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Treating Post-COVID Fatigue and Post-Exertional Malaise

by: Post-COVID Support Team

October 7, 2022

Fatigue is one of the tell-tale signs of a COVID-19 infection. More than just sleepiness or drowsiness, fatigue is a feeling of extreme tiredness or lack of energy. In other words, you feel exhausted all the time – even if you don’t engage in any physically or mentally demanding tasks.

With bed rest and medication, most COVID patients start to feel like their “normal” selves again over time. But for some, fatigue (along with a spate of other symptoms) can linger for weeks on end and cause significant distress and impairment. This is what is known as Post-COVID or Long COVID, a broad set of conditions that affects approximately 30% of all Canadians who have been infected with COVID-19.

That said, navigating life with Post-COVID is not impossible. Here, we take a closer look at the symptoms and risk factors for Long COVID and introduce some practical treatment options for Post-COVID fatigue.

What is Post-COVID?

Though most people who acquire COVID-19 make a full recovery, the World Health Organization estimates that at least 10 to 20% of patients experience a “constellation of mid- and long-term symptoms” known collectively as Post-COVID conditions. Also known as Long COVID or Post-Acute Sequelae of SARS-CoV-2 (PASC), Post-COVID conditions can last for a few weeks to several months after a person has developed COVID-19.

For most people, their symptoms gradually improve over time. However, for some patients, Long COVID can feel like the “new normal”, where chronic fatigue, cognitive impairment and shortness of breath are just another part of daily life.

What do Post-COVID symptoms look like?

As per the Centers for Disease Control and Prevention’s (CDC) guidelines, you are likely suffering from Post-COVID if you experience the following symptoms more than four weeks after you’ve tested positive for COVID-19:

  • Brain fog
  • Difficulty breathing or breathlessness
  • Chest pain
  • Heart palpitations
  • Lightheadedness
  • Insomnia
  • Loss of or change in smell or taste
  • Muscle and joint pain
  • Headaches
  • Gastrointestinal issues
  • Mental health problems such as anxiety, depression and post-traumatic stress disorder
  • Fatigue and Post-Exertional Malaise

Research suggests that long-haul COVID affects multiple organs or systems in the body. This means that long-haulers can experience several symptoms and medical conditions at the same time, from cognitive impairment to mast cell activation syndrome – a condition that results in severe, repeated allergic reactions. One study found that there are about 200 symptoms linked to Long COVID.

Post-COVID conditions may not be immediately obvious at first. Some patients initially feel as though they’ve fully recovered from COVID-19, only to develop Long COVID symptoms weeks later.

Who is more likely to develop Post-COVID conditions?

While it isn’t quite clear what causes Long COVID, researchers and healthcare providers now know that people with certain risk factors are more likely to experience long-haul COVID. This includes people who:

  • Experienced severe COVID-19 symptoms, particularly those who spent a lot of time in the intensive care unit
  • Have ongoing health problems such as asthma and mental illness
  • Experienced multiple symptoms (at least over five) in the first week of illness
  • Developed multisystem inflammatory syndrome (MIS) while sick with COVID-19 or after recovery
  • Got sick before getting vaccinated for COVID-19

Experts are still trying to determine how Post-COVID conditions can be prevented. That said, researchers in Italy found that people who experienced breakthrough infections after being fully vaccinated are less likely to develop Long COVID than unvaccinated people.

What is Post-COVID fatigue?

Post-COVID fatigue is a kind of extreme fatigue that keeps you from going about your daily activities. Again, unlike sleepiness or tiredness, fatigue doesn’t go away after taking a break from work or getting a full night of sleep.

Fatigue brought on by a COVID infection can affect both your body and your mind, leaving you feeling physically, mentally and emotionally exhausted. Some people describe COVID and Post-COVID fatigue as like wading through a thick swamp or having one’s batteries taken out.

But not everyone experiences Post-COVID fatigue to the same degree. Some people may still be able to go about their old routines, albeit without the same kind of energy or satisfaction as before. Others may feel completely debilitated by their fatigue, unable to take on more than one or two tasks each day.

What causes Post-COVID fatigue?

Experts don’t have all the answers yet on what exactly causes Post-COVID fatigue. However, some believe that fatigue is a result of the body’s continued response to the COVID-19 virus.

When our bodies respond to a viral infection, our immune system releases cytokines, chemicals that cause inflammation and, in turn, symptoms like joint and muscular pain, exhaustion, malaise, etc.

Post-COVID fatigues vs chronic fatigue syndrome

Post-COVID fatigue is often compared to myalgic encephalomyelitis/chronic fatigue syndrome or ME/CFS, a complex and disabling condition that shares many similarities to Long COVID, including symptoms like:

  • Brain fog
  • Chronic fatigue
  • Insomnia
  • Lightheadedness
  • Muscle and joint pain
  • Shortness of breath
  • GI issues
  • Post-Exertional Malaise

Aside from these symptoms, ME/CFS also manifests similarly to Long COVID, oftentimes developing in patients who were infected with other viruses such as the Epstein-Barr virus and the Ross River virus.

Due to these commonalities, research into Long COVID could point to the exact causes and treatments for chronic fatigue syndrome and vice versa.

What is Post-Exertional Malaise?

Another striking similarity between Long COVID and ME/CFS is the persistence of Post-Exertional Malaise (PEM). This is when patients experience a worsening of symptoms after engaging in minimal physical or mental activity.

A distinguishing feature of PEM is that the level of fatigue and malaise felt by the patient is disproportionate to the effort exerted or activities done. Most long-haulers experience PEM after completing tasks like housework, errands, schoolwork and other daily activities that weren’t difficult or exhausting before the person got sick.

PEM often manifests several hours or days after the person completed an activity. This makes it difficult for healthcare providers to immediately diagnose long-haul COVID and recognize the patient’s triggers.

What can trigger PEM?

PEM can be triggered by any of the following things:

  • Physical exertion: This can range from “heavy” tasks such as lifting large objects to simple tasks like brushing teeth or showering.
  • Mental activity: This includes activities that require deep concentration, memory and problem-solving.
  • Social activity: This can include interacting with people in person, over the phone, or even online.
  • Strong emotions: This includes feelings of anger, excitement, grief, anxiety and stress.
  • Sensory experiences: This includes exposure to loud noises, bright or flashing lights, extreme temperatures and changes in weather conditions, strong smells and side effects from medications.

How to manage Post-COVID fatigue and PEM

While there is no magic bullet to cure Post-COVID fatigue and PEM, long-haulers can take the following steps to treat and manage their symptoms:

Accept your condition

If you fractured your foot, you wouldn’t force yourself to walk on your broken leg. The same should go for people who suffer from Post-COVID fatigue and PEM.

Post-COVID is just as real as any other kind of physical condition or mental health problem. Therefore, you shouldn’t try to ignore or downplay your symptoms or push yourself to do things that are beyond your capabilities. This will just cause you unnecessary stress and delay your recovery.

It’s impossible to put a timeline on how long your Post-COVID recovery will take, so it’s important to accept that, for the time being, this will be your “new normal”. Once you’ve accepted that, you can begin to make adjustments to accommodate your new lifestyle, including:

  • Pacing yourself: This involves spacing out your activities to give yourself ample time to rest and recover in between. This keeps you from pushing yourself beyond your limit and “crashing” from overexertion.
  • Planning your day ahead of time: This means observing your energy levels throughout the day and organizing your basic activities and routines to sync with your energy levels.
  • Prioritizing your needs: This involves being more deliberate about which events or activities to say yes to, cutting out unnecessary tasks from your daily routine and learning to ask for help from friends and family.

Make more conscious food choices

There isn’t enough definitive research yet on whether diet plays a big enough role in Post-COVID recovery. But, generally, maintaining a well-balanced diet gives you more energy to tackle the day, equips your body with the tools it needs to grow and repair itself and prevents you from developing illnesses like heart disease, stroke, diabetes and cancer.

People with chronic fatigue or Post-COVID fatigue may benefit from:

  • Eating nutrient-dense foods like salmon, kale, eggs and various fruits and vegetables
  • Staying hydrated throughout the day
  • Avoiding too much sugar, processed foods and fatty foods

Get as much rest and sleep as you need

For people with Post-COVID fatigue and PEM, sleep is essential. Lack of sleep and rest could cause patients to crash early and make symptoms worse. Patients should make an effort to conserve energy throughout the day, taking plenty of breaks and resting in between activities.

Take care of your mental health

A recent study found that people who suffer from mental health issues are more susceptible to developing Long COVID. Another study with people diagnosed with multiple sclerosis found that participants with depression or anxiety took more time to recover from COVID-19.

In short, issues like depression, anxiety and mood disorders may affect how people heal from Post-COVID conditions.

On the flip side, Post-COVID is in itself a highly stressful ordeal. It can upend your life in a variety of ways, put your body through immense physical changes, deprive you of much-needed social interactions and leave you feeling incapable of doing many of the things you used to do for long periods.

As such, it’s all the more important for people with Post-COVID to take care of their mental health. Here are some tips for reducing stress and combatting depression and anxiety when you suffer from chronic fatigue:

  • Take up mindfulness meditation.
  • Practice journaling.
  • Try light, relaxation techniques like yoga or tai chi.
  • Practice self-care activities like weekly pampering sessions, taking long baths and going for short walks.
  • Find a therapist who is familiar with Long COVID and chronic fatigue syndrome.
  • Join a support group.

Post-COVID fatigue treatment with RT Medical

RT Medical is a Post-COVID virtual clinic designed to help patients navigate the long road to recovery.

We provide a centralized interdisciplinary approach to managing mild symptoms and severe illnesses associated with Post-COVID conditions. Our plans are tailor-made to fit each patient’s unique needs and capabilities.

Here is what you get when you sign up for an RT Medical Post-COVID recovery program:

  • A comprehensive health assessment with our healthcare providers
  • Referrals to necessary diagnostic tests and specialist doctors
  • Drug prescriptions
  • A customized healthcare plan with practical tips and activities for managing your symptoms
  • Remote care that can be scheduled to meet your availability

The bottom line

Fatigue is a common symptom of Post-COVID and can be very debilitating. But there are ways you can manage your fatigue, especially with RT Medical’s treatment plans.

If you suspect you may have Post-COVID conditions, feel free to reach out for help. Our team is here to support you in this difficult time.

Post-COVID fatigue FAQs

How long does it take to recover from Post-COVID conditions?

It can take anywhere from a few weeks to several months for people with Post-COVID to recover. Recovery time is different for everyone and depends on a variety of factors, including the severity of one’s COVID-19 experience.

What are the common symptoms of Post-COVID fatigue?

The most common symptoms of Post-COVID fatigue are:

  • Persistent tiredness
  • General malaise
  • Dizziness and nausea
  • Brain fog
  • Muscle and joint pain
  • Exhaustion after mild exertion
  • Headaches
  • Increased irritability
  • Poor appetite

How can I avoid getting Post-COVID fatigue?

The best way to avoid getting Post-COVID fatigue is to avoid getting infected with COVID-19. This means reducing exposure to other people, wearing a mask in crowded spaces and getting vaccinated.

Can I apply for disability benefits for Post-COVID fatigue?

Yes, you can apply for long-term disability benefits if you are suffering from Post-COVID conditions like chronic fatigue, brain fog, difficulty breathing, etc.