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Post-COVID-19 illness
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==Treatment== No treatment studies have yet been published, despite this and the uncertainty over long term physical and psychological health consequences of coronavirus disease 19 (COVID-19), some self-help advice has already been published.<ref name="openletter20042020" /> A group of over 20 [[Myalgic encephalomyelitis|ME]] and [[chronic fatigue syndrome]] specialists and patient groups have recommended [[fatigue]] after COVID-19 should be treated/managed using: *[[pacing]] *[[nutrition]] and *[[sleep hygiene]], stating that should help reduce the risk of developing ME/CFS after COVID-19.<ref name="Vink2019">{{Cite journal | last = Vink | last2 = Vink-Niese | date = 2019-09-20| title = Work Rehabilitation and Medical Retirement for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Patients. A Review and Appraisal of Diagnostic Strategies|url=https://www.mdpi.com/2075-4418/9/4/124|journal=Diagnostics|language=en|volume=9|issue=4|pages=124|doi=10.3390/diagnostics9040124|issn=2075-4418 | first = Mark | first2 = Alexandra|pmc=|pmid= | author-link = Mark Vink | authorlink2 = Alexandra Vink-Niese|access-date=|via=}}</ref><ref name="openletter20042020" /> ===Pacing=== Less controversially, the self-help leaflet mentions [[pacing]], a symptom-management approach also without evidence for COVID-19 survivors, but which is used by many people with chronic fatigue, chronic pain, and/or persistent illness that limits their everyday activities.<ref name="TullerOx16apr2020" /> ME patient associations surveys have found pacing helped most, but not all, patients.<ref name="forwardme-survey" /><ref name="IIMER-NICE" />{{See also|Pacing}}<div role="note" class="hatnote navigation-not-searchable">{{See also|Pacing}}</div> ===CBT and GET not recommended for fatigue=== The Oxford Health NHS Foundation Trust published a ''Coping with Coronavirus: Fatigue'' leaflet referring to [[chronic fatigue syndrome]], a neurological disease, as a possible ''[[mental health]]'' consequence of COVID-19, and confusing fatigue after COVID-19 illness with [[chronic fatigue syndrome]]. The leaflet recommenddations included the highly controversial use of [[cognitive behavioral therapy]] (CBT) and graded exercise therapy (GET) to address the physical symptoms of chronic fatigue syndrome. The leaflet was withdrawn after public health expert [[David Tuller]] asked for the evidence based used by it, details of its authorship, and strongly criticised the advice given in it. An [[Opposition to Oxford Health NHS Foundation Trust: "Coping with Coronavirus: Fatigue"|open letter opposing the leaflet]] was signed by a large number of medical professionals and UK patient groups at around the same time.<ref name="openletter20042020" /> CBT for fatigue is a psychological therapy focused on treating a presumed [[illness beliefs]] such as a fear of activity and GET is exercise/activity based, both treatments rely on the [[deconditioning|assumption]] that there is no lasting physical damage or underlying illness process that could prevent full recovery. GET is particularly controversial and has been found to cause most patients with [[chronic fatigue syndrome]] (not resulting from COVID-19) to deteriorate, sometimes permanently.<ref name="openletter20042020" /> CBT and GET are no longer recommended by the [[Centers for Disease Control|CDC]], and their use within the UK's [[National Health Service]] is currently under review, with many concerns having been raised about high rates of patient harm resulting from these treatments, and a lack of effectiveness.<ref name="forwardme-survey">{{Cite web|url=https://www.meassociation.org.uk/2019/04/forward-me-and-oxford-brookes-university-announce-results-of-patient-survey-on-cbt-and-get-in-me-cfs-03-april-2019 | date = Apr 3, 2019| title = Forward-ME and Oxford Brookes University announce results of Patient Survey on CBT and GET in ME/CFS {{!}} 3 April 2019 | last = ME Association | authorlink = ME Association}}</ref><ref name="mea2015" /><ref name="timetodeliver" /><ref name="IIMER-NICE" /> CBT and GET they are not recommended by the UK's [[ME Association]], [[Action for ME]], [[Invest in ME Research]], [[The MEAction Network]], or [[25 Percent ME Group|The 25% ME Group]].<ref name="mea2015">{{Cite web|url=https://www.meassociation.org.uk/wp-content/uploads/2015-ME-Association-Illness-Management-Report-No-decisions-about-me-without-me-30.05.15.pdf| title = ME/CFS Illness Management Survey Results "No decisions about me without me" | date = May 30, 2015 | last = The ME Association | authorlink = ME Association}}</ref><ref name="timetodeliver">{{Cite web|url=https://www.actionforme.org.uk/uploads/pdfs/me-time-to-deliver-survey-report.pdf | date = 2014 | title=Time to deliver: initial findings of Action for MEβs 2014 survey | last = Action for ME | authorlink = Action for ME|access-date=Jul 1, 2016}}</ref><ref name="aformetrustees">{{Cite web|url=https://www.actionforme.org.uk/news/board-of-trustees-on-cbt-get-and-pace/| title = Our Board of Trustees on CBT, GET and PACE | date = May 17, 2017 | last = Action for ME | authorlink = Action for ME|website=[[Action for ME]]}}</ref><ref name="IIMER-NICE">{{Cite web|url=http://www.investinme.org/IIMER-Newslet-17-07-04.shtml| title = Response to NICE 10 year surveillance (2017) β Chronic fatigue syndrome/myalgic encephalomyelitis | last = Invest in ME Research | first = | authorlink = Invest in ME Research | date = July 17, 2017 | website = [[Invest in ME Research]]|archive-url=|access-date=2019-02-07}}</ref><ref name="timetodeliver" /> CBT may be useful for depression or generalized anxiety.<ref>{{Cite web|url=https://www.nhs.uk/conditions/clinical-depression/| title = Clinical depression | last = National Health Service | first = | authorlink = National Health Service | date = 2017-10-24|website=National Health Service|language=en|archive-url=|archive-date=|url-status=|access-date=2020-04-29}}</ref><ref>{{Cite web|url=https://www.nhs.uk/conditions/generalised-anxiety-disorder/treatment/| title = Generalised anxiety disorder in adults - Treatment | last = National Health Service | first = | authorlink = National Health Service | date = 2018-07-18 | website = National Health Service|language=en|archive-url=|archive-date=|url-status=|access-date=2020-04-29}}</ref> {{See also|Cognitive behavioral therapy}}{{See also|Graded exercise therapy}}
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