Post-Viral Chronic Fatigue: A Fascinating Look at the Link to COVID-19

We’re all familiar with feeling a little “under the weather.” When you’re sick or fighting off an infection, you often feel extra tired, and completely exhausted even after minor activity. You might struggle to concentrate and get aches and pains. Sometimes you might get a sore throat or have trouble getting a restful night’s sleep. 

This is all normal and to be expected when you’ve “caught a bug.” But what happens when these feelings of sickness and exhaustion linger long after the acute stages of infection?

Unfortunately, this is the reality for people suffering from a debilitating condition known as post-viral chronic fatigue syndrome. Today we’re going to dive into exactly how a viral infection, like COVID-19, can cause this chronic and prolonged fatigue. And more importantly, we’ll cover some ways to manage the challenging symptoms associated with this diagnosis.

  

What Is Chronic Fatigue Syndrome (CFS)?

Chronic fatigue syndrome (CFS), also referred to as myalgic encephalomyelitis, is a serious and complex condition. 

CFS is defined as an acquired, multi-systemic disease characterized by unrelenting and persistent fatigue. Symptoms typically wax and wane, making this a consistently inconsistent experience for those with CFS. Physical, emotional, or cognitive exertion of any kind can cause exhaustion that doesn’t resolve regardless of how much rest you get.1 

The name “chronic fatigue syndrome” may seem quite self-explanatory, but this disease is anything but straightforward. In fact, the disorder of “chronic fatigue syndrome” is not even an actual diagnosis in itself. Rather, the term CFS, is used as a label to identify a collection of symptoms originating from an unidentified underlying issue. 

This makes CFS particularly difficult to diagnose and typically requires ruling out other disorders first. Because of its often vague symptoms, slow onset, and similarity to disorders such as hypothyroidism, adrenal burnout, or sleep deprivation – it often takes months to years for a diagnosis of CFS to be reached. This can leave sufferers struggling with debilitating symptoms and desperately searching for answers.

 

So, What Are the Symptoms of Chronic Fatigue Syndrome?

As implied by its name, the overarching symptom of this condition is chronic and persistent fatigue. CFS is more than just feeling tired after a long day of work – it’s debilitating, unrelenting fatigue. 

Officially, there are nine cardinal symptoms associated with CFS which are:2

1. Fatigue
2. Loss of memory or difficulty concentration
3. Sore throat
4. Enlarged lymph nodes in your neck or armpits
5. Unexplained muscle pain
6. Pain that moves from one joint to another without swelling or redness
7. Headaches of a new pattern, type, or severity
8. Unrefreshing sleep
9. Extreme exhaustion that lasts more than 24 hours after physical or mental exertion

With such vague and seemingly unrelated symptoms, it’s easy to see why this condition can be frustrating and difficult to diagnose.

 

What Causes Chronic Fatigue Syndrome?

Pinpointing the root cause of CFS is where things get even more challenging. A number of factors can potentially be the to be the underlying cause of CFS, which include:3,4,5

• Poor immune system response
• Viral infections
• Increased activity in mast cells
• Food allergies and sensitivities
• Oxidative stress
• Hormonal imbalances

If you look over the list of potential underlying causes, you might notice that they all share something in common – inflammation and immune activation. Let’s take a little deeper look at exactly how the inflammation and immune activation triggered by a viral infection can sometimes lead to chronic fatigue syndrome.

 

How Can a Viral Infection Cause Chronic Fatigue Syndrome?

Viral-like illnesses have been found to precede approximately 50% of patients diagnosed with chronic fatigue syndrome.6 While still not entirely understood, viral infections most likely cause chronic fatigue syndrome in a few ways:6,7 

• Viral latency: After an acute infection, viruses can remain latent in the body – essentially lying dormant to evade detection by the immune system. This hidden viral infection can cause chronic low-level inflammation and can even be reactivated under various conditions.
• Chronic cytokine production: Cytokines are tiny proteins secreted by your cells that act as molecular messengers – binding to other cells and signaling them to perform a certain action. An overproduction of pro-inflammatory cytokines can throw your immune system out of whack and diminish your body’s ability to regulate inflammation.
• Decreased natural killer cell function: Natural killer cells are a type of white blood cell that removes other cells infected with a virus during the immune response. When natural killer cells’ function is depressed, it lowers your body’s ability to fight off potentially harmful compounds, making you more susceptible to infection and depleting the resources of your immune system.
• Disruption of T-cell activation: T-cells are another type of immune cell that have several functions including activating other immune cells, producing cytokines, and neutralizing foreign microbes. T-cells also play an important role in regulating the immune response by triggering the immune system to ramp up or down. When T-cells are disrupted they become either overactive or underactive, then the immune system becomes imbalanced. 
• Imbalanced HPA-Axis: The HPA-axis stands for the hypothalamic-pituitary-adrenal axis and is the complex network of glands and hormones that regulates many of your body’s processes. This delicate network plays a critical role in the immune response – and sometimes this balance is thrown off due to a low-level infection. This can not only hinder your body’s natural immune response but can throw other hormones off-kilter and contribute to the symptoms associated with CFS.

In simplest terms, researchers speculate that in certain individuals, a viral infection essentially forces your immune system to remain in the “on” position. This causes a shift in the homeostasis of your immune system, and never really allows your immune system to rest or reset. Because the immune system requires massive amounts of energy to function, this leaves your body energy-depleted and causes CFS symptoms.

And in the wake of 2020’s coronavirus pandemic, some speculate that we may be facing a massive wave of new cases of chronic fatigue syndrome.

 

COVID-19 and Chronic Fatigue Syndrome

COVID-19 is the official name of the disease caused by the virus SARS-COV-2 – or more commonly known as coronavirus. Evidence has clearly indicated that coronavirus can potentially cause serious and sometimes irreversible damage to the lungs, heart, and brain. But emerging reports are finding that coronavirus may have some less obvious long term effects as well.

More and more patients recovering from coronavirus infections are reporting suffering from:8

• Ongoing and debilitating fatigue
• Unexplained muscle pain
• Brain fog, difficulty concentrating, and other cognitive problems
• Headaches that come and go

This has some medical professionals and researchers concerned that some patients recovering from COVID may remain sick and convert from acute viral infection into chronic fatigue syndrome.

 

Does Chronic Fatigue Syndrome Ever Go Away?

Unfortunately, this answer is complicated. Because CFS is a label for a cluster of symptoms and there’s not a single diagnostic tool, it’s difficult to know if CFS actually ever goes away.

Some people have more mild symptoms that come and go. While others with CFS may be homebound and never bounce back. But the good news is, even if CFS doesn’t necessarily go away, you have the power to manage your condition and influence the severity of your symptoms.

 

How Can I Manage Chronic Fatigue Syndrome?

The focus of managing the symptoms of CFS is minimizing inflammation – particularly in cases of CFS that follow a viral infection. Here are some simple and powerful ways you can minimize inflammation to manage symptoms and reduce chronic fatigue flare-ups.

• Show Your Gut Some Love: The health of your digestive tract is inexplicably linked to the health of your immune system. Prioritizing gut health can help ensure your immune system is functioning at full capacity and has the resources to fight off infection. To learn more about how your gut health influences your immune system, head over to my article How to Heal Your Gut for a Stronger Immune System.
• Lower Your Toxic Burden: When your body’s detox mechanisms are unable to keep up with the level of toxins you’re exposed to, harmful toxins can begin to accumulate in your body. This can send your immune system into overdrive and burn it out – depleting your body of energy and resources. To learn more about how exactly you can address your toxic burden, I recommend diving into my article How to Boost Your Immune System by Reducing Your Toxic Burden. 
• Prioritize Rest and Relaxation: Sleep deprivation and chronic stress are like kryptonite to your immune system. Making an effort to log adequate hours of high-quality sleep and finding healthy ways to manage stress can go a long way in supporting your body’s defenses. 

Overall, the focus of managing CFS requires adopting a balanced lifestyle that puts your overall health at the top of your priority list.

 

Next Steps If You’re Struggling With Chronic Fatigue

Contracting a viral infection certainly doesn’t mean you’re destined to develop a chronic illness like chronic fatigue syndrome. But knowledge is power and having an understanding of post-viral chronic fatigue syndrome can help you better protect yourself, and give us clues to better understand how to treat and manage this elusive illness.  

If you or a loved one is struggling with unrelenting fatigue or have been diagnosed with chronic fatigue syndrome, I highly recommend seeking out a functional medicine doctor well versed in managing CFS. An experienced and educated professional can help you identify the root cause of your issues and provide guidance in implementing lifestyle changes to address the underlying problems. 

If you’re new to the functional medicine approach and aren’t sure where to start when it comes to choosing the right practitioner for you, head over and read my article on How to Choose a Good Integrative and Functional Medicine Doctor.

Now it’s time to hear from you. Are you surprised to learn that a viral infection like COVID-19 could potentially cause CFS?  If you suffer from chronic fatigue, what steps have you taken to fight back? Leave your questions and thoughts in the comments below.

 

References

1. https://mecfs.ctss.nih.gov/
2. http://www.mayoclinic.org/diseases-conditions/chronic-fatigue-syndrome/basics/definition/con-20022009
3. https://www.cdc.gov/me-cfs/about/possible-causes.html
4. https://www.ncbi.nlm.nih.gov/pubmed/11703165
5. https://forums.phoenixrising.me/threads/fibromyalgia-trial-shows-promise-for-chronic-fatigue-syndrome-mast-cells-and-ketiotifen-in.59952/
6. https://translational-medicine.biomedcentral.com/articles/10.1186/s12967-018-1644-y
7. https://www.cdc.gov/me-cfs/about/possible-causes.html
8. https://www.washingtonpost.com/health/could-covid-19-cause-long-term-chronic-fatigue-and-illness-in-some-patients/2020/05/29/bcd5edb2-a02c-11ea-b5c9-570a91917d8d_story.html