Fatigue after COVID-19: virus or post-traumatic stress fault?

People who have been seriously ill and have been treated in intensive care units have a few months to fully recover, regardless of the condition. However, with COVID-19 it is observed that recovery is also very long in those patients in whom the disease was mild and who, therefore, were not hospitalized.

Extreme fatigue, heart palpitations, muscle aches, pins and needles are just a few of the many side effects that are under consideration today. About 10% of the 3.9 million people who participated through a app in a study to know the symptoms of the new coronavirus (COVID Symptom Study app) stated that the effects of the disease were sustained for more than four weeks.

Chronic fatigue, classified as that lasting more than six weeks, is seen in clinical settings ranging from cancer treatment to inflammatory arthritis. It can be disabling. If 1% of the approximately 290,000 people who have had COVID-19 in the United Kingdom continue to feel unwell three months after contracting the disease, today there are still thousands of people for whom it is impossible to return to your workplace. They will likely have complex needs that health systems are currently unprepared for.

COVID-19 is not the only cause of chronic fatigue. It appears after other viral infections such as the Epstein-Barr virus, which causes infectious mononucleosis (also known as glandular fever). It is also seen in a quarter of the SARS-infected population that ravaged Hong Kong in 2003.

In treating chronic fatigue, the emphasis to date had been on effective treatment for the underlying disease, with the idea that this would reduce fatigue. However, there is no specific medication for most viral infections, and since COVID-19 is so new, how to treat the fatigue it causes is still unknown.

What Could Cause Post-Coronaviral Fatigue?

While we know that long-lasting fatigue follows other viral illnesses, for most the mechanism is unknown. One of them could be a persistent viral infection in the lungs, brain, fatty tissues or other places. It could also be due to a prolonged and inappropriate immune response after infection.

Despite this, a study published in 2018 shed some light. When patients with hepatitis C were given treatment with a chemical called interferon-alpha, a few developed a flu-like illness. In others, post-viral fatigue occurred.

Researchers have studied this "artificial response to infection" as a model for chronic fatigue. They found that baseline levels of these two inflammation-promoting molecules in the body (interleukin 6 and 10) predicted the later development of chronic fatigue in patients.

Of particular interest is the fact that these same pro-inflammatory molecules are seen in the cytokine storm of many highly affected COVID-19 patients. This suggests that there could be a pattern of activation of the immune system during the viral response that is relevant to the symptoms manifested.

The successful use of tocilizumab (a treatment that reduces the impact of interleukin 6 and reduces inflammation) in severe cases of COVID-19 also supports the suspicion that interleukin 6 may be playing some role.

What>

In TwinsUK's King’s College London, the UK's largest register of adult twins for scientific purposes, genetic and environmental factors influencing disease are investigated by studying twins.

With the app COVID Symptom Study longer lasting symptoms are examined. To do this, questionnaires are sent to volunteer adult twins registered in the database, many of whom had been included well before the pandemic, in studies of immune systems. From here our goal is to define a syndrome post-covid and pay attention to blood markers to explain how immune mechanisms contribute to long-term symptoms.

It is a study whose design raises several challenges: people with COVID-19 have had more than a simple viral infection suffered in a context of normality. They have fallen ill at a time when the world was experiencing unprecedented social change. Around them, movement restrictions and a period full of anxiety in which it was difficult to quantify the risks, since bombed informatively The 24 hours of the day. A good number of patients spent the disease at home and felt on the verge of death.

For this reason, post-traumatic stress is also being studied, since the interpretation of the reported symptoms has to be done in context.

Chronic fatigue is not the province of a single medical specialty, so it is often overlooked in the race and doctors are barely trained to diagnose or treat it. However, it is true that in recent months some progress has been made in this regard and that training is already available on-line for health professionals, in order for them to learn to address at least the cases of those patients whose symptomatology it is more pronounced.

Guidelines are also available for patients and intended to help patients cope with chronic fatigue and maintain energy. Among all the recommendations, it is worth highlighting the one that insists that joining the gym and forcing yourself to exercise is negative, and that it only makes people turn back. Small efforts, both mental and physical, should be followed by doses of rest. Returning to work, when you arrive, should also be a gradual and staggered process. Learning to pace activities is increasingly the order of the day.

Frances Williams, Professor of Genomic Epidemiology and Hon Consultant Rheumatologist, King's College London

This article was originally published on The Conversation. Read the original.

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