HEALTH PLUS MED­ICAL COR­RE­SPON­DENT

For many of us, be­com­ing ill with any virus might put us on the couch for a day or two. It can be drain­ing, but af­ter re­cov­er­ing we can gen­er­al­ly get back to the things we’re used to. For some peo­ple, how­ev­er, con­tract­ing a vi­ral in­fec­tion can be life-al­ter­ing. It can cause months, years or even a life­time of de­bil­i­tat­ing symp­toms that dras­ti­cal­ly re­duce one’s qual­i­ty of life.

These symp­toms, some­times called “post-vi­ral fa­tigue syn­drome”, have been re­port­ed by suf­fer­ers of many vi­ral dis­eases in­clud­ing in­fluen­za, glan­du­lar fever, SARS and now, COVID-19.

What are the symp­toms?

The World Health Or­gan­i­sa­tion has clas­si­fied post-vi­ral fa­tigue syn­drome un­der the sec­tion of “dis­eases of the ner­vous sys­tem”. It is de­fined as: “A com­plex med­ical con­di­tion, char­ac­terised by long-term fa­tigue and oth­er symp­toms. These symp­toms are to such a de­gree that they lim­it a per­son’s abil­i­ty to car­ry out or­di­nary dai­ly ac­tiv­i­ties.”

De­spite the word “fa­tigue”, the symp­toms can be broad­er and more de­bil­i­tat­ing than sim­ple tired­ness. They can in­clude a sore throat, aches and pains across the body, blood pres­sure changes, gas­tric up­sets such as ir­ri­ta­ble bow­el syn­drome, headaches, sleep dis­tur­bance, de­pres­sion and dizzi­ness. More se­vere neu­ro­log­i­cal symp­toms can al­so oc­cur, in­clud­ing new sen­si­tiv­i­ties or al­ler­gic re­ac­tions and burn­ing or prick­ling sen­sa­tions in the limbs. Many COVID-19 pa­tients, for ex­am­ple, re­port a pro­longed loss of smell and taste.

A key fea­ture of the con­di­tion is that symp­toms can sud­den­ly wors­en fol­low­ing on­ly min­i­mal phys­i­cal or men­tal ac­tiv­i­ty.

The symp­toms are es­sen­tial­ly the same as those of chron­ic fa­tigue syn­drome, al­so called myal­gic en­cephalomyelitis or ME, which is why the WHO places them un­der the same cat­e­go­ry of neu­ro­log­i­cal dis­or­ders.

If you went to see a doc­tor, the clin­i­cal as­sess­ment for post vi­ral fa­tigue syn­drome would be the same as for chron­ic fa­tigue syn­drome. How­ev­er, not every­body who gets chron­ic fa­tigue syn­drome had a virus, which may ex­plain why both terms per­sist. There are no cur­rent di­ag­nos­tic tests for post-vi­ral fa­tigue syn­drome, and a di­ag­no­sis can on­ly be made based on a se­ries of symp­toms.

It’s be­ing re­port­ed in COVID-19 sur­vivors

Post-vi­ral symp­toms have been re­port­ed fol­low­ing out­breaks of of­ten un­ex­plained virus­es in many dif­fer­ent coun­tries. One of the ear­li­est out­breaks record­ed was in 1934 in Cal­i­for­nia, where peo­ple in­fect­ed with an un­known virus (thought to be po­lio) ex­pe­ri­enced “burst­ing headaches”, aching limbs and mus­cle weak­ness for a pro­longed pe­ri­od.

For ex­am­ple, an Ital­ian study from Ju­ly 2020 found 55% of the hos­pi­talised COVID-19 pa­tients stud­ied, suf­fered at least three de­bil­i­tat­ing symp­toms two months af­ter their ap­par­ent re­cov­ery from the ini­tial in­fec­tion. And a UK study in Au­gust 2020 es­ti­mat­ed 10% of those with COVID-19 go on to de­vel­op post-vi­ral symp­toms.

This is not nec­es­sar­i­ly sur­pris­ing, giv­en re­search on oth­er sim­i­lar virus­es. One Cana­di­an study found 21 health-care work­ers from Toron­to had post-vi­ral symp­toms for up to three years af­ter catch­ing SARS in 2003, and were un­able to re­turn to their usu­al work.

What caus­es it?

The con­di­tion, along­side chron­ic fa­tigue syn­drome, is poor­ly un­der­stood. Re­searchers are still try­ing to un­der­stand how the body is af­fect­ed, and a way to ob­jec­tive­ly di­ag­nose it.

Al­most every part of the body is af­fect­ed by a virus, and some lay dor­mant in our sys­tem and can be re­ac­ti­vat­ed when our im­mune sys­tem is weak­ened. A good ex­am­ple of this is shin­gles, which is a re­ac­ti­va­tion of the chick­en­pox virus.

Au­toim­mune? Mi­to­chon­dria?

While a virus might be the trig­ger, sci­en­tists do not yet know the ac­tu­al cause. One the­o­ry is that post-vi­ral fa­tigue syn­drome may re­sult from an over­re­ac­tion of the body’s im­mune sys­tem, in­duc­ing wide­spread in­flam­ma­tion. This is high­light­ed by el­e­vat­ed lev­els of im­mune mes­sen­gers called cy­tokines, which can cross the blood-brain bar­ri­er and po­ten­tial­ly cause long-term tox­ic brain changes af­fect­ing the whole ner­vous sys­tem.

Re­searchers are al­so fo­cus­ing on whether there’s an au­toim­mune com­po­nent to the dis­ease, where our im­mune sys­tem pro­vides a rapid re­sponse which can in­ad­ver­tent­ly dam­age healthy tis­sue, af­fect­ing all of the body’s sys­tems such as the heart, di­ges­tion, and may even cause di­a­betes.

Oth­ers are look­ing in­to why mi­to­chon­dria, the struc­tures that gen­er­ate en­er­gy with­in cells, are af­fect­ed and may re­sult in fa­tigue. Re­searchers are al­so work­ing to­ward find­ing “bio­mark­ers” in the body, ob­jec­tive in­di­ca­tors that can help with di­ag­nos­ing the con­di­tion, though no re­li­able ones have been lo­cat­ed yet.

How is it treat­ed?

Usu­al­ly treat­ment fo­cus­es on spe­cif­ic symp­toms. If pain is the main fea­ture, a rheuma­tol­o­gist might be used, who spe­cialis­es in man­ag­ing dis­eases of the joints, bones and mus­cles. Psy­cho­log­i­cal treat­ments such as cog­ni­tive be­hav­iour­al ther­a­py or mind­ful­ness might al­so help re­lieve some symp­toms.

The most ef­fec­tive cur­rent treat­ment is to­tal rest. This means fo­cus­ing on re­ju­ve­nat­ing ac­tiv­i­ties as much as pos­si­ble, with min­i­mal men­tal stim­u­la­tion such as tele­vi­sion or screen time. If you are sup­port­ing some­one with the con­di­tion, it is im­por­tant to re­spect their need for rest and help them through the anx­i­ety of end­less tests in their search for an­swers. The ex­pe­ri­ence of get­ting a virus dur­ing a pan­dem­ic is stress­ful, caus­ing anx­i­ety and even PTSD for some.

Un­for­tu­nate­ly, there is no spe­cif­ic med­ica­tion or speedy treat­ment for post-vi­ral fa­tigue or chron­ic fa­tigue syn­drome.

Treat­ment op­tions should al­ways be rec­om­mend­ed by a health pro­fes­sion­al and typ­i­cal­ly tai­lored to the in­di­vid­ual, with a well­be­ing ap­proach.