Funding For Long Covid Research Is Surging
The $15m figure starts to look even slimmer when compared to the research funding now available for long Covid. In the UK alone, the National Institute for Health Research and UK Research and Innovation have funded four studies to address the long term physical and mental effects of Covid-19, for a total of £18.5m.
Its not yet possible to say whether long Covid is clinically distinct from ME or simply the same condition arising en-masse from one clearly identifiable cause, warranting its own signifier. What is clear is that the significant overlap of symptoms mean a lot of long Covid research will have implications for the wider treatment of post-viral fatigue.
For me personally theres a deep sadness, a sort of grief, about what could happen in terms of research or treatment options, she says. Im happy that maybe this is the turning point for the condition, options will be available and hopefully one day soon people wont have to be forgotten, but at the same time, I find it strangely upsetting that I never had that opportunity.
I think a lot of people in the chronic illness community feel this way its almost guilt for feeling that way as well, but its hard not to feel some level of resentment.
Viral And Other Infections
The term post-viral fatigue syndrome is used to describe CFS-like symptoms that occur after a viral infection. A recent review found Epstein-Barr virus antibody activity to be higher in patients with CFS, and that a subset of patients with CFS were likely to have increased EBV activity compared to controls. Viral infection is a significant risk factor for CFS, with one study finding 22% of people with EBV experience fatigue six months later, and 9% having strictly defined CFS. A systematic review found that fatigue severity was the main predictor of prognosis in CFS, and did not identify psychological factors linked to prognosis. One review found risk factors for developing CFS after mononucleosis, dengue fever or the bacterial infection Q-fever include longer bed-rest during the illness, poorer pre-illness physical fitness, attributing symptoms to physical illness, belief that a long recovery time is needed, as well as pre-infection distress and fatigue. The same review found biological factors such as CD4 and CD8 activation and liver inflammation are predictors of sub-acute fatigue, but not CFS, however these findings are not generally accepted due to the use of the Oxford criteria in selecting patients. The CDC does not recognize attribution of symptoms as a risk factor.
Symptoms Of Chronic Fatigue
According to the Institute of Medicine of National Academies in the US, ME/CFS affects 836,000 to 2.5 million Americans since 2015. For this reason, early prevention and treatment for chronic fatigue can avoid this disease. If youre experiencing some of these chronic fatigue symptoms, it may be best to visit your local hospital right away.
- Unending body, joint, and muscle pain for more than six months
- Extreme exhaustion even after short periods of exercise
- Restless leg syndrome
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How Does Chronic Fatigue Impact A Persons Life
Chronic Fatigue Syndrome or CFS is severe fatigue that lasts for six months or more. Even during resting periods, it may not treat a person diagnosed with chronic fatigue syndrome. Hence, this complex medical illness often relies on treating the symptoms rather than the disease itself. This disorder is also called Myalgic Encephalomyelitis or ME/CFS, which may disable a person altogether. There are significant consequences of overlooking the symptoms of chronic fatigue. Mostly, there are times when fatigue may look like daytime tiredness or sleepiness. Yet, the first sign of continuous pain and lethargy needs a general physician for further examination and diagnosis.
What Can I Do To Manage Covid Fatigue
Fatigue can drain your energy and keep you from doing day-to-day things when youre down with a viral sickness like COVID-19 or long-haul COVID-19.
To manage your health and ease fatigue symptoms while youre sick or post-COVID, you should:
- Accept that fatigue is a real side effect of having COVID-19.
- Make sure to get a good nights sleep. This can help your body preserve energy.
- Try relaxation techniques like mindful meditation, aromatherapy, yoga, and tai chi. These can help to reduce stress and fatigue symptoms.
- Plan ahead on what you can get done with limited energy.
- Prioritize the tasks that are important. This will help you spend energy on only those things that need to be done.
- Delegate certain tasks to others who can complete them for you. This can include activities like grocery shopping or cooking.
- Try to stay active. A viral infection can knock your energy out, but moving and light exercise can energize you.
- Keep a diary on all things that either trigger your fatigue or make it worse. This will help you steer clear of energy-draining activities.
- Eat foods that give your body energy.
- Stay hydrated.
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A Hypothetical Association Between Ebv And Me/cfs
As mentioned above, EBV infection has been identified as a risk factor in a subgroup of ME/CFS patients . There are studies showing a statistically significant elevation of anti-EBV-dUTPase antibodies , a defective EBV-specific B and T cell response , a high rate of active EBV infection , serologic evidence of EBV reactivation with elevated IgM antibodies against late VCA antigen , and a positive up-regulation of EBV-induced gene 2 mRNA in peripheral blood mononuclear cells from a subgroup of patients with ME/CFS. However, serological observations related to EBV were not always confirmed and, accordingly, the association between EBV infection and ME/CFS is not established . Furthermore, the presence of an active EBV infection in a subgroup of ME/CFS patients has been actively debated, because most studies revealed no increase in EBV viral load in ME/CFS patients. If a third state of virus, defined as abortive/lytic/leaky replication could explain the presence of certain EBV proteins with the potential capacity to contribute to the symptomatology of ME/CFS , is an hypothesis that remains unconfirmed.
How Long Does Post
Recovery from post-viral fatigue varies from person to person, and theres no clear timeline. Some recover to the point where they can return to all of their daily activities after a month or two, while others continue to have symptoms for years.
According to a small 2017 study in Norway, getting an early diagnosis may improve recovery. A better prognosis is often associated with people who have had the condition for a longer period of time.
If you think you might have post-viral fatigue, try to see a doctor as soon as possible. If you have limited access to healthcare and live in the United States, you can find free or low-cost health centers here.
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Me/cfs And Viral Triggers
Over the years, researchers have investigated multiple pathogens in relation to ME/CFS. The disease is known to be associated with immune-system dysfunction, and possibly some features of autoimmunity
Viruses that have been studied thus far include:
The diseases also share cardiac abnormalities, but in COVID-19, its believed to be caused by myocarditis , which isnt believed to be present in ME/CFS.
What remains to be seen about post-COVID-19 symptoms is whether it includes a defining symptom of ME/CFSpost-exertional malaise .
PEM is a reaction in which mild physical or mental exertion triggers a ME/CFS symptom flare and leaves you unable to perform the same activity a day later. The reaction can range from mild to extreme, and the severity and triggers vary.
Someone with a mild case of ME/CFS may be able to handle grocery shopping if they otherwise relax that day. Someone else may be in bed for a few days after walking around the block. In the most severe cases, people cannot sit up without triggering symptoms.
This is a difficult symptom to spot in someone who’s too fatigued to be very active, especially if they have other factors limiting their exertion levels, such as shortness of breath. It may be a while before healthcare providers are able to identify whether people with post-COVID-19 symptoms experience PEM.
Background And Main Text
Myalgic encephalomyelitis/chronic fatigue syndrome is a complex and controversial clinical condition without having established causative factors. Increasing numbers of cases during past decade have created awareness among patients as well as healthcare professionals. Chronic viral infection as a cause of ME/CFS has long been debated. However, lack of large studies involving well-designed patient groups and validated experimental set ups have hindered our knowledge about this disease. Moreover, recent developments regarding molecular mechanism of pathogenesis of various infectious agents cast doubts over validity of several of the past studies.
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Permanently Exhausted After An Infection
Many COVID-19 patients feel permanently exhausted even months after their disease. Image: Stock-Asso/Shutterstock.com
COVID-19 can also trigger chronic fatigue syndrome in some infected individuals. How many patients are affected – and why the disease has so far been difficult to recognize and treat.
After a year with SARS-CoV-2, we know more and more about the virus and the disease it causes, COVID-19. It is now clear that a small proportion of those who become ill can suffer from various late effects after recovery – ranging from shortness of breath to impairment of lung, kidney and liver functions and the brain to temporary loss of smell and taste.
Carmen Scheibenbogen heads the Charité Fatigue Center and is a professor at Charité – Universitätsmedizin Berlin.
Chronic fatigue syndrome is also one of the possible long-term consequences of COVID-19. “Since the summer, we have been seeing more and more patients in our outpatient clinic who are still complaining of persistent exhaustion and many other complaints months after they have been infected with SARS-CoV-2,” says immunologist and oncologist Carmen Scheibenbogen, professor at Charité – Universitätsmedizin Berlin and head of the Charité Fatigue Center. Many of these patients met the criteria for chronic fatigue syndrome, she says. “That’s alarming – and at the same time, it’s not very surprising.”
Chronic fatigue syndrome is often not recognized
“A viral infection can be a trigger for fatigue syndrome.”
How Viral Infections Affect Our Health
Chronic viral infections are systemic and can last for months or years. They can cause diseases by compromising our immune system and altering the genetic material within the cells they have hijacked.
Chronic viral infections are a major trigger for inflammation and can cause many unwanted symptoms and health conditions. One of the main symptoms of chronic viral infections is fatigue. In fact, one study showed that 78% of people with chronic fatigue syndrome had markers of reactivated EBV and almost 50% had increased antibody titers to HHV .
Viruses can affect your central and peripheral nervous system. Human herpes viruses are common in the brains of the elderly . They are usually dormant but can become active in response to stress or a compromised immune system.
The herpes simplex virus is known to damage the central nervous system and the limbic system in the brain. There is strong evidence that it is linked to the development of Alzheimers disease. This can happen years or decades after the initial infection .
Numerous autoimmune diseases are linked to chronic viral infections, including autoimmune thyroid conditions and multiple sclerosis . With autoimmune diseases, the bodys immune system triggers an inflammatory response to its own tissues. The body responds as if normal tissues are infected and attacks these tissues. Autoimmune conditions develop as a result.
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Some Of The Reasons For Chronic Fatigue Syndrome
1. Emotional stress, typically related to grief or loss of a loved one, Marital stress, loss of a job or worrying about a health problem.
2. High Viral/Bacterial/ Mold Biotoxin Load-Because some people develop chronic fatigue syndrome after having a viral infection, researchers question whether some viruses might trigger the disorder. Suspicious viruses include the Epstein-Barr virus, human herpes virus Epstein Barr Virus, Fibromyalgia, CMV, Mycoplasma, Hepatitis C, Herpes, H.pylori, E.Coli, Pseudomonas, Salmonella
3. Toxic Body Burden-We are exposed to more environmental toxins on a daily basis than ever before in history. Even the simplest of daily routines can expose one to several common pollutants found in the water we drink, food we eat, and air we breathe. While our liver, kidneys and lymphatic system play a major role in removing biologically harmful compounds, our bodies have not evolved to deal with the growing number of toxins we unknowingly interact with every day.
When chemicals enter the body, then can bind to human tissue proteins causing a variety of chronic health problems such as diabetes, autoimmune disease, MS, inflammatory disease, hormone imbalances and neurodegenerative diseases. In addition to binding to human proteins, they easily overwhelm our Detoxification system causing stress to the liver and toxin overload. This happens when your body has taken in more toxins than it can process.
Why Fatigue Replaces Fever
Ari Whitten: Okay. Id love for you to talk about this thing that you just mentioned in passing, the fever and fatigue thing. In an evolutionary context, fatigue is replacing fever. Can you explain a little bit more about what you mean by that?
Dr. J.E. Williams, OMD: Sure. With an acute illness, acute infection from a microbial organism like a bacteria or a virus or a parasite, you mount a fever as a response to that organism. We also know that theres lots of cellular activity going on and crosstalk between so-called messenger molecules, cytokines and chemokines.
For thousands of years, doctors have known that fever is the first sign of illness. In my nature pure training, you would promote and/or support the fever, and you would want the patient to sweat. This is how Hippocrates did it, this is how Chinese medicine does it, this is how my mentor Bernard Jensen did it. Then you manage that fever with cool compresses, so you dont want it to go too high, but you actually want to support it, and then that heats the body up, makes things more fluid, activates certain chemicals that are temperature sensitive and knocks down those microbes and you respond and get better.
Ari Whitten: Got you. Is it possible that fevers are more of a short-term response, and the body limits them to a certain length of time, whereas fatigue can be sort of an indefinite response in a way?
Ari Whitten: Interesting.
Dr. J.E. Williams, OMD: Mm-hmm.
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Naturopathic Approach To Epstein
A fairly common and reasonable response to reactivated Epstein-Barr is that the immune system should be treatednot the virus. This is quite a reasonable approach, but it still leaves the patient trying to figure out what to do. Certainly more sleep, a better diet, stress reduction, and immune support with vitamin C, vitamin A, zinc, vitamin D, monolaurin, lysine, and mushroom extracts are warranted. I have found light therapy, valacyclovir , and intravenous vitamin C to be the most effective.
Some interesting more aggressive treatments for this include the application of different wavelengths of blue, green, and red light, similar to the type of light cold lasers use. This is also known as low-level laser therapy or photobiomodulation. The best application is sublingual because the vascular located there is close to the surface and the light can penetrate into the blood circulation easily.
There are studies on the ability of these wavelengths of light to treat a variety of viruses and bacteria.
There is also good human data on intravenous vitamin C. , Because there is limited absorption of vitamin C taken through an oral route, in the study cited they used intravenous vitamin C. There are a number of ways that intravenous vitamin C can work. It can decrease inflammation caused by acute or chronic viral infection, increase the activity and antiviral function of immune cells, and stimulate antiviral cytokines and direct antiviral activity.
Why Does It Matter How You Manage Fatigue When You Have Been Ill
This guideline aims to give advice to help people after an illness, such as a viral infection, to try to manage and reduce the fatigue that they may be experiencing. There has been very little research done looking at how to manage fatigue in the early stages following an infection. We dont yet confidently know the scientific answer to whether managing fatigue in different ways leads to different outcomes in terms of recovery. Many people who have experienced fatigue for a longer period of time, along with those who have developed ME/CFS, report that they wished they had received good advice earlier on in their illness regarding how to manage fatigue. Fatigue can interfere with every aspect of day to day life so learning how to cope with it, and feeling confident with helpful strategies, may help to reduce the impact of the fatigue.
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About Jill Carnahan Md Abfm Abihm Ifmcp
Dr. Jill Carnahan is board certified in both Family Medicine and Integrative Holistic Medicine. At her practice, Flatiron Functional Medicine in Louisville, CO, Dr. Carnahan uses functional medicine to help her patients find answers to the cause of their illness and the nutritional and biochemical imbalances that may be making them feel ill.
Why Viral Infections Become Chronic
Ari Whitten: Okay. Having said that there is a link between some of these viral infections and chronic fatigue syndrome and that you can see certain results on blood tests that paralleled with severity of symptoms, what is it, what do you think is really going on there? Let me phrase this a little differently, because when I was in my mid-20s, I got mononucleosis from Epstein-Barr virus, and I was severely chronically fatigued for several months after that, but then I got better over the course of, not instantly, but after six months, a year, I was mostly back to normal, and I havent had chronic Epstein-Barr virus since then, or chronic fatigue syndrome since then. Why is it that in some people this becomes chronic?
Ari Whitten: Mm-hmm.
Dr. J.E. Williams, OMD: But not always. The inflammation thats causing it is from a group of subcellular chemicals called cytokines. We can measure those, and we have profiles of those, interleukin 6 and tumor necrosis factor, interleukin 17, 13, we can measure those. Even seven years ago, there was just experimental, but now theyre available and not super expensive testing.
Sometimes they have bacterial infections like you said and sometimes they dont. Sometimes they have autoimmune, and sometimes they dont.
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