{"id":29999,"date":"2021-03-07T22:51:58","date_gmt":"2021-03-07T22:51:58","guid":{"rendered":"https:\/\/wames.org.uk\/cms-english\/?p=29999"},"modified":"2021-03-07T22:51:58","modified_gmt":"2021-03-07T22:51:58","slug":"managing-covid-19-post-viral-fatigue-syndrome","status":"publish","type":"post","link":"https:\/\/wames.org.uk\/cms-english\/managing-covid-19-post-viral-fatigue-syndrome\/","title":{"rendered":"Managing COVID-19 post viral fatigue syndrome"},"content":{"rendered":"

Managing COVID-19 post viral fatigue syndrome<\/a>, by\u00a0Charles W Lapp and Joseph F John\u00a0 in<\/span> Fatigue: Biomedicine, Health & Behavior<\/em>, Feb 22, 2021<\/h3>\n

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Article abstract:<\/strong><\/h3>\n

\"\"In online surveys, over 50% of persons who contract COVD-19 experience symptoms lasting longer than 90 days [Pelanti S, Grassi E, Markris N, et al. J Psych Res. 2020. doi:10.1016\/j.jpsychires.2020.08.008<\/a>]<\/p>\n

Despite an estimated 3 million Americans being affected by COVID post-viral fatigue, there has been little discussion about the care of these patients, most of whom report feeling unsupported or dismissed by their providers [Amitay O, Komaroff AL. The Guardian, 20 Aug 2020<\/a>].<\/p>\n

This article points out the similarity between this post-viral fatigue syndrome and Chronic Fatigue Syndrome (ME\/CFS) or Systemic Exertion Intolerance Disease (SEID), and offers evidence-based suggestions for management.<\/p>\n

Recommendations for management<\/strong><\/h3>\n

One year has elapsed with the COVID-19 pandemic, and it appears that this novel virus is capable of causing a syndrome similar to ME\/CFS, as many other infections have done in the past. There is currently no Standard of Care for the management of such Long Haulers, so our recommendations are based on past experiences with SARS, expert opinion, our experience with ME\/CFS, as well as expanding knowledge of COVID-19 illness. Here, we offer a sequence for diagnosis and treatment based primarily on our experience treating ME\/CFS.<\/p>\n

First, a rigorous history and physical examination<\/strong> should commence care. Second, routine testing<\/strong> should be performed to establish a baseline and to rule out sequelae of the disease that might produce chronic fatigue (see\u00a0Table 2<\/a>). Third, patients should be encouraged to rest frequently and aggressively and to set limits on daily activities<\/strong> so as to avoid exacerbations of their symptoms and post-exertional malaise. Overexertion leads to a prolonged exacerbation of symptoms (known as \u2018post-exertional malaise\u2019 or PEM) in persons with ME\/CFS, and empirically we know that repeated PEM perpetuates or worsens the illness. Therefore, it is imperative that patients be advised to limit activity and balance activity with adequate rest in order to avoid PEM. Finally, clinicians can address the major issues<\/strong> of sleep disruption, pain, orthostatic symptoms, headache, and other co-morbidities so common in ME\/CFS. These symptoms can be managed in the usual manner or referral to specialists.<\/p>\n

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Sleep disruption frequently responds to simple measures such as melatonin, over-the-counter antihistamines (such as diphenhydramine or doxylamine), or low doses of amitriptyline, nortriptyline, or trazodone. Primary sleep disorders are common in ME\/CFS, so highly consider specialist referral and polysomnography if sleep remains problematic.<\/span><\/div>\n<\/div>\n

Pain is very common in ME\/CFS but is frequently managed with physical therapies (hot or cold packs, Epsom soaks, massage, topical creams or liniments). In the past few years, low dose naltrexone (0.1\u20135\u2005mg daily) has proved to be useful for myalgic pain. For more severe pain non-narcotic pain medications such as pregabalin, duloxetine or milnacipran are recommended. Opiates \u2013 if considered appropriate \u2013 might best be prescribed by a pain specialist.<\/p>\n

Orthostatic symptoms such as lightheadedness, dizziness, upright intolerance, orthostatic hypotension or tachycardia, and even neurally mediated hypotension are common in ME\/CFS. Management begins with volume expansion (drinking at least 64 ounces of water or non-caffeinated beverage daily and ingesting extra salt \u2013 if not hypertensive). Tachycardia may require a beta-blocker for symptomatic relief. If orthostasis is not improved by volume expansion (including parenteral fluids) consider consultation by cardiology.<\/p>\n

Treating fatigue requires novel approaches as fatigue may respond to agents that clinicians may not regularly employ in their routine practices. This constellation may involve caffeinated drinks, low dose naltrexone, the use of stimulants including modafinil and methylphenidate, and other agents including antivirals. Other modalities including a wide variety of non-prescription supplements may help optimize the patient\u2019s health. The following supplements are recommended based on available evidence:<\/p>\n