INmost everyone is familiar with the short-term symptoms of an acute SARS-CoV-2 infection. These include fever, cough, breathing problems, fatigue, diarrhea, and other flu-like symptoms. While some doctors are alarmed about the potential of the infection to cause permanent organ damage, the popular belief of Covid-19 is that a small percentage of patients die and the rest recover.
But as the pandemic has spread, experts have begun to recognize that many Covid-19 patients – perhaps even a majority – continue to have a range of “post-viral” symptoms.
“Prolonged fatigue, such as brain fog and other persistent symptoms have been reported in many Covid-19 patients.”
Some of thesthe patients eventually return completely to normal, even if it takes a few weeks or months before that happens. But some do not. And for those who still need to fully recover, there is a growing suspicion that the virus can act as a catalyst for a condition that is often, if a little misleading, known as chronic fatigue syndrome.
“Prolonged fatigue, such as brain fog and other persistent symptoms have been reported in many Covid-19 patients,” says John Swartzberg, MD, an infectious disease expert and emeritus professor at the University of California, Berkeley. He says these post-viral symptoms are typical of chronic fatigue syndrome, a disease also known as myalgic encephalomyelitis and often abbreviated ME / CFS.
“We know that in patients who develop [ME/CFS], it is often activated by a bad viral infection, ”he says. “And so there is the thought that SARS-CoV-2 may be a cause.”
In July, the Journal of the American Medical Association (JAMA) published a report from Italy which found that the majority of former Covid-19 patients – those who were hospitalized, discharged, and who no longer tested positive for the infection – continue to have health problems months after their apparent recovery.
Among the 143 people interviewed for the report, only 18 were symptom-free 60 days after their discharge from the hospital. More than half of the people interviewed said they still experienced three or more symptoms, including fatigue was named the most common problem.
At a recent press conference, Anthony Fauci, MD, director of the US National Institute of Allergy and Infectious Diseases, spoke about the potential long-term effects of Covid-19 – and specifically whether people who develop the disease are at risk for chronic ailments. , Fauci said many Covid-19 patients report health issues that are “highly suggestive” of ME / CFS. “If you look anecdotally, there is no question that there are a fair number of people who have post-viral syndrome… They can incapacitate weeks and weeks after so-called recovery and eradication of the virus,” he said. said Fauci.
He cited brain fog, fatigue, and concentration problems as some of the symptoms often mentioned while recovering from Covid-19 patients. Poor sleep, muscle aches and depressive symptoms are some others. “This is what we need to take really seriously,” he said. “It can be very good there. . . a post-virus syndrome associated with Covid-19. ”
Doctors have long recognized that viral infections can act as catalysts for fatigue, intestinal problems, and other health problems that persist long after the infection itself is gone. A 1987 report in the Journal of the Royal College of General Practitioners outlined the outlines of post-viral syndrome. “The syndrome typically follows an upper respiratory tract infection from which the sufferer fails to make a complete recovery,” the author of that report wrote. The “cardinal symptom” is deep muscle fatigue, but poor memory, lack of concentration, and sleep disorders are also common characteristics, the report states.
“We know that 80% of ME / CFS cases diagnosed in the past are attributed to some type of infection, and typically it is a viral infection.”
While doctors first identified and documented cases of ME / CFS more than 70 years ago, the disease was until recently considered “psychosomatic”, something some experts use as a polite euphemism for “proposed”. Fortunately, that has changed. “I think it is now generally accepted that there is a condition that causes deep and chronic fatigue in patients, and it is not a psychosomatic disease,” says Swartzberg of UC-Berkeley. “It seems to be normal, but we do not really know why it is happening.”
To date, few medical schools include ME / CFS in their curriculum, and most physicians and medical professionals are not trained to identify and treat the disease. “I would say this is one of the most stigmatized diseases,” says Leonard Jason, PhD, a professor of clinical psychology and an ME / CFS researcher at DePaul University in Chicago. “There are a few experts in this field, and everything about it is controversial.”
Part of the problem, says Jason, is that there is currently no simple blood or lab test for ME / CFS. People who have it are normally diagnosed based on self-reported symptoms, although some recent work at Stanford University has identified potential biomarkers of ME / CFS. The CDC estimates that up to 2.5 million Americans have ME / CFS, but that 90% of those people have not been formally diagnosed.
One thing experts know: ME / CFS often follows an attack of infectious disease. “We know that 80% of ME / CFS cases diagnosed in the past are attributed to some type of infection, and typically it is a viral infection,” said Oved Amitay, director of the non-profit Solve ME / CFS Initiative. He says the Epstein-Barr virus, which causes mononucleosis (mono), is an established ME / CFS trigger. These are also some of the older coronaviruses, including SARS and MERS.
He says he and other members of his organization expected to hear reports of debilitating fatigue and other ME / CFS symptoms from the start of the SARS-CoV-2 outbreak. “Unfortunately, none of this was surprising to us.”
How many people with Covid-19 could develop ME / CFS? Jason says some older studies suggest that a significant percentage of people who develop viral infections – “we think maybe 10%, but it could be a larger percentage” – still feel sick six months later.
This six-month threshold is normally used to differentiate ME / CFS from the shorter-lived post-viral syndrome. But at this point, and especially when it comes to Covid-19, there are far more questions than answers.
Jason says there are theories, but no hard and fast answers. “Some people think that remnants of a virus can still be in a person’s system causing problems,” he says. While normal tests do not reveal the continued presence of a virus, a component of it can still be present in the brain when the body is secreted and damaged. “There are others who think the immune system is regenerating and doing damage.”
The authors of a 2020 paper on post-viral syndrome among Covid-19 patients point out that the related SARS virus was known to cross the blood-brain barrier and trigger an incorrect inflammatory response that resembled the “disorders” that were observed in ME-CFS patients,
The importance of the medical community in post-viral syndrome and ME / CFS has until recently been minuscule. The novel coronavirus can change that.
The inflammation in the brain and hypothalamus could cause short-term symptoms such as fever, as well as long-term symptoms such as a disturbed sleep-wake cycle, cognitive dysfunction, and fatigue, they write.
What goes wrong, Jason says, is that he believes it ultimately has something to do with the brain. “It’s the master organ, and we do some work with brain neurons where we see some signs of dysfunction,” he says. “We think the immune system has the hit of the infection, and then it does the structural damage to the brain.” Some of his recent work on college students who have mono and then continue to develop ME / CFS suggests that certain factors of immune system may predict who is at greater risk for the disease. But much more work needs to be done, he says.
As for treatments, he says most are focused on specific symptoms – not on alleviating or curing the disease. “Sometimes it just helps people with pain management,” he says. For those who experience exhaustion after physical activity, there are calibrated “pacing” guidelines that can help them avoid exercising too much and increase their condition. There are also some experimental drugs, although none have yet been approved for the treatment of ME / CFS.
The bottom line, Jason says, is that the importance of the medical community in post-viral syndrome and ME / CFS, until recently, was poor. The novel coronavirus can change that.
“The field of ME / CFS has changed dramatically in recent months,” he says. “Before, there were quite a few people who would raise their eyebrows, like patients who were treated pretty badly.” Now that so many people are developing ME / CFS-like symptoms in the course of Covid-19 disease, he says most doubters are silent.
Amitay of ME / CFS Initiative Resolve says it has never been more important for the medical science community and its public and private sponsors to invest in ME / CFS research. “We have to study this now because we believe this is a situation that will become a crisis if we do not pay attention to it,” he says. “We know what we know, but there are many that we do not.”
