Can COVID-19 Cause Chronic Fatigue Syndrome?

A Look at the Underlying Similarities

Corona viruses circulate in the blood stream along with red blood cells.

 

Radoslav Zilinsky/Getty Images

 

As COVID-19’s long-term impacts on the body come to light, a comparison keeps coming up: The symptoms look a lot like those of myalgic encephalomyelitis (ME), formerly called chronic fatigue syndrome (CFS) and often denoted by the abbreviation ME/CFS.

While it’s too soon to say how long lingering COVID-19 symptoms may last once you’ve recovered from the acute illness, concern in the medical community is growing that this virus will leave a lot of people with chronic health conditions—possibly including ME/CFS or something similar—in its wake.

The Concern

The similarities between ME/CFS and post-acute COVID-19 symptoms are so striking that the U.S. Centers for Disease Control and Prevention (CDC) website says, “A recent [Morbidity and Mortality Weekly] report found that COVID-19 can result in prolonged illness, even among adults without underlying chronic medical conditions. Studies are planned to identify whether some people with delayed recovery develop and ME/CFS-like illness.”

CNN reported on July 9, 2020, that Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases (NIAID), acknowledged that post-COVID-19 symptoms do resemble those of ME/CFS.

The coronavirus that causes COVID-19 is related to the one that causes severe acute respiratory syndrome (SARS), which has been linked to an ME/CFS-like illness.

A letter to the editor of the medical journal Medical Hypotheses states, “After the acute SARS episode some patients, many of whom were healthcare workers went on to develop a Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) – like illness which nearly 20 months on prevented them returning to work.

"We propose that once an acute COVID-19 infection has been overcome, a subgroup of remitted patients are likely to experience long-term adverse effects resembling CFS/ME symptomatology such as persistent fatigue, diffuse myalgia, depressive symptoms, and non-restorative sleep.”

Lingering Symptoms

Early studies of long-term effects have found that a lot of people aren’t back to feeling healthy just because they’ve survived or “recovered” from the virus.

An Italian study showed that most people who’d been hospitalized for acute COVID-19 disease still were struggling with symptoms two months later.

  • Only 12.6% had no COVID-19-related symptoms
  • 32% had one or two symptoms
  • 55% had three or more symptoms

The symptoms they were most likely to experience were:

  • Fatigue: 53.1%
  • Difficulty breathing: 43.4%
  • Joint pain: 27.3%
  • Chest pain: 21.7%

Data from the COVID Symptom Study app, which people from several countries have used to track their symptoms, suggest that between 10% and 15% of people have had lengthy recovery periods, including some who had only mild cases.

A study published prior to peer-review in August 2020 surveyed people discharged after being hospitalized with COVID-19. Participants said both their physical and mental health were worse because of the viral illness.

A Chinese study showed that 16% of COVID-19 survivors still experienced fatigue three months after being discharged from the hospital.

In people who recover from COVID-19, doctors are seeing a host of lingering symptoms, including:

  • Fatigue and malaise, sometimes described as “crushing”
  • Cough
  • Headaches and body aches
  • Fever
  • Chills
  • Lost sense of smell or taste
  • Diarrhea
  • Congestion
  • Shortness of breath
  • Nausea
  • Sore throat
  • Chest and abdominal pain
  • Immune-system damage
  • Neuroinflammation and other brain/nervous system abnormalities
  • Cognitive dysfunction (“brain fog”)
  • Depression
  • Insomnia
  • Impaired blood-sugar regulation
  • Damage to multiple organs, including the heart, lungs, kidneys

It’s not an exact match to ME/CFS symptoms lists, but it bears some striking similarities—especially when you consider that many cases of ME/CFS may have been triggered by an acute illness.

ME/CFS and Viral Triggers

Over the years, researchers have investigated multiple pathogens in relation to ME/CFS. The disease is known to be involved immune-system dysfunction and possibly some features of autoimmunity (in which the body attacks itself.)

Viruses that have been studied thus far include:

None has been found to be a universal trigger of ME/CFS and infection doesn’t appear to be active in most cases; however, it’s theorized that they may, in some people make permanent changes to the immune system in a “hit and run” fashion.

Symptoms in Common

ME/CFS is a complex illness involving dozens of potential symptoms of varying severities. Symptoms shared by ME/CFS and post-acute cases of COVID-19 include:

  • Fatigue and malaise
  • Headaches and body aches
  • Fever
  • Chills
  • Shortness of breath
  • Nausea
  • Sore throat
  • Chest and abdominal pain
  • Immune-system damage
  • Neuroinflammation and other brain/nervous system abnormalities
  • Cognitive dysfunction
  • Depression
  • Insomnia

The diseases also share cardiac abnormalities but in COVID-19, it’s believed to be caused by myocarditis (inflammation around the heart), which isn’t believed to be present in ME/CFS.

What remains to be seen about post-COVID-19 symptoms is whether it includes a defining symptom of ME/CFS—post-exertional malaise (PEM).

PEM is an extreme reaction to even small amounts of physical or mental exertion that triggers a symptom flare and leave you unable to perform the same activity a day later. It varies from person-to-person depending on their own ability to tolerate exertion.

Someone with a mild case of ME/CFS may be able to handle grocery shopping if they otherwise relax that day. Someone else may be in bed for a few days after walking around the block. In the most severe cases, people cannot sit up without triggering symptoms.

This is a difficult symptom to spot in someone who's too fatigued to be very active, especially if they have other factors limiting their exertion levels, such as shortness of breath. It may be a while before doctors are able to identify whether people with post-COVID-19 symptoms experience PEM.

Recommendations

Several medical recommendations for helping people recover from post-COVID-19 symptoms had surfaced by the end of the summer of 2020. They're bound to change and grow over time, as the full extent of the long-term effects become better understood.

One early consensus statement describes COVID-19 as a multisystem disease requiring a multidisciplinary medical team for rehabilitation and full recovery. It recommends:

  • Individualized treatment plans depending on your needs and other health problems
  • Education about your condition and strategies for recovery
  • Regular review of your progress as you go through the rehabilitation process
  • A focus on improving symptoms, physical function, and quality of life

Types of rehabilitation may include physiotherapy, occupational therapy, and speech-language therapy, depending on the specific symptoms you have. A review of literature on COVID-19 suggests doctors should use neuroimaging and watch for signs of multiple sclerosis or other demyelinating diseases.

Potential Problems Ahead

According to the CDC, as many as 2.5 million people may be living with ME/CFS, most of them undiagnosed due to the poorly understood and controversial nature of the illness.

Many of them are unable to hold a job and it's notoriously difficult to win a Social Security disability filing with this disease. Thus far, the U.S. Food and Drug Administration hasn't approved a single drug for ME/CFS.

Millions of people are now COVID-19 survivors. If the pandemic does lead to a rash of ME/CFS or a similar illness, the personal and societal toll could be significant, taking away careers, creating emotional and financial problems for individuals and their families, and straining healthcare and government resources.

A Word From Verywell

If you’ve had or suspect you’ve had COVID-19 and now you're dealing with lingering symptoms, talk to your doctor. They can help with your recovery and diagnose any new problems resulting from the coronavirus infection. To get you back to functional and feeling good, sooner is better than later.

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