Can COVID-19 Cause Chronic Fatigue Syndrome?

Some people who have recovered from the acute effects of COVID-19 experience symptoms similar to myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).

While it’s too soon to say how long lingering COVID-19 symptoms may last once you’ve recovered from the acute infection, there is a concern in the medical community that this virus could lead to chronic health conditions—possibly including ME/CFS or something similar.

The Concern

Similarities between ME/CFS and post-acute COVID-19 symptoms are documented on the U.S. Centers for Disease Control and Prevention (CDC) website, which states, “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 an 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), noted that post-COVID-19 symptoms can 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

Researchers estimate that roughly 80% of people who have COVID-19 continue to experience new or lingering symptoms more than two weeks after infection. The five most common symptoms are:

• Fatigue (58%)
• Headache (44%)
• Attention disorder (27%)
• Hair loss (25%)
• Difficulty breathing (24%)

Data from the COVID Symptom Study suggests 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 that their physical and mental health was worse because of the viral illness.

In people who recover from COVID-19, healthcare providers 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 dysfunction
• 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 similarities—especially in light of the consideration that many cases of ME/CFS are believed to have been triggered by an acute illness.

However, these symptoms are reported by patients 2-3 weeks after testing positive for COVID. This is quite different than ME/CFS—by definition, symptoms must persist for at least 6 months before a diagnosis of ME/CFS can be made.

ME/CFS and Viral Triggers

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

Viruses that have been studied thus far include:

• Epstein-Barr virus
• Some human herpesviruses
• Cytomegalovirus
• Human parvovirus
• Enteroviruses

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 an acute infection may, in some people, trigger 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 dysfunction
• Neuroinflammation and other 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 a reaction in which mild physical or mental exertion triggers a ME/CFS symptom flare and leaves you unable to perform the same activity a day later. The reaction can range from mild to extreme, and the severity and triggers vary.

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 healthcare providers 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 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.

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 be approved for Social Security disability filing with this disease. Thus far, there is not a single drug that's specifically indicated for treating ME/CFS.

Millions of people are now COVID-19 survivors. If the pandemic leads to an increased incidence of ME/CFS or a similar illness, the personal and societal toll could be significant, potentially 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 healthcare provider. 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.

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.