Post-COVID-19 illness: Difference between revisions

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[[File:Post-COVID-19_illness_recovery.png|thumb|right|alt=Post-COVID-19 illness and recovery. A wave of chronically ill and slow-healing survivors is an inevitability we can and must prepare ourselves for. - Fiona Lowenstein]]
[[File:Post-COVID-19_illness_recovery.png|thumb|right|alt=Post-COVID-19 illness and recovery. A wave of chronically ill and slow-healing survivors is an inevitability we can and must prepare ourselves for. - Fiona Lowenstein]]
There have been some reports of long term illness in survivors of [[COVID-19]]; it is unclear how many people are affected at this stage.<ref name="ns-15042020">{{Cite news | date = Apr 15, 2020|url=https://www.newscientist.com/article/mg24632783-400-could-the-coronavirus-trigger-post-viral-fatigue-syndromes/| title = Could the coronavirus trigger post-viral fatigue syndromes? | first = Clare | last = Wilson | publisher = New Scientist}}</ref><ref name="somag-16042020">{{Cite news | date = Apr 16, 2020|url=https://www.somagnews.com/get-covid-19-get-healed-can-face-another-disease-years/| title = User Those Who Get COVID-19 and Get Healed Can Face Another Disease After A Few Years | first = Daniel | last = Kucher|publisher=SOMAG news}}</ref><ref name="NYPost17042020">{{Cite news | last = Malamut | first=Melissa | date = Apr 17, 2020| title = Coronavirus survivors say they fear long-term effects|publisher=New York Post | url = https://nypost.com/2020/04/17/my-lungs-are-on-fire-coronavirus-survivors-say-they-fear-long-term-effects/}}</ref>  A small early study from Wuhan, China, found that survivors of [[COVID-19]] who tested negative twice before discharge from hospital still had some abnormalities in [[metabolism]] and liver function markers when discharged.<ref name="Wu2020">{{Cite journal | last = Wu | first = Di | last2 = Shu | first2 = Ting | last3 = Yang | first3 = Xiaobo|last4 = Song | first4 = Jian-Xin | last5 = Zhang|first5=Mingliang | last6 = Yao | first6 = Chengye | last7 = Wen | first7 = Liu | last8 = Huang | first8 = Muhan | last9 = Yu | first9 = Yuan | date = 2020-04-21| title = Plasma Metabolomic and Lipidomic Alterations Associated with COVID-19|url=https://www.medrxiv.org/content/10.1101/2020.04.05.20053819v2|journal=medRxiv|language=en|pages=2020.04.05.20053819|doi=10.1101/2020.04.05.20053819}}</ref>
There have been some reports of long term illness in survivors of [[COVID-19]]; it is unclear how many people are affected at this stage.<ref name="ns-15042020">{{Cite news | date = Apr 15, 2020|url=https://www.newscientist.com/article/mg24632783-400-could-the-coronavirus-trigger-post-viral-fatigue-syndromes/| title = Could the coronavirus trigger post-viral fatigue syndromes? | first = Clare | last = Wilson | publisher = New Scientist}}</ref><ref name="somag-16042020">{{Cite news | date = Apr 16, 2020|url=https://www.somagnews.com/get-covid-19-get-healed-can-face-another-disease-years/| title = User Those Who Get COVID-19 and Get Healed Can Face Another Disease After A Few Years | first = Daniel | last = Kucher|publisher=SOMAG news}}</ref><ref name="NYPost17042020">{{Cite news | last = Malamut | first = Melissa | date = Apr 17, 2020| title = Coronavirus survivors say they fear long-term effects|publisher=New York Post | url = https://nypost.com/2020/04/17/my-lungs-are-on-fire-coronavirus-survivors-say-they-fear-long-term-effects/}}</ref>  A small early study from Wuhan, China, found that survivors of [[COVID-19]] who tested negative twice before discharge from hospital still had some abnormalities in [[metabolism]] and liver function markers when discharged.<ref name="Wu2020">{{Cite journal | last = Wu | first = Di | last2 = Shu | first2 = Ting | last3 = Yang | first3 = Xiaobo | last4 = Song | first4 = Jian-Xin | last5 = Zhang | first5 = Mingliang | last6 = Yao | first6 = Chengye | last7 = Wen | first7 = Liu | last8 = Huang | first8 = Muhan | last9 = Yu | first9 = Yuan | date = 2020-04-21| title = Plasma Metabolomic and Lipidomic Alterations Associated with COVID-19|url=https://www.medrxiv.org/content/10.1101/2020.04.05.20053819v2|journal=medRxiv|language=en|pages=2020.04.05.20053819|doi=10.1101/2020.04.05.20053819}}</ref>


===Long COVID===
===Long COVID===
Many patients, dubbed '''long haulers''', have described continuing symptoms of COVID-19, often described as '''long COVID''', which include [[fatigue|chronic, severe fatigue]], [[brain fog]] (thinking and concentration problems), [[dyspnea|breathlessness]], [[myalgia|muscle pain]], [[Exercise intolerance|inability to exercise]] and other symptoms.<ref name="Yellin2020">{{Cite journal | last = Yelin | first = Dana | last2 = Wirtheim | first2 = Eytan | last3 = Vetter | first3=Pauline|last4 = Kalil | first4 = Andre C. | last5 = Bruchfeld | first5=Judith | last6 = Runold | first6=Michael | last7 = Guaraldi | first7 = Giovanni | last8 = Mussini | first8 = Cristina | last9 = Gudiol | first9 = Carlota | date = 2020-10-01| title = Long-term consequences of COVID-19: research needs|url=https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30701-5/abstract|journal=The Lancet Infectious Diseases|language=English|volume=20|issue=10|pages=1115–1117|doi=10.1016/S1473-3099(20)30701-5|issn=1473-3099|pmid=32888409}}</ref><ref name="NHSlong">{{Cite web|url=https://www.gov.uk/government/publications/covid-19-long-term-health-effects/covid-19-long-term-health-effects| title = COVID-19 Long Term Health Effects | last = National Health Service | first = |authorlink=National Health Service | date = Sep 7, 2020 | website = |archive-url=|archive-date=|url-status=|access-date=}}</ref> Several studies have found groups of patients continuing to experience many symptoms of COVID-19,<ref name="Halpin2020a" /><ref name="Arnold2020b" /> including patients who were not ill enough to be hospitalized.<ref name="NHSlong" /> There is an absence of medical advice and little information on the likely prognosis for these patients.<ref name="Yellin2020" />
Many patients, dubbed '''long haulers''', have described continuing symptoms of COVID-19, often described as '''long COVID''', which include [[fatigue|chronic, severe fatigue]], [[brain fog]] (thinking and concentration problems), [[dyspnea|breathlessness]], [[myalgia|muscle pain]], [[Exercise intolerance|inability to exercise]] and other symptoms.<ref name="Yellin2020">{{Cite journal | last = Yelin | first = Dana | last2 = Wirtheim | first2 = Eytan | last3 = Vetter | first3 = Pauline | last4 = Kalil | first4 = Andre C. | last5 = Bruchfeld | first5 = Judith | last6 = Runold | first6 = Michael | last7 = Guaraldi | first7 = Giovanni | last8 = Mussini | first8 = Cristina | last9 = Gudiol | first9 = Carlota | date = 2020-10-01| title = Long-term consequences of COVID-19: research needs|url=https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30701-5/abstract|journal=The Lancet Infectious Diseases|language=English|volume=20|issue=10|pages=1115–1117|doi=10.1016/S1473-3099(20)30701-5|issn=1473-3099|pmid=32888409}}</ref><ref name="NHSlong">{{Cite web|url=https://www.gov.uk/government/publications/covid-19-long-term-health-effects/covid-19-long-term-health-effects| title = COVID-19 Long Term Health Effects | last = National Health Service | first = | authorlink = National Health Service | date = Sep 7, 2020 | website = |archive-url=|archive-date=|url-status=|access-date=}}</ref> Several studies have found groups of patients continuing to experience many symptoms of COVID-19,<ref name="Halpin2020a" /><ref name="Arnold2020b" /> including patients who were not ill enough to be hospitalized.<ref name="NHSlong" /> There is an absence of medical advice and little information on the likely prognosis for these patients.<ref name="Yellin2020" />
{{See also|Long COVID}}
{{See also|Long COVID}}


===Relapse or reinfection===
===Relapse or reinfection===
Some patients have described feeling fully recovered, then experiencing COVID-19 symptoms again, and feeling like their lungs were "on fire" for some weeks afterwards.<ref name="NYPost17042020" /> There has been uncertainty about whether this is a relapse due to the virus remaining at low levels in the body and being reactivated, an immune system rebound response, or a reinfection; a relapsing / remitting pattern of COVID-19 became known as [[Long COVID]].<ref name="NS-Oct2020">{{Cite web|url=https://www.newstatesman.com/politics/health/2020/10/what-ive-learned-front-line-against-long-covid| title = What I've learned on the front line against Long Covid | last = Whitaker | first=Phil|authorlink= | date = |website=New Statesman|language=en|archive-url=|archive-date=|url-status=|access-date=2020-10-07}}</ref><ref name="Buskermolen">{{Cite journal | last = Buskermolen | first = Maaike|author-link= | last2 = Te Paske | first2=Karlijn | author-link2= | last3 = Van Beek | first3 = Janko|author-link3=|last4 = Kortbeek | first4 = Titia | author-link4= | last5 = Götz|first5=Hannelore | authorlink5 = | last6 = Fanoy | first6 = Ewout | authorlink6 = | last7 = Feenstra | first7 = Sabiena | last8 = Richardus | first8 = Jan Hendrik | last9 = Vollaard | first9 = Albert | date = 2021-06-17| title = Relapse in the first 8 weeks after onset of COVID-19 disease in outpatients: Viral reactivation or inflammatory rebound?|url=https://www.journalofinfection.com/article/S0163-4453(21)00310-8/abstract|journal=Journal of Infection|language=English|volume=|issue=|pages=|doi=10.1016/j.jinf.2021.06.015|issn=0163-4453|pmc=|pmid=34147529|access-date=|quote=|via=}}</ref><ref name="Tang2021">{{Cite journal | last = Tang | first = Xiujuan | last2 = Musa | first2=Salihu S. | last3 = Zhao | first3 = Shi|last4 = He | first4=Daihai | date = 2021-06-11| title = Reinfection or Reactivation of Severe Acute Respiratory Syndrome Coronavirus 2: A Systematic Review | url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8226004/|journal=Frontiers in Public Health|volume=9|doi=10.3389/fpubh.2021.663045|issn=2296-2565|pmc=8226004|pmid=34178920}}</ref>
Some patients have described feeling fully recovered, then experiencing COVID-19 symptoms again, and feeling like their lungs were "on fire" for some weeks afterwards.<ref name="NYPost17042020" /> There has been uncertainty about whether this is a relapse due to the virus remaining at low levels in the body and being reactivated, an immune system rebound response, or a reinfection; a relapsing / remitting pattern of COVID-19 became known as [[Long COVID]].<ref name="NS-Oct2020">{{Cite web|url=https://www.newstatesman.com/politics/health/2020/10/what-ive-learned-front-line-against-long-covid| title = What I've learned on the front line against Long Covid | last = Whitaker | first=Phil | authorlink= | date = |website=New Statesman|language=en|archive-url=|archive-date=|url-status=|access-date=2020-10-07}}</ref><ref name="Buskermolen">{{Cite journal | last = Buskermolen | first = Maaike | author-link = | last2 = Te Paske | first2 = Karlijn | author-link2 = | last3 = Van Beek | first3 = Janko | authorlink3 = | last4 = Kortbeek | first4 = Titia | author-link4 = | last5 = Götz | first5 = Hannelore | authorlink5 = | last6 = Fanoy | first6 = Ewout | authorlink6 = | last7 = Feenstra | first7 = Sabiena | last8 = Richardus | first8 = Jan Hendrik | last9 = Vollaard | first9 = Albert | date = 2021-06-17| title = Relapse in the first 8 weeks after onset of COVID-19 disease in outpatients: Viral reactivation or inflammatory rebound?|url=https://www.journalofinfection.com/article/S0163-4453(21)00310-8/abstract|journal=Journal of Infection|language=English|volume=|issue=|pages=|doi=10.1016/j.jinf.2021.06.015|issn=0163-4453|pmc=|pmid=34147529|access-date=|quote=|via=}}</ref><ref name="Tang2021">{{Cite journal | last = Tang | first = Xiujuan | last2 = Musa | first2 = Salihu S. | last3 = Zhao | first3 = Shi | last4 = He | first4 = Daihai | date = 2021-06-11| title = Reinfection or Reactivation of Severe Acute Respiratory Syndrome Coronavirus 2: A Systematic Review | url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8226004/|journal=Frontiers in Public Health|volume=9|doi=10.3389/fpubh.2021.663045|issn=2296-2565|pmc=8226004|pmid=34178920}}</ref>


==Post-SARS illness==
==Post-SARS illness==
COVID-19 is caused by the [[Severe acute respiratory syndrome coronavirus 2|SARS-CoV-2]] virus; the similar [[Severe acute respiratory syndrome coronavirus|SARS-CoV]] coronavirus causes [[SARS]], and SARS is known to have caused long term illness in some survivors, including [[chronic fatigue syndrome]] and a post-SARS syndrome similar to [[fibromyalgia]] involving chronic widespread musculoskeletal pain, [[chronic fatigue|fatigue]], [[depression]] and [[sleep dysfunction|disordered sleep]].<ref name="Lam2009">{{Cite journal | last = Lam | first = Marco Ho-Bun | last2 = Wing | first2 = Yun-Kwok | last3 = Yu | first3 = Mandy Wai-Man|last4 = Leung | first4 = Chi-Ming | last5 = Ma | first5=Ronald C. W. | last6 = Kong | first6 = Alice P. S. | last7 = So | first7 = W. Y. | last8 = Fong | first8 = Samson Yat-Yuk | last9 = Lam | first9 = Siu-Ping | date = 2009-12-14| title = Mental Morbidities and Chronic Fatigue in Severe Acute Respiratory Syndrome Survivors: Long-term Follow-up | url = https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/415378|journal=Archives of Internal Medicine|language=en|volume=169|issue=22|pages=2142–2147|doi=10.1001/archinternmed.2009.384|issn=0003-9926}}</ref><ref name="Moldofsky2011">{{Cite journal | last = Moldofsky | first = Harvey | last2 = Patcai | first2 = John | date = 2011-03-24| title = Chronic widespread musculoskeletal pain, fatigue, depression and disordered sleep in chronic post-SARS syndrome; a case-controlled study|url=https://doi.org/10.1186/1471-2377-11-37|journal=BMC Neurology|volume=11|issue=1|pages=37|doi=10.1186/1471-2377-11-37|issn=1471-2377|pmc =  3071317|pmid=21435231}}</ref>
COVID-19 is caused by the [[Severe acute respiratory syndrome coronavirus 2|SARS-CoV-2]] virus; the similar [[Severe acute respiratory syndrome coronavirus|SARS-CoV]] coronavirus causes [[SARS]], and SARS is known to have caused long term illness in some survivors, including [[chronic fatigue syndrome]] and a post-SARS syndrome similar to [[fibromyalgia]] involving chronic widespread musculoskeletal pain, [[chronic fatigue|fatigue]], [[depression]] and [[sleep dysfunction|disordered sleep]].<ref name="Lam2009">{{Cite journal | last = Lam | first = Marco Ho-Bun | last2 = Wing | first2 = Yun-Kwok | last3 = Yu | first3 = Mandy Wai-Man | last4 = Leung | first4 = Chi-Ming | last5 = Ma | first5 = Ronald C.W. | last6 = Kong | first6 = Alice P.S. | last7 = So | first7 = W.Y. | last8 = Fong | first8 = Samson Yat-Yuk | last9 = Lam | first9 = Siu-Ping | date = 2009-12-14| title = Mental Morbidities and Chronic Fatigue in Severe Acute Respiratory Syndrome Survivors: Long-term Follow-up | url = https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/415378|journal=Archives of Internal Medicine|language=en|volume=169|issue=22|pages=2142–2147|doi=10.1001/archinternmed.2009.384|issn=0003-9926}}</ref><ref name="Moldofsky2011">{{Cite journal | last = Moldofsky | first = Harvey | last2 = Patcai | first2 = John | date = 2011-03-24| title = Chronic widespread musculoskeletal pain, fatigue, depression and disordered sleep in chronic post-SARS syndrome; a case-controlled study|url=https://doi.org/10.1186/1471-2377-11-37|journal=BMC Neurology|volume=11|issue=1|pages=37|doi=10.1186/1471-2377-11-37|issn=1471-2377|pmc =  3071317|pmid=21435231}}</ref>


==Severe COVID-19 survivors==
==Severe COVID-19 survivors==
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<br />Long term physical, cognitive and mental health problems have also been found to be relatively common in patients discharged from intensive care from illnesses other than COVID-19, with the length of time in intensive care influencing the long term health impacts.<ref name="nbc28032020" />
<br />Long term physical, cognitive and mental health problems have also been found to be relatively common in patients discharged from intensive care from illnesses other than COVID-19, with the length of time in intensive care influencing the long term health impacts.<ref name="nbc28032020" />
    
    
Post Intensive Care Syndrome (PICS) is one of several conditions that can result, including Critical Illness Polyneuropathy (CIP) and Critical Illness Myopathy (CIM), and requires both short and medium term rehabilitation treatments.<ref name="Stam2020">{{Cite web|url=https://medicaljournals.se/jrm/content/html/10.2340/16501977-2677| title = Covid-19 and Post Intensive Care Syndrome: A Call for Action | first = H J | last = Stam|authorlink= | first2 = G | last2 = Stucki | authorlink2 = | date = 2020-04-15 | website = Journal of rehabilitation medicine|language=en|doi=10.2340/16501977-2677|pmid=32286675|archive-url=|archive-date=|url-status=|access-date=2020-04-23 | last3 = J | first3 = Bickenbach|volume=52|issue=4}}</ref>
Post Intensive Care Syndrome (PICS) is one of several conditions that can result, including Critical Illness Polyneuropathy (CIP) and Critical Illness Myopathy (CIM), and requires both short and medium term rehabilitation treatments.<ref name="Stam2020">{{Cite web|url=https://medicaljournals.se/jrm/content/html/10.2340/16501977-2677| title = Covid-19 and Post Intensive Care Syndrome: A Call for Action | first = H J | last = Stam | authorlink= | first2 = G | last2 = Stucki | authorlink2 = | date = 2020-04-15 | website = Journal of rehabilitation medicine|language=en|doi=10.2340/16501977-2677|pmid=32286675|archive-url=|archive-date=|url-status=|access-date=2020-04-23 | last3 = J | first3 = Bickenbach|volume=52|issue=4}}</ref>


===COVID-19 pneumonia and SARI===
===COVID-19 pneumonia and SARI===
Moderately ill patients with COVID-19 may develop mild viral pneumonia.<ref name="CDC-clinicalguide">{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html| title = Coronavirus Disease 2019 (COVID-19) | last = CDC | first = |authorlink=Centers for Disease Control and Prevention | date = 2020-02-11 | website = Centers for Disease Control and Prevention|language=en-us|archive-url=|archive-date=|url-status=|access-date=2020-04-22}}</ref> Severe acute respiratory infection (SARI) is known to develop in some people severely ill with COVID-19. SARI resulting from other illnesses has been studied.<ref>{{Cite journal | last = Zhang | first = Chen | last2 = Zhu | first2 = Na | last3 = Xie | first3=Zhengde|last4 = Lu | first4 = Roujian | last5 = He | first5=Bin | last6 = Liu | first6 = Chunyan | last7 = Ma | first7 = Xuejun | last8 = Tan | first8 = Wenjie | date = 2013-08-22| title = Viral Etiology and Clinical Profiles of Children with Severe Acute Respiratory Infections in China|url=https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0072606|journal=PLOS ONE|language=en|volume=8|issue=8| pages = e72606|doi=10.1371/journal.pone.0072606|issn=1932-6203|pmc=PMC3750056|pmid=23991128}}</ref>
Moderately ill patients with COVID-19 may develop mild viral pneumonia.<ref name="CDC-clinicalguide">{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html| title = Coronavirus Disease 2019 (COVID-19) | last = CDC | first = | authorlink = Centers for Disease Control and Prevention | date = 2020-02-11 | website = Centers for Disease Control and Prevention|language=en-us|archive-url=|archive-date=|url-status=|access-date=2020-04-22}}</ref> Severe acute respiratory infection (SARI) is known to develop in some people severely ill with COVID-19. SARI resulting from other illnesses has been studied.<ref>{{Cite journal | last = Zhang | first = Chen | last2 = Zhu | first2 = Na | last3 = Xie | first3 = Zhengde | last4 = Lu | first4 = Roujian | last5 = He | first5 = Bin | last6 = Liu | first6 = Chunyan | last7 = Ma | first7 = Xuejun | last8 = Tan | first8 = Wenjie | date = 2013-08-22| title = Viral Etiology and Clinical Profiles of Children with Severe Acute Respiratory Infections in China|url=https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0072606|journal=PLOS ONE|language=en|volume=8|issue=8| pages = e72606|doi=10.1371/journal.pone.0072606|issn=1932-6203|pmc=PMC3750056|pmid=23991128}}</ref>


===Acute respiratory distress syndrome===
===Acute respiratory distress syndrome===
Acute respiratory distress syndrome (ARDS) is a life-threatening condition that involves the patient's lungs becoming inflamed, and being unable to produce enough oxygen for the body's vital organs.<ref name="ARDS-NHS">{{Cite web|url=https://www.nhs.uk/conditions/acute-respiratory-distress-syndrome/| title = Acute respiratory distress syndrome (ARDS) | last = National Health Service | first = |authorlink=National Health Service | date = 2017-10-17 | website = nhs.uk|language=en|archive-url=|archive-date=|url-status=|access-date=2020-04-01}}</ref> ARDS develops in 17-29% of ''hospitalized'' COVID-19 patients and is known to have long term effects.<ref name="JH-ABX-540747">{{Cite web| title = Coronavirus COVID-19 (SARS-CoV-2) | first = Paul G.| last1 = Auwaerter | date = Apr 8, 2020|access-date=Apr 17, 2020|url=https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_ABX_Guide/540747/all/Coronavirus_COVID_19__SARS_CoV_2_}}</ref><ref name="MMW-27Mar2020">{{Citation| title = Severe Outcomes Among Patients with Coronavirus Disease 2019 (COVID-19) — United States, February 12–March 16, 2020 | last = CDC COVID-19 Response Team | date = Mar 27, 2020|journal=MMWR Morb Mortal Wkly Rep 2020|volume=69|issue=12|pages=343-346|doi=10.15585/mmwr.mm6912e2|url=http://dx.doi.org/10.15585/mmwr.mm6912e2|pmid=32214079}}</ref><ref name="CDC-clinicalguide" /> ARDS can cause nerve and muscle damage, which causes [[chronic pain|pain]] and weakness.<ref name="ARDS-NHS" />
Acute respiratory distress syndrome (ARDS) is a life-threatening condition that involves the patient's lungs becoming inflamed, and being unable to produce enough oxygen for the body's vital organs.<ref name="ARDS-NHS">{{Cite web|url=https://www.nhs.uk/conditions/acute-respiratory-distress-syndrome/| title = Acute respiratory distress syndrome (ARDS) | last = National Health Service | first = | authorlink = National Health Service | date = 2017-10-17 | website = nhs.uk|language=en|archive-url=|archive-date=|url-status=|access-date=2020-04-01}}</ref> ARDS develops in 17-29% of ''hospitalized'' COVID-19 patients and is known to have long term effects.<ref name="JH-ABX-540747">{{Cite web| title = Coronavirus COVID-19 (SARS-CoV-2) | first = Paul G. | last1 = Auwaerter | date = Apr 8, 2020|access-date=Apr 17, 2020|url=https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_ABX_Guide/540747/all/Coronavirus_COVID_19__SARS_CoV_2_}}</ref><ref name="MMW-27Mar2020">{{Citation| title = Severe Outcomes Among Patients with Coronavirus Disease 2019 (COVID-19) — United States, February 12–March 16, 2020 | last = CDC COVID-19 Response Team | date = Mar 27, 2020|journal=MMWR Morb Mortal Wkly Rep 2020|volume=69|issue=12|pages=343-346|doi=10.15585/mmwr.mm6912e2|url=http://dx.doi.org/10.15585/mmwr.mm6912e2|pmid=32214079}}</ref><ref name="CDC-clinicalguide" /> ARDS can cause nerve and muscle damage, which causes [[chronic pain|pain]] and weakness.<ref name="ARDS-NHS" />


===Mechanical ventilator effects===
===Mechanical ventilator effects===
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==Fatigue after COVID-19==
==Fatigue after COVID-19==


COVID-19 can cause severe [[fatigue]], however experiencing fatigue after recovering from the virus should not be the considered the same as the illness [[chronic fatigue syndrome]] (CFS) or [[myalgic encephalomyelitis]] (ME), a neurological disease involving multiple bodily systems and sustained symptoms over an extended period of time.<ref name="openletter20042020">{{Cite web|url=https://cec5c48f-2e98-4bb8-9110-208373420a79.filesusr.com/ugd/4f94c1_c7aa8bd5b9c748888a32e5e992dd323f.pdf| title = Opposition to Oxford Health NHS Foundation Trust: "Coping with Coronavirus: Fatigue" | date = 2020-04-20}}</ref><ref name="fukuda1994">{{Cite journal | last = Fukuda | first = K. | authorlink = Keiji Fukuda | last2 = Straus | first2 = S.E. | authorlink2 = Stephen Straus | last3 = Hickie | first3 = I. | authorlink3 = Ian Hickie | last4 = Sharpe | first4 = M.C. | authorlink4 = Michael Sharpe | last5 = Dobbins | first5 = J.G. | authorlink5 = James Dobbins | last6 = Komaroff | first6 = A. | authorlink6 = Anthony Komaroff | date = 1994-12-15| title = The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group | url = https://www.researchgate.net/profile/Michael_Sharpe2/publication/247808895_The_Chronic_Fatigue_Syndrome_A_Comprehensive_Approach_to_Its_Definition_and_Study/links/0c96053201643bfc4b000000/The-Chronic-Fatigue-Syndrome-A-Comprehensive-Approach-to-Its-Definition-and-Study.pdf|journal=Annals of Internal Medicine|volume=121|issue=12 | pages = 953–959|issn=0003-4819|pmid=7978722|via=|publisher=American College of Physicians}}</ref> Post-viral fatigue which does not meet the [[Fukuda criteria|criteria for CFS]] or [[International Consensus Criteria|ME]] and lasts ''at least 6 months'' is known as [[chronic fatigue]] (without the "syndrome"), or [[idiopathic chronic fatigue]] if the cause is unknown.<ref name="ICC2011primer">{{citation | last1 = Carruthers | first1 = BM | authorlink1 = Bruce Carruthers | last2 = van de Sande | first2 = MI | authorlink2 = Marjorie van de Sande | last3 = De Meirleir | first3 = KL | authorlink3 = Kenny de Meirleir | last4 = Klimas | first4 = NG | authorlink4 = Nancy Klimas | last5 = Broderick | first5 = G | authorlink5 = Gordon Broderick | last6 = Mitchell | first6 = T | authorlink6 = Terry Mitchell | last7 = Staines | first7 = D | authorlink7 = Donald Staines | last8 = Powles | first8 = ACP | authorlink8 = A C Peter Powles | last9 = Speight | first9 = N | authorlink9 = Nigel Speight | last10 = Vallings | first10 = R | authorlink10 = Rosamund Vallings | last11 = Bateman | first11 =  L | authorlink11 = Lucinda Bateman | last12 = Bell | first12 = DS | authorlink12 = David Bell | last13 = Carlo-Stella | first13 =  N | authorlink13= Nicoletta Carlo-Stella | last14 = Chia | first14 =  J | authorlink14= John Chia | last15 = Darragh | first15 =  A | authorlink15= Austin Darragh | last16 = Gerken | first16 = A | authorlink16= Anne Gerken | last17 = Jo | first17 =  D | authorlink17= Daehyun Jo | last18 = Lewis | first18 =  DP | authorlink18= Donald Lewis | last19 = Light | first19 = AR | authorlink19= Alan Light | last20 = Light | first20 =  KC | authorlink20= Kathleen Light | last21 = Marshall-Gradisnik | first21 =  S | authorlink21= Sonya Marshall-Gradisnik | last22 = McLaren-Howard | first22 =  J | authorlink22= John McLaren-Howard | last23 = Mena | first23 =  I | authorlink23= Ismael Mena | last24 = Miwa | first24 =  K | authorlink24= Kunihisa Miwa | last25 = Murovska | first25 =  M | authorlink25= Modra Murovska | last26 = Stevens | first26 =  SR | authorlink26= Staci Stevens | title = Myalgic encephalomyelitis: Adult & Paediatric: International Consensus Primer for Medical Practitioners | date = 2012
COVID-19 can cause severe [[fatigue]], however experiencing fatigue after recovering from the virus should not be the considered the same as the illness [[chronic fatigue syndrome]] (CFS) or [[myalgic encephalomyelitis]] (ME), a neurological disease involving multiple bodily systems and sustained symptoms over an extended period of time.<ref name="openletter20042020">{{Cite web|url=https://cec5c48f-2e98-4bb8-9110-208373420a79.filesusr.com/ugd/4f94c1_c7aa8bd5b9c748888a32e5e992dd323f.pdf| title = Opposition to Oxford Health NHS Foundation Trust: "Coping with Coronavirus: Fatigue" | date = 2020-04-20}}</ref><ref name="fukuda1994">{{Cite journal | last = Fukuda | first = K. | authorlink = Keiji Fukuda | last2 = Straus | first2 = S.E. | authorlink2 = Stephen Straus | last3 = Hickie | first3 = I. | authorlink3 = Ian Hickie | last4 = Sharpe | first4 = M.C. | authorlink4 = Michael Sharpe | last5 = Dobbins | first5 = J.G. | authorlink5 = James Dobbins | last6 = Komaroff | first6 = A. | authorlink6 = Anthony Komaroff | date = 1994-12-15| title = The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group | url = https://www.researchgate.net/profile/Michael_Sharpe2/publication/247808895_The_Chronic_Fatigue_Syndrome_A_Comprehensive_Approach_to_Its_Definition_and_Study/links/0c96053201643bfc4b000000/The-Chronic-Fatigue-Syndrome-A-Comprehensive-Approach-to-Its-Definition-and-Study.pdf|journal=Annals of Internal Medicine|volume=121|issue=12 | pages = 953–959|issn=0003-4819|pmid=7978722|via=|publisher=American College of Physicians}}</ref> Post-viral fatigue which does not meet the [[Fukuda criteria|criteria for CFS]] or [[International Consensus Criteria|ME]] and lasts ''at least 6 months'' is known as [[chronic fatigue]] (without the "syndrome"), or [[idiopathic chronic fatigue]] if the cause is unknown.<ref name="ICC2011primer">{{citation | last1 = Carruthers | first1 = BM | authorlink1 = Bruce Carruthers | last2 = van de Sande | first2 = MI | authorlink2 = Marjorie van de Sande | last3 = De Meirleir | first3 = KL | authorlink3 = Kenny de Meirleir | last4 = Klimas | first4 = NG | authorlink4 = Nancy Klimas | last5 = Broderick | first5 = G | authorlink5 = Gordon Broderick | last6 = Mitchell | first6 = T | authorlink6 = Terry Mitchell | last7 = Staines | first7 = D | authorlink7 = Donald Staines | last8 = Powles | first8 = ACP | authorlink8 = A C Peter Powles | last9 = Speight | first9 = N | authorlink9 = Nigel Speight | last10 = Vallings | first10 = R | authorlink10 = Rosamund Vallings | last11 = Bateman | first11 =  L | authorlink11 = Lucinda Bateman | last12 = Bell | first12 = DS | authorlink12 = David Bell | last13 = Carlo-Stella | first13 =  N | authorlink13 = Nicoletta Carlo-Stella | last14 = Chia | first14 =  J | authorlink14 = John Chia | last15 = Darragh | first15 =  A | authorlink15 = Austin Darragh | last16 = Gerken | first16 = A | authorlink16 = Anne Gerken | last17 = Jo | first17 =  D | authorlink17 = Daehyun Jo | last18 = Lewis | first18 =  DP | authorlink18 = Donald Lewis | last19 = Light | first19 = AR | authorlink19 = Alan Light | last20 = Light | first20 =  KC | authorlink20 = Kathleen Light | last21 = Marshall-Gradisnik | first21 =  S | authorlink21 = Sonya Marshall-Gradisnik | last22 = McLaren-Howard | first22 =  J | authorlink22 = John McLaren-Howard | last23 = Mena | first23 =  I | authorlink23 = Ismael Mena | last24 = Miwa | first24 =  K | authorlink24 = Kunihisa Miwa | last25 = Murovska | first25 =  M | authorlink25= Modra Murovska | last26 = Stevens | first26 =  SR | authorlink26 = Staci Stevens | title = Myalgic encephalomyelitis: Adult & Paediatric: International Consensus Primer for Medical Practitioners | date = 2012
| isbn = 978-0-9739335-3-6 | url = http://www.investinme.org/Documents/Guidelines/Myalgic%20Encephalomyelitis%20International%20Consensus%20Primer%20-2012-11-26.pdf }}</ref><ref name="canadianconsensus-CCC">{{Citation | last1   = Carruthers | first1 = Bruce M.   | authorlink1 = Bruce Carruthers | last2   = Jain | first2 = Anil Kumar  | authorlink2 = Anil Kumar Jain | last3   = De Meirleir | first3 = Kenny L. | authorlink3 = Kenny De Meirleir | last4 = Peterson | first4 = Daniel L.   | authorlink4 = Daniel Peterson | last5 = Klimas | first5 = Nancy G. | authorlink5 = Nancy Klimas | last6 = Lerner | first6 = A. Martin  | authorlink6 = Martin Lerner | last7 = Bested | first7 = Alison C.   | authorlink7 = Alison Bested | last8 = Flor-Henry | first8 = Pierre   | authorlink8 = Pierre Flor-Henry | last9 = Joshi | first9 = Pradip     | authorlink9 = Pradip Joshi | last10 = Powles | first10 = A C Peter | authorlink10 = A C Peter Powles | last11 = Sherkey | first11 = Jeffrey A.   | authorlink11 = Jeffrey Sherkey | last12 = van de Sande | first12 = Marjorie I.  | authorlink12 = Marjorie van de Sande | title = Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols | journal = Journal of Chronic Fatigue Syndrome | volume = 11 | issue = 2 | page = 7-115 | date = 2003 | pmid = | doi = 10.1300/J092v11n01_02
| isbn = 978-0-9739335-3-6 | url = http://www.investinme.org/Documents/Guidelines/Myalgic%20Encephalomyelitis%20International%20Consensus%20Primer%20-2012-11-26.pdf }}</ref><ref name="canadianconsensus-CCC">{{Citation | last1 = Carruthers | first1 = Bruce M. | authorlink1 = Bruce Carruthers | last2 = Jain | first2 = Anil Kumar  | authorlink2 = Anil Kumar Jain | last3 = De Meirleir | first3 = Kenny L. | authorlink3 = Kenny De Meirleir | last4 = Peterson | first4 = Daniel L. | authorlink4 = Daniel Peterson | last5 = Klimas | first5 = Nancy G. | authorlink5 = Nancy Klimas | last6 = Lerner | first6 = A. Martin  | authorlink6 = Martin Lerner | last7 = Bested | first7 = Alison C. | authorlink7 = Alison Bested | last8 = Flor-Henry | first8 = Pierre | authorlink8 = Pierre Flor-Henry | last9 = Joshi | first9 = Pradip | authorlink9 = Pradip Joshi | last10 = Powles | first10 = AC Peter | authorlink10 = A C Peter Powles | last11 = Sherkey | first11 = Jeffrey A. | authorlink11 = Jeffrey Sherkey | last12 = van de Sande | first12 = Marjorie I.  | authorlink12 = Marjorie van de Sande | title = Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols | journal = Journal of Chronic Fatigue Syndrome | volume = 11 | issue = 2 | pages = 7-115 | date = 2003 | pmid = | doi = 10.1300/J092v11n01_02
| url = http://www.investinme.org/Documents/PDFdocuments/CanadianDefinitionME-CFS.pdf }}</ref><ref name="fukuda1994" />
| url = http://www.investinme.org/Documents/PDFdocuments/CanadianDefinitionME-CFS.pdf }}</ref><ref name="fukuda1994" />


== Potential brain damage ==
== Potential brain damage ==
Scientists warn of a potential wave of coronavirus-related brain damage as new evidence suggests [[COVID-19]] can lead to severe [[Nervous system|neurological]] complications, including [[brain inflammation]], [[psychosis]] and [[delirium]].<ref name="ReutersJul2020">{{Cite news|url=https://af.reuters.com/article/worldNews/idAFKBN248381| title = Scientists warn of potential wave of COVID-linked brain damage | date = 2020-07-07|work=Reuters|access-date=2020-07-08|language=en}}</ref><ref name="Varatharaj2020a" /><blockquote>“Whether we will see an epidemic on a large scale of brain damage linked to the pandemic – perhaps similar to the encephalitis lethargica outbreak in the 1920s and 1930s after the 1918 influenza pandemic – remains to be seen,” said Michael Zandi, from UCL’s Institute of Neurology, who co-led the study.<ref name="ReutersJul2020" /></blockquote>
Scientists warn of a potential wave of coronavirus-related brain damage as new evidence suggests [[COVID-19]] can lead to severe [[Nervous system|neurological]] complications, including [[brain inflammation]], [[psychosis]] and [[delirium]].<ref name="ReutersJul2020">{{Cite news | url=https://af.reuters.com/article/worldNews/idAFKBN248381| title = Scientists warn of potential wave of COVID-linked brain damage | date = 2020-07-07|work=Reuters|access-date=2020-07-08|language=en}}</ref><ref name="Varatharaj2020a" /><blockquote>“Whether we will see an epidemic on a large scale of brain damage linked to the pandemic – perhaps similar to the encephalitis lethargica outbreak in the 1920s and 1930s after the 1918 influenza pandemic – remains to be seen,” said Michael Zandi, from UCL’s Institute of Neurology, who co-led the study.<ref name="ReutersJul2020" /></blockquote>


Reuters reported:
Reuters reported:
Line 63: Line 63:
People who remain ill after 6 months may meet the criteria for [[postviral fatigue syndrome]] (PVFS), which is more commonly diagnosed as [[chronic fatigue syndrome]] or [[myalgic encephalomyelitis]], although it may be possible to diagnose this sooner using the [[International Consensus Criteria|international consensus criteria]].<ref name="fukuda1994" /><ref name="canadianconsensus-CCC" /><ref name="ICC2011primer" /> For most people, this is a very disabling, long-term (chronic) illness.<ref name="ns-15042020" /><ref name="openletter20042020" /><ref name="fukuda1994" /><ref name="canadianconsensus-CCC" />
People who remain ill after 6 months may meet the criteria for [[postviral fatigue syndrome]] (PVFS), which is more commonly diagnosed as [[chronic fatigue syndrome]] or [[myalgic encephalomyelitis]], although it may be possible to diagnose this sooner using the [[International Consensus Criteria|international consensus criteria]].<ref name="fukuda1994" /><ref name="canadianconsensus-CCC" /><ref name="ICC2011primer" /> For most people, this is a very disabling, long-term (chronic) illness.<ref name="ns-15042020" /><ref name="openletter20042020" /><ref name="fukuda1994" /><ref name="canadianconsensus-CCC" />


Dr. [[Anthony Fauci]], the [[United States]] top [[infectious disease]] expert, acknowledged that many unrecovered [[COVID-19]] patients may have [[Myalgic encephalomyelitis|ME]], also known as [[chronic fatigue syndrome]], or [[ME/CFS]].<ref name="STAT21Jul2020">{{Cite web|url=https://www.statnews.com/2020/07/21/chronic-fatigue-syndrome-keys-understanding-post-covid-syndrome/| title = Post-Covid syndrome prompts new look at chronic fatigue syndrome | date = 2020-07-21 | website = STAT|language=en-US|access-date=2020-07-21}}</ref><ref name="CNN9Jul2020">{{Cite news|url=https://edition.cnn.com/world/live-news/coronavirus-pandemic-07-09-20-intl/h_5125152a01f8c98d362cf15d6860ab37| title = Coronavirus may cause fatigue syndrome, Fauci says | last = Berlinger | first=Joshua | first2=Brett | last2 = McKeehan | first3=Ivana | last3 = Kottasová | first4 = Ed|last4 = Upright |first5=Meg | last5 = Wagner | first6=Melissa | last6 = Macaya | date = 2020-07-09 | website = CNN|language=en|access-date=2020-07-21|authorlink= | authorlink2 = |archive-url=|archive-date=|url-status=|work=|quote=}}</ref> Dr. Fauci stated: “There may well be a post-viral syndrome associated with Covid-19,...If you look anecdotally, there is no question that there are a considerable number of individuals who have a post-viral syndrome that in many respects incapacitates them for weeks and weeks following so-called recovery,”<ref name="CNN9Jul2020" /> At the International AIDS conference, Fauci stated: "Brain fog, fatigue, and difficulty in concentrating. So this is something we really need to seriously look at because it very well might be a post-viral syndrome associated with COVID-19.<ref name="FauciAIDSConf2020">https://www.youtube.com/watch?v=UMmT48IC0us</ref>   
Dr. [[Anthony Fauci]], the [[United States]] top [[infectious disease]] expert, acknowledged that many unrecovered [[COVID-19]] patients may have [[Myalgic encephalomyelitis|ME]], also known as [[chronic fatigue syndrome]], or [[ME/CFS]].<ref name="STAT21Jul2020">{{Cite web|url=https://www.statnews.com/2020/07/21/chronic-fatigue-syndrome-keys-understanding-post-covid-syndrome/| title = Post-Covid syndrome prompts new look at chronic fatigue syndrome | date = 2020-07-21 | website = STAT|language=en-US|access-date=2020-07-21}}</ref><ref name="CNN9Jul2020">{{Cite news | url=https://edition.cnn.com/world/live-news/coronavirus-pandemic-07-09-20-intl/h_5125152a01f8c98d362cf15d6860ab37| title = Coronavirus may cause fatigue syndrome, Fauci says | last = Berlinger | first=Joshua | first2 = Brett | last2 = McKeehan | first3 = Ivana | last3 = Kottasová | first4 = Ed | last4 = Upright | first5 = Meg | last5 = Wagner | first6 = Melissa | last6 = Macaya | date = 2020-07-09 | website = CNN|language=en|access-date=2020-07-21 | authorlink = | authorlink2 = |archive-url=|archive-date=|url-status=|work=|quote=}}</ref> Dr. Fauci stated: “There may well be a post-viral syndrome associated with Covid-19,...If you look anecdotally, there is no question that there are a considerable number of individuals who have a post-viral syndrome that in many respects incapacitates them for weeks and weeks following so-called recovery,”<ref name="CNN9Jul2020" /> At the International AIDS conference, Fauci stated: "Brain fog, fatigue, and difficulty in concentrating. So this is something we really need to seriously look at because it very well might be a post-viral syndrome associated with COVID-19.<ref name="FauciAIDSConf2020">https://www.youtube.com/watch?v=UMmT48IC0us</ref>   


An internist at Texas Health Presbyterian Hospital, Dr. Donna Casey, said “We can now see documented abnormalities in your [[nervous system]], [[immune system|immune]], and [[metabolic]] systems. So we’re seeing abnormalities in all three that create [[myalgic encephalomyelitis]].”<ref name="IB17Jul2020">{{Cite web|url=https://www.ibtimes.com/fauci-warns-post-viral-syndrome-among-covid-19-patients-causes-fatigue-brain-fog-3012876| title = Fauci Warns Of 'Post-Viral Syndrome' Among COVID-19 Patients That Causes Fatigue, Brain Fog After Recovery | last = Ramaswamy | first = Divya | date = 2020-07-17 | website = International Business Times|access-date=2020-07-21}}</ref> Dr. Casey did say that we are not at the six month mark<ref>{{Cite web|url=https://www.cdc.gov/me-cfs/healthcare-providers/diagnosis/iom-2015-diagnostic-criteria.html| title = IOM 2015 Diagnostic Criteria {{!}} Diagnosis {{!}} Healthcare Providers {{!}} Myalgic Encephalomyelitis/Chronic Fatigue Syndrome | date = 2019-11-19 | website = [[Centers for Disease Control and Prevention]]|language=en-us|access-date=2020-07-21}}</ref><ref>{{Cite web|url=https://www.nap.edu/resource/19012/MECFS_DiagnosticAlgorithm.jpg| title = Diagnostic Algorithm for ME/CFS | last = | first = |authorlink= | date = |website=National Academy of Medicine (Formerly the Institute of Medicine)|archive-url=|archive-date=|url-status=|access-date=}}</ref> for COVID, but she does see ongoing improvement in her hospitalized patients.<ref name="IB17Jul2020" /> Dr. Amir K. Ghiassi, a pulmonologist with St. Joseph Hospital in Orange County, California said of the ongoing symptoms they were uncertain if it had to do with the virus or “because of the immune system reacting the way it does that causes symptoms.”<ref name="IB17Jul2020" />
An internist at Texas Health Presbyterian Hospital, Dr. Donna Casey, said “We can now see documented abnormalities in your [[nervous system]], [[immune system|immune]], and [[metabolic]] systems. So we’re seeing abnormalities in all three that create [[myalgic encephalomyelitis]].”<ref name="IB17Jul2020">{{Cite web|url=https://www.ibtimes.com/fauci-warns-post-viral-syndrome-among-covid-19-patients-causes-fatigue-brain-fog-3012876| title = Fauci Warns Of 'Post-Viral Syndrome' Among COVID-19 Patients That Causes Fatigue, Brain Fog After Recovery | last = Ramaswamy | first = Divya | date = 2020-07-17 | website = International Business Times|access-date=2020-07-21}}</ref> Dr. Casey did say that we are not at the six month mark<ref>{{Cite web|url=https://www.cdc.gov/me-cfs/healthcare-providers/diagnosis/iom-2015-diagnostic-criteria.html| title = IOM 2015 Diagnostic Criteria {{!}} Diagnosis {{!}} Healthcare Providers {{!}} Myalgic Encephalomyelitis/Chronic Fatigue Syndrome | date = 2019-11-19 | website = [[Centers for Disease Control and Prevention]]|language=en-us|access-date=2020-07-21}}</ref><ref>{{Cite web|url=https://www.nap.edu/resource/19012/MECFS_DiagnosticAlgorithm.jpg| title = Diagnostic Algorithm for ME/CFS | last = | first = | authorlink = | date = |website=National Academy of Medicine (Formerly the Institute of Medicine)|archive-url=|archive-date=|url-status=|access-date=}}</ref> for COVID, but she does see ongoing improvement in her hospitalized patients.<ref name="IB17Jul2020" /> Dr. Amir K. Ghiassi, a pulmonologist with St. Joseph Hospital in Orange County, California said of the ongoing symptoms they were uncertain if it had to do with the virus or “because of the immune system reacting the way it does that causes symptoms.”<ref name="IB17Jul2020" />


==Postviral fatigue syndrome and ME/CFS==
==Postviral fatigue syndrome and ME/CFS==
[[File:COVID-19_and_ME-CFS.png|thumb|right|alt=COVID-19 and ME/CFS. "It's quite likely that some people will be developing a post-viral fatigue syndrome, which may then lead into an ME/CFS-like illness." - [[Charles Shepherd]], M.E. Association]]
[[File:COVID-19_and_ME-CFS.png|thumb|right|alt=COVID-19 and ME/CFS. "It's quite likely that some people will be developing a post-viral fatigue syndrome, which may then lead into an ME/CFS-like illness." - [[Charles Shepherd]], M.E. Association]]
[[Myalgic encephalomyelitis]], better known as ME, is a neurological disease that commonly begins after a virus, although other possible triggers include bacterial infections, injuries, surgery and other events.<ref name="ICC2011primer" /><ref name="fukuda1994" /><ref name="icd10" /> Some researchers and some patients use the term [[chronic fatigue syndrome]] (CFS), or [[ME/CFS]] to refer to ME, although CFS has different diagnostic criteria.<ref name="canadianconsensus-CCC" /><ref name="ICC2011primer" /><ref name="fukuda1994" /> The older term [[Postviral fatigue syndrome]] (PVFS) is rarely used, although the [[World Health Organization]] recognize PVFS, ME, and CFS using the same diagnostic code. Some countries including the [[United States]], deviate from this.<ref name="icd10">{{Cite web|url=https://icd.who.int/browse10/2016/en#/G93| title = ICD-10: Version 2016 | last = World Health Organization|website=[[World Health Organization]]|author-link=World Health Organization}}</ref><ref name="icd10-us">{{Cite web|url=https://www.cdc.gov/nchs/icd/icd10cm.htm | last = Centers for Disease Control| title = ICD-10-CM|website=[[Centers for Disease Control and Prevention]]|author-link=Centers for Disease Control | date = |access-date=Apr 17, 2020 | first = |archive-url=|archive-date=|url-status=}}</ref>
[[Myalgic encephalomyelitis]], better known as ME, is a neurological disease that commonly begins after a virus, although other possible triggers include bacterial infections, injuries, surgery and other events.<ref name="ICC2011primer" /><ref name="fukuda1994" /><ref name="icd10" /> Some researchers and some patients use the term [[chronic fatigue syndrome]] (CFS), or [[ME/CFS]] to refer to ME, although CFS has different diagnostic criteria.<ref name="canadianconsensus-CCC" /><ref name="ICC2011primer" /><ref name="fukuda1994" /> The older term [[Postviral fatigue syndrome]] (PVFS) is rarely used, although the [[World Health Organization]] recognize PVFS, ME, and CFS using the same diagnostic code. Some countries including the [[United States]], deviate from this.<ref name="icd10">{{Cite web|url=https://icd.who.int/browse10/2016/en#/G93| title = ICD-10: Version 2016 | last = World Health Organization|website=[[World Health Organization]] | author-link = World Health Organization}}</ref><ref name="icd10-us">{{Cite web|url=https://www.cdc.gov/nchs/icd/icd10cm.htm | last = Centers for Disease Control| title = ICD-10-CM|website=[[Centers for Disease Control and Prevention]] | author-link = Centers for Disease Control | date = |access-date=Apr 17, 2020 | first = |archive-url=|archive-date=|url-status=}}</ref>


{{Quote box| title = PVFS (post-viral fatigue syndrome)|quote=This term was introduced during the eariy 1980s in Britain as an alternative to ME. It remains a useful description for anyone whose illness can clearly be traced back to an acute viral infection. The drawback to PVFS is that it cannot be used to describe cases where some other factor (e.g. vaccination or pesticide) acted as the principal trigger.<ref name="Livingwithme" />|source=Dr Charles Shepherd, [[Living with M.E.]] (2008)}}
{{Quote box| title = PVFS (post-viral fatigue syndrome)|quote=This term was introduced during the eariy 1980s in Britain as an alternative to ME. It remains a useful description for anyone whose illness can clearly be traced back to an acute viral infection. The drawback to PVFS is that it cannot be used to describe cases where some other factor (e.g. vaccination or pesticide) acted as the principal trigger.<ref name="Livingwithme" />|source=Dr Charles Shepherd, [[Living with M.E.]] (2008)}}


Moldofsky et al. (2011) conducted a long term follow up of 21 SARS survivors in Toronto, Canada, all of who remained too ill to return to work, and concluded that that ''chronic post-SARS'' was similar to [[fibromyalgia]].<ref name="Moldofsky2011" /> Lam et al. (2009) conducted a much larger long term follow-up of SARS survivors in Hong Kong, and reported that 27% had [[chronic fatigue syndrome]], 40% had [[chronic fatigue]], and 40% has [[depression]].<ref name="Lam2009" /> A number of the SARS survivors unable to return to work were previously healthy health-care workers.<ref name="Lam2009">{{Cite journal | last = Lam | first = Marco Ho-Bun | last2 = Wing | first2 = Yun-Kwok | last3 = Yu | first3 = Mandy Wai-Man|last4 = Leung | first4 = Chi-Ming | last5 = Ma | first5=Ronald C. W. | last6 = Kong | first6 = Alice P. S. | last7 = So | first7 = W. Y. | last8 = Fong | first8 = Samson Yat-Yuk | last9 = Lam | first9 = Siu-Ping | date = 2009-12-14| title = Mental Morbidities and Chronic Fatigue in Severe Acute Respiratory Syndrome Survivors: Long-term Follow-up | url = https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/415378|journal=Archives of Internal Medicine|language=en|volume=169|issue=22|pages=2142–2147|doi=10.1001/archinternmed.2009.384|issn=0003-9926}}</ref> The high rates of chronic fatigue could not be accounted got by [[depression]] or psychiatric illness.<ref name="Lam2009" />
Moldofsky et al. (2011) conducted a long term follow up of 21 SARS survivors in Toronto, Canada, all of who remained too ill to return to work, and concluded that that ''chronic post-SARS'' was similar to [[fibromyalgia]].<ref name="Moldofsky2011" /> Lam et al. (2009) conducted a much larger long term follow-up of SARS survivors in Hong Kong, and reported that 27% had [[chronic fatigue syndrome]], 40% had [[chronic fatigue]], and 40% has [[depression]].<ref name="Lam2009" /> A number of the SARS survivors unable to return to work were previously healthy health-care workers.<ref name="Lam2009">{{Cite journal | last = Lam | first = Marco Ho-Bun | last2 = Wing | first2 = Yun-Kwok | last3 = Yu | first3 = Mandy Wai-Man | last4 = Leung | first4 = Chi-Ming | last5 = Ma | first5 = Ronald C.W. | last6 = Kong | first6 = Alice P.S. | last7 = So | first7 = W.Y. | last8 = Fong | first8 = Samson Yat-Yuk | last9 = Lam | first9 = Siu-Ping | date = 2009-12-14| title = Mental Morbidities and Chronic Fatigue in Severe Acute Respiratory Syndrome Survivors: Long-term Follow-up | url = https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/415378|journal=Archives of Internal Medicine|language=en|volume=169|issue=22|pages=2142–2147|doi=10.1001/archinternmed.2009.384|issn=0003-9926}}</ref> The high rates of chronic fatigue could not be accounted got by [[depression]] or psychiatric illness.<ref name="Lam2009" />
{{See also|Postviral fatigue syndrome}}
{{See also|Postviral fatigue syndrome}}
{{See also|Chronic fatigue syndrome}}
{{See also|Chronic fatigue syndrome}}
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*[[pacing]]
*[[pacing]]
*[[nutrition]] and
*[[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" />
*[[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===
===Pacing===
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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" />
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 | author-link=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 | author-link=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 ME’s 2014 survey | last = Action for ME |author-link=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 |author-link=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) – 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>
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 ME’s 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) – 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}}
{{See also|Cognitive behavioral therapy}}{{See also|Graded exercise therapy}}
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==Notable studies on the short- and long-term effects of COVID-19==
==Notable studies on the short- and long-term effects of COVID-19==
* Jun 25, 2020, Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study<ref name="Varatharaj2020a">{{Cite journal | last = Varatharaj | first = Aravinthan | author-link= | last2 = Thomas | first2=Naomi | authorlink2 = | last3 = Ellul | first3 = Mark A | authorlink3 = |last4 = Davies | first4 = Nicholas W S | authorlink4 = | last5 = Pollak|first5=Thomas A  | authorlink5 = | last6 = Tenorio | first6 = Elizabeth L | authorlink6 = | last7 = Sultan | first7 = Mustafa | last8 = Easton | first8 = Ava | last9 = Breen | first9 = Gerome | date = Jun 2020| title = Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study|url=https://doi.org/10.1016/S2215-0366(20)30287-X|journal=The Lancet Psychiatry|volume=7|issue= | pages = 875–82|doi=10.1016/s2215-0366(20)30287-x|issn=2215-0366|pmc =  7316461|pmid=32593341|access-date=|quote=|via=}}</ref> - [https://doi.org/10.1016/S2215-0366(20)30287-X (Full text)] from the CoroNerve platform
* Jun 25, 2020, Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study<ref name="Varatharaj2020a">{{Cite journal | last = Varatharaj | first = Aravinthan | author-link = | last2 = Thomas | first2 = Naomi | authorlink2 = | last3 = Ellul | first3 = Mark A | authorlink3 = | last4 = Davies | first4 = Nicholas W S | authorlink4 = | last5 = Pollak | first5 = Thomas A  | authorlink5 = | last6 = Tenorio | first6 = Elizabeth L | authorlink6 = | last7 = Sultan | first7 = Mustafa | last8 = Easton | first8 = Ava | last9 = Breen | first9 = Gerome | date = Jun 2020| title = Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study|url=https://doi.org/10.1016/S2215-0366(20)30287-X|journal=The Lancet Psychiatry|volume=7|issue= | pages = 875–82|doi=10.1016/s2215-0366(20)30287-x|issn=2215-0366|pmc =  7316461|pmid=32593341|access-date=|quote=|via=}}</ref> - [https://doi.org/10.1016/S2215-0366(20)30287-X (Full text)] from the CoroNerve platform
* Jun 29, 2020 (pre-print), Blood parameters measured on admission as predictors of outcome for COVID-19; a prospective UK cohort study<ref name="Arnold2020a">{{Cite journal | last = Arnold | first=David T.|author-link=David Arnold | last2 = Attwood | first2=Marie | authorlink2 = | last3 = Barratt | first3=Shaney|author-link3=|last4 = Elvers | first4=Karen | author-link4= | last5 = Morley|first5=Anna | authorlink5 = | last6 = McKernon | first6=Jorgen | authorlink6 = | last7 = Oates | first7 = Adrian | last8 = Donald | first8 = Charmaine | last9 = Noel | first9 = Alan | date = 2020-06-29| title = Blood parameters measured on admission as predictors of outcome for COVID-19; a prospective UK cohort study|url=https://www.medrxiv.org/content/10.1101/2020.06.25.20137935v1|journal=medRxiv|language=en|volume=|issue=|pages=2020.06.25.20137935|doi=10.1101/2020.06.25.20137935|pmc=|pmid=|access-date=|quote=|via=}}</ref> - [https://doi.org/10.1101/2020.06.25.20137935 (Full text)] - from the DISCOVER study
* Jun 29, 2020 (pre-print), Blood parameters measured on admission as predictors of outcome for COVID-19; a prospective UK cohort study<ref name="Arnold2020a">{{Cite journal | last = Arnold | first=David T. | author-link = David Arnold | last2 = Attwood | first2 = Marie | authorlink2 = | last3 = Barratt | first3 = Shaney | authorlink3 = | last4 = Elvers | first4 = Karen | author-link4 = | last5 = Morley | first5 = Anna | authorlink5 = | last6 = McKernon | first6 = Jorgen | authorlink6 = | last7 = Oates | first7 = Adrian | last8 = Donald | first8 = Charmaine | last9 = Noel | first9 = Alan | date = 2020-06-29| title = Blood parameters measured on admission as predictors of outcome for COVID-19; a prospective UK cohort study|url=https://www.medrxiv.org/content/10.1101/2020.06.25.20137935v1|journal=medRxiv|language=en|volume=|issue=|pages=2020.06.25.20137935|doi=10.1101/2020.06.25.20137935|pmc=|pmid=|access-date=|quote=|via=}}</ref> - [https://doi.org/10.1101/2020.06.25.20137935 (Full text)] - from the DISCOVER study
* Jul 8, 2020, Postdischarge symptoms and rehabilitation needs in survivors of COVID-19 infection: A cross-sectional evaluation<ref name="Halpin2020a">{{Cite journal | last = Halpin | first = Stephen J. | last2 = McIvor | first2=Claire | last3 = Whyatt | first3=Gemma|last4 = Adams | first4=Anastasia | last5 = Harvey|first5=Olivia | last6 = McLean | first6=Lyndsay | last7 = Walshaw | first7 = Christopher | last8 = Kemp | first8 = Steven | last9 = Corrado | first9 = Joanna| title = Postdischarge symptoms and rehabilitation needs in survivors of COVID-19 infection: A cross-sectional evaluation|url=https://onlinelibrary.wiley.com/doi/abs/10.1002/jmv.26368|journal=Journal of Medical Virology|volume = 93| issue =2 |pages =1013-1022|language=en|doi=10.1002/jmv.26368|issn=1096-9071}}</ref> - [https://onlinelibrary.wiley.com/doi/epdf/10.1002/jmv.26368 (Full text)]
* Jul 8, 2020, Postdischarge symptoms and rehabilitation needs in survivors of COVID-19 infection: A cross-sectional evaluation<ref name="Halpin2020a">{{Cite journal | last = Halpin | first = Stephen J. | last2 = McIvor | first2 = Claire | last3 = Whyatt | first3 = Gemma | last4 = Adams | first4 = Anastasia | last5 = Harvey | first5 = Olivia | last6 = McLean | first6 = Lyndsay | last7 = Walshaw | first7 = Christopher | last8 = Kemp | first8 = Steven | last9 = Corrado | first9 = Joanna | title = Postdischarge symptoms and rehabilitation needs in survivors of COVID-19 infection: A cross-sectional evaluation|url=https://onlinelibrary.wiley.com/doi/abs/10.1002/jmv.26368|journal=Journal of Medical Virology|volume = 93 | issue =2 |pages =1013-1022|language=en|doi=10.1002/jmv.26368|issn=1096-9071}}</ref> - [https://onlinelibrary.wiley.com/doi/epdf/10.1002/jmv.26368 (Full text)]
* Jul 8, 2020, The emerging spectrum of COVID-19 neurology: clinical, radiological and laboratory findings<ref name="Paterson2020a">{{Cite journal | last = Paterson | first = Ross W. | last2 = Brown | first2 = Rachel L. | last3 = Benjamin | first3 = Laura|last4 = Nortley | first4 = Ross | last5 = Wiethoff|first5=Sarah | last6 = Bharucha | first6=Tehmina | last7 = Jayaseelan | first7 = Dipa L. | last8 = Kumar | first8 = Guru | last9 = Raftopoulos | first9 = Rhian E. | title=The emerging spectrum of COVID-19 neurology: clinical, radiological and laboratory findings|url=https://academic.oup.com/brain/article/doi/10.1093/brain/awaa240/5868408|journal=Brain|volume =143|issue = 2020 |pages =3104-3120|language=en|doi=10.1093/brain/awaa240}}</ref> - [https://doi.org/10.1101/2020.06.25.20137935 (Full text)]
* Jul 8, 2020, The emerging spectrum of COVID-19 neurology: clinical, radiological and laboratory findings<ref name="Paterson2020a">{{Cite journal | last = Paterson | first = Ross W. | last2 = Brown | first2 = Rachel L. | last3 = Benjamin | first3 = Laura | last4 = Nortley | first4 = Ross | last5 = Wiethoff | first5 = Sarah | last6 = Bharucha | first6 = Tehmina | last7 = Jayaseelan | first7 = Dipa L. | last8 = Kumar | first8 = Guru | last9 = Raftopoulos | first9 = Rhian E. | title=The emerging spectrum of COVID-19 neurology: clinical, radiological and laboratory findings|url=https://academic.oup.com/brain/article/doi/10.1093/brain/awaa240/5868408|journal=Brain|volume =143|issue = 2020 |pages =3104-3120|language=en|doi=10.1093/brain/awaa240}}</ref> - [https://doi.org/10.1101/2020.06.25.20137935 (Full text)]
* Aug 14, 2020 (pre-print), Patient outcomes after hospitalisation with COVID-19 and implications for follow-up; results from a prospective UK cohort<ref name="Arnold2020b">{{Cite journal | last = Arnold | first=David T.|author-link=David Arnold | last2 = Hamilton | first2=Fergus W. | authorlink2 = | last3 = Milne | first3=Alice|author-link3=|last4 = Morley | first4 = Anna | author-link4= | last5 = Viner | first5=Jason | authorlink5 = | last6 = Attwood | first6=Marie | authorlink6 = | last7 = Noel | first7 = Alan | last8 = Gunning | first8 = Samuel | last9 = Hatrick | first9 = Jessica | date = 2020-08-14| title = Patient outcomes after hospitalisation with COVID-19 and implications for follow-up; results from a prospective UK cohort.|url=https://www.medrxiv.org/content/10.1101/2020.08.12.20173526v1|journal=medRxiv|language=en|volume=|issue=|pages=2020.08.12.20173526|doi=10.1101/2020.08.12.20173526|pmc=|pmid=|access-date=|quote=|via=}}</ref> - [https://www.medrxiv.org/content/10.1101/2020.08.12.20173526v1 (Full text)] - from the DISCOVER project
* Aug 14, 2020 (pre-print), Patient outcomes after hospitalisation with COVID-19 and implications for follow-up; results from a prospective UK cohort<ref name="Arnold2020b">{{Cite journal | last = Arnold | first=David T. | author-link = David Arnold | last2 = Hamilton | first2 = Fergus W. | authorlink2 = | last3 = Milne | first3 = Alice | authorlink3 = | last4 = Morley | first4 = Anna | author-link4 = | last5 = Viner | first5 = Jason | authorlink5 = | last6 = Attwood | first6 = Marie | authorlink6 = | last7 = Noel | first7 = Alan | last8 = Gunning | first8 = Samuel | last9 = Hatrick | first9 = Jessica | date = 2020-08-14| title = Patient outcomes after hospitalisation with COVID-19 and implications for follow-up; results from a prospective UK cohort.|url=https://www.medrxiv.org/content/10.1101/2020.08.12.20173526v1|journal=medRxiv|language=en|volume=|issue=|pages=2020.08.12.20173526|doi=10.1101/2020.08.12.20173526|pmc=|pmid=|access-date=|quote=|via=}}</ref> - [https://www.medrxiv.org/content/10.1101/2020.08.12.20173526v1 (Full text)] - from the DISCOVER project


===Notable studies announced or in progress===
===Notable studies announced or in progress===
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*'''COVID Symptom Study''' and the related COVID Symptom Study App by ZOE, with KCL and the [[National Health Service|NHS]] - [https://www.qmul.ac.uk/covidence COVID Symptom Study website]
*'''COVID Symptom Study''' and the related COVID Symptom Study App by ZOE, with KCL and the [[National Health Service|NHS]] - [https://www.qmul.ac.uk/covidence COVID Symptom Study website]
::The world's largest set of data for investigating Long COVID<ref name="joinzoewhy">{{Cite web | title = Why you need both apps. The COVID Symptom Study app and NHS COVID-19 app are different. Here’s why you need both!|date =Oct 5, 2020 | url = https://covid.joinzoe.com/post/nhs-app-covid-symptom-study|website=joinzoe.com}}</ref> Lead by [[Tim Spector]].
::The world's largest set of data for investigating Long COVID<ref name="joinzoewhy">{{Cite web | title = Why you need both apps. The COVID Symptom Study app and NHS COVID-19 app are different. Here’s why you need both! | date = Oct 5, 2020 | url = https://covid.joinzoe.com/post/nhs-app-covid-symptom-study|website=joinzoe.com}}</ref> Lead by [[Tim Spector]].


* '''Covid-19 Symptômes persistants enquête''' - France
* '''Covid-19 Symptômes persistants enquête''' - France


* '''COVIDENCE UK Research Study'''
* '''COVIDENCE UK Research Study'''
:A UK-wide study with a number of different aims, including monitoring long term complications of COVID-19, recovery, and wider physical, mental and economic wellbeing.<ref name="covidence">{{Cite web|url=https://www.qmul.ac.uk/covidence/| title = COVIDENCE UK | last = | first = |authorlink= | date = |website=qmul.ac.uk|archive-url=|archive-date=|url-status=|access-date=2021-07-23}}</ref> - [https://www.qmul.ac.uk/covidence COVIDENCE website]
:A UK-wide study with a number of different aims, including monitoring long term complications of COVID-19, recovery, and wider physical, mental and economic wellbeing.<ref name="covidence">{{Cite web|url=https://www.qmul.ac.uk/covidence/| title = COVIDENCE UK | last = | first = | authorlink = | date = |website=qmul.ac.uk|archive-url=|archive-date=|url-status=|access-date=2021-07-23}}</ref> - [https://www.qmul.ac.uk/covidence COVIDENCE website]


* PHOSP-COVID - '''P'''ost'''-HOSP'''italisation COVID - [https://www.phosp.org/study-news/phosp-covid-launching-press-release/ PHOSP-COVID website]  
* PHOSP-COVID - '''P'''ost'''-HOSP'''italisation COVID - [https://www.phosp.org/study-news/phosp-covid-launching-press-release/ PHOSP-COVID website]  
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==News articles and blogs==
==News articles and blogs==
* Aug 20, 2020, [https://www.independent.co.uk/news/health/coronavirus-patients-complications-covid-19-study-southmead-hospital-bristol-a9678391.html Coronavirus patients still suffering from complications three months later, study finds] - The Independent  
* Aug 20, 2020, [https://www.independent.co.uk/news/health/coronavirus-patients-complications-covid-19-study-southmead-hospital-bristol-a9678391.html Coronavirus patients still suffering from complications three months later, study finds] - The Independent  
* Aug 19, 2020, [https://www.theatlantic.com/health/archive/2020/08/long-haulers-covid-19-recognition-support-groups-symptoms/615382/ Long haulers are redefining COVID-19]<ref name="long-haulers-redefining">{{Cite news|url=https://www.theatlantic.com/health/archive/2020/08/long-haulers-covid-19-recognition-support-groups-symptoms/615382/| title = Long-Haulers Are Redefining COVID-19 | last = Yong | first = Ed | date = Aug 19, 2020|work=The Atlantic|access-date=2020-08-21|archive-url=|archive-date=|url-status=|issn=1072-7825|quote=}}</ref> -  The Atlantic  
* Aug 19, 2020, [https://www.theatlantic.com/health/archive/2020/08/long-haulers-covid-19-recognition-support-groups-symptoms/615382/ Long haulers are redefining COVID-19]<ref name="long-haulers-redefining">{{Cite news | url=https://www.theatlantic.com/health/archive/2020/08/long-haulers-covid-19-recognition-support-groups-symptoms/615382/| title = Long-Haulers Are Redefining COVID-19 | last = Yong | first = Ed | date = Aug 19, 2020|work=The Atlantic|access-date=2020-08-21|archive-url=|archive-date=|url-status=|issn=1072-7825|quote=}}</ref> -  The Atlantic  
* Jul 29, 2020, [https://www.nbcnews.com/health/health-news/covid-19-long-haulers-report-nearly-100-symptoms-more-100-n1235217 COVID-19 'long-haulers' report nearly 100 symptoms for more than 100 days]<ref name="long-haulers100days">{{Cite web|url=https://www.nbcnews.com/health/health-news/covid-19-long-haulers-report-nearly-100-symptoms-more-100-n1235217| title = COVID-19 'long-haulers' report nearly 100 symptoms for more than 100 days | last = Edwards | first = Erika | authorlink= | date = Jul 29, 2020 | website = NBC News|language=en|archive-url=|archive-date=|url-status=|access-date=2020-08-21}}</ref> - Erika Edwards, NBC News
* Jul 29, 2020, [https://www.nbcnews.com/health/health-news/covid-19-long-haulers-report-nearly-100-symptoms-more-100-n1235217 COVID-19 'long-haulers' report nearly 100 symptoms for more than 100 days]<ref name="long-haulers100days">{{Cite web|url=https://www.nbcnews.com/health/health-news/covid-19-long-haulers-report-nearly-100-symptoms-more-100-n1235217| title = COVID-19 'long-haulers' report nearly 100 symptoms for more than 100 days | last = Edwards | first = Erika | authorlink= | date = Jul 29, 2020 | website = NBC News|language=en|archive-url=|archive-date=|url-status=|access-date=2020-08-21}}</ref> - Erika Edwards, NBC News
* Jul 9, 2020, [https://edition.cnn.com/world/live-news/coronavirus-pandemic-07-09-20-intl/h_5125152a01f8c98d362cf15d6860ab37 Coronavirus may cause fatigue syndrome, Fauci says]  
* Jul 9, 2020, [https://edition.cnn.com/world/live-news/coronavirus-pandemic-07-09-20-intl/h_5125152a01f8c98d362cf15d6860ab37 Coronavirus may cause fatigue syndrome, Fauci says]  
Line 135: Line 135:
* May 4, 2020, [https://www.nbcnews.com/health/health-news/fever-fatigue-fear-some-recovering-covid-19-patients-weeks-illness-n1197806 Fever, fatigue, fear: For some recovering COVID-19 patients, weeks of illness, uncertainty] - Erika Edwards, NBC News  
* May 4, 2020, [https://www.nbcnews.com/health/health-news/fever-fatigue-fear-some-recovering-covid-19-patients-weeks-illness-n1197806 Fever, fatigue, fear: For some recovering COVID-19 patients, weeks of illness, uncertainty] - Erika Edwards, NBC News  
*Apr 17, 2020, [https://nypost.com/2020/04/17/my-lungs-are-on-fire-coronavirus-survivors-say-they-fear-long-term-effects/ Coronavirus survivors say they fear long-term effects] - Melissa Malamut, New York Post
*Apr 17, 2020, [https://nypost.com/2020/04/17/my-lungs-are-on-fire-coronavirus-survivors-say-they-fear-long-term-effects/ Coronavirus survivors say they fear long-term effects] - Melissa Malamut, New York Post
*Apr 17, 2020, [https://abcnews.go.com/Health/coronavirus-long-term-effects/story?id=69811566 What we know about coronavirus' long-term effects]<ref name="ABC-17042020">{{Cite news|url=https://abcnews.go.com/Health/coronavirus-long-term-effects/story?id=69811566 | last = Shumaker | first=Erin | date = 2020-04-17 | website = ABC news| title = What we know about coronavirus' long-term effects}}</ref> - Erin Shumaker, ABC news
*Apr 17, 2020, [https://abcnews.go.com/Health/coronavirus-long-term-effects/story?id=69811566 What we know about coronavirus' long-term effects]<ref name="ABC-17042020">{{Cite news | url=https://abcnews.go.com/Health/coronavirus-long-term-effects/story?id=69811566 | last = Shumaker | first=Erin | date = 2020-04-17 | website = ABC news| title = What we know about coronavirus' long-term effects}}</ref> - Erin Shumaker, ABC news
*Apr 16, 2020, [https://www.virology.ws/2020/04/16/trial-by-error-oxford-nhs-recommends-get-cbt-for-post-covid-cfs-patients/ Trial By Error: Oxford-NHS Recommends GET/CBT for Post-COVID “CFS” Patients]<ref name="TullerOx16apr2020">{{Cite web|url=https://www.virology.ws/2020/04/16/trial-by-error-oxford-nhs-recommends-get-cbt-for-post-covid-cfs-patients/| title = Trial By Error: Oxford-NHS Recommends GET/CBT for Post-COVID “CFS” Patients | last = Tuller | first=David | date = Apr 16, 2020|author-link=David Tuller|website=[[Virology blog]]}}</ref> - David Tuller
*Apr 16, 2020, [https://www.virology.ws/2020/04/16/trial-by-error-oxford-nhs-recommends-get-cbt-for-post-covid-cfs-patients/ Trial By Error: Oxford-NHS Recommends GET/CBT for Post-COVID “CFS” Patients]<ref name="TullerOx16apr2020">{{Cite web|url=https://www.virology.ws/2020/04/16/trial-by-error-oxford-nhs-recommends-get-cbt-for-post-covid-cfs-patients/| title = Trial By Error: Oxford-NHS Recommends GET/CBT for Post-COVID “CFS” Patients | last = Tuller | first=David | date = Apr 16, 2020 | author-link = David Tuller|website=[[Virology blog]]}}</ref> - David Tuller
*Apr 16, 2020, [https://www.somagnews.com/get-covid-19-get-healed-can-face-another-disease-years/ Those Who Get COVID-19 and Get Healed Can Face Another Disease After A Few Years] - Daniel Kucher - SOMAG news
*Apr 16, 2020, [https://www.somagnews.com/get-covid-19-get-healed-can-face-another-disease-years/ Those Who Get COVID-19 and Get Healed Can Face Another Disease After A Few Years] - Daniel Kucher - SOMAG news
*Apr 15, 2020, [https://www.newscientist.com/article/mg24632783-400-could-the-coronavirus-trigger-post-viral-fatigue-syndromes/ Could the coronavirus trigger post-viral fatigue syndromes?]<ref name="ns-15042020" /> - Clare Wilson, New Scientist  
*Apr 15, 2020, [https://www.newscientist.com/article/mg24632783-400-could-the-coronavirus-trigger-post-viral-fatigue-syndromes/ Could the coronavirus trigger post-viral fatigue syndromes?]<ref name="ns-15042020" /> - Clare Wilson, New Scientist  
* Apr 15, 2020, [https://www.washingtonpost.com/health/coronavirus-destroys-lungs-but-doctors-are-finding-its-damage-in-kidneys-hearts-and-elsewhere/2020/04/14/7ff71ee0-7db1-11ea-a3ee-13e1ae0a3571_story.html Coronavirus destroys lungs. But doctors are finding its damage in kidneys, hearts and elsewhere]<ref name="WashPost15042020">{{Cite news| title = Coronavirus destroys lungs. But doctors are finding its damage in kidneys, hearts and elsewhere | date = Apr 15, 2020|url=https://www.washingtonpost.com/health/coronavirus-destroys-lungs-but-doctors-are-finding-its-damage-in-kidneys-hearts-and-elsewhere/2020/04/14/7ff71ee0-7db1-11ea-a3ee-13e1ae0a3571_story.html | first = Lenny | last = Bernstein | first2 =Carolyn Y. | last2 = Johnson | first3=Sarah | last3 = Kaplan | first4 = Laurie|last4 = McGinley|publisher=Washington Post}}</ref> - Lenny Bernstein, Carolyn Y. Johnson, Sarah Kaplan and Laurie McGinley, Washington Post
* Apr 15, 2020, [https://www.washingtonpost.com/health/coronavirus-destroys-lungs-but-doctors-are-finding-its-damage-in-kidneys-hearts-and-elsewhere/2020/04/14/7ff71ee0-7db1-11ea-a3ee-13e1ae0a3571_story.html Coronavirus destroys lungs. But doctors are finding its damage in kidneys, hearts and elsewhere]<ref name="WashPost15042020">{{Cite news | title = Coronavirus destroys lungs. But doctors are finding its damage in kidneys, hearts and elsewhere | date = Apr 15, 2020|url=https://www.washingtonpost.com/health/coronavirus-destroys-lungs-but-doctors-are-finding-its-damage-in-kidneys-hearts-and-elsewhere/2020/04/14/7ff71ee0-7db1-11ea-a3ee-13e1ae0a3571_story.html | first = Lenny | last = Bernstein | first2 =Carolyn Y. | last2 = Johnson | first3 = Sarah | last3 = Kaplan | first4 = Laurie | last4 = McGinley|publisher=Washington Post}}</ref> - Lenny Bernstein, Carolyn Y. Johnson, Sarah Kaplan and Laurie McGinley, Washington Post
*Apr 13, 2020, [https://www.nytimes.com/2020/04/13/opinion/coronavirus-recovery.html We Need to Talk About What Coronavirus Recoveries Look Like]<ref name="Lowenstein13042020">{{Cite news|url=https://www.nytimes.com/2020/04/13/opinion/coronavirus-recovery.html | date = 2020-04-13|publisher=New York Times| title = We Need to Talk About What Coronavirus Recoveries Look Like | last = Lowenstein | first = Fiona | author-link=Fiona Lowenstein | last2 = Davis | first2 = Hannah  | authorlink2 = Hannah Davis}}</ref> - Fiona Lowenstein and Hannah Davis, New York Times Opinion
*Apr 13, 2020, [https://www.nytimes.com/2020/04/13/opinion/coronavirus-recovery.html We Need to Talk About What Coronavirus Recoveries Look Like]<ref name="Lowenstein13042020">{{Cite news | url=https://www.nytimes.com/2020/04/13/opinion/coronavirus-recovery.html | date = 2020-04-13|publisher=New York Times| title = We Need to Talk About What Coronavirus Recoveries Look Like | last = Lowenstein | first = Fiona | authorlink = Fiona Lowenstein | last2 = Davis | first2 = Hannah  | authorlink2 = Hannah Davis}}</ref> - Fiona Lowenstein and Hannah Davis, New York Times Opinion
*Apr 2, 2020, [http://simmaronresearch.com/2020/04/will-covid-19-leave-an-explosion-of-me-cfs-cases-in-its-wake/? Will COVID-19 -19 leave an explosion of ME/CFS cases in its wake?] - blog by [[Cort Johnson]]
*Apr 2, 2020, [http://simmaronresearch.com/2020/04/will-covid-19-leave-an-explosion-of-me-cfs-cases-in-its-wake/? Will COVID-19 -19 leave an explosion of ME/CFS cases in its wake?] - blog by [[Cort Johnson]]
*Mar 28, 2020, [https://www.nbcnews.com/health/health-news/post-intensive-care-syndrome-why-some-covid-19-patients-may-n1166611 'Post intensive-care syndrome': Why some COVID-19 patients may face problems even after recovery]<ref name="nbc28032020">{{Cite news| title = Potential Post intensive-care syndrome': Why some COVID-19 patients may face problems even after recovery|url=https://www.nbcnews.com/health/health-news/post-intensive-care-syndrome-why-some-covid-19-patients-may-n1166611 | date =Mar 28, 2020 | last = Edwards | first = Erika|publisher=NBC News}}</ref> - Erika Edwards, NBC News
*Mar 28, 2020, [https://www.nbcnews.com/health/health-news/post-intensive-care-syndrome-why-some-covid-19-patients-may-n1166611 'Post intensive-care syndrome': Why some COVID-19 patients may face problems even after recovery]<ref name="nbc28032020">{{Cite news | title = Potential Post intensive-care syndrome': Why some COVID-19 patients may face problems even after recovery|url=https://www.nbcnews.com/health/health-news/post-intensive-care-syndrome-why-some-covid-19-patients-may-n1166611 | date =Mar 28, 2020 | last = Edwards | first = Erika|publisher=NBC News}}</ref> - Erika Edwards, NBC News


==See also==
==See also==
Line 154: Line 154:
*[[Opposition_to_Oxford_Health_NHS_Foundation_Trust:_%22Coping_with_Coronavirus:_Fatigue%22#References|Opposition to to Oxford Health NHS Foundation Trust: "Coping with Coronavirus: Fatigue"]]
*[[Opposition_to_Oxford_Health_NHS_Foundation_Trust:_%22Coping_with_Coronavirus:_Fatigue%22#References|Opposition to to Oxford Health NHS Foundation Trust: "Coping with Coronavirus: Fatigue"]]
*[[Fibromyalgia]]
*[[Fibromyalgia]]
*[[Living with M.E.]]<ref name="Livingwithme">{{Cite book | title = Living With M.E.|pages=|isbn=978-1-4090-2095-0|edition=|volume=|language=en|title-link=Living with M.E.|url=|access-date= | date = 2008-12-05|publisher=Random House | last = Shepherd | first=Charles|author-link=Charles Shepherd|others=|oclc=|quote=|archive-url=|archive-date=|location=}}</ref> - Dr Charles Shepherd (book)
*[[Living with M.E.]]<ref name="Livingwithme">{{Cite book | title = Living With M.E.|pages=|isbn=978-1-4090-2095-0|edition=|volume=|language=en|title-link=Living with M.E. | url = |access-date= | date = 2008-12-05|publisher=Random House | last = Shepherd | first = Charles | authorlink = Charles Shepherd|others=|oclc=|quote=|archive-url=|archive-date=|location=}}</ref> - Dr Charles Shepherd (book)


==Learn more==
==Learn more==
* Sep 2020, [https://www.gov.uk/government/publications/covid-19-long-term-health-effects/covid-19-long-term-health-effects COVID-19: Long Term Health Effects] - NHS
* Sep 2020, [https://www.gov.uk/government/publications/covid-19-long-term-health-effects/covid-19-long-term-health-effects COVID-19: Long Term Health Effects] - NHS
* May 2020, [https://www.meassociation.org.uk/wp-content/uploads/MEA-PVF-and-PVFS-Following-Coronavirus-Infection-30.04.20.pdf MEA Information on Post-viral fatigue (PVF) and Post-viral fatigue syndrome (PVFS) following coronovirus infection]<ref name="MEA-PVF-PVFSleaflet">{{Cite web|url=https://www.meassociation.org.uk/wp-content/uploads/MEA-PVF-and-PVFS-Following-Coronavirus-Infection-30.04.20.pdf| title = MEA INFORMATION ON Post-viral fatigue (PVF) and Post-viral fatigue syndrome (PVFS) following coronovirus infection | date = May 2020 | last = ME Association |author-link=ME Association|access-date=May 1, 2020 | website = [[ME Association]]}}</ref> - ME Association
* May 2020, [https://www.meassociation.org.uk/wp-content/uploads/MEA-PVF-and-PVFS-Following-Coronavirus-Infection-30.04.20.pdf MEA Information on Post-viral fatigue (PVF) and Post-viral fatigue syndrome (PVFS) following coronovirus infection]<ref name="MEA-PVF-PVFSleaflet">{{Cite web|url=https://www.meassociation.org.uk/wp-content/uploads/MEA-PVF-and-PVFS-Following-Coronavirus-Infection-30.04.20.pdf| title = MEA INFORMATION ON Post-viral fatigue (PVF) and Post-viral fatigue syndrome (PVFS) following coronovirus infection | date = May 2020 | last = ME Association | authorlink = ME Association|access-date=May 1, 2020 | website = [[ME Association]]}}</ref> - ME Association
* May 2020, [https://www.physiosforme.com/covid-19 Post Covid-19 Rehabilitation]<ref name="PhysiosforME-COVID19">{{Cite web|url=https://www.physiosforme.com/covid-19| title = Post Covid-19 Rehabilitation | last = Physio for ME | first = |authorlink=Physios for ME | last2 = Workwell Foundation | first2= | authorlink2 = Workwell Foundation | date = May 2020 | website = Physiosforme|language=en|archive-url=|archive-date=|url-status=|access-date=2020-05-02 | last3 = ME Association | author-link3=ME Association}}</ref> - [[Physios for ME]], [[Workwell Foundation]], and [[ME Association]]
* May 2020, [https://www.physiosforme.com/covid-19 Post Covid-19 Rehabilitation]<ref name="PhysiosforME-COVID19">{{Cite web|url=https://www.physiosforme.com/covid-19| title = Post Covid-19 Rehabilitation | last = Physio for ME | first = | authorlink = Physios for ME | last2 = Workwell Foundation | first2 = | authorlink2 = Workwell Foundation | date = May 2020 | website = Physiosforme|language=en|archive-url=|archive-date=|url-status=|access-date=2020-05-02 | last3 = ME Association | author-link3 = ME Association}}</ref> - [[Physios for ME]], [[Workwell Foundation]], and [[ME Association]]
* May 2020, [https://le.ac.uk/news/2020/may/coronavirus-me-risk Patients at higher risk of developing ME after COVID-19 diagnosis] - University of Leicester
* May 2020, [https://le.ac.uk/news/2020/may/coronavirus-me-risk Patients at higher risk of developing ME after COVID-19 diagnosis] - University of Leicester
* Apr 30, 2020, [https://www.meassociation.org.uk/2020/04/covid-19-and-post-viral-fatigue-syndrome-by-dr-charles-shepherd-30-april-2020/? Covid-19 and Post-viral Fatigue Syndrome]<ref name="MEA-Covid19-PVFS-20200430">{{Cite web|url= https://www.meassociation.org.uk/2020/04/covid-19-and-post-viral-fatigue-syndrome-by-dr-charles-shepherd-30-april-2020/?| title = Covid-19 and Post-viral Fatigue Syndrome by Dr Charles Shepherd | date = Apr 30, 2020 | last = Charles Shepherd | author-link=Charles Shepherd|access-date=May 1, 2020 | website = meassociation.org}}</ref> - Charles Shepherd, ME Association
* Apr 30, 2020, [https://www.meassociation.org.uk/2020/04/covid-19-and-post-viral-fatigue-syndrome-by-dr-charles-shepherd-30-april-2020/? Covid-19 and Post-viral Fatigue Syndrome]<ref name="MEA-Covid19-PVFS-20200430">{{Cite web|url= https://www.meassociation.org.uk/2020/04/covid-19-and-post-viral-fatigue-syndrome-by-dr-charles-shepherd-30-april-2020/?| title = Covid-19 and Post-viral Fatigue Syndrome by Dr Charles Shepherd | date = Apr 30, 2020 | last = Charles Shepherd | authorlink = Charles Shepherd|access-date=May 1, 2020 | website = meassociation.org}}</ref> - Charles Shepherd, ME Association
*[https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_ABX_Guide/540747/all/Coronavirus_COVID_19__SARS_CoV_2_ Coronavirus disease 19 (SARS-CoV-2)] - John Hopkins University
*[https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_ABX_Guide/540747/all/Coronavirus_COVID_19__SARS_CoV_2_ Coronavirus disease 19 (SARS-CoV-2)] - John Hopkins University
* [https://airtable.com/shrQ1uCYwLYf6uiA9 List of Long Covid  studies] - ME Action
* [https://airtable.com/shrQ1uCYwLYf6uiA9 List of Long Covid  studies] - ME Action

Latest revision as of 14:16, July 25, 2023

Post-COVID-19 illness and recovery. A wave of chronically ill and slow-healing survivors is an inevitability we can and must prepare ourselves for. - Fiona Lowenstein

There have been some reports of long term illness in survivors of COVID-19; it is unclear how many people are affected at this stage.[1][2][3] A small early study from Wuhan, China, found that survivors of COVID-19 who tested negative twice before discharge from hospital still had some abnormalities in metabolism and liver function markers when discharged.[4]

Long COVID[edit | edit source]

Many patients, dubbed long haulers, have described continuing symptoms of COVID-19, often described as long COVID, which include chronic, severe fatigue, brain fog (thinking and concentration problems), breathlessness, muscle pain, inability to exercise and other symptoms.[5][6] Several studies have found groups of patients continuing to experience many symptoms of COVID-19,[7][8] including patients who were not ill enough to be hospitalized.[6] There is an absence of medical advice and little information on the likely prognosis for these patients.[5]

Relapse or reinfection[edit | edit source]

Some patients have described feeling fully recovered, then experiencing COVID-19 symptoms again, and feeling like their lungs were "on fire" for some weeks afterwards.[3] There has been uncertainty about whether this is a relapse due to the virus remaining at low levels in the body and being reactivated, an immune system rebound response, or a reinfection; a relapsing / remitting pattern of COVID-19 became known as Long COVID.[9][10][11]

Post-SARS illness[edit | edit source]

COVID-19 is caused by the SARS-CoV-2 virus; the similar SARS-CoV coronavirus causes SARS, and SARS is known to have caused long term illness in some survivors, including chronic fatigue syndrome and a post-SARS syndrome similar to fibromyalgia involving chronic widespread musculoskeletal pain, fatigue, depression and disordered sleep.[12][13]

Severe COVID-19 survivors[edit | edit source]

Post-Intensive Care Syndrome[edit | edit source]

Post-COVID-19 illness. The notion that patients surviving intensive care and mechanical ventilation for several weeks can be discharged home without further medical attention is a dangerous illusion." - Stam, Stucki & Bickenbach (2020)
Post Intensive Care Syndrome symptoms. Source: J Rehabil Med 2020; 52: jrm00044. License: CC-BY NC.


Long term physical, cognitive and mental health problems have also been found to be relatively common in patients discharged from intensive care from illnesses other than COVID-19, with the length of time in intensive care influencing the long term health impacts.[14]

Post Intensive Care Syndrome (PICS) is one of several conditions that can result, including Critical Illness Polyneuropathy (CIP) and Critical Illness Myopathy (CIM), and requires both short and medium term rehabilitation treatments.[15]

COVID-19 pneumonia and SARI[edit | edit source]

Moderately ill patients with COVID-19 may develop mild viral pneumonia.[16] Severe acute respiratory infection (SARI) is known to develop in some people severely ill with COVID-19. SARI resulting from other illnesses has been studied.[17]

Acute respiratory distress syndrome[edit | edit source]

Acute respiratory distress syndrome (ARDS) is a life-threatening condition that involves the patient's lungs becoming inflamed, and being unable to produce enough oxygen for the body's vital organs.[18] ARDS develops in 17-29% of hospitalized COVID-19 patients and is known to have long term effects.[19][20][16] ARDS can cause nerve and muscle damage, which causes pain and weakness.[18]

Mechanical ventilator effects[edit | edit source]

Invasive ventilation using a mechanical ventilator was needed by 47-71% of patients admitted to Intensive Care Units.[19]

COVID-19 complications[edit | edit source]

These include:

  • Anecdotal reports of DVT and pulmonary embolism in critically ill patients
  • Central nervous system encephalitis and encephalomyelitis
  • anecdotal evidence of pulmonary aspergillosis
  • pneumonia
  • hypoxemic respiratory failure/ARDS
  • sepsis and septic shock
  • cardiomyopathy and arrhythmia
  • acute kidney injury
  • complications from prolonged hospitalization including:

Fatigue after COVID-19[edit | edit source]

COVID-19 can cause severe fatigue, however experiencing fatigue after recovering from the virus should not be the considered the same as the illness chronic fatigue syndrome (CFS) or myalgic encephalomyelitis (ME), a neurological disease involving multiple bodily systems and sustained symptoms over an extended period of time.[22][23] Post-viral fatigue which does not meet the criteria for CFS or ME and lasts at least 6 months is known as chronic fatigue (without the "syndrome"), or idiopathic chronic fatigue if the cause is unknown.[24][25][23]

Potential brain damage[edit | edit source]

Scientists warn of a potential wave of coronavirus-related brain damage as new evidence suggests COVID-19 can lead to severe neurological complications, including brain inflammation, psychosis and delirium.[26][21]

“Whether we will see an epidemic on a large scale of brain damage linked to the pandemic – perhaps similar to the encephalitis lethargica outbreak in the 1920s and 1930s after the 1918 influenza pandemic – remains to be seen,” said Michael Zandi, from UCL’s Institute of Neurology, who co-led the study.[26]

Reuters reported:

A study by researchers at University College London (UCL) described 43 cases of patients with COVID-19 who suffered either temporary brain dysfunction, strokes, nerve damage or other serious brain effects.
Previous research has also shown COVID-19 could damage the brain in some patients.[26][21]

Post-viral syndrome[edit | edit source]

Post-viral syndrome or post-viral state is sometimes used to refer to symptoms that occur as a result of a virus, which take longer than a few weeks to resolve. The older term Post-infective fatigue is no longer in use. Post-viral syndrome may include shortness of breath, fatigue, difficulty thinking, aches and pains, or other symptoms, and typically improves gradually over time. People who remain ill after 6 months may meet the criteria for postviral fatigue syndrome (PVFS), which is more commonly diagnosed as chronic fatigue syndrome or myalgic encephalomyelitis, although it may be possible to diagnose this sooner using the international consensus criteria.[23][25][24] For most people, this is a very disabling, long-term (chronic) illness.[1][22][23][25]

Dr. Anthony Fauci, the United States top infectious disease expert, acknowledged that many unrecovered COVID-19 patients may have ME, also known as chronic fatigue syndrome, or ME/CFS.[27][28] Dr. Fauci stated: “There may well be a post-viral syndrome associated with Covid-19,...If you look anecdotally, there is no question that there are a considerable number of individuals who have a post-viral syndrome that in many respects incapacitates them for weeks and weeks following so-called recovery,”[28] At the International AIDS conference, Fauci stated: "Brain fog, fatigue, and difficulty in concentrating. So this is something we really need to seriously look at because it very well might be a post-viral syndrome associated with COVID-19.[29]

An internist at Texas Health Presbyterian Hospital, Dr. Donna Casey, said “We can now see documented abnormalities in your nervous system, immune, and metabolic systems. So we’re seeing abnormalities in all three that create myalgic encephalomyelitis.”[30] Dr. Casey did say that we are not at the six month mark[31][32] for COVID, but she does see ongoing improvement in her hospitalized patients.[30] Dr. Amir K. Ghiassi, a pulmonologist with St. Joseph Hospital in Orange County, California said of the ongoing symptoms they were uncertain if it had to do with the virus or “because of the immune system reacting the way it does that causes symptoms.”[30]

Postviral fatigue syndrome and ME/CFS[edit | edit source]

COVID-19 and ME/CFS. "It's quite likely that some people will be developing a post-viral fatigue syndrome, which may then lead into an ME/CFS-like illness." - Charles Shepherd, M.E. Association

Myalgic encephalomyelitis, better known as ME, is a neurological disease that commonly begins after a virus, although other possible triggers include bacterial infections, injuries, surgery and other events.[24][23][33] Some researchers and some patients use the term chronic fatigue syndrome (CFS), or ME/CFS to refer to ME, although CFS has different diagnostic criteria.[25][24][23] The older term Postviral fatigue syndrome (PVFS) is rarely used, although the World Health Organization recognize PVFS, ME, and CFS using the same diagnostic code. Some countries including the United States, deviate from this.[33][34]

PVFS (post-viral fatigue syndrome)

This term was introduced during the eariy 1980s in Britain as an alternative to ME. It remains a useful description for anyone whose illness can clearly be traced back to an acute viral infection. The drawback to PVFS is that it cannot be used to describe cases where some other factor (e.g. vaccination or pesticide) acted as the principal trigger.[35]

Dr Charles Shepherd, Living with M.E. (2008)


Moldofsky et al. (2011) conducted a long term follow up of 21 SARS survivors in Toronto, Canada, all of who remained too ill to return to work, and concluded that that chronic post-SARS was similar to fibromyalgia.[13] Lam et al. (2009) conducted a much larger long term follow-up of SARS survivors in Hong Kong, and reported that 27% had chronic fatigue syndrome, 40% had chronic fatigue, and 40% has depression.[12] A number of the SARS survivors unable to return to work were previously healthy health-care workers.[12] The high rates of chronic fatigue could not be accounted got by depression or psychiatric illness.[12]

Treatment[edit | edit source]

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.[22]

A group of over 20 ME and chronic fatigue syndrome specialists and patient groups have recommended fatigue after COVID-19 should be treated/managed using:

Pacing[edit | edit source]

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.[37] ME patient associations surveys have found pacing helped most, but not all, patients.[38][39]

CBT and GET not recommended for fatigue[edit | edit source]

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 open letter opposing the leaflet was signed by a large number of medical professionals and UK patient groups at around the same time.[22]

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 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.[22] CBT and GET are no longer recommended by the 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.[38][40][41][39] CBT and GET they are not recommended by the UK's ME Association, Action for ME, Invest in ME Research, The MEAction Network, or The 25% ME Group.[40][41][42][39][41] CBT may be useful for depression or generalized anxiety.[43][44]

Recovery advice[edit | edit source]

Notable studies on the short- and long-term effects of COVID-19[edit | edit source]

  • Jun 25, 2020, Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study[21] - (Full text) from the CoroNerve platform
  • Jun 29, 2020 (pre-print), Blood parameters measured on admission as predictors of outcome for COVID-19; a prospective UK cohort study[45] - (Full text) - from the DISCOVER study
  • Jul 8, 2020, Postdischarge symptoms and rehabilitation needs in survivors of COVID-19 infection: A cross-sectional evaluation[7] - (Full text)
  • Jul 8, 2020, The emerging spectrum of COVID-19 neurology: clinical, radiological and laboratory findings[46] - (Full text)
  • Aug 14, 2020 (pre-print), Patient outcomes after hospitalisation with COVID-19 and implications for follow-up; results from a prospective UK cohort[8] - (Full text) - from the DISCOVER project

Notable studies announced or in progress[edit | edit source]

  • CoroNerve Study Group - by collaboration of specialists in neurology, psychiatry, stroke and intensive care run by Perspectum, Oxford University Hospitals NHS Trust and the Mayo Clinic, UK - website
  • COVID-19 and ME/CFS - severely ill hospitalised patients will be followed through recovery and rehabilitation, with biological samples taken at different stages, to look at how patients who develop ME/CFS and post-viral fatigue triggered by COVID-19 do so, and to look at monitor other illness which may develop eg fibromyalgia - run by the Open Medicine Foundation charity - US and Sweden - Website
  • DISCOVER - DIagnostic and Severity markers of COVid-19 to Enable Rapid triage
University of Bristol, UK - DISCOVER announcement
The world's largest set of data for investigating Long COVID[47] Lead by Tim Spector.
  • Covid-19 Symptômes persistants enquête - France
  • COVIDENCE UK Research Study
A UK-wide study with a number of different aims, including monitoring long term complications of COVID-19, recovery, and wider physical, mental and economic wellbeing.[48] - COVIDENCE website
"a consortium of leading researchers and clinicians from across the UK working together to understand and improve long-term health outcomes for patients who have been in hospital with confirmed or suspected COVID-19", University of Leicester, UK

News articles and blogs[edit | edit source]

See also[edit | edit source]

Learn more[edit | edit source]

References[edit | edit source]

  1. 1.0 1.1 1.2 Wilson, Clare (April 15, 2020). "Could the coronavirus trigger post-viral fatigue syndromes?". New Scientist.
  2. Kucher, Daniel (April 16, 2020). "User Those Who Get COVID-19 and Get Healed Can Face Another Disease After A Few Years". SOMAG news.
  3. 3.0 3.1 Malamut, Melissa (April 17, 2020). "Coronavirus survivors say they fear long-term effects". New York Post.
  4. Wu, Di; Shu, Ting; Yang, Xiaobo; Song, Jian-Xin; Zhang, Mingliang; Yao, Chengye; Wen, Liu; Huang, Muhan; Yu, Yuan (April 21, 2020). "Plasma Metabolomic and Lipidomic Alterations Associated with COVID-19". medRxiv: 2020.04.05.20053819. doi:10.1101/2020.04.05.20053819.
  5. 5.0 5.1 Yelin, Dana; Wirtheim, Eytan; Vetter, Pauline; Kalil, Andre C.; Bruchfeld, Judith; Runold, Michael; Guaraldi, Giovanni; Mussini, Cristina; Gudiol, Carlota (October 1, 2020). "Long-term consequences of COVID-19: research needs". The Lancet Infectious Diseases. 20 (10): 1115–1117. doi:10.1016/S1473-3099(20)30701-5. ISSN 1473-3099. PMID 32888409.
  6. 6.0 6.1 National Health Service (September 7, 2020). "COVID-19 Long Term Health Effects".
  7. 7.0 7.1 Halpin, Stephen J.; McIvor, Claire; Whyatt, Gemma; Adams, Anastasia; Harvey, Olivia; McLean, Lyndsay; Walshaw, Christopher; Kemp, Steven; Corrado, Joanna. "Postdischarge symptoms and rehabilitation needs in survivors of COVID-19 infection: A cross-sectional evaluation". Journal of Medical Virology. 93 (2): 1013–1022. doi:10.1002/jmv.26368. ISSN 1096-9071.
  8. 8.0 8.1 Arnold, David T.; Hamilton, Fergus W.; Milne, Alice; Morley, Anna; Viner, Jason; Attwood, Marie; Noel, Alan; Gunning, Samuel; Hatrick, Jessica (August 14, 2020). "Patient outcomes after hospitalisation with COVID-19 and implications for follow-up; results from a prospective UK cohort". medRxiv: 2020.08.12.20173526. doi:10.1101/2020.08.12.20173526.
  9. Whitaker, Phil. "What I've learned on the front line against Long Covid". New Statesman. Retrieved October 7, 2020.
  10. Buskermolen, Maaike; Te Paske, Karlijn; Van Beek, Janko; Kortbeek, Titia; Götz, Hannelore; Fanoy, Ewout; Feenstra, Sabiena; Richardus, Jan Hendrik; Vollaard, Albert (June 17, 2021). "Relapse in the first 8 weeks after onset of COVID-19 disease in outpatients: Viral reactivation or inflammatory rebound?". Journal of Infection. doi:10.1016/j.jinf.2021.06.015. ISSN 0163-4453. PMID 34147529.
  11. Tang, Xiujuan; Musa, Salihu S.; Zhao, Shi; He, Daihai (June 11, 2021). "Reinfection or Reactivation of Severe Acute Respiratory Syndrome Coronavirus 2: A Systematic Review". Frontiers in Public Health. 9. doi:10.3389/fpubh.2021.663045. ISSN 2296-2565. PMC 8226004. PMID 34178920.
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  13. 13.0 13.1 Moldofsky, Harvey; Patcai, John (March 24, 2011). "Chronic widespread musculoskeletal pain, fatigue, depression and disordered sleep in chronic post-SARS syndrome; a case-controlled study". BMC Neurology. 11 (1): 37. doi:10.1186/1471-2377-11-37. ISSN 1471-2377. PMC 3071317. PMID 21435231.
  14. 14.0 14.1 Edwards, Erika (March 28, 2020). "Potential Post intensive-care syndrome': Why some COVID-19 patients may face problems even after recovery". NBC News.
  15. Stam, H J; Stucki, G; J, Bickenbach (April 15, 2020). "Covid-19 and Post Intensive Care Syndrome: A Call for Action". Journal of rehabilitation medicine. doi:10.2340/16501977-2677. PMID 32286675. Retrieved April 23, 2020.
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  17. Zhang, Chen; Zhu, Na; Xie, Zhengde; Lu, Roujian; He, Bin; Liu, Chunyan; Ma, Xuejun; Tan, Wenjie (August 22, 2013). "Viral Etiology and Clinical Profiles of Children with Severe Acute Respiratory Infections in China". PLOS ONE. 8 (8): e72606. doi:10.1371/journal.pone.0072606. ISSN 1932-6203. PMC 3750056. PMID 23991128.
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  22. 22.0 22.1 22.2 22.3 22.4 22.5 "Opposition to Oxford Health NHS Foundation Trust: "Coping with Coronavirus: Fatigue"" (PDF). April 20, 2020.
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  24. 24.0 24.1 24.2 24.3 Carruthers, BM; van de Sande, MI; De Meirleir, KL; Klimas, NG; Broderick, G; Mitchell, T; Staines, D; Powles, ACP; Speight, N; Vallings, R; Bateman, L; Bell, DS; Carlo-Stella, N; Chia, J; Darragh, A; Gerken, A; Jo, D; Lewis, DP; Light, AR; Light, KC; Marshall-Gradisnik, S; McLaren-Howard, J; Mena, I; Miwa, K; Murovska, M; Stevens, SR (2012), Myalgic encephalomyelitis: Adult & Paediatric: International Consensus Primer for Medical Practitioners (PDF), ISBN 978-0-9739335-3-6
  25. 25.0 25.1 25.2 25.3 Carruthers, Bruce M.; Jain, Anil Kumar; De Meirleir, Kenny L.; Peterson, Daniel L.; Klimas, Nancy G.; Lerner, A. Martin; Bested, Alison C.; Flor-Henry, Pierre; Joshi, Pradip; Powles, AC Peter; Sherkey, Jeffrey A.; van de Sande, Marjorie I. (2003), "Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols" (PDF), Journal of Chronic Fatigue Syndrome, 11 (2): 7–115, doi:10.1300/J092v11n01_02
  26. 26.0 26.1 26.2 "Scientists warn of potential wave of COVID-linked brain damage". Reuters. July 7, 2020. Retrieved July 8, 2020.
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  29. https://www.youtube.com/watch?v=UMmT48IC0us
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  32. "Diagnostic Algorithm for ME/CFS". National Academy of Medicine (Formerly the Institute of Medicine).
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  37. 37.0 37.1 Tuller, David (April 16, 2020). "Trial By Error: Oxford-NHS Recommends GET/CBT for Post-COVID "CFS" Patients". Virology blog.
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