.

  9. Know what makes you fatigued - for say a doctor’s appointment build in lots of rest both before and after.

  10. Get food delivered if you can, get others to put it away, ask for food packages from family and friends, if you have to cook do it in bulk, again break meal prep up throughout the day, sit down to do prep.

  11. Healthy balance diet, reduce sugar and refined carbohydrates, avoid processed foods and any trigger foods that make your fatigue worse, an anti inflammatory diet can help

  12. Cut back on alcohol

  13. Gentle exercise as tolerated and within your aerobic threshold. Covid-19 recovery yoga is great

  14. Sit down to brush teeth and shower, shower less often, have a cooler shower, take baths (unless you have dysautonomia), dry off by wrapping up in a dressing gown and retreat to your bed. Showers are exhausting! Use dry shampoo

  15. Consider taking sick leave/ leave of absence from work if you can, otherwise adapt pacing to your working day

  16. Use reminders such as calendars, lists, post it notes to aid memory, use mobile phone alarms for reminders

  17. Reduce screen time and consider blue light filters

  18. Weighted bed blankets to calm the nervous system

  19. Drink 2-3 litres of water a day

  20. Use compression socks, tights or leggings if you are dizzy on standing

  21. Rest halfway up the stairs

  22. Consider being pushed in a wheelchair if you have to visit a shopping centre. They can be hired for the day.

  23. Take an advocate to all doctors appointments, write a list of your symptoms and keep it handy, I have all my Covid-19 letters in a big lever arch file.

  24. Reread books or rewatch a series you loved - you can enjoy them without using precious mental energy trying to understand the plot, audiobooks are great and some can send you to sleep - I had a period of insomnia and every night listened to Neil Gaiman’s The Graveyard Book. His voice is so soporific! Podcasts are a great alternative to books.

  25. If you are stuck in bed watch the clouds go by. I always wished I had bought a bird feeder that I could stick on the window and watch their arrival and departures

  26. Don’t neglect your mental health

  27. Try and get some daylight daily to help with your natural circadian rhythm


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