Of all the classic COVID symptoms (dry cough, prickly throat, pain), fatigue can be one of the most debilitating, persistent, and confusing.
Dr. Mark Sala, co-director of Northwestern Medicine’s Comprehensive COVID-19 Center, said fatigue has become a leading complaint of his patients. This may be because COVID symptoms are becoming milder overall — he no longer routinely sees patients with severe respiratory damage, and so fatigue has come to the forefront, he said. It’s also possible that fatigue could be a more common symptom with the new variants, he said.
Some degree of COVID-related fatigue is expected. When a person is in the acute phase of a COVID infection, “the body is really busy fighting its own battle against the virus” and tries to conserve energy, said Dr. Ziad Al-Ali, head of research and development at VA St. he said. Louis Healthcare System. He said, “You don’t want to do anything – you want to sit in bed.”
But it’s somewhat of a mystery why some people actually experience intense fatigue during infection — the kind of fatigue that leaves them lying on the couch, even watching TV or warming up soup. Even some become incapacitated – while others simply feel tired. It is also not yet clear why some people continue to have extreme fatigue, a hallmark of long Covid, even months after testing negative.
Dr. Paul Auwerter, a professor at the Johns Hopkins University School of Medicine, said doctors have seen a spectrum of COVID-related fatigue: Some people get tired after working hard, while others experience persistent fatigue.
“I don’t think we really understand it,” said E. John Weary, director of the Institute of Immunology and Immune Health at the University of Pennsylvania Perelman School of Medicine. “There is a lot of speculation.”
Why can Covid cause fatigue?
One hypothesis for why people might feel so tired is that COVID may disrupt mitochondria — what Dr. Peter Chin-Hong, an infectious disease expert at the University of California, San Francisco, calls the energizer bunnies of our cells. Mitochondrial dysfunction can slow down the body, he said, and this may persist even after the acute phase of infection.
Sleep disturbances during and after infection may also contribute to overall fatigue, as COVID makes it harder to get a good night’s rest.
Another theory, particularly related to long COVID, is that the virus may persist in the body even after someone tests negative, Dr. Al-Aly said. After the infection is cleared, the body should turn the “off switch,” signaling that it no longer needs to fight the virus. But in people suffering from long-term Covid, the body remains in defense mode, continuing to conserve energy.
New research published Monday points to an additional possible reason: Dr. Chin-Hong said people with long COVID have significantly lower morning cortisol, the hormone that causes you to “wake up” when you wake up. Does. In general, a lack of cortisol can cause fatigue.
Researchers are still trying to figure out why some people develop long COVID and not others. “This is a really big puzzle,” Dr. Al-Aly said.
possible solution
There is no established protocol yet for addressing fatigue, but “the basic rule is rest,” Dr. Al-Aly said. “You don’t want to fight this.”
During an active infection, listen to your body: Stay as rested as possible and make sure you’re adequately replenishing fluids.
If intense fatigue persists for more than 30 days after your test comes back negative, Dr. Al-Ali recommends talking to your primary care physician as soon as possible to find out a course of action.
For people suffering from long-term COVID, getting enough sleep is important, said Dr. Fernando Carnavalli, site director of the Center for Post-Covid Care at Mount Sinai Doctors, Ansonia. Fragmented or inadequate sleep can increase fatigue. It’s important to follow the basic principles of sleep hygiene: try to go to sleep and wake up at regular times, keep your bedroom dark and cool, avoid drinking alcohol close to bedtime and try to relax before you close your eyes. Take time out.
People suffering from long-term COVID-related fatigue should also be careful about exercise, starting slow and gradually building up exercise tolerance, Dr. Carnavali said.
If you’re struggling with fatigue, recognize that you may have a new baseline, Dr. Carnavali said. He advises his long-term Covid patients to keep a journal for a two-week period to track how they feel after doing everyday activities – maybe a night out with friends. You may feel tired after eating, or you may find it difficult to study for an hour. Understanding these correlations can help you stop putting too much pressure on yourself. Dr. Carnavali also said reframing is important: “I can’t do 10 miles; I will do half of his work. I can’t wash the utensils for half an hour; I’ll do them for five minutes.
“You have to define new baselines for adaptation,” he said. The extreme fatigue associated with long-term Covid may be going away, he said – some people are getting better, and that’s great to see.
But “new patients come every week,” he said.