Is there treatment for persistent fatigue experienced months after testing positive for COVID-19?

Clinical Symptoms

A: Yes. While there is no easy fix, there are ways to manage and improve post-viral fatigue.

The constellation of symptoms suffered weeks and even months after being diagnosed with COVID-19 is called “long COVID”, post-COVID-19 syndrome, or post-acute sequelae of SARS-CoV-2 (PASC). People with this condition have been dubbed “long haulers.” Fatigue is one of most common symptoms. The occurrence or severity of PASC has not been found to correlate to the degree of illness from the acute infection. Even those who are asymptomatic with COVID-19 may become “long haulers”. Let’s look at the details and consider ways to combat the fatigue.

As with other infections like Lyme disease, COVID-19 can have a period of relief after the acute phase followed by a recurrence of symptoms, or even the development of new problems. Shortness of breath and fatigue are the most common symptoms suffered in PASC.

A study of 128 individuals from November 2020 used the Chalder Fatigue Score (CFQ-11) to track the prevalence of fatigue after COVID-19 diagnoses. This is a standard tool used to measure fatigue in clinical settings.

The 11 questions of the CFQ-11 are:

Do you have problems with tiredness?
Do you need to rest more?
Do you feel sleepy or drowsy?
Do you have problems starting things?
Do you lack energy?
Do you have less strength in your muscles?
Do you feel weak?
Do you have difficulties concentrating?
Do you make slips of the tongue when speaking?
Do you find it more difficult to find the right word?
How is your memory?

To score the CFQ-11, one ranks the intensity of the response from 0 (less than usual) to 3 (more than usual). Similar to the pain scale used to monitor chronic pain, this tool can be used to monitor an individual’s level of fatigue rather than compare it to the experience of others or to determine the presence of fatigue.

No underlying cause of fatigue was found among the participants by routine lab. The study revealed that more than half of the people experienced significant symptoms of post-viral fatigue 10 weeks after their initial diagnosis.

Many factors including recovery from a viral illness can contribute to fatigue. For that reason, the treatment of fatigue is multifaceted. The first thing to do is eliminate or manage treatable conditions that may have occurred because of the infection. Dehydration, anemia, malnutrition, pneumonia, and hypoxemia (low oxygen in the blood) can be accompanied by fatigue and should be ruled out by a health care professional. Underlying medical and mental health conditions can make the fatigue of PASC worse. Once you have managed these conditions, here are a few things you can do for the best self-care.

1. Rest and get proper sleep.

If you do not wake in the morning feeling refreshed, you are not getting proper sleep. This is essential to any recovery from illness. Your body requires time to heal. Turn off electronic devices, TV’s and music at least 1/2 hour before going to bed. When you don’t your brain continues to process stimuli even while you are sleeping. Give your mind complete rest.

2. Exercise gently.

Movement helps to remove toxins from the body through the lymphatic system. Muscle contraction and deep breathing act as pumps for lymph which carries debris off to be eliminated. Make sure that as you move, you drink plenty of water so not to dehydrate.

3. Avoid stimulants.

Natural stimulants in energy drinks, caffeine, simple sugars, and starches will give a boost of energy especially if you are fatigued. However, the crash that comes after can be worse. Good nutrition provides sustained energy so you don’t feel a need for a quick pick-me-up.

4. Allow time.

Keep activity low as you recover. Avoid taking on too many projects at the first sign of feeling better. Your body needs time to rebuild after a viral infection. No one can tell you how long you need. Only you can set your boundaries.

5. Set a daily routine.

Small goals met in a lightly organized day will allow your mind to anticipate what is next. This regularity is beneficial and used in other types of healing such as grief integration. Remember to keep the schedule light. A few accomplishments will build confidence and encourage you to do even more as are able.

6. Practice thinking exercises.

Mental gymnastics is not only healing, it’s fun. Puzzles, riddles, tales that stretch your imagination are a great low-impact way to spend time as your strength improves. Activation of the reward system in your brain increases the circulation of dopamine which improves motivation.

7. Laugh.

Laughter is good medicine and encourages the release of natural endorphins, the body’s pain killers. The body aches that accompany fatigue will dissipate with more circulating endorphins.

Finally, talk to your health care professional. The attached infographic is an excellent resource to share at your next appointment. Use it as a check list to be sure that you and your health care team cover all aspects of fatigue after COVID-19.


“Persistent fatigue following SARS-CoV-2 is common and independent of severity of initial infection”

Infographic: “Management of post-acute covid-19 in primary care” BMJ 2020

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