Post-viral fatigue

It is really important to take the time to recover fully from any virus, especially one as virulent as Covid-19. Post viral fatigue (PVF) or post viral fatigue syndrome (PVFS) are similar to ME or chronic fatigue syndrome (ME/CFS), and can have extremely long-lasting and debilitating symptoms, particularly fatigue.

Doctors are currently reporting that many patients, who were previously healthy, have been unable to return to their normal level of health and energy following a Covid-19 infection which was mild enough to be managed at home. It is likely that they are experiencing PVF/PVFS, which could develop into ME/CFS. This post contains guidance on how good convalescence and basic management of post infection fatigue, especially in the early stages, can reduce the risk of this turning into a long term and debilitating illness.

What is PVF/PVFS?

Some degree of post-viral fatigue or debility is common after any viral infection. Usually it is short-lived and there is a progressive return to normal health. However, sometimes it takes much longer and additional symptoms may develop. We don’t yet have sufficient information, but early signs suggest that the situation following a Covid-19 infection is not only more complicated but also more serious. 

We are still unsure what causes post-viral fatigue, but part of the explanation for the lack of energy, muscular aches and pains and general malaise is due to the production of cytokines by the body’s immune system. We’ve recently heard a lot about cytokine storms causing serious respiratory complications from Covid-19. Research shows that when fatigue and flu-like symptoms persist after a viral infection, it is because this immune response has not returned to normal. It is also likely that cellular energy production in the mitochondria is being impacted. Mitochondria are basically the batteries in your cells – they make the energy that powers them. 

Symptoms of PVF/PVFS

·      Activity-induced fatigue – this basically means no longer being able to carry out your usual level of activity. This may range from mild to severe. You find you can carry out short periods of activity, but then need to stop and rest and ‘recharge your batteries’. You may no longer be able to sustain normal levels of activity or do anything that involves a large amount of energy in a short period of time, eg going for a run. 

·      Sleep disturbance – this may be sleeping longer than usual during the night, or needing to sleep during the day. Sleep is when the body repairs itself and so this is a natural response to illness.

·      Cognitive dysfunction – you need energy for mental, as well as physical, activity; so your concentration and short-term (working) memory may be affected.

If these symptoms persist for more than 6 months and cause a degree of functional impairment which prevents returning to work/school/core activity, a diagnosis of ME/CFS should be considered. 

Other symptoms which may be experienced:

Alcohol intolerance; feeling wobbly/unsteady; feeling dizzy when standing up quickly; new headaches; muscle aches/pains; sore throat; tender glands; problems with temperature control and post-exertional malaise/symptom exacerbation. 

How you can help yourself now

Convalescence

It sounds old fashioned but proper convalescence is essential. This means taking things easy and getting lots of rest and relaxation. It is extremely important to take the time to allow your body to recover fully from this virus. In our hectic lives, there will be enormous pressures to restore previous levels of activity as quickly as possible, especially from things like looking after children and getting back to work or school. But we also put pressures on ourselves in response to feeling frustrated that things aren’t getting done.  It’s important you don’t resume these things until you are well again.

Progress varies between individuals: for some it may involve a steady improvement; for others a more variable pattern of good days and bad days. Doing too much on a good day will often lead to a worsening of your symptoms the following day. This is known as post-exertional malaise. 

Gentle activity within your limits

Finding and keeping within your activity tolerance limit is known as pacing.  Become aware of when you reach your physical or mental activity limit (ie are starting to feel tired/no longer feel comfortable) and stop and rest. Do not carry on doing it when you are no longer easily able to. Finding this balance is an on-going process and will change not only day to day but also throughout each day. It will also be unique to you. 

Once you have established this baseline, try to gradually build up your activity levels. Activity management needs flexibility. Avoid any kind of vigorous, sporting or prolonged physical activity until you have fully recovered. Yoga is an ideal form of physical activity which also supports relaxation – stick to the gentler types such as yin or hatha.

Mental health

Understandably the restrictions on what you are able to do often makes people feel frustrated and sometimes also anxious or depressed. Take care of your mental health and seek help if you need it.  Some people find meditation to be helpful. 

It is always a good idea to avoid stress wherever possible, but especially so when in recovery.  The infection itself has also been a huge physical stress on your body.

Sleep

Listen to your body and give it the amount of sleep it needs. It is normal to have an increased sleep requirement when recovering from an acute infection. So if you need to sleep longer during the night or go to bed during the day, then do it. But lying in bed all day otherwise is not beneficial. 

If you are experiencing sleep disturbance, please see this blog post for tips on improving sleep. 

Nutrition

·      Eating a nutritious and well-balanced diet is always important, but especially when your body is doing extra work to heal and repair. Choose organic if you can.

·      Eat plenty of colourful fruit and vegetables, 8-10 portions each day. These provide antioxidants to combat the oxidative stress from the infection and inflammation. Leafy green vegetables, eg spinach, kale, greens and herbs eg parsley, coriander are especially beneficial as they are high in magnesium which supports fatigue and anxiety. Cacao is another good source of magnesium - treat yourself to a little dark chocolate (min. 70%)!

·      Include good quality protein with every meal/snack. Whether it is animal or plant-based, ensure it has received minimal processing.

·      Choose complex rather than simple carbohydrates to give a more steady energy release. 

·      Avoid refined or processed foods and instead eat foods in their wholefood form. As tempting at it is to reach for snacks and ‘junk food’, try and avoid doing it.

·      Choose more easily digested foods and avoid heavy meals. 

·      Reduce caffeine and avoid alcohol, but ensure you are well hydrated. 

Speak to your doctor

If your symptoms continue for 3-4 months after having a virus without improvement or you are experiencing continuing fever or periodic spikes of fever, persistent cough, shortness of breath or respiratory symptoms, significant weight loss and feeling depressed, please contact your GP.