Post-viral fatigue and COVID-19
Here we offer our reflections on the potential relationship between COVID-19 and post-viral fatigue, based on both the clinical data from research into other viruses and what we know anecdotally from our personal and professional networks. We then go on to offer advice on:
how to manage the fatigue symptoms associated with the virus
how to manage when the acute phase passes
the importance of the recovery phase itself
What we do know
In 2002 there was an outbreak of the SARS virus. Harvey Moldofsky at the University of Toronto conducted studies into the ongoing health problems of some people who were diagnosed with SARS. He recruited 22 people who had not been able to return to work after an average of 19 months after the illness and found that the symptoms of chronic post-SARS form a syndrome which includes chronic fatigue, pain, weakness, depression, and sleep disturbance. These symptoms have similarities with those experienced by people with fibromyalgia and CFS/ME.
“While the current Covid-19 pandemic is caused by a different virus, it is a member of the same coronavirus family, so it might also cause a post-viral fatigue syndrome.”
— Harvey Moldolfsky, quoted in New Scientist 15 April 2020
Marco Lam and his colleagues at The University of Hong Kong found that 40% of SARS survivors experienced symptoms of chronic fatigue following the illness (27% were classified as having CFS/ME).
In comparison with SARS, COVID-19 is thought to be more infectious but with a lower mortality and lower average severity of symptoms. Therefore, it is likely that the proportion of people affected by post-viral fatigue will be less than with SARS.
How to manage fatigue symptoms during the acute phase of infection
It is normal to experience fatigue during an illness caused by a virus, however mild the symptoms may be. During this acute stage it is important to balance your body’s need for rest with regular routines, including when you go to bed and wake up. Stop working if this is relevant and reduce other activities as well as all the normal, common sense things to do when you are ill - keeping hydrated, eating well, and staying connected with others (albeit remotely at this time) are all important. By keeping things simple and doing small amounts of the things that give you comfort and pleasure you help give your body get the rest it needs.
How to manage in the recovery phase
Resist ‘pushing through’ fatigue too soon - start activity again slowly
When you are starting to feel better it is tempting to engage more fully in activities. It is crucial that this is done slowly. It is beneficial to start with some degree of activity but imperative that this is done in a slow, gentle manner and is increased gradually. Even if you are frustrated, do your best to resist pushing through your fatigue. Keep your expectations low and listen to how your body copes with this transition. It is better to stop BEFORE you get tired. It will be different for everyone but stay gentle and compassionate with yourself and don’t give yourself a hard time thinking you have to do everything all at once.
Exercise in moderation
To do some exercise can be helpful - it might be stretches, short walks - but even if you are someone who usually does a lot of exercise, it is important that you only do a percentage of what you normally would. Resume slowly; gradually increasing time and exertion levels. Remember the tortoise and the hare!
Balance rest and activity; levels and types
Pay attention to ensuring a balance of activities – don’t just work; also rest and play! It’s important to approach any activity in small chunks and intersperse them with different types of activities, including pleasurable ones. For example, don’t try to do all your chores in one go just because you feel a bit better. Maybe clean one room then stop for a cuppa, listen to some music or watch some television. Make sure you continue to spend time resting too, and listening to your body and establishing a routine can be helpful with this. If you have noticed that you always get tired an hour after lunch, decide that you will have a rest then whether you think you need it or not.
Quality rest
Intersperse activity with QUALITY rest. You may be used to thinking that checking emails, watching TV, reading, or listening to music are restful, but they also take concentration or can engage you emotionally and lead to cognitive fatigue. Quality rest is really important and should enable you to just ‘zone out’ so the body’s parasympathetic/soothing system is activated. It can be helpful to think of this as ‘recharge’ rather than rest. Listening to soothing sounds (like the sea, on apps like Insight Timer), lying in the sun, body scans, and meditation are great for this. Listening to the Rolling Stones or Adele are less helpful!
Resist ‘pushing through’ fatigue & returning to work too soon
Even though your initial symptoms have passed, it may be necessary to take longer off work. Speak to your employer and ask for a ‘phased return’ to work to help you build up slowly. Most workplaces have this as part of their sickness/absence policies and procedures. There might also be parts of your job that you find more draining. You can also ask if these can be changed temporarily. Occupational health or a ‘fit for work’ note from your GP can help you talk to your employer about what will enable you to return to your job.
This guidance from the ME Association is particularly relevant if you wish to find out more about working and fatigue. It is crucial that any activities (including work) are done gradually and our guide is to always do less than you think!
Ongoing fatigue
Post viral fatigue can be improved through the practices suggested above and a sound balance of rest, activity and fun. It can, however, take many months to recover fully. If your fatigue symptoms are not improving (after 4 months) and are interfering with your capacity to carry out normal day-to-day activities, then we recommend that you visit your GP for further tests.
Depending on the outcome of this you may be referred to a specialist fatigue service if they are available. We are also very happy to talk to you about whether one of our rehabilitation programmes could support you.
You can book in a free 15-minute chat to find out more.
Written by the Vitality360 team
References & Resources