Fatigue after COVID….what is it and what can I do about it?

Long COVID Mental Health

We have a great question here today about just that. Read on for more!

Karin from Kansas wants to know, “Varying degrees of fatigue after COVID-19 is the biggest complaint I hear and some people are pushing through it. I worry about how this will impact them. What are some ways to support a person’s recovery?”

➡️  TL; DR: There is not one answer, but recognizing what fatigue is, then using the principles of the 3Ps (Pacing, Planning, and Prioritizing) to guide recovery can help. We don’t yet know how moving too quickly will impact the recovery.

❓What is fatigue?

Fatigue can mean a lot of things to different people, but we can describe it as a group of symptoms that happen after having an infection, like COVID-19. Many people are studying fatigue and we know that it is more than a psychological symptom (check out the first link to learn about a group working on this). Fatigue is a signal that something is off balance in your body. Fatigue is not the same thing as long COVID, but is common among people who have long COVID. A recent paper that reviewed many studies of people who had COVID over a period of time found that up to one third of people who report symptoms after infection have fatigue at 4-5 months post-infection (the second link below). We can’t draw conclusions from this paper (like who it affects the most) because of limitations of the studies included, but we can say that it is a common symptom among people who report long term symptoms.

Fatigue is both a physical state and a constant feeling and includes reports of what the person can or cannot do as well as how they feel. There can be many reasons for fatigue, including other medical conditions like hypothyroidism or anemia. Fatigue is more than just being tired. It makes it hard for someone to do the things they need to do, like work, be social, and take care of their home. Fatigue is probably caused by immune and nervous system problems after illness.

❓When is fatigue a problem and what can someone do?

Fatigue can be normal when you are actively sick, but when it goes on for up to 6 months after an infection, it is chronic. Fatigue can include symptoms like: pain, mood changes, cognitive issues like not being forgetful or getting tired when reading, fever, sleepiness, and inability to do an activity without making the fatigue worse.

Helping people cope with fatigue at different points in time can vary. Here are recommendations from the Royal College of Occupational Therapists (reference in third link below).

SICK NOW: When someone is actively sick, it is important to stay hydrated, eat well, sleep enough, and decrease the level of activity. People should try to take at least a few weeks before they return to their normal level of activities.

RECENTLY SICK: Right after someone is sick, if they still feel fatigued, rest needs to be a priority. This includes both physical activities and activities that use your brain. People should try to use the basics of mental health to guide their recovery including: making a schedule, making sure to eat well and hydrate, and prioritizing sleep. In this phase, people should also take more time from work if needed and start with small levels of activities (like making food for oneself or going for a 10 minute walk). If the fatigue is severe (where someone can’t do basic things for themselves like prepare food), it would be a good idea to reach out to a primary care clinician and/or request assistance from a physical and/or occupational therapist. Seeking support from family, friends, and a therapist will also be helpful in this phase.

SICK 3+ MONTHS AGO: If the fatigue continues beyond a few months, there are some additional things to do in addition to what is listed above. People should also seek to build in activities that bring them joy, document the activities they can/cannot do, and try to keep a log of fatigue related to activities throughout the day. People with chronic symptoms should also seek professional support to learn additional strategies to get through the day. The Royal College of Occupational Therapists (RCOT) provides an excellent framework for this by providing the 3Ps Principle (Pace, Plan and Prioritize) (fourth link below). The recommendation is to pace (do small activities at a time that you CAN do for a shorter period of time, spacing them out during the day); plan (schedule your activities throughout the week based on what may or may not increase your fatigue and pair with down time); and Prioritize (focus on doing the tasks that you have to do every day and once you are able to do those, do more).

❓Are there treatments for fatigue?

There is little agreement on long term treatments for fatigue, including fatigue in other medical conditions or fatigue related to myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Across many studies, fatigue is measured in many different ways and most fatigue research focuses on a small part of the population, which makes it hard to draw conclusions. One recent paper summarized over 40 studies and found that 1) Physical support is critical and works better with psychological support; 2) Strength based activities are important so that the person does not get weaker (deconditioning); and 3) Support should focus on what the person can do and where they can do it. This can be helpful information for people who want to know what might work best.

Because we don’t yet have long term studies on long COVID, we don’t yet know how pushing through can influence someone’s recovery. There are many things that haven’t been studied yet, including how different people might respond differently, so it is important that we have more data across groups of people and that we follow a large group, including people who were not sick and people with varying levels of severity of illness from COVID-19, among other things.

➡️  THE BOTTOM LINE: Fatigue after COVID-19 is real and is not just something someone experiences in their mind. Helping lessen fatigue after COVID-19 involves both physical interventions and emotional/psychological support as well as guidance on how to structure activities and work so that someone can do the things they need to do on a daily basis. More research is needed to understand who is struggling with this symptom as well as how we can help them.

Stay safe. Stay well.
Those Nerdy Girls

Additional links:

1. The Collaborative on Fatigue Following Infection

2. Long COVID and Post-Infective Fatigue Syndrome

3. Strategies for getting better at home (with nice handouts)

4. 3Ps Principles

5. Review paper of fatigue interventions

Link to Original FB Post