People with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) have been concerned since the start of the coronavirus pandemic that a subset of COVID-19 patients will go on to develop ME/CFS. Unfortunately, we are already hearing from many COVID-19 survivors around the world that they are continuing to experience debilitating symptoms for many months, even after “mild” cases. On just one COVID-19 tracking application, 300,000 people have reported long-term symptoms. Tens of thousands of these “long-haulers” are participating in Facebook and Slack groups to discuss symptoms they experience past the point when clinicians and public health officials have claimed they should be fully recovered. Long-term consequences of SARS-CoV-2 infection (the viral cause of COVID-19) are already a crisis.
Not everyone experiencing long-term consequences from SARS-CoV-2 (“sequelae”) will fit ME/CFS diagnostic criteria. Some symptoms will likely be due to blood vessel damage and/or specific organ damage caused by SARS-CoV-2; and patients who were hospitalized may have post-intensive care syndrome or post-acute respiratory distress syndrome. Other patients may develop autoimmune disorders triggered by the virus, such as Type I diabetes or Guillain-Barre syndrome. We need to ensure that researchers and clinicians do thorough workups and consider each of these potential issues in their differential diagnosis. But based on what’s been reported in the aftermath of other infections that triggered ME/CFS, we expect many long-haulers will fit ME/CFS criteria.
It is vital that researchers and clinicians who treat and study long-haulers understand ME/CFS diagnostic criteria and management advice. Common rehabilitation approaches, such as graded exercise therapy, can cause permanent damage in people with ME/CFS, and COVID-19 patients experiencing long-term symptoms have been urged to avoid graded exercise for this reason. These approaches are being recommended and used to treat patients with COVID-19 sequelae right now, without understanding of the harm they might cause.
#MEAction will continue to advocate by educating researchers, clinicians and the public to help them distinguish ME/CFS from other post-infectious diseases, and helping ensure that everyone experiencing long-term symptoms from COVID-19 has access to the diagnostic and management advice they need.
The Atlantic: COVID-19 can last for several months