More Than 50% of People with COVID-19 Have Unrelenting Fatigue as a Lingering Symptom
A growing body of research suggests that the effects of COVID-19 don’t end once the virus has left your body—and a new study has found that one symptom in particular is pretty common: lingering fatigue. The study, which is pre-print and hasn’t been peer-reviewed yet, analyzed symptoms in more than 128 people who had COVID-19, 10 weeks after they originally noticed signs of the novel coronavirus.
The researchers found that 52% of the participants experienced “persistent fatigue,” regardless of how severe their case of COVID-19 case was. “Our findings demonstrate a significant burden of post-viral fatigue in individuals with previous SARS-CoV-2 infection after the acute phase of COVID-19 illness,” the researchers wrote, adding that their findings indicate the importance of screening people who are recovering from the virus for “severe fatigue.”
The concept of lingering fatigue after COVID-19 isn’t new. Anthony Fauci, M.D., the director of the National Institute of Allergy and Infectious Diseases, told Medscape in July that “it’s extraordinary how many people have a post-viral syndrome that’s very strikingly similar to myalgic encephalomyelitis—chronic fatigue syndrome.”
Doctors have seen this in the field, too. “This syndrome after COVID-19 is real. I’ve seen many, many patients with this, even 100 days after being infected,” says Rajeev Fernando, M.D., an infectious disease expert in Southampton, N.Y.
Here’s what you need to know about chronic fatigue after a COVID-19 diagnosis.
First, what is chronic fatigue syndrome?
Myalgic encephalomyelitis, a.k.a. chronic fatigue syndrome, is a debilitating disease that doesn’t have a universally accepted definition, cause, diagnosis, or treatment, the National Institutes of Health (NIH) says. At least a quarter of people with chronic fatigue syndrome are bed-bound or housebound at some point in their illness and most never regain their pre-disease level of functioning. Symptoms usually include the following, per the NIH:
At least six months of incapacitating fatigue
Profound exhaustion
Extremely poor stamina
Problems with concentration and short-term memory
Feeling worse within 12 to 48 hours after physical or mental exertion
The exact cause of chronic fatigue syndrome is unknown, but symptoms can be triggered by an infection, the NIH says. For example, one study found that that 40% of people recovering from SARS—a viral respiratory disease also caused by a coronavirus—had chronic fatigue symptoms 3.5 years after being diagnosed, per a recent report from the World Health Organization.
Why might COVID-19 cause chronic fatigue?
Experts aren’t sure at this point, explains Richard Watkins, M.D., an infectious disease physician and professor of internal medicine at the Northeast Ohio Medical University. Given that it’s unclear what causes chronic fatigue syndrome in the first place, it can be especially difficult to know why COVID-19 can spur this in certain patients, he says.
But “this is important,” stresses Thomas Russo, M.D., professor and chief of infectious disease at the University at Buffalo. “Data is showing this is not just an acute illness, but that it has potentially long-term effects.”
Lingering fatigue isn’t unique to COVID-19. “Whenever someone has a physiological insult, whatever that may be, the body goes through an acute inflammatory process and then a repair process,” Dr. Russo says. “Eventually, you get back to your regular state of being.”
A novel coronavirus infection causes “inflammation in multiple organs—the heart, kidneys, gastrointestinal tract, and sometimes the central nervous system,” he explains. “It takes time to recover from that,” adding that “everyone is different in terms of how they deal with that and the time frame of getting back to normal.”
COVID-19 can also cross the blood-brain barrier and actually cause inflammation in your brain. “In my opinion, this is what is responsible for the fatigue,” Dr. Fernando says.
Lingering fatigue may also be a sign of organ damage to the heart or lungs, but experts don’t know yet if that improves with time. “It probably does for most, but the data is unclear at this point,” Dr. Watkins says.
What should you do if you have persistent fatigue?
It’s important to point out that having persistent fatigue doesn’t automatically mean that you had COVID-19, and having COVID-19 doesn’t automatically mean that you’ll have persistent fatigue.
“At least to date, fatigue is unlikely to be due to infection with the new coronavirus if you had an asymptomatic case,” Dr. Russo says. Meaning, if you never had symptoms of COVID-19, it’s unlikely that the fatigue you’re experiencing now is due to the virus.
There are many other conditions that can lead to persistent fatigue, including anemia, a chronic infection, diabetes, depression, and heart disease.
But living with persistent fatigue is not normal. If you’re experiencing it, talk to your doctor. “Regardless of whether this can be due to COVID or not, it’s critical to reach out to your healthcare provider. It could be something that’s correctable,” Dr. Russo says. “It needs to be sorted out, whether it’s due to COVID or not.”
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