Chronic Fatigue Syndrome in the Time of COVID-19: Understanding the Connection

Bhavana Soma—McMaster Life Sciences 2024

Imagine constantly feeling tired to the point where it is difficult to perform daily activities, having no amount of rest make you feel energized, having difficulty sleeping, taking a long time to recover after physical activity, and having issues with thinking, concentrating and remembering. This miserable slew of symptoms that deeply affect the quality of one’s life is characteristic of a debilitating condition known as chronic fatigue syndrome (CFS). Presentation of these symptoms, in addition to physiological symptoms including heart palpitations, general malaise, flu-like symptoms and body pains, over an extended period of time can lead to a diagnosis of CFS if not thoroughly explained by underlying medical conditions [1]. This complicated disorder affects anywhere between 836 000 to 2.5 million Americans, and millions more worldwide [2].

SOURCE: Medical News Today

Scientists have identified a similar condition in those that have contracted COVID-19. COVID-19 starts with a respiratory infection that produces common flu-like symptoms. However, it can have extensive systemic effects on the body as the virus attacks cells and disrupts bodily functions. This means that it may eventually affect the heart, blood vessels, brain, liver, eyes, and kidneys in the long term, in addition to the respiratory system and immune system [3]. The long-term effects become apparent when the test that initially detected the virus is no longer able to, which implies that affected individuals should return to normal since the virus is no longer present in their bodies [4]. However, COVID-19 research has demonstrated that this is not always the case.

Ongoing research suggests that up to a year after having COVID-19, 20% of adults have at least one medical condition that may be a result of the viral infection. This increases to 25% for seniors above the age of 64 [5]. The development of new conditions may be attributed to damage to different organ systems throughout the body and the experience of severe COVID-19, resulting in hospitalization, could trigger mental health conditions [5]. Not only have individuals been diagnosed with new conditions after supposedly having recovered from COVID-19 within a few weeks, many have been experiencing long-term symptoms including, but not limited to, fatigue, difficulty thinking, remembering or concentrating, cognitive difficulties, sleep disturbances, shortness of breath, increased instance of mental health issues, and body pains [6]. These ongoing symptoms are collectively being referred to as a condition called “Long COVID [4].”

SOURCE: RCNi

With the significant overlap between the symptoms of Long COVID and CFS, and the fact that the onset of both Long COVID and up to 75% of CFS cases are confirmed to be linked to a viral infection, many researchers have begun to wonder if the two conditions are actually the same the condition [7].

As of present, there is no cure for either condition. The treatment of CFS is mainly concerned with searching for underlying causes and treating any that are found, as well as alleviating symptoms. Doctors attempt to address the most debilitating symptom prior to treating others that are present [8].

As for Long COVID, researchers all over the world are currently conducting studies and trials to learn more about the condition. In one recent study, people who had been infected with the virus prior to vaccination had a 9 percent lower risk of developing Long COVID after receiving two doses of an mRNA or adenoviral vector vaccine. According to many researchers, we can learn more about the disease and how to better treat it by looking at in-depth analyses of markers such as autoantibodies that are associated with the disease. Current trials that are being conducted include anti-inflammatory drugs, and future potential research could be conducted on immune-suppressing drugs [9].

Since the overlap between Long COVID and CFS has been identified and the question of Long COVID being a form of CFS has been raised, influential CFS researchers believe that the similarities between the two could help millions manage their condition. Their research has shown how CFS may develop due to an overactive immune response in the early stages of the disease that results in immune exhaustion which is also found in chronic viral infections. Future research suggestions include examining biological markers of those who successfully made a full recovery from COVID-19 to better understand the mechanisms that result in a full recovery [7].

References

1. Myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS) [Internet]. NHS. NHS; 2021 [cited 2022 Nov 28]. Available from: https://www.nhs.uk/conditions/chronic-fatigue-syndrome-cfs/
2. Institute of Medicine, Board on the Health of Select Populations, Committee on the Diagnostic Criteria for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Beyond myalgic encephalomyelitis/chronic fatigue syndrome: Redefining an illness. Washington, District of Columbia: The National Academies Press; 2015. 
3. How COVID-19 affects your body in pictures [Internet]. WebMD. WebMD; 2020 [cited 2022 Nov 28]. Available from: https://www.webmd.com/lung/ss/slideshow-covid-19-body-effects
4. Komaroff AL, Bateman L. Will COVID-19 lead to myalgic encephalomyelitis/chronic fatigue syndrome? Frontiers in Medicine. 2021;7. 
5. Mayo Clinic Staff. Covid-19: Long-term effects [Internet]. Mayo Clinic. Mayo Foundation for Medical Education and Research; 2022 [cited 2022 Nov 28]. Available from: https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/coronavirus-long-term-effects/art-20490351
6. Public Health Agency of Canada. Government of Canada [Internet]. Post-COVID-19 condition (long COVID) – Canada.ca. / Gouvernement du Canada; 2022 [cited 2022 Nov 28]. Available from: https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/symptoms/post-covid-19-condition.html#s
7. Is long covid really chronic fatigue syndrome by another name? [Internet]. Columbia University Mailman School of Public Health. Columbia University Irving Medical Center; 2021 [cited 2022 Nov 28]. Available from: https://www.publichealth.columbia.edu/public-health-now/news/long-covid-really-chronic-fatigue-syndrome-another-name
8. Chronic fatigue syndrome [Internet]. Mayo Clinic. Mayo Foundation for Medical Education and Research; 2022 [cited 2022 Nov 28]. Available from: https://www.mayoclinic.org/diseases-conditions/chronic-fatigue-syndrome/diagnosis-treatment/drc-20360510
9. Ledford H. Long-Covid Treatments: Why the world is still waiting [Internet]. Nature News. Nature Publishing Group; 2022 [cited 2022 Nov 28]. Available from: https://www.nature.com/articles/d41586-022-02140-w