Prolonged cases of coronavirus resemble chronic fatigue syndrome

• Many COVID-19 patients who have long lasting symptoms report too much physical activity as foggy or foggy.
• This is a characteristic of chronic fatigue syndrome, a often debilitating disease that can last for several years or more.
• Researchers have just begun to understand the link between the coronavirus and chronic fatigue.
• Further research into the similarities may be critical to the long-term care of patients.
• Visit the Business Insider website for more stories.

Before Marissa Oliver arrived in California in May, she finally began recovering from COVID-19. Her breathing was improved: she could talk for half an hour on the phone or take a 40-minute walk without much discomfort. But traveling almost took her away.

“I actually came back upon arrival,” Oliver, a 36-year-old manager of an arts organization in New York City, told Business Insider.

Lately, she said, simple tasks such as making back-to-back work calls can leave them “completely destroyed.”

It is not uncommon for COVID-19 patients to experience excessive regression in their recovery from excessive physical activity. In fact, doctors say that being sensitive or misty to normal tasks has become a distinctive pattern among patients with long-lasting symptoms. It reminds her of another condition that is also somewhat mysterious: chronic fatigue syndrome.

Patients with chronic fatigue – clinically known as myalgic encephalomyelitis – often “crash” or “relapse” from simple activities such as taking a shower, going to the supermarket, or getting mail. They may feel dizzy or weak from getting up too fast, or struggle to think clearly. Some patients may be bedridden for several days or weeks without feeling better after sleeping or resting.

“There has been talk in the medical community about a chronic fatigue syndrome-like disease that can occur after coronavirus,” Drs. Nate Favini, the medical director at Forward, a primary care practice that collects data on coronavirus patients around the country, told Business Insider. “Unfortunately, there will be a small subset of people for whom that will be the case and these symptoms will really become a chronic thing that you have to deal with for years.”

But COVID-19 patients need to be sick for at least six months to be diagnosed with chronic fatigue, and many have not yet reached that mark. However, even if they eventually receive this diagnosis, no cure or approved treatment awaits them. Doctors are still working to understand chronic fatigue, which is often unpredictable and can carry a striking resemblance to other diseases such as fibromyalgia.

However, the pandemic has brought renewed attention to chronic fatigue. That may mean better treatments in the future for the newly diagnosed – and for those who have been battling ‘fatigue’ for years.

Chronic fatigue: poorly explained and poorly treated

There is no test to confirm that someone has chronic fatigue syndrome.

“It is very poorly explained and it is being treated badly,” said Drs. Frances Williams, a rheumatologist and professor of genomic epidemiology at King’s College London, to Business Insider. She added: “The medical community still does not accept the existence of such a thing.”

The Centers for Disease Control and Prevention estimates that up to 2.5 million Americans suffer from chronic fatigue syndrome, the majority undiagnosed. The condition costs the U.S. economy up to $ 24 billion a year in medical bills and lost income, according to the agency. Data suggest that white people are more likely to be diagnosed with chronic fatigue than other races.

Doctors are not quite sure what causes chronic fatigue, but the syndrome can be delayed by infectious diseases such as Lyme disease or Epstein-Barr virus. Some patients may be ill for several years, while others may never fully recover. Some may not be able to return to work at all.

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Although researchers have just begun to study the relationship between chronic fatigue and the new coronavirus, they have some indications of past SARS patients who became infected in 2003.

A follow-up study of SARS patients in Hong Kong found that 27% met the CDC’s clinical criteria for chronic fatigue syndrome four years after their illness began. Another study of 109 SARS patients in Toronto found that more than half of the patients did not return to work due to persistent fatigue and weakness a year after they were discharged from the ICU.

Some physicians think that COVID-19 patients may also be out of work for long periods of time.

“One can anticipate – and this is a prediction – that a significant part of the population was employed when they became ill [COVID-19] is perhaps unable to work back in any meaningful way, “Dr. Harvey Moldofsky, a professor emeritus at the University of Toronto who studied SARS patients, told Business Insider. Can you imagine the economic impact? “

A link between the coronavirus and chronic fatigue

Based on what doctors know so far, blood clots may be one reason some COVID-19 patients feel tired.

“When people have a bunch of small lumps in their lungs, that can continue with fatigue for a long period of time – even after the clots are gone – if there is damage to the blood vessels,” Favini said.

An aggressive immune response to the virus could also trigger inflammation in the body that damages healthy tissue.

“We think the basic immune system of people predicts who will get chronic fatigue,” Drs. Frances Williams, a rheumatologist and professor of genomic epidemiology at King’s College London, to Business Insider. Their research team is currently investigating the link between the coronavirus and chronic fatigue syndrome in adult twins.

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Williams pointed to a 2018 study that showed how inflammatory molecules can predict chronic fatigue syndrome in patients with hepatitis C.

“Those who had the biggest reaction to it and made more inflammatory cytokines were the people who were most likely to get chronic fatigue,” she added. “It seems very plausible that this is what we will find in COVID, but we do not know the answer yet.”

An overactive inflammatory response could reduce the nervous system, resulting in depleted energy, muscle weakness, or difficulty concentrating while sleeping. Moldofsky’s 2011 study of SARS patients in Toronto found evidence that the virus had crossed patients’ blood-brain barriers, leading to long-term neurological problems that disrupted their sleep and cognition. The new coronavirus could operate in a similar way.

“It is an inflammatory disease that interferes with the conduction of the normal pathways of the nervous system,” Moldofsky said.

Dr. Noah Greenspan, a physical therapist in New York City who works with patients with long-distance coronary virus, said he has seen many patients for whom the simple act of sitting or walking across a room lowers their heart rate or blood pressure. That’s probably because the coronavirus disrupts their autonomic nervous system, he said, which regulates blood pressure, heart rate, and body temperature.

“You will only heal as fast as your slowest system, and unfortunately the neurological system is one of the slower systems to heal,” Greenspan said. “Until that inflammation goes away, you may not see the change.”

Understand how to handle post-COVID cases

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Oliver said she has been finding ways to treat her dizziness, headaches and fatigue more lately. Daily exercises for breathing seem to help, just take a break when work becomes difficult. She also tries to limit her activity on social media to less than five minutes a day.

“I only get this fatigue – which they say is part of the post-COVID syndrome – when I expand myself, like when I walk too much or talk too much,” she said.

Doctors say taking it easy will be important in the recovery process for COVID-19 patients with symptoms of chronic fatigue.

“You have to be extremely slow with COVID patients because they can sometimes feel perfect during a treatment or they can feel perfect during an activity, but if you go that one step over the edge, they could be knocked out in a week. after that or they may have a flare up in their symptoms, “Greenspan said.

Sill, many patients find it difficult to know when they have reached their limit.

“There’s no easy way to tell someone or predict what their exercise tolerance is,” Williams said. “The best thing is really to listen to your body. If you know something has pushed you over the edge in the past, do not repeat it. Do something active, but for less time or less rigorously.”

The more doctors understand chronic fatigue, she added, the more they can find ways to treat patients.

A few new studies are already underway: In May, a coalition of scientists at the Open Medicine Foundation began a multi-year study to see if COVID-19 triggered chronic fatigue syndrome. Rep. Jamie Raskin, a Democrat from Maryland, has also co-sponsored a bill in Congress that would require $ 15 million in annual funding by 2024 to support research into COVID-related cases of chronic fatigue.

Having a proper diagnosis would also help COVID-19 patients with long-term fatigue receive better care.

“Rheumatologists are not at all interested in dealing with things that are not inflammatory, and we assume this will be a kind of post-inflammatory condition,” Williams said. “We need to figure out where and who these people need to help.”