What You Need To Know About Post
While COVID-19 is a short-lived illness in most people, others experience lingering symptoms, including fatigue, for months after their initial infection. So what should you do if you’re suffering with post-viral fatigue, following COVID-19 or a different virus?
Reviewed byDr Sarah Jarvis MBE
10-Nov-20·5 mins read
By now, many of us are familiar with the idea of ‘long COVID‘ – a lingering post-viral illness that can follow a COVID-19 infection. Most people who contract the coronavirus recover within two to three weeks. However, we now know there’s a subset of patients for whom that’s not the case.
The British Medical Journal defines ‘long COVID’ as “illness in people who have either recovered from COVID-19 but are still reporting lasting effects of the infection or have had the usual symptoms for far longer than would be expected”. While we don’t know exactly how many people this applies to, the tally could be as high as one in 10 of those infected.
According to data from the UK’s COVID-19 symptom app, there are around 300,000 people in the UK who have reported symptoms lasting for more than a month. Over 60,000 were still experiencing symptoms after three months.
What To Expect At Your Provider’s Office
There is no laboratory test for chronic fatigue syndrome. But your health care provider may use tests to rule out other illnesses. Your provider will go over your symptoms, check your medical history, and do a physical examination.
If you have CFS, your provider may prescribe drugs to treat your symptoms, or suggest herbs, vitamins, or dietary changes to help you. Get plenty of rest, exercise regularly, and learn to pace yourself. Often this combination of treatments will help you get better.
If the usual treatments do not work, your provider may check for other conditions that can cause symptoms similar to those of CFS.
I Haven’t Felt Good Since I Was Sick Last Year
If this describes you, you could have post-viral syndrome.
When Ill feel better in a week or so drags out for months with many confusing symptoms, you may begin to lose hopeespecially if your doctor says she can find nothing wrong with you.
You may have been told your symptoms point to depression, and your doctor may have recommended you take anti-depressants or other psychiatric medications.
Most people recover from an acute illness like respiratory or stomach flu relatively quickly and then return to normal activities. But what happens when recovery isnt all its cracked up to be? You may:
- Develop aches and pains.
- Feel like you cant think clearly anymore .
- Half a day of shopping or yard work causes you extreme exhaustion.
- Find that you have no endurance and feel like you can barely drag yourself through your day.
If youve never heard of post-viral syndrome, you may not make the connection between your symptoms and when your symptoms started.
The medical community has recognized post-viral syndrome for decades, and it has been well-documented and confirmed with scientific research. Exactly how to categorize it remains controversial, though.
Although one perspective continues to claim it is primarily psychogenic , there are real physical changes that can be measured, so its definitely not just all in your head.
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What Is The Outlook For Someone With Chronic Fatigue Syndrome
The long-term outlook varies quite a bit. There may be times when your symptoms are not too bad and other times when they flare up and become worse. However, many people improve over time and some recover well. Children and younger people have a better rate of full recovery. Early diagnosis and treatment may lessen the impact of the illness. The important thing to remember is that this is not a progressive or life-threatening disease and that for many people full recovery is possible.
Other Herbs And Supplements
A double-blind, placebo-controlled study available only in the form of a press release reportedly found dark chocolate helpful for CFS.33
Traditional Chinese herbal medicine is part of a comprehensive and unique approach to healing developed over many centuries in Asia. A double-blind, placebo-controlled study of 29 people suggests that the use of an herbal formula originating in this system may be helpful for CFS.27
A test tube study ofechinacea andPanax ginseng found that both increased cellular immune function in cells taken from people with CFS.20 However, many herbs and supplements can cause measurable changes in immune function, and such observations do not prove that there will be an actual benefit in people with the disease.
Bothbeta-carotene andDHEA have been suggested as treatments for CFS, but the evidence that they work remains extremely preliminary at best.21,22,23
Based on the theory mentioned above that CFS might be related to low blood pressure, the herblicorice has been recommended for CFS by some herbalists. Licorice raises blood pressure when taken in high doses for a long time. However, there is no evidence that it works for CFS, and other treatments to raise blood pressure have proven ineffective for CFS.24
Another study failed to findmelatonin helpful for CFS.29
A special bran extract marketed for enhancing immunity failed to prove more effective than placebo for CFS symptoms .31
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What To Do If You’re Worried
Recovery from post-viral fatigue can vary a lot from one person to the next. Some people are back to normal within a month or two, while others experience lingering symptoms for years. However, there is some evidence to suggest that getting an early diagnosis may improve recovery.
If you’re concerned you may be suffering with ‘long COVID’, or that you’ve developed an illness similar to CFS/ME, it’s important to speak with your doctor as soon as possible. They can investigate further and, if necessary, refer you to specialist services. The NHS has recently set up the Your COVID Recovery programme, but while there is extensive advice on their website, there are as yet few clinics where tailored treatment can be offered. In addition, some patient groups have criticised the site for setting unrealistic targets for exercise and activity.
However, the number of NHS clinics is gradually increasing and they may be able to provide a more tailored approach to recovery than the more general advice on the Your Covid Recovery website.
Massive Gap In Hiv Screening
Between 2009 and 2012, white males 1539 years of age made an average of 1.35 visits to physicians offices each year. But in 99% of those visits, they did not get a human immunodeficiency virus testeven though in 2012, an estimated 15% of males living with HIV had undiagnosed HIV infection. Thats worse than the findings for blacks and Hispanics, although those numbers were not much better: Only 2.7% of black men and 1.4% of Hispanic men were tested, and they were less likely to visit the doctors office.
Because there is room for improvement, Centers for Disease Control and Prevention researchers analyzed data from the 20092012 National Ambulatory Medical Care Survey and U.S. Census data to identify opportunities for HIV diagnosis in young men.
The number of men visiting health care offices was up from 59% in 2010 and 63% in 2011, to 75% in 2014. But it appears that the age group of 2029 years old is getting whatever attention there is. HIV testing was lowest among males 1519 years of age and 3539 years of age.
Why is screening still so rare? The researchers suggest providers may not know about national testing recommendations, believe that their patients are not at risk, or believe that HIV testing is the responsibility of other health care professionals in other settings.
The CDC report says interventions to make HIV testing routine, such as opt-out testing, might help increase coverage among young men who might not otherwise seek it.
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Burning Mouth Syndrome Due To Varicella Zoster
Burning mouth syndrome may be a clue to herpes simplex virus type 1 or varicella-zoster virus , say clinicians at the University of Colorado. They report on two female patients with BMS who had elevated levels of serum anti-VZV immunoglobulin M antibodies.
One patient had had BMS for eight months, the other for two years. Routine blood counts, and liver, kidney, thyroid, and other tests were normal for both patients. No VZV, HSV-1, or HSV-2 DNA was detected in saliva samples, but serum anti-VZV IgG antibody was present and elevated.
Both patients had received the zoster vaccine within a year of the onset of BMS, but the clinicians say it seems unlikely that immunization contributed to their condition because none of more than 19,000 adults who received the zoster vaccine in the Shingles Prevention Study developed BMS.
Oral valacyclovir 1 g three times a day for two months reduced the pain to minimal for the first patient, although severe pain recurred when the dose was lowered or the drug was discontinued. She has continued to improve on the daily dose. The second patient was also started on oral valacyclovir 1 g three times daily for three months. Her anti-VZV IgM antibody remained elevated after three months. The same dose, continued for another three months, reduced the pain by 60%. The dose was lowered to 1 g daily. After eight months, she was pain free for three to four days a week the pain otherwise was mild.
Source: BMJ Case Reports, July 2016
Can Diet Help Post
What you eat after a viral infection, when symptoms of fatigue persist, can have a marked impact on your speed of recovery. Some authors claim that to improve fatigue specific foods need to be totally avoided, or included in your diet. So what is the truth and the evidence about diet and post-viral fatigue?
The COVID-19 virus is a new illness and behaves in different ways to other viruses. It is unclear whether the ongoing symptoms such as fatigue differ from other viral illnesses. Doctors and scientists are still trying to understand more the mechanisms causing the symptoms and effective treatments. To date, there is no research, or evidence, that any one diet or vitamin supplement is beneficial, for post-viral fatigue. The only exception is vitamin D where internationally experts recognise that it is possible that those who are vitamin D deficient could be at increased risk of contracting COVID-19 or for having a more severe disease course. However, at this point, further research is ongoing to determine if taking vitamin D supplements is beneficial. In the UK it is recommended for everyone to have a 10 micrograms supplement daily as vitamin D does play a key role in the bodys immune function. Be very cautious of other claims advising on a restrictive diet, cutting out basic foods or recommending expensive supplements.
The following questions are worth asking in the order of importance for fatigue symptoms:
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Ethics And Informed Consent
The present clinical trial was conducted as per the ethical principles contained in the current revision of the Declaration of Helsinki 2013, ICH harmonized guideline integrated addendum to ICH E6: Guidelines for Good Clinical Practice ICH E6 and following the Ethical Guidelines for Biomedical Research on Human Subjects issued by the Indian Council of Medical Research and all other applicable laws and regulations of the country. Informed written consent was obtained from all participants. No vulnerable subject participated in the study. The trial was conducted at three centers in India , by qualified investigators for a duration of 14 days. The trial was registered with the Clinical Trial Registry of India as per Indian regulations with the following registration number: CTRI/2021/05/033576. Date of approval: 10 May 2021.
Vitamin D And C Deficiencies Re: Nice Guideline On Long Covid
Dear Editor
It is absurd that NICE wants doctors to “explain to people that it is not known if over-the-counter vitamins and supplements are helpful, harmful or have no effect in the treatment of new or ongoing symptoms of COVID 19”.1
Does that mean none of the NICE experts have experience of assessing and correcting the very common deficiencies of essential nutrients especially, in this case, of Vitamins D and C?
Dr David Grimes emphasised in his Blog that 19 world-wide studies have demonstrated that low blood levels of Vitamin D are associated with severe or fatal Covid-19. The latest International studies indicate that a blood level of more than 30ng/ml is a level that indicates protection against serious or fatal Covid-19 infection. A target level of 40ng/ml would appear to be appropriate, and to achieve this vitamin D in a daily supplement of 4,000 units is effective, perfectly safe, and costs about £12 per year.
Magnesium is needed in the metabolism of Vitamin D and for normal functioning of the myocardium and skeletal muscles. However, low red blood cell levels of magnesium and low white cell zinc levels are also very common but such tests seem to be only available in private laboratories.
It seems that expensive drugs are preferred to cheap essential nutrients
1 NICE COVID-19 rapid guideline: managing the long-term effects of COVID-19NICE guideline Published date: 18 December 2020
Competing interests: No competing interests
30 December 2020
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Physical Aspects Of Recovery
Give up exercise I have been a lifelong fan of exercise, and it was always my coping mechanism. I had to give this up completely . If you’re certain that you suffer from ME/CFS as defined above, don’t let anyone tell you that exercise is a good idea. Gradually doing more exercise may be great for those suffering from depression, but it’s a disaster for someone with ME/CFS. One of the greatest misconceptions about ME/CFS which gained ground following the publication of the PACE survey discussed by Rebecca Goldin’s article above is that a “Fear of exercise is the biggest barrier to chronic fatigue syndrome recovery”. Several books have been written about how Graded Exercise Therapy can help with ME/CFS they’re all utter horseshit. Instead you need to learn about pacing.
PacingPacing is the art of expending less energy than you have. It is almost impossible to convey how difficult this is during the early months of ME/CFS. You rest for days, and then when you feel like you have enough energy to do a little more, you do something that causes you to crash. The kicker is that your body is now capable of less than it was before you crashed, but you won’t find that out until the next time you crash. This cycle repeats, and your boundaries close in around you, forcing you to stay indoors, and perhaps stay in bed for an extended period of time.
For about 8 months I also took:
Long Covid: Dr Chris Gives Advice On Supplements To Fight Fatigue
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Symptoms, such as fatigue, may linger on following a COVID infection, for a really long time. Dr Chris shares two tips to overcome exhaustion. What are they?
Appearing on ITV’s This Morning, Dr Chris addressed the “long Covid” symptoms younger people are encountering.
The doctor explained fatigue can be “quite debilitating” and that it can “drag on for a few months”.
Anybody suffering from post-viral fatigue is urged by Dr Chris “to rest” – “you’ve got to rest,” he said.
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What If I Am Not Improving
SEEK ADVICE: If you are experiencing ongoing fatigue symptoms following an infection, you should ask your GP for advice so that they can check that there arent any other causes for the symptoms.SPECIALIST INPUT: If you continue to experience high levels of fatigue, then specialist ME/CFS services or chronic fatigue services may be available to provide further guidance. Ask your GP regarding local referral options. The BACME website has a map showing NHS ME/CFS services.
Mitochondria: A Matter Of Life And Death
These tiny organelles are found inside each human cell, and number over 2000 in hard-working cells! They actually evolved from bacteria and can be seen as cells within cells, co-existing with us in a symbiotic relationship. In return for nutrients and oxygen, these fascinating structures convert chemical energy from food into energy that our cells can use: adenosine triphosphate, commonly known as ATP. Healthy humans generate their own body weight in ATP each day! Because the body cant store ATP, the mitochondria must produce it continuously. The brain guzzles around 70% of ATP, explaining why mitochondrial dysfunction can lead to a feeling of brain fog. Mitochondria also have the power to influence which cells die, by releasing a toxic chemical that triggers programmed cell death.
Energy production inevitably generates reactive oxygen species , including free radicals which damage mitochondrial DNA and membranes. If only partially damaged, mitochondria have the remarkable ability to shed their injured part and join together with another in the same position , thereby maintaining a healthy colony. Its more beneficial to have smaller numbers of healthy mitochondria, than a larger number that are dysfunctional. There is always a balance between the generation of reactive oxygen molecules and the ability of antioxidants in the body to deal with them – oxidative stress occurs when the antioxidant system becomes overwhelmed.
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How To Alleviate Symptoms
So what should you do if you’re suffering from post-viral fatigue? Jarvis says that while there are no precise treatments, there are many things you can do to ease your symptoms and aid your recovery.
“Taking over-the-counter pain relief such as paracetamol may help ease any lingering pain. By managing pain, you may also be able to improve the quantity and quality of your sleep at night, thereby reducing fatigue throughout the day,” she says. “Going to bed at the same time each night and setting your alarm for the same time each morning will help your body slowly ease into a sleeping schedule.”
She warns that, while resting throughout the day is important, too much rest can actually cause sufferers to feel more fatigued. It’s sensible to take small, frequent naps during the day, if you feel exhausted, rather than sleeping for several hours at a time.
For many conditions, including depression and cancer-related tiredness, exercise can actually improve tiredness. However, if you have post-viral fatigue it is important to take things very gently – as we’ve heard, in some people even minor physical exertion can cause rebound worsening of fatigue.
