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COVID-19 vaccines

2022-01-20T15:45:08Z

Loopy:x

[[File:Covid vaccine.png|300px|thumb|COVID-19 Vaccine]]

'''Coronavirus disease 19''' or '''coronavirus''' has a range of different [[vaccine]]s available, and the vaccines work using many different methods including old, well-established technologies like inactivated vaccines, newer viral vector vaccines, and mRNA engineering vaccines.

==Vaccine approvals==
Some COVID-19 vaccines are now fully approved in certain countries, some approved for emergency use only after clinical trials, and a few COVID vaccines only permitted for experimental use (generally limited to Russia, parts of Eastern Europe, and parts of Asia). COVID-19 vaccines are designed to protect against the [[Severe acute respiratory syndrome coronavirus 2|virus that causes COVID-19]], preventing COVID-19 will also provide protection against [[Long COVID]] because it is only caused by COVID-19.<ref name="ACR">{{Cite web|date= Mar 2021|url =https://www.rheumatology.org/Portals/0/Files/ACR-Information-Vaccination-Against-SARS-CoV-2.pdf|title =Information on Vaccination Against SARS-CoV-2|website = American College of Rheumatology}}</ref>

==ME/CFS ==
* Dec 2 2021, [https://youandmeregistry.com/after-covid-19-vaccination-health-of-people-with-me-cfs-more-likely-to-worsen-compared-to-controls/ After Covid-19 Vaccination, Health of People with ME/CFS More Likely to Worsen Compared to Controls] You + ME
<blockquote>About five months after receiving their first or only shot of Covid-19 vaccine, 19% of survey participants with [[ME/CFS]] indicated their health had worsened, 9% reported that it had improved and 73% responded that it had not changed. </blockquote><blockquote>This compares to 4% of controls (people who did not have ME/CFS) who said their health had worsened, 7% who indicated it had improved and 89% who reported it had not changed.</blockquote>

==ME/CFS advice from specialists ==
* [https://www.nova.edu/nim/To-Vaccinate-or-Not-with-MECFS.html To Vaccinate or Not - with ME/CFS] - [[Nancy Klimas]], Nova Southeastern University
* [https://batemanhornecenter.org/wp-content/uploads/filebase/COVIDVaccineGuide01072021.pdf Bateman Horne Center COVID-19 Vaccine Guide]
*[https://25megroup.org/download/1796/?v=3689 25% ME Group (for severe ME), ME Association and Action for ME statement]
*[https://drlapp.com/ask-the-doctor/covid-19-vaccines/? Covid-19 vaccines] - Dr Charles Lapp
*[https://meassociation.org.uk/2021/01/free-leaflet-covid-19-vaccine-update-by-dr-charles-shepherd/? ME Association]

* Dec 2020, [https://www.healthrising.org/wp-content/uploads/2021/01/Covid19-vaccine.pdf COVID-19 Vaccine] - Center for Complex Diseases

*[https://www.healthrising.org/blog/2021/01/28/coronavirus-vaccine-effects-chronic-fatigue-syndrome-fibromyalgia/?unapproved=1000271&moderation-hash=c2ffbc9abdfe5d4b51f2b22c33e7186b#comment-1000271 COVID-19 vaccine side effects poll results for ME/CFS] - HealthRising

==Immunocompromised people ==
People with [[ME/CFS]] have [[immune system]] dysfunction, but are not considered immunocompromised, instead many may have an [[Autoimmune hypothesis|overactive immune system]].{{Citation needed|date=Mar 2021}}

People who are regarded as immunocompromised, such as those living with HIV, or who are immunosuppressed, such as whole organ or stem cell transplant or who are taking [[:Category:immunosuppressants|immunosuppressants]] are as '''significantly greater risk''' of severe illness from COVID-19, and they do not need to automatically avoid COVID-19 vaccination; the Pfizer/BioNTech, AstraZeneca/Oxford, and Moderna vaccines have been approved for use in these patients in the UK and none of these contain any active or live [[Severe acute respiratory syndrome coronavirus 2|SARS-CoV-2]] virus particles.<ref name="immunocompromised-bsi">https://www.immunology.org/news/bsi-statement-covid-19-vaccines-for-patients-immunocompromised-immunosuppressed</ref>

Vaccines work better in people who are not immunocompromised or immunosuppressed, but these people are likely to achieve a lower lower of protection against [[COVID-19]].<ref name="immunocompromised-bsi" /> The British Society for Immunology recommend that immunocompromised and immunosuppressed people get a COVID-19 vaccine, and to have both doses, since this will still give some protection against COVID-19, and will help protect them from becoming seriously ill.<ref name="immunocompromised-bsi" />

People with stable HIV took part in the Pfizer-BioNTech and Moderna mRNA COVID-19 vaccine trials, although in general there is limited information on safety and efficacy of COVID-19 vaccines for immunocompromised and immunosuppressed people.<ref name="immunocompromised-bsi" />

Immosuppressants that may be used in people with [[ME/CFS]] include [[cyclophosphamide]] (a nitrogen mustard), [[dexamethasone]], [[hydrocortísone]], [[prednisolone]] and [[rituximab]].<ref name="immunosup-ie">{{Cite web|url=https://www.hse.ie/eng/services/publications/clinical-strategy-and-programmes/list-of-immunosuppressant-medication.pdf|access-date=Mar 17, 2021|title=List of Immunosuppressants|website=HSE (Ireland)}}</ref><ref name="isdrugs-drugbank">{{Cite web|url=https://go.drugbank.com/categories/DBCAT000047|access-date=Mar 17, 2021|title=Immunosuppressive Agents|website=DrugBank Online}}</ref>

==See also ==
*[[Coronavirus disease 19|COVID-19]]
*[[Long COVID]]
*[[Vaccine]]

==Learn more ==
* Jan 2021, [https://www.healthrising.org/blog/2021/01/28/coronavirus-vaccine-effects-chronic-fatigue-syndrome-fibromyalgia/ The Coronavirus Vaccine Side Effects Poll for ME/CFS and Fibromyalgia] - [[Health Rising]]
* Jan 2021, [https://www.healthrising.org/blog/2021/01/03/chronic-fatigue-fibromyalgia-experts-coronavirus-vaccine/ ME/CFS and FM Experts on Whether to Take the Coronavirus Vaccine – Plus The Vaccine Polls] - Health Rising

===Allergies and MCAS ===
*[https://acaai.org/news/acaai-updates-guidance-risk-allergic-reactions-covid-19-vaccines ACAAI Provides Further Guidance on Risk of Allergic Reactions to mRNA COVID-19 Vaccines] - American College of Allergy, Asthma and Immunology
*[https://acaai.org/news/acaai-provides-further-guidance-risk-allergic-reactions-mrna-covid-19-vaccines ACAAI Provides Further Guidance on Risk of Allergic Reactions to mRNA COVID-19 Vaccines]
*[https://acaai.org/news/american-college-allergy-asthma-and-immunology-updates-guidance-risk-allergic-reactions-mrna American College of Allergy, Asthma and Immunology COVID-19 vaccine recommendations]
*[https://www.anaphylaxis.org.uk/covid-19-advice/pfizer-covid-19-vaccine-and-allergies/ Anaphylaxis (allergies) COVID-19 Vaccine advice] - The Mast Cell Disease Society
*[https://tmsforacure.org/covid19-statement/ Covid-19 statement] - The Mast Cell Disease Society and Physicians from TMS Medical Advisory Board

===Immunosuppressant therapy and COVID-19 vaccines===
* Mar 2021, [https://www.rheumatology.org/Portals/0/Files/ACR-Information-Vaccination-Against-SARS-CoV-2.pdf Information on Vaccination Against SARS-CoV-2] - American College of Rheumatology guidance - for people on immunosuppressive therapy

===General COVID-19 vaccine information ===
*[https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/allergic-reaction.html CDC Allergic reactions to the Coronavirus Vaccine]
*[https://www.who.int/news-room/feature-stories/detail/who-can-take-the-pfizer-biontech-covid-19--vaccine Who can take the Pfizer-BioNTech COVID-19 vaccine?] - World Health Organization
*[https://www.nhs.uk/covidvaccination COVID B vaccination] - National Health Service
*[https://www.ulh.nhs.uk/content/uploads/2020/12/PHE-vaccine-leaflet.pdf Public Health England COVID-19 vaccine leaflet]

==References ==
{{Reflist}}

[[Category:Vaccines]]

COVID-19 vaccines

2022-01-20T15:44:29Z

Loopy:Upload Image

[[File:Covid vaccine.png|200px|thumb|COVID-19 Vaccine]]

'''Coronavirus disease 19''' or '''coronavirus''' has a range of different [[vaccine]]s available, and the vaccines work using many different methods including old, well-established technologies like inactivated vaccines, newer viral vector vaccines, and mRNA engineering vaccines.

==Vaccine approvals==
Some COVID-19 vaccines are now fully approved in certain countries, some approved for emergency use only after clinical trials, and a few COVID vaccines only permitted for experimental use (generally limited to Russia, parts of Eastern Europe, and parts of Asia). COVID-19 vaccines are designed to protect against the [[Severe acute respiratory syndrome coronavirus 2|virus that causes COVID-19]], preventing COVID-19 will also provide protection against [[Long COVID]] because it is only caused by COVID-19.<ref name="ACR">{{Cite web|date= Mar 2021|url =https://www.rheumatology.org/Portals/0/Files/ACR-Information-Vaccination-Against-SARS-CoV-2.pdf|title =Information on Vaccination Against SARS-CoV-2|website = American College of Rheumatology}}</ref>

==ME/CFS ==
* Dec 2 2021, [https://youandmeregistry.com/after-covid-19-vaccination-health-of-people-with-me-cfs-more-likely-to-worsen-compared-to-controls/ After Covid-19 Vaccination, Health of People with ME/CFS More Likely to Worsen Compared to Controls] You + ME
<blockquote>About five months after receiving their first or only shot of Covid-19 vaccine, 19% of survey participants with [[ME/CFS]] indicated their health had worsened, 9% reported that it had improved and 73% responded that it had not changed. </blockquote><blockquote>This compares to 4% of controls (people who did not have ME/CFS) who said their health had worsened, 7% who indicated it had improved and 89% who reported it had not changed.</blockquote>

==ME/CFS advice from specialists ==
* [https://www.nova.edu/nim/To-Vaccinate-or-Not-with-MECFS.html To Vaccinate or Not - with ME/CFS] - [[Nancy Klimas]], Nova Southeastern University
* [https://batemanhornecenter.org/wp-content/uploads/filebase/COVIDVaccineGuide01072021.pdf Bateman Horne Center COVID-19 Vaccine Guide]
*[https://25megroup.org/download/1796/?v=3689 25% ME Group (for severe ME), ME Association and Action for ME statement]
*[https://drlapp.com/ask-the-doctor/covid-19-vaccines/? Covid-19 vaccines] - Dr Charles Lapp
*[https://meassociation.org.uk/2021/01/free-leaflet-covid-19-vaccine-update-by-dr-charles-shepherd/? ME Association]

* Dec 2020, [https://www.healthrising.org/wp-content/uploads/2021/01/Covid19-vaccine.pdf COVID-19 Vaccine] - Center for Complex Diseases

*[https://www.healthrising.org/blog/2021/01/28/coronavirus-vaccine-effects-chronic-fatigue-syndrome-fibromyalgia/?unapproved=1000271&moderation-hash=c2ffbc9abdfe5d4b51f2b22c33e7186b#comment-1000271 COVID-19 vaccine side effects poll results for ME/CFS] - HealthRising

==Immunocompromised people ==
People with [[ME/CFS]] have [[immune system]] dysfunction, but are not considered immunocompromised, instead many may have an [[Autoimmune hypothesis|overactive immune system]].{{Citation needed|date=Mar 2021}}

People who are regarded as immunocompromised, such as those living with HIV, or who are immunosuppressed, such as whole organ or stem cell transplant or who are taking [[:Category:immunosuppressants|immunosuppressants]] are as '''significantly greater risk''' of severe illness from COVID-19, and they do not need to automatically avoid COVID-19 vaccination; the Pfizer/BioNTech, AstraZeneca/Oxford, and Moderna vaccines have been approved for use in these patients in the UK and none of these contain any active or live [[Severe acute respiratory syndrome coronavirus 2|SARS-CoV-2]] virus particles.<ref name="immunocompromised-bsi">https://www.immunology.org/news/bsi-statement-covid-19-vaccines-for-patients-immunocompromised-immunosuppressed</ref>

Vaccines work better in people who are not immunocompromised or immunosuppressed, but these people are likely to achieve a lower lower of protection against [[COVID-19]].<ref name="immunocompromised-bsi" /> The British Society for Immunology recommend that immunocompromised and immunosuppressed people get a COVID-19 vaccine, and to have both doses, since this will still give some protection against COVID-19, and will help protect them from becoming seriously ill.<ref name="immunocompromised-bsi" />

People with stable HIV took part in the Pfizer-BioNTech and Moderna mRNA COVID-19 vaccine trials, although in general there is limited information on safety and efficacy of COVID-19 vaccines for immunocompromised and immunosuppressed people.<ref name="immunocompromised-bsi" />

Immosuppressants that may be used in people with [[ME/CFS]] include [[cyclophosphamide]] (a nitrogen mustard), [[dexamethasone]], [[hydrocortísone]], [[prednisolone]] and [[rituximab]].<ref name="immunosup-ie">{{Cite web|url=https://www.hse.ie/eng/services/publications/clinical-strategy-and-programmes/list-of-immunosuppressant-medication.pdf|access-date=Mar 17, 2021|title=List of Immunosuppressants|website=HSE (Ireland)}}</ref><ref name="isdrugs-drugbank">{{Cite web|url=https://go.drugbank.com/categories/DBCAT000047|access-date=Mar 17, 2021|title=Immunosuppressive Agents|website=DrugBank Online}}</ref>

==See also ==
*[[Coronavirus disease 19|COVID-19]]
*[[Long COVID]]
*[[Vaccine]]

==Learn more ==
* Jan 2021, [https://www.healthrising.org/blog/2021/01/28/coronavirus-vaccine-effects-chronic-fatigue-syndrome-fibromyalgia/ The Coronavirus Vaccine Side Effects Poll for ME/CFS and Fibromyalgia] - [[Health Rising]]
* Jan 2021, [https://www.healthrising.org/blog/2021/01/03/chronic-fatigue-fibromyalgia-experts-coronavirus-vaccine/ ME/CFS and FM Experts on Whether to Take the Coronavirus Vaccine – Plus The Vaccine Polls] - Health Rising

===Allergies and MCAS ===
*[https://acaai.org/news/acaai-updates-guidance-risk-allergic-reactions-covid-19-vaccines ACAAI Provides Further Guidance on Risk of Allergic Reactions to mRNA COVID-19 Vaccines] - American College of Allergy, Asthma and Immunology
*[https://acaai.org/news/acaai-provides-further-guidance-risk-allergic-reactions-mrna-covid-19-vaccines ACAAI Provides Further Guidance on Risk of Allergic Reactions to mRNA COVID-19 Vaccines]
*[https://acaai.org/news/american-college-allergy-asthma-and-immunology-updates-guidance-risk-allergic-reactions-mrna American College of Allergy, Asthma and Immunology COVID-19 vaccine recommendations]
*[https://www.anaphylaxis.org.uk/covid-19-advice/pfizer-covid-19-vaccine-and-allergies/ Anaphylaxis (allergies) COVID-19 Vaccine advice] - The Mast Cell Disease Society
*[https://tmsforacure.org/covid19-statement/ Covid-19 statement] - The Mast Cell Disease Society and Physicians from TMS Medical Advisory Board

===Immunosuppressant therapy and COVID-19 vaccines===
* Mar 2021, [https://www.rheumatology.org/Portals/0/Files/ACR-Information-Vaccination-Against-SARS-CoV-2.pdf Information on Vaccination Against SARS-CoV-2] - American College of Rheumatology guidance - for people on immunosuppressive therapy

===General COVID-19 vaccine information ===
*[https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/allergic-reaction.html CDC Allergic reactions to the Coronavirus Vaccine]
*[https://www.who.int/news-room/feature-stories/detail/who-can-take-the-pfizer-biontech-covid-19--vaccine Who can take the Pfizer-BioNTech COVID-19 vaccine?] - World Health Organization
*[https://www.nhs.uk/covidvaccination COVID B vaccination] - National Health Service
*[https://www.ulh.nhs.uk/content/uploads/2020/12/PHE-vaccine-leaflet.pdf Public Health England COVID-19 vaccine leaflet]

==References ==
{{Reflist}}

[[Category:Vaccines]]

COVID-19 vaccines

2022-01-20T15:39:28Z

Loopy:Image Upload

{{Https://me-pedia.org/wiki/File:Covid vaccine.png}}

'''Coronavirus disease 19''' or '''coronavirus''' has a range of different [[vaccine]]s available, and the vaccines work using many different methods including old, well-established technologies like inactivated vaccines, newer viral vector vaccines, and mRNA engineering vaccines.

==Vaccine approvals==
Some COVID-19 vaccines are now fully approved in certain countries, some approved for emergency use only after clinical trials, and a few COVID vaccines only permitted for experimental use (generally limited to Russia, parts of Eastern Europe, and parts of Asia). COVID-19 vaccines are designed to protect against the [[Severe acute respiratory syndrome coronavirus 2|virus that causes COVID-19]], preventing COVID-19 will also provide protection against [[Long COVID]] because it is only caused by COVID-19.<ref name="ACR">{{Cite web|date= Mar 2021|url =https://www.rheumatology.org/Portals/0/Files/ACR-Information-Vaccination-Against-SARS-CoV-2.pdf|title =Information on Vaccination Against SARS-CoV-2|website = American College of Rheumatology}}</ref>

==ME/CFS ==
* Dec 2 2021, [https://youandmeregistry.com/after-covid-19-vaccination-health-of-people-with-me-cfs-more-likely-to-worsen-compared-to-controls/ After Covid-19 Vaccination, Health of People with ME/CFS More Likely to Worsen Compared to Controls] You + ME
<blockquote>About five months after receiving their first or only shot of Covid-19 vaccine, 19% of survey participants with [[ME/CFS]] indicated their health had worsened, 9% reported that it had improved and 73% responded that it had not changed. </blockquote><blockquote>This compares to 4% of controls (people who did not have ME/CFS) who said their health had worsened, 7% who indicated it had improved and 89% who reported it had not changed.</blockquote>

==ME/CFS advice from specialists ==
* [https://www.nova.edu/nim/To-Vaccinate-or-Not-with-MECFS.html To Vaccinate or Not - with ME/CFS] - [[Nancy Klimas]], Nova Southeastern University
* [https://batemanhornecenter.org/wp-content/uploads/filebase/COVIDVaccineGuide01072021.pdf Bateman Horne Center COVID-19 Vaccine Guide]
*[https://25megroup.org/download/1796/?v=3689 25% ME Group (for severe ME), ME Association and Action for ME statement]
*[https://drlapp.com/ask-the-doctor/covid-19-vaccines/? Covid-19 vaccines] - Dr Charles Lapp
*[https://meassociation.org.uk/2021/01/free-leaflet-covid-19-vaccine-update-by-dr-charles-shepherd/? ME Association]

* Dec 2020, [https://www.healthrising.org/wp-content/uploads/2021/01/Covid19-vaccine.pdf COVID-19 Vaccine] - Center for Complex Diseases

*[https://www.healthrising.org/blog/2021/01/28/coronavirus-vaccine-effects-chronic-fatigue-syndrome-fibromyalgia/?unapproved=1000271&moderation-hash=c2ffbc9abdfe5d4b51f2b22c33e7186b#comment-1000271 COVID-19 vaccine side effects poll results for ME/CFS] - HealthRising

==Immunocompromised people ==
People with [[ME/CFS]] have [[immune system]] dysfunction, but are not considered immunocompromised, instead many may have an [[Autoimmune hypothesis|overactive immune system]].{{Citation needed|date=Mar 2021}}

People who are regarded as immunocompromised, such as those living with HIV, or who are immunosuppressed, such as whole organ or stem cell transplant or who are taking [[:Category:immunosuppressants|immunosuppressants]] are as '''significantly greater risk''' of severe illness from COVID-19, and they do not need to automatically avoid COVID-19 vaccination; the Pfizer/BioNTech, AstraZeneca/Oxford, and Moderna vaccines have been approved for use in these patients in the UK and none of these contain any active or live [[Severe acute respiratory syndrome coronavirus 2|SARS-CoV-2]] virus particles.<ref name="immunocompromised-bsi">https://www.immunology.org/news/bsi-statement-covid-19-vaccines-for-patients-immunocompromised-immunosuppressed</ref>

Vaccines work better in people who are not immunocompromised or immunosuppressed, but these people are likely to achieve a lower lower of protection against [[COVID-19]].<ref name="immunocompromised-bsi" /> The British Society for Immunology recommend that immunocompromised and immunosuppressed people get a COVID-19 vaccine, and to have both doses, since this will still give some protection against COVID-19, and will help protect them from becoming seriously ill.<ref name="immunocompromised-bsi" />

People with stable HIV took part in the Pfizer-BioNTech and Moderna mRNA COVID-19 vaccine trials, although in general there is limited information on safety and efficacy of COVID-19 vaccines for immunocompromised and immunosuppressed people.<ref name="immunocompromised-bsi" />

Immosuppressants that may be used in people with [[ME/CFS]] include [[cyclophosphamide]] (a nitrogen mustard), [[dexamethasone]], [[hydrocortísone]], [[prednisolone]] and [[rituximab]].<ref name="immunosup-ie">{{Cite web|url=https://www.hse.ie/eng/services/publications/clinical-strategy-and-programmes/list-of-immunosuppressant-medication.pdf|access-date=Mar 17, 2021|title=List of Immunosuppressants|website=HSE (Ireland)}}</ref><ref name="isdrugs-drugbank">{{Cite web|url=https://go.drugbank.com/categories/DBCAT000047|access-date=Mar 17, 2021|title=Immunosuppressive Agents|website=DrugBank Online}}</ref>

==See also ==
*[[Coronavirus disease 19|COVID-19]]
*[[Long COVID]]
*[[Vaccine]]

==Learn more ==
* Jan 2021, [https://www.healthrising.org/blog/2021/01/28/coronavirus-vaccine-effects-chronic-fatigue-syndrome-fibromyalgia/ The Coronavirus Vaccine Side Effects Poll for ME/CFS and Fibromyalgia] - [[Health Rising]]
* Jan 2021, [https://www.healthrising.org/blog/2021/01/03/chronic-fatigue-fibromyalgia-experts-coronavirus-vaccine/ ME/CFS and FM Experts on Whether to Take the Coronavirus Vaccine – Plus The Vaccine Polls] - Health Rising

===Allergies and MCAS ===
*[https://acaai.org/news/acaai-updates-guidance-risk-allergic-reactions-covid-19-vaccines ACAAI Provides Further Guidance on Risk of Allergic Reactions to mRNA COVID-19 Vaccines] - American College of Allergy, Asthma and Immunology
*[https://acaai.org/news/acaai-provides-further-guidance-risk-allergic-reactions-mrna-covid-19-vaccines ACAAI Provides Further Guidance on Risk of Allergic Reactions to mRNA COVID-19 Vaccines]
*[https://acaai.org/news/american-college-allergy-asthma-and-immunology-updates-guidance-risk-allergic-reactions-mrna American College of Allergy, Asthma and Immunology COVID-19 vaccine recommendations]
*[https://www.anaphylaxis.org.uk/covid-19-advice/pfizer-covid-19-vaccine-and-allergies/ Anaphylaxis (allergies) COVID-19 Vaccine advice] - The Mast Cell Disease Society
*[https://tmsforacure.org/covid19-statement/ Covid-19 statement] - The Mast Cell Disease Society and Physicians from TMS Medical Advisory Board

===Immunosuppressant therapy and COVID-19 vaccines===
* Mar 2021, [https://www.rheumatology.org/Portals/0/Files/ACR-Information-Vaccination-Against-SARS-CoV-2.pdf Information on Vaccination Against SARS-CoV-2] - American College of Rheumatology guidance - for people on immunosuppressive therapy

===General COVID-19 vaccine information ===
*[https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/allergic-reaction.html CDC Allergic reactions to the Coronavirus Vaccine]
*[https://www.who.int/news-room/feature-stories/detail/who-can-take-the-pfizer-biontech-covid-19--vaccine Who can take the Pfizer-BioNTech COVID-19 vaccine?] - World Health Organization
*[https://www.nhs.uk/covidvaccination COVID B vaccination] - National Health Service
*[https://www.ulh.nhs.uk/content/uploads/2020/12/PHE-vaccine-leaflet.pdf Public Health England COVID-19 vaccine leaflet]

==References ==
{{Reflist}}

[[Category:Vaccines]]

File:Covid vaccine.png

2022-01-20T15:37:47Z

Loopy:/* Author: (Missvain) */ edit author

== Summary ==
==== Title: (A person, wearing gloves and a surgical mask, handles a COVID-19 Vaccine vial and syringe) ====

==== Author: (Uploaded a work by United States Census from <nowiki>https://twitter.com/uscensusbureau/status/1354534652351041542/photo/1</nowiki> with UploadWizard) ====

==== Source: (https://commons.wikimedia.org/wiki/File:COVID-19_Vaccine_vial_and_syringe_-_US_Census.jpg) ====

==== Other information: ====
== Licensing ==
{{PD-USGov}}

File:Covid vaccine.png

2022-01-20T15:36:49Z

Loopy:==== Title: (A person, wearing gloves and a surgical mask, handles a COVID-19 Vaccine vial and syringe) ==== ==== Author: (Missvain) ==== ==== Source: (https://commons.wikimedia.org/wiki/File:COVID-19_Vaccine_vial_and_syringe_-_US_Census.jpg) ==== =...

== Summary ==
==== Title: (A person, wearing gloves and a surgical mask, handles a COVID-19 Vaccine vial and syringe) ====

==== Author: (Missvain) ====

==== Source: (https://commons.wikimedia.org/wiki/File:COVID-19_Vaccine_vial_and_syringe_-_US_Census.jpg) ====

==== Other information: ====
== Licensing ==
{{PD-USGov}}

COVID-19 vaccines

2022-01-20T15:23:11Z

Loopy:/* ME/CFS */ Block Quote

{{NeedsImage}}
'''Coronavirus disease 19''' or '''coronavirus''' has a range of different [[vaccine]]s available, and the vaccines work using many different methods including old, well-established technologies like inactivated vaccines, newer viral vector vaccines, and mRNA engineering vaccines.

==Vaccine approvals==
Some COVID-19 vaccines are now fully approved in certain countries, some approved for emergency use only after clinical trials, and a few COVID vaccines only permitted for experimental use (generally limited to Russia, parts of Eastern Europe, and parts of Asia). COVID-19 vaccines are designed to protect against the [[Severe acute respiratory syndrome coronavirus 2|virus that causes COVID-19]], preventing COVID-19 will also provide protection against [[Long COVID]] because it is only caused by COVID-19.<ref name="ACR">{{Cite web|date= Mar 2021|url =https://www.rheumatology.org/Portals/0/Files/ACR-Information-Vaccination-Against-SARS-CoV-2.pdf|title =Information on Vaccination Against SARS-CoV-2|website = American College of Rheumatology}}</ref>

==ME/CFS ==
* Dec 2 2021, [https://youandmeregistry.com/after-covid-19-vaccination-health-of-people-with-me-cfs-more-likely-to-worsen-compared-to-controls/ After Covid-19 Vaccination, Health of People with ME/CFS More Likely to Worsen Compared to Controls] You + ME
<blockquote>About five months after receiving their first or only shot of Covid-19 vaccine, 19% of survey participants with [[ME/CFS]] indicated their health had worsened, 9% reported that it had improved and 73% responded that it had not changed. </blockquote><blockquote>This compares to 4% of controls (people who did not have ME/CFS) who said their health had worsened, 7% who indicated it had improved and 89% who reported it had not changed.</blockquote>

==ME/CFS advice from specialists ==
* [https://www.nova.edu/nim/To-Vaccinate-or-Not-with-MECFS.html To Vaccinate or Not - with ME/CFS] - [[Nancy Klimas]], Nova Southeastern University
* [https://batemanhornecenter.org/wp-content/uploads/filebase/COVIDVaccineGuide01072021.pdf Bateman Horne Center COVID-19 Vaccine Guide]
*[https://25megroup.org/download/1796/?v=3689 25% ME Group (for severe ME), ME Association and Action for ME statement]
*[https://drlapp.com/ask-the-doctor/covid-19-vaccines/? Covid-19 vaccines] - Dr Charles Lapp
*[https://meassociation.org.uk/2021/01/free-leaflet-covid-19-vaccine-update-by-dr-charles-shepherd/? ME Association]

* Dec 2020, [https://www.healthrising.org/wp-content/uploads/2021/01/Covid19-vaccine.pdf COVID-19 Vaccine] - Center for Complex Diseases

*[https://www.healthrising.org/blog/2021/01/28/coronavirus-vaccine-effects-chronic-fatigue-syndrome-fibromyalgia/?unapproved=1000271&moderation-hash=c2ffbc9abdfe5d4b51f2b22c33e7186b#comment-1000271 COVID-19 vaccine side effects poll results for ME/CFS] - HealthRising

==Immunocompromised people ==
People with [[ME/CFS]] have [[immune system]] dysfunction, but are not considered immunocompromised, instead many may have an [[Autoimmune hypothesis|overactive immune system]].{{Citation needed|date=Mar 2021}}

People who are regarded as immunocompromised, such as those living with HIV, or who are immunosuppressed, such as whole organ or stem cell transplant or who are taking [[:Category:immunosuppressants|immunosuppressants]] are as '''significantly greater risk''' of severe illness from COVID-19, and they do not need to automatically avoid COVID-19 vaccination; the Pfizer/BioNTech, AstraZeneca/Oxford, and Moderna vaccines have been approved for use in these patients in the UK and none of these contain any active or live [[Severe acute respiratory syndrome coronavirus 2|SARS-CoV-2]] virus particles.<ref name="immunocompromised-bsi">https://www.immunology.org/news/bsi-statement-covid-19-vaccines-for-patients-immunocompromised-immunosuppressed</ref>

Vaccines work better in people who are not immunocompromised or immunosuppressed, but these people are likely to achieve a lower lower of protection against [[COVID-19]].<ref name="immunocompromised-bsi" /> The British Society for Immunology recommend that immunocompromised and immunosuppressed people get a COVID-19 vaccine, and to have both doses, since this will still give some protection against COVID-19, and will help protect them from becoming seriously ill.<ref name="immunocompromised-bsi" />

People with stable HIV took part in the Pfizer-BioNTech and Moderna mRNA COVID-19 vaccine trials, although in general there is limited information on safety and efficacy of COVID-19 vaccines for immunocompromised and immunosuppressed people.<ref name="immunocompromised-bsi" />

Immosuppressants that may be used in people with [[ME/CFS]] include [[cyclophosphamide]] (a nitrogen mustard), [[dexamethasone]], [[hydrocortísone]], [[prednisolone]] and [[rituximab]].<ref name="immunosup-ie">{{Cite web|url=https://www.hse.ie/eng/services/publications/clinical-strategy-and-programmes/list-of-immunosuppressant-medication.pdf|access-date=Mar 17, 2021|title=List of Immunosuppressants|website=HSE (Ireland)}}</ref><ref name="isdrugs-drugbank">{{Cite web|url=https://go.drugbank.com/categories/DBCAT000047|access-date=Mar 17, 2021|title=Immunosuppressive Agents|website=DrugBank Online}}</ref>

==See also ==
*[[Coronavirus disease 19|COVID-19]]
*[[Long COVID]]
*[[Vaccine]]

==Learn more ==
* Jan 2021, [https://www.healthrising.org/blog/2021/01/28/coronavirus-vaccine-effects-chronic-fatigue-syndrome-fibromyalgia/ The Coronavirus Vaccine Side Effects Poll for ME/CFS and Fibromyalgia] - [[Health Rising]]
* Jan 2021, [https://www.healthrising.org/blog/2021/01/03/chronic-fatigue-fibromyalgia-experts-coronavirus-vaccine/ ME/CFS and FM Experts on Whether to Take the Coronavirus Vaccine – Plus The Vaccine Polls] - Health Rising

===Allergies and MCAS ===
*[https://acaai.org/news/acaai-updates-guidance-risk-allergic-reactions-covid-19-vaccines ACAAI Provides Further Guidance on Risk of Allergic Reactions to mRNA COVID-19 Vaccines] - American College of Allergy, Asthma and Immunology
*[https://acaai.org/news/acaai-provides-further-guidance-risk-allergic-reactions-mrna-covid-19-vaccines ACAAI Provides Further Guidance on Risk of Allergic Reactions to mRNA COVID-19 Vaccines]
*[https://acaai.org/news/american-college-allergy-asthma-and-immunology-updates-guidance-risk-allergic-reactions-mrna American College of Allergy, Asthma and Immunology COVID-19 vaccine recommendations]
*[https://www.anaphylaxis.org.uk/covid-19-advice/pfizer-covid-19-vaccine-and-allergies/ Anaphylaxis (allergies) COVID-19 Vaccine advice] - The Mast Cell Disease Society
*[https://tmsforacure.org/covid19-statement/ Covid-19 statement] - The Mast Cell Disease Society and Physicians from TMS Medical Advisory Board

===Immunosuppressant therapy and COVID-19 vaccines===
* Mar 2021, [https://www.rheumatology.org/Portals/0/Files/ACR-Information-Vaccination-Against-SARS-CoV-2.pdf Information on Vaccination Against SARS-CoV-2] - American College of Rheumatology guidance - for people on immunosuppressive therapy

===General COVID-19 vaccine information ===
*[https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/allergic-reaction.html CDC Allergic reactions to the Coronavirus Vaccine]
*[https://www.who.int/news-room/feature-stories/detail/who-can-take-the-pfizer-biontech-covid-19--vaccine Who can take the Pfizer-BioNTech COVID-19 vaccine?] - World Health Organization
*[https://www.nhs.uk/covidvaccination COVID B vaccination] - National Health Service
*[https://www.ulh.nhs.uk/content/uploads/2020/12/PHE-vaccine-leaflet.pdf Public Health England COVID-19 vaccine leaflet]

==References ==
{{Reflist}}

[[Category:Vaccines]]

COVID-19 vaccines

2022-01-20T15:19:49Z

Loopy:You + ME COVID Vaccine Data

{{NeedsImage}}
'''Coronavirus disease 19''' or '''coronavirus''' has a range of different [[vaccine]]s available, and the vaccines work using many different methods including old, well-established technologies like inactivated vaccines, newer viral vector vaccines, and mRNA engineering vaccines.

==Vaccine approvals==
Some COVID-19 vaccines are now fully approved in certain countries, some approved for emergency use only after clinical trials, and a few COVID vaccines only permitted for experimental use (generally limited to Russia, parts of Eastern Europe, and parts of Asia). COVID-19 vaccines are designed to protect against the [[Severe acute respiratory syndrome coronavirus 2|virus that causes COVID-19]], preventing COVID-19 will also provide protection against [[Long COVID]] because it is only caused by COVID-19.<ref name="ACR">{{Cite web|date= Mar 2021|url =https://www.rheumatology.org/Portals/0/Files/ACR-Information-Vaccination-Against-SARS-CoV-2.pdf|title =Information on Vaccination Against SARS-CoV-2|website = American College of Rheumatology}}</ref>

==ME/CFS ==
* Dec 2 2021, [https://youandmeregistry.com/after-covid-19-vaccination-health-of-people-with-me-cfs-more-likely-to-worsen-compared-to-controls/ After Covid-19 Vaccination, Health of People with ME/CFS More Likely to Worsen Compared to Controls] You + ME

==ME/CFS advice from specialists ==
* [https://www.nova.edu/nim/To-Vaccinate-or-Not-with-MECFS.html To Vaccinate or Not - with ME/CFS] - [[Nancy Klimas]], Nova Southeastern University
* [https://batemanhornecenter.org/wp-content/uploads/filebase/COVIDVaccineGuide01072021.pdf Bateman Horne Center COVID-19 Vaccine Guide]
*[https://25megroup.org/download/1796/?v=3689 25% ME Group (for severe ME), ME Association and Action for ME statement]
*[https://drlapp.com/ask-the-doctor/covid-19-vaccines/? Covid-19 vaccines] - Dr Charles Lapp
*[https://meassociation.org.uk/2021/01/free-leaflet-covid-19-vaccine-update-by-dr-charles-shepherd/? ME Association]

* Dec 2020, [https://www.healthrising.org/wp-content/uploads/2021/01/Covid19-vaccine.pdf COVID-19 Vaccine] - Center for Complex Diseases

*[https://www.healthrising.org/blog/2021/01/28/coronavirus-vaccine-effects-chronic-fatigue-syndrome-fibromyalgia/?unapproved=1000271&moderation-hash=c2ffbc9abdfe5d4b51f2b22c33e7186b#comment-1000271 COVID-19 vaccine side effects poll results for ME/CFS] - HealthRising

==Immunocompromised people ==
People with [[ME/CFS]] have [[immune system]] dysfunction, but are not considered immunocompromised, instead many may have an [[Autoimmune hypothesis|overactive immune system]].{{Citation needed|date=Mar 2021}}

People who are regarded as immunocompromised, such as those living with HIV, or who are immunosuppressed, such as whole organ or stem cell transplant or who are taking [[:Category:immunosuppressants|immunosuppressants]] are as '''significantly greater risk''' of severe illness from COVID-19, and they do not need to automatically avoid COVID-19 vaccination; the Pfizer/BioNTech, AstraZeneca/Oxford, and Moderna vaccines have been approved for use in these patients in the UK and none of these contain any active or live [[Severe acute respiratory syndrome coronavirus 2|SARS-CoV-2]] virus particles.<ref name="immunocompromised-bsi">https://www.immunology.org/news/bsi-statement-covid-19-vaccines-for-patients-immunocompromised-immunosuppressed</ref>

Vaccines work better in people who are not immunocompromised or immunosuppressed, but these people are likely to achieve a lower lower of protection against [[COVID-19]].<ref name="immunocompromised-bsi" /> The British Society for Immunology recommend that immunocompromised and immunosuppressed people get a COVID-19 vaccine, and to have both doses, since this will still give some protection against COVID-19, and will help protect them from becoming seriously ill.<ref name="immunocompromised-bsi" />

People with stable HIV took part in the Pfizer-BioNTech and Moderna mRNA COVID-19 vaccine trials, although in general there is limited information on safety and efficacy of COVID-19 vaccines for immunocompromised and immunosuppressed people.<ref name="immunocompromised-bsi" />

Immosuppressants that may be used in people with [[ME/CFS]] include [[cyclophosphamide]] (a nitrogen mustard), [[dexamethasone]], [[hydrocortísone]], [[prednisolone]] and [[rituximab]].<ref name="immunosup-ie">{{Cite web|url=https://www.hse.ie/eng/services/publications/clinical-strategy-and-programmes/list-of-immunosuppressant-medication.pdf|access-date=Mar 17, 2021|title=List of Immunosuppressants|website=HSE (Ireland)}}</ref><ref name="isdrugs-drugbank">{{Cite web|url=https://go.drugbank.com/categories/DBCAT000047|access-date=Mar 17, 2021|title=Immunosuppressive Agents|website=DrugBank Online}}</ref>

==See also ==
*[[Coronavirus disease 19|COVID-19]]
*[[Long COVID]]
*[[Vaccine]]

==Learn more ==
* Jan 2021, [https://www.healthrising.org/blog/2021/01/28/coronavirus-vaccine-effects-chronic-fatigue-syndrome-fibromyalgia/ The Coronavirus Vaccine Side Effects Poll for ME/CFS and Fibromyalgia] - [[Health Rising]]
* Jan 2021, [https://www.healthrising.org/blog/2021/01/03/chronic-fatigue-fibromyalgia-experts-coronavirus-vaccine/ ME/CFS and FM Experts on Whether to Take the Coronavirus Vaccine – Plus The Vaccine Polls] - Health Rising

===Allergies and MCAS ===
*[https://acaai.org/news/acaai-updates-guidance-risk-allergic-reactions-covid-19-vaccines ACAAI Provides Further Guidance on Risk of Allergic Reactions to mRNA COVID-19 Vaccines] - American College of Allergy, Asthma and Immunology
*[https://acaai.org/news/acaai-provides-further-guidance-risk-allergic-reactions-mrna-covid-19-vaccines ACAAI Provides Further Guidance on Risk of Allergic Reactions to mRNA COVID-19 Vaccines]
*[https://acaai.org/news/american-college-allergy-asthma-and-immunology-updates-guidance-risk-allergic-reactions-mrna American College of Allergy, Asthma and Immunology COVID-19 vaccine recommendations]
*[https://www.anaphylaxis.org.uk/covid-19-advice/pfizer-covid-19-vaccine-and-allergies/ Anaphylaxis (allergies) COVID-19 Vaccine advice] - The Mast Cell Disease Society
*[https://tmsforacure.org/covid19-statement/ Covid-19 statement] - The Mast Cell Disease Society and Physicians from TMS Medical Advisory Board

===Immunosuppressant therapy and COVID-19 vaccines===
* Mar 2021, [https://www.rheumatology.org/Portals/0/Files/ACR-Information-Vaccination-Against-SARS-CoV-2.pdf Information on Vaccination Against SARS-CoV-2] - American College of Rheumatology guidance - for people on immunosuppressive therapy

===General COVID-19 vaccine information ===
*[https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/allergic-reaction.html CDC Allergic reactions to the Coronavirus Vaccine]
*[https://www.who.int/news-room/feature-stories/detail/who-can-take-the-pfizer-biontech-covid-19--vaccine Who can take the Pfizer-BioNTech COVID-19 vaccine?] - World Health Organization
*[https://www.nhs.uk/covidvaccination COVID B vaccination] - National Health Service
*[https://www.ulh.nhs.uk/content/uploads/2020/12/PHE-vaccine-leaflet.pdf Public Health England COVID-19 vaccine leaflet]

==References ==
{{Reflist}}

[[Category:Vaccines]]

Fibromyalgia

2021-07-21T17:26:26Z

Loopy:/* Take the Online Fibromyalgia Test */ lowercase

{{Cleanup|date=Mar 2021|reason=Check science guidelines are met, e.g. no blogs or unreferenced articles for citations regarding general health information. Image captions should state author and copyright license. See [[help:Images%23Displaying_an_image_on_a_page]].}}

[[Fibromyalgia]] '''(FM/FMS)''' is a chronic disorder characterized by widespread [[Musculoskeletal system|musculoskeletal]] pain, [[fatigue]], and tenderness in localized areas. [[Myalgia|Muscle pain]] is widespread, on both sides of the body, and above and below the waist.<ref name="ACR1990" /><ref name="excerpt2" /><ref name="ACR2010" /><ref name="excerpt" />

Sufferers are fatigued and tired even when sleeping for long periods of time, and sleep is often disrupted by pain. Many FM sufferers have [[Sleep dysfunction|sleep disorders]] like [[sleep apnea]] and [[restless legs syndrome]] (RLS).<ref name="webmd-guide" /><ref name="mayo" /><ref name=":35" /> [[Cognitive impairment]], when one cannot focus or pay attention and the patient has difficulty concentrating on mental tasks, is known by FM sufferers as "[[fibro fog]]".<ref name="webmd-guide" /><ref name="mayo" /><ref name=":35" /> Some experience [[depression]], [[headache]]s, and lower [[abdominal pain]] or muscle cramp. Other symptoms include [[Paresthesia|tingling]] or [[numbness]] in hands and feet, pain in jaw and disorders of the jaw such as [[temporomandibular joint disorder|temporomandibular joint disorder]] (TMJ/TMD), [[Menstrual cycle#Health effects in other conditions|menstrual cycle]] cramps, and [[digestive problems]] like [[irritable bowel syndrome]] (IBS).<ref name="webmd-guide">{{Cite news|url=https://www.webmd.com/fibromyalgia/guide/fibromyalgia-symptoms#1|title=Fibromyalgia Symptoms|work=WebMD|access-date=2018-08-09|language=en-US}}</ref><ref name="mayo">{{Cite news|url=https://www.mayoclinic.org/diseases-conditions/fibromyalgia/symptoms-causes/syc-20354780|title=Fibromyalgia - Symptoms and causes|work=Mayo Clinic|access-date=2018-08-09|language=en}}</ref><ref name=":35" />

[[Pain#Pain in Fibromyalgia|Other pain conditions are associated with FM]], such as [[rheumatoid arthritis]] (RA), [[systemic lupus erythematosus]] (Lupus), ankylosing spondylitis, [[interstitial cystitis]], and more.<ref name="mayocause">{{Cite web|url=https://www.mayoclinic.org/diseases-conditions/fibromyalgia/symptoms-causes/syc-20354780|title=Fibromyalgia - Symptoms and causes|website=Mayo Clinic|language=en|access-date=2019-05-03}}</ref>

The [[United Kingdom|United Kingdom]] (UK) [[National Health Service]] (NHS) lists FM as one of 20 most painful conditions.<ref>{{Cite web|url=https://www.newsweek.com/20-most-painful-conditions-nhs-1191081|title=Here are 20 of the most painful health conditions you can get|last=EDT|first=Hannah Osborne On 10/29/18 at 7:14 AM|date=2018-10-29|website=Newsweek|language=en|access-date=2019-03-26}}</ref><ref name=":39">{{Cite web|url=https://www.cambridge-news.co.uk/news/uk-world-news/nhs-gout-ulcer-endometriosis-arthritis-15339123|title=The NHS says these are the 20 most painful health conditions you can suffer from|last=Campbell|first=James|last2=Pengelly|first2=Ella|date=2019-03-26|website=cambridgenews|access-date=2019-03-26}}</ref> The NHS describes the pain as diffuse aching or burning, head to toe, and can be worse at some times than at others. The pain can change location. "The fatigue ranges from feeling tired, to the exhaustion of a [[flu-like illness]]."<ref name=":39" /> The [[United States|United States]] (US) [[Centers for Disease Control and Prevention]] (CDC) states FM "can cause pain, [[Fibromyalgia disability process|disability, and lower quality of life]]."<ref name=":35" /> The medical guide book [[Mayo Clinic Guide to Fibromyalgia: Strategies to Take Back Your Life|''Mayo Clinic Guide to'' ''Fibromyalgia: Strategies to Take Back Your Life'']] describes fibromyalgia as "a [[Central sensitization|sensory disorder]] caused by a miscommunication between the [[Nervous system|nerves through your body and your brain]]."<ref>{{Cite web|url=https://www.amazon.com/Mayo-Clinic-Guide-Fibromyalgia-Strategies/dp/1893005496/ref=sr_1_1|title=Mayo Clinic Guide to Fibromyalgia: Strategies to Take Back Your Life|last=Abril, M.D.|first=Andy|authorlink=|last2=Bruce Ph.D. L.P.|first2=Barbara K.|authorlink2=|date=2019|website=www.amazon.com|publisher=Mayo Clinic Press; Paperback Original edition|page=15|archive-url=|archive-date=|access-date=2019-11-13}}</ref>

The [[American_College_of_Rheumatology|American College of Rheumatology]] (ACR) created and updates the diagnostic criteria for FM.<ref name="ACR1990" /><ref name="ACR2010">{{Cite journal|url=https://www.rheumatology.org/Portals/0/Files/2010_Preliminary_Diagnostic_Criteria.pdf|title=American College of Rheumatology (ACR) Preliminary Diagnostic Criteria for Fibromyalgia|last=Wolfe|first=Frederick|date=May 2010|volume =62 | issue = 5 | pages= 600–610| doi = 10.1002/acr.20140|type=PDF|archive-url=|archive-date=|access-date=|authorlink=|last2=Clauw|first2=Daniel|authorlink2=|journal=Arthritis Care & Research|last3=Fitzcharles|first3=Mary-Ann|first4=Don|last5=Katz|last4=Goldenberg|first5=Robert|last6=Mease|first6=Philip|last7=Russel|first7=Anthony|last8=Russel|first8=I. Jon|first9=John|last9=Winfield|first10=Muhammad|last10=Yunus|quote=The reference list consisted of: [[myalgia|muscle pain]], [[irritable bowel syndrome]], [[fatigue]]/tiredness, [[cognitive dysfunction|thinking or remembering problem]], [[paresis|muscle weakness]], [[headache]], pain/cramps in the abdomen, [[paresthesia|numbness/tingling]], [[dizziness]], [[insomnia]], [[depression]], [[constipation]], pain in the upper abdomen, [[nausea]], nervousness, [[chest pain]], [[blurred vision]], [[fever]], [[diarrhea]], dry mouth, [[skin itch|itching]], wheezing, [[Raynaud's syndrome|Raynaud’s phenomenon]], [[hives|hives/welts]], [[tinnitus|ringing in ears]], [[vomiting]], [[heartburn]], oral ulcers, loss of/change in taste, [[seizure]]s, [[dry eye syndrome|dry eyes]], [[dyspnea|shortness of breath]], [[anorexia (appetite loss)|loss of appetite]], [[skin rash|rash]], [[photophobia|sun sensitivity]], hearing difficulties, easy [[bruising]], [[hair loss]], frequent urination, [[painful bladder syndrome|painful urination]], and bladder spasms.}}</ref><ref name="ACR1990" /><ref name="excerpt2" /><ref name="ACR2010" /><ref name="excerpt">{{Cite web|url=https://www.rheumatology.org/Portals/0/Files/2010%20Fibromyalgia%20Diagnostic%20Criteria_Excerpt.pdf|title=2010 Fibromyalgia Diagnostic Criteria - Excerpt|last=|first=|authorlink=|last2=|first2=|website=rheumatology.org|page=|archive-url=|archive-date=|access-date=}}</ref> See: [[Fibromyalgia#Diagnosis|Fibromyalgia (Diagnosis)]].

[[File:Fibro_Tender_Points.png|400px|thumb|right|<span id="ACR1990-image">1990 ACR Diagnostic Criteria: 18 Tender Points</span><ref name="ACR1990">{{Cite journal|last=Wolfe|first=Frederick|author-link=Frederick Wolfe|last2=Smythe|first2=Hugh|author-link2=|last3=Yunus|first3=Muhammad|author-link3=Muhammad Yunnus|last4=Bennett|first4=Robert|author-link4=|last5=Bombardier|first5=Claire|author-link5=|last6=Goldenberg|first6=Don|author-link6=|last7=Tugwell|first7=Peter|author-link7=|last8=Campbell|first8=Stephen|author-link8=|last9=Abeles|first9=Micha|author-link9=|others=P Clark; A Fam; S Farber; J Fiechtner; CM Franklin; R Gatter; D Hamaty; J Lessard; A Lichtbroun; A Masi; G McCain; WJ Reynolds; T Romano; IJ Russell; R Sheon|date =1990|title=The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia|url=https://www.rheumatology.org/Portals/0/Files/1990_Criteria_for_Classification_Fibro.pdf|journal=Arthritis and Rheumatism|publisher=The American College of Rheumatology|volume=33|issue=2|pages=160-172|quote=|via=}}</ref><ref name="excerpt2">{{Cite web|url=https://www.rheumatology.org/Portals/0/Files/1990%20Fibromyalgia_Excerpt.pdf|title=1990 Fibromyalgia Excerpt|last=Wolfe|first=Frederick|authorlink=|last2=|first2=|authorlink2=|date=1990|website=rheumatology.org|archive-url=|archive-date=|access-date=}}</ref>]]
[[File:Fibro_Widespread_Pain.png|400px|thumb|right|<span id="ACR1990-image">2010 ACR Preliminatry Diagnostic Criteria:</span> '''Widespread Pain Index (WPI'''), 19 Tender Point Areas<ref name="ACR2010" /><ref name="excerpt" />]]

==Prevalence==
FM is the second most common rheumatic disorder behind [[osteoarthritis]] and is "now considered to be a lifelong [[central nervous system]] disorder."<ref>{{Cite web|url=https://www.sciencedaily.com/releases/2015/05/150517071813.htm|title=Fibromyalgia has central nervous system origins|last=|first=|authorlink=|last2=|first2=|authorlink2=|date=May 17, 2015|website=ScienceDaily|at=Summary|language=en|archive-url=|archive-date=|access-date=2019-11-13|quote=now considered to be a lifelong central nervous system disorder}}</ref><ref>{{Cite news|url=https://naidw.org/blog/members-myblogs/fibromyalgia-now-considered-as-a-lifelong-central-nervous-system-disorder|title=Fibromyalgia now considered as a lifelong central nervous system disorder|work=NAIDW.org®|access-date=2018-08-09|language=en-gb}}</ref> An estimated 10 million people in the US and 3-6% of the world population have FM. It is seen in women, men, children, and all ethnic groups. It is often seen in families and diagnosed between the ages of 20 to 50 years; incidence increases with age.<ref>{{Cite news|url=http://www.fmaware.org/about-fibromyalgia/prevalence/|title=Prevalence - National Fibromyalgia Association (NFA)|work=National Fibromyalgia Association (NFA)|access-date=2018-08-09|language=en-US}}</ref>

FM has a female:male 7:1 ratio under the ''American College of Rheumatology (ACR) 1990 Diagnostic Criteria''<ref name="ACR1990" /><ref name="excerpt2" /> and 2:1 when the ACR 2010 Preliminary Diagnostic Criteria<ref name="ACR2010" /><ref name="excerpt" /> is used.<ref>{{Cite journal|last=Boomershine|first=Chad|date=Nov 4, 2017|title=Fibromyalgia: Practice Essentials, Background, Pathophysiology|url=http://emedicine.medscape.com/article/329838-overview#a5|journal=Medscape|volume=|pages=|via=|publisher=|editor-last=Diamond|editor-first=Herbert|at=Sex-related differences in incidence}}</ref> See: [[Fibromyalgia#American College of Rheumatology (ACR) Criteria|Fibromyalgia (''American College of Rheumatology (ACR) Criteria'')]]. A September 2018, Wolfe et al study ''Fibromyalgia diagnosis and biased assessment: Sex, prevalence and bias''<ref name=":28" /> found fewer women and more men are diagnosed under the 2010/11 criteria (this criterion further updated in 2016<ref>{{Cite journal|date=2016-12-01|title=2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria|url=https://www.sciencedirect.com/science/article/pii/S0049017216302086|journal=Seminars in Arthritis and Rheumatism|language=en|volume=46|issue=3|pages=319–329|doi=10.1016/j.semarthrit.2016.08.012|issn=0049-0172}}</ref>). They found the ratio is F/M 1.5:1.<ref name=":28">{{Cite journal|last=Wolfe|first=Frederick|last2=Walitt|first2=Brian|last3=Perrot|first3=Serge|last4=Rasker|first4=Johannes J.|last5=Häuser|first5=Winfried|date=2018-09-13|title=Fibromyalgia diagnosis and biased assessment: Sex, prevalence and bias|url=https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0203755|journal=PLOS ONE|language=en|volume=13|issue=9|pages=e0203755|doi=10.1371/journal.pone.0203755|issn=1932-6203|pmc=|pmid=30212526|via=}}</ref><blockquote>What we did not find in our unbiased CritFM samples was 9:1 female to male fibromyalgia ratios that are widely described by expert sources [11–13]. We believe that such findings only occur in the presence of selection bias or biased ascertainment.<ref name=":28" /></blockquote><blockquote>As unbiased epidemiological studies show only a small increase in the female to male sex ratio (~1.5:1) as opposed to the observed ratio in clinical studies of 9:1, we believe that the over-identification of fibromyalgia in women and the consequent under-identification of men is the result of bias.<ref name=":28" /></blockquote>

==Fibromyalgia in ME/CFS==
"The most common overlapping condition with [[ME/CFS]] is fibromyalgia."<ref name="ammes-overlap">{{Cite web|url=https://ammes.org/overlapping-conditions/|title=Overlapping Conditions|website = [[American Myalgic Encephalomyelitis and Chronic Fatigue Syndrome Society]]|last=|first=|date=|language=en-US|archive-url=|archive-date=|access-date=2018-08-12}}</ref><ref>{{Cite web|url=http://www.ayushveda.com/healthcare/dysphasia.htm|title=Dysphasia - Causes, Symptoms & Treatment|website=www.ayushveda.com|access-date=2018-08-09}}</ref> See also: [[Dyscalculia]].
* [[ME/CFS]]<ref name="ammes-overlap" /><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=":31">{{Cite journal|last=Jason|first=Leonard|last2=Taylor|first2=R.R.|last3=Kennedy|first3=C.L.|last4=Song|first4=S|last5=Johnson|first5=D|last6=Torres|first6=S.R.|date=2001-01-01|title=Chronic fatigue syndrome: Comorbidity with fibromyalgia and psychiatric illness|url=https://www.researchgate.net/publication/285787383_Chronic_fatigue_syndrome_Comorbidity_with_fibromyalgia_and_psychiatric_illness|journal=Medicine and Psychiatry|volume=4|pages=29–34}}</ref> While some have posited ME/CFS and FM are variants of the same illness, [[Benjamin Natelson]], MD summoned considerable amounts of data that suggest the two illnesses differ with different pathophysiologic processes leading to different treatments.<ref name=":36">{{Cite journal|last=Natelson|first=Benjamin H.|date=2019-02-19|title=Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Fibromyalgia: Definitions, Similarities, and Differences|url=https://www.clinicaltherapeutics.com/article/S0149-2918(19)30003-7/abstract|journal=Clinical Therapeutics|language=English|volume=41|issue=4|pages=612|doi=10.1016/j.clinthera.2018.12.016|issn=0149-2918|pmid=30795933}}</ref>

Dr. [[Jarred Younger]] has said that many patients that meet the criteria for FM also meet criteria for [[chronic fatigue syndrome]] (CFS) but the reverse is not necessarily true as a lot of people with [[CFS]] do not have [[chronic pain]].<ref>{{Cite web|url=https://www.youtube.com/watch?v=wJB95m4FLa0#t=57m27s|title=Webinar with Jarred Younger, Ph.D.|last=Younger|first=Jarred|date=May 20, 2016|website=YouTube|at=57:27|via=|archive-url=|archive-date=|access-date=|publisher=SolveCFS|type=Video}}</ref> However, the [[Canadian Consensus Criteria]] (CCC) requires the symptom of pain to diagnose ME/CFS.<ref name="Carruthers, 2003">{{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
| url = http://phoenixrising.me/wp-content/uploads/Canadian-definition.pdf
}}</ref> It is the pattern (on both sides of the body, and above and below the waist) of chronic widespread [[Musculoskeletal system|musculoskeletal]] pain (involving muscle, cartilage, ligaments, and connective tissue) in FM that sets it apart from other diseases that have pain; it also causes [[cognitive symptoms]] and [[unrefreshing sleep]].<ref name="webmd-guide" /><ref name="mayo" />

A Swedish study of 234 ME/CFS patients meeting the [[Canadian Consensus Criteria]] found that 96% had trigger point pain consistent with fibromyalgia and 67% met the diagnostic criteria for fibromyalgia.<ref>{{Cite web|url=https://osf.io/qwn5h/|website=Center for Open Science|access-date=2019-12-03|title=Bragee Bertilson et al. - ME CFS and Intracranial Hypertension|date=Nov 27, 2019|last=|first=|authorlink=|last2=|first2=|authorlink2=|archive-url=|archive-date=}}</ref>

==Health complications==
FM is not a progressive disease but according to Dr. [[Daniel Clauw|Dan Clauw]] the "slow gradual worsening of chronic pain patients over time is due to downstream consequences of poorly controlled pain and other symptoms, wherein individuals then progressively get less active, sleep worse, are under more stress and unknowingly develop bad habits which worsen pain and other symptoms."<ref>{{Cite news|url=http://nationalpainreport.com/ask-the-dctors-is-fibromyalgia-progressive-8831105.html|title=Ask the Doctors: Is Fibromyalgia Progressive?|date=2016-08-09|work=National Pain Report|access-date=2018-08-09|language=en-US}}</ref>

*[https://www.sharecare.com/health/fibromyalgia-effects Fibromyalgia Complications]<ref name=":19" />

:<blockquote>People who have fibromyalgia frequently complain of a variety of symptoms that affect other parts of the body. Many people complain of [[gastrointestinal]] issues and restless legs syndrome (RLS). Additionally, the [[chronic pain]] and discomfort of fibromyalgia may lead to [[depression]].<ref name=":19">{{Cite news|url=https://www.sharecare.com/health/fibromyalgia-effects|title=Fibromyalgia Complications - Fibromyalgia - Joint Health|work=Sharecare|access-date=2018-08-09|language=en}}</ref></blockquote>

*[https://www.sharecare.com/health/fibromyalgia-effects/can-fibromyalgia-cause-medical-conditions Can fibromyalgia cause other medical conditions?]<ref name=":20" />

:<blockquote>Fibromyalgia is not known to cause other medical conditions. However, people who have fibromyalgia seem to be at high risk for developing other painful conditions, including osteoarthritis (the common type of arthritis caused by wear and tear on the joints) as well as other related conditions, such as rheumatoid arthritis, lupus, and ankylosing spondylitis. Also, people with fibromyalgia are frequently diagnosed with chronic fatigue syndrome, [[irritable bowel syndrome]] (IBS), and temporomandibular joint (TMJ) disorder.<ref name=":20">{{Cite web|url=https://www.sharecare.com/health/fibromyalgia-effects/can-fibromyalgia-cause-medical-conditions|title=Can fibromyalgia cause other medical conditions? {{!}} Fibromyalgia Complications|last=Honor Society of Nursing|first=|date=|website=Sharecare|language=en|archive-url=|archive-date=|access-date=2018-08-09}}</ref></blockquote>

==Risk factors==
[[Lupus]] and [[rheumatoid arthritis]] (RA) are risk factors in developing FM. Car accidents, [[post-traumatic stress disorder]] (PTSD), [[Carpal tunnel syndrome|repetitive injuries]], illness such as a [[virus]], family history, and obesity have all been linked to FM.<ref name=":35">{{Cite web|url=https://www.cdc.gov/arthritis/basics/fibromyalgia.htm|title=Fibromyalgia {{!}} Arthritis|date=2018-04-03|website=[[Centers for Disease Control]]|language=en-us|access-date=2018-08-09}}</ref><ref>{{Cite news|url=https://www.niams.nih.gov/health_info/Fibromyalgia/|title=Fibromyalgia What Causes it?|last=Director|first=Nancy Garrick, Deputy|work=National Institute of Arthritis and Musculoskeletal and Skin Diseases|access-date=2018-08-09|archive-url=|archive-date=|language=en}}</ref><ref>{{Cite news|url=http://www.prohealth.com/library/showarticle.cfm?libid=22315|title=When Fibromyalgia Is More than Pain - Prohealth|date=2016-01-08|work=Prohealth|access-date=2018-08-09|language=en-US}}</ref>

==Diagnosis==
Tender points, not [trigger points]], are used to diagnose FM.<ref>{{Cite web|url=http://www.healthcentral.com/chronic-pain/c/662034/176031/fibromyalgia-trigger/|title=The Difference Between Fibromyalgia Tender Points and Myofascial Trigger Points - Chronic Pain {{!}} HealthCentral|last=Cooper|first=Celeste|date=May 8, 2015|website=www.healthcentral.com|language=en-US|archive-url=|archive-date=|access-date=2018-08-09}}</ref> Tender points will be above and below the waist and on both sides of the body. (See: 1990 ACR and 2010 ACR images above right depicting tender points.) It is important to check for other conditions that could be causing pain such as [[hypothyroidism]], RA or lupus, osteoarthritis, ankylosing spondylitis, and polymyalgia rheumatica.<ref>{{Cite news|url=https://www.webmd.com/fibromyalgia/guide/fibromyalgia-diagnosis-and-misdiagnosis#1|title=How Is Fibromyalgia Diagnosed?|work=WebMD|access-date=2018-08-12|language=en-US}}</ref>

===United States===
=====<span id="bloodtest"> Blood test </span>=====
EpicGenetics has a blood test that is identifying the presence of specific [[Leucocyte|white blood cell]] abnormalities of patients diagnosed with FM and has partnered with two universities to offer whole exome sequencing free of charge to those who test positive with their '''FM/a® test'''.<ref>{{Cite news|url=http://www.businesswire.com/news/home/20170419005324/en/EpicGenetics-Assistance-Leading-Medical-Centers-Expands-Clinical|title=EpicGenetics, with the Assistance of Leading Medical Centers, Expands Clinical Study of FM/a® Test to Diagnose Fibromyalgia, Identify Genetic Markers Unique to the Disorder and Explore Direct Treatment Approaches|last=|first=|date=Apr 19, 2017|work=|access-date=2018-08-09|archive-url=|archive-date=|language=en}}</ref><ref name=":38">{{Cite web|url=http://fmtest.com/|title=Home|last=|website=EpicGenetics' FM/a® Test is FDA-compliant and has successfully diagnosed patients with fibromyalgia since 2012.|language=en-US|access-date=2019-03-25}}</ref> Most insurance companies will cover the test.<ref>{{Cite web|url=https://www.painnewsnetwork.org/stories/2015/5/27/fibromyalgia-blood-test-gets-insurance-coverage|title=Fibromyalgia Blood Test Gets Insurance Coverage|last=Anson|first=Pat|authorlink=|last2=|first2=|authorlink2=|date=May 27, 2015|website=Pain News Network|language=en-US|archive-url=|archive-date=|access-date=2019-03-25}}</ref><ref>{{Cite web|url=http://nationalpainreport.com/more-insurance-companies-now-paying-for-fibromyalgia-blood-test-8829994.html|title=More Insurance Companies Now Paying for Fibromyalgia Blood Test|last=Gregory-Burch|first=Donna|authorlink=|last2=|first2=|authorlink2=|date=2016-04-04|website=National Pain Report|language=en-US|archive-url=|archive-date=|access-date=2019-03-25}}</ref> EpicGenetics offers help to determine if your insurance will cover their test.<ref name=":38" />

==== American College of Rheumatology (ACR) Criteria ====

=====1990 ACR criteria=====

*1990, [http://www.rheumatology.org/Portals/0/Files/1990_Criteria_for_Classification_Fibro.pdf The American College Of Rheumatology 1990 Criteria For The Classification Of Fibromyalgia]<ref name="ACR1990" /><ref name="excerpt2" /> "American College of Rheumatology guidelines suggest that people with fibromyalgia have pain in at least 11 of these tender points when a doctor applies a certain amount of pressure."<ref>{{Cite news|url=http://www.health.com/health/gallery/0,,20345635,00.html|title=18 Points Used to Diagnose Fibromyalgia|last=|first=|date=Feb 4, 2011|work=Health.com|access-date=2018-08-09|archive-url=|archive-date=|language=en}}</ref><ref>{{Cite web|url=https://www.masscfids.org/8-resource-library/diagnosis/266-tender-points-might-no-longer-be-used-for-diagnosis-of-fibromyalgia|title=Tender Points might no longer be used for diagnosis of Fibromyalgia|last=Proskauer|first=Charmian|date=Feb 2011|website=www.masscfids.org|language=en-GB|archive-url=|archive-date=|access-date=2018-08-09}}</ref>

=====2010 ACR criteria=====

*2010, The [https://www.rheumatology.org/Portals/0/Files/2010_Preliminary_Diagnostic_Criteria.pdf 2010 American College of Rheumatology (ACR) Preliminary Diagnostic Criteria for Fibromyalgia: Overview]<ref name="ACR2010" /><ref name="excerpt" /> was proposed and modified in 2011<ref>{{Cite news|url=http://www.rheumatologynetwork.com/fibromyalgia/new-and-modified-fibromyalgia-diagnostic-criteria|title=New and Modified Fibromyalgia Diagnostic Criteria|last=Garg|first=Neha|date=Feb 9, 2012|work=Rheumatology Network|access-date=Aug 9, 2017|archive-url=|archive-date=|last2=Deodhar|first2=Atul}}</ref> with the modification being validated in 2013 and published in 2014.<ref>{{Cite journal|last=Bennett|first=Robert M.|last2=Friend|first2=Ronald|last3=Marcus|first3=Dawn|last4=Bernstein|first4=Cheryl|last5=Han|first5=Bobby Kwanghoon|last6=Yachoui|first6=Ralph|last7=Deodhar|first7=Atul|last8=Kaell|first8=Alan|last9=Bonafede|first9=Peter|date=2014|title=Criteria for the diagnosis of fibromyalgia: validation of the modified 2010 preliminary American College of Rheumatology criteria and the development of alternative criteria|url=https://www.ncbi.nlm.nih.gov/pubmed/24497443|journal=Arthritis Care & Research|volume=66|issue=9|pages=1364–1373|doi=10.1002/acr.22301|issn=2151-4658|pmid=24497443|via=}}</ref> September of 2016, another revision has been made.<ref name=":14">{{Cite news|url=http://acrabstracts.org/abstract/2016-revisions-to-the-20102011-fibromyalgia-diagnostic-criteria/|title=2016 Revisions to the 2010/2011 Fibromyalgia Diagnostic Criteria - ACR Meeting Abstracts|last=|first=|date=Sep 28, 2016|work=ACR Meeting Abstracts|access-date=2018-08-09|archive-url=|archive-date=|language=en-US}}</ref>

:Men do not seem to form the tender points needed for diagnosis under the 1990 criteria,<ref>{{Cite news|url=http://www.webmd.com/fibromyalgia/features/how-fibromyalgia-affects-men#2|title=How Fibromyalgia Affects Men: Symptoms and Diagnosis|work=WebMD|access-date=2018-08-09|language=en-US}}</ref> the 2010 proposed criteria diagnoses more men with a F/M ratio of 2:1.<ref>{{Cite journal|last=Boomershine|first=Chad|date=Nov 4, 2017|title=Fibromyalgia: Practice Essentials, Background, Pathophysiology|url=http://emedicine.medscape.com/article/329838-overview#a5|journal=Medscape|volume=|pages=|via=}}</ref>
:Tender points were used to diagnose with the 1990 criteria, however "considerable skill is needed to correctly check for a patient’s tender points (i.e., digital palpation that is done with certain amount of applied pressure), yet this technique is not typically taught at most medical schools."<ref name="masscfids">{{Cite web|url=https://www.masscfids.org/8-resource-library/diagnosis/266-tender-points-might-no-longer-be-used-for-diagnosis-of-fibromyalgia#2|title=Tender Points might no longer be used for diagnosis of Fibromyalgia|last=Proskauer|first=Charmian|date=Feb 5, 2011|website=www.masscfids.org|language=en-GB|archive-url=|archive-date=|access-date=2018-08-09}}</ref>
:The new standards were designed to:
:*eliminate the use of a tender point examination
:*include a severity scale by which to identify and measure characteristic FM symptoms
:*utilize an index by which to rate pain<ref name="masscfids" />

There are 19 tender point areas in the widespread pain index (WPI), whereas the 1990 criteria had 18 tender points.<ref name="masscfids" />

====== Widespread pain index and Symptom severity ======

The '''Widespread Pain Index''' (WPI) and '''Symptom Severity''' (SS) are explained in the study ''Fibromyalgia Syndrome: An Overview of Pathophysiology, Diagnosis and Management''.<ref name="Firdous2012" />
[[File:Widespread Pain Index Areas with numbers.svg|200px|thumb|right|'''WPI''' 19 areas of pain. Count 1 point for each area of pain<ref name="Firdous2012" /><ref name="ACR2010" /><ref name="excerpt" />]]
<blockquote>In place of the tender point count, patients (or their physician) may endorse 19 body regions in which pain has been experienced during the past week. One point is given for each area, so the score is between 0-19. This number is referred to as the '''Widespread Pain Index (WPI)''' and it is one of the two required scores needed for a doctor to make a diagnosis of fibromyalgia.</blockquote><blockquote>The second part of the score required to assess the diagnosis of fibromyalgia involves the evaluation of a person's symptoms. The patient ranks specific symptoms on a scale of 0-3. These symptoms include: [[Fatigue]], [[Unrefreshing sleep|Waking unrefreshed]], [[Cognitive dysfunction|Cognitive symptoms]], Somatic (physical) symptoms in general (such as [[headache]], weakness, [[Gastrointestinal system|bowel problems]], [[nausea]], [[dizziness]], [[numbness]] / [[Paresthesia|tingling]], [[hair loss]], [[Dry eye syndrome|dry eyes]], [[Raynaud's syndrome|Raynaud's]] phenomenon, painful urination, and more).<ref name="Firdous2012" /><ref name="ACR2010" /> The numbers assigned to each are added up, for a total of 0-12.</blockquote><blockquote>The diagnosis is based on both the '''WPI''' score and the '''SS''' score either:</blockquote>
::'''WPI''' of at least 7 and '''SS''' scale score of at least 5, ''or''
::'''WPI''' of 4-6<ref name=":14" /> and '''SS''' scale score of at least 9.<ref name="Firdous2012" />

[[File:WPI SS Fibro.JPG|600px|thumb|center|Table 2: '''SS''' scale score. Add a 4th column for Somatic (physical) symptoms in general (such as Headache, weakness, bowel problems, nausea, dizziness, numbness/tingling, hair loss, dry eyes, Raynaud's phenomenon, painful urination, and more).<ref name="Firdous2012" /><ref name="ACR2010" /> The patient ranks specific symptoms on a scale of 0-3. The numbers assigned to each column are added up, for a total of 0-12.<ref name="Firdous2012" /> ]]

The [[Social Security Administration]] (SSA) accepts a diagnosis of FM with the 1990<ref name="ACR1990" /><ref name="excerpt2" /> or 2010<ref name="ACR2010" /><ref name="excerpt" /> ACR criteria.<ref name="ssa">{{Cite web|url=https://www.ssa.gov/OP_Home/rulings/di/01/SSR2012-02-di-01.html|title=Social Security Ruling: SSR 12-2p|last=ORDP|last2=OPPS|first=|date=Jul 25, 2012|website=www.ssa.gov|language=en|archive-url=|archive-date=|access-date=2018-08-09}}</ref>
{{See also|Fibromyalgia disability process}}

=== Sleep study ===
[[Sleep dysfunction]] is often involved in FM. Treating a sleep disorder can help with FM symptoms. A diagnosed sleep disorder is also helpful if one needs to [[Fibromyalgia disability process|file for disability]].<ref>{{Cite news|url=https://www.sciencedaily.com/releases/2008/09/080903134311.htm|title=What A Sleep Study Can Reveal About Fibromyalgia|work=ScienceDaily|access-date=2018-08-09|language=en}}</ref><ref>{{Cite news|url=http://linkis.com/nationalpainreport.com/lzYea|title=Fibromyalgia Sufferers Have Difficulty Maintaining Continuous Sleep, Study Says|last=|first=|date=Mar 25, 2016|work=National Pain Report|access-date=2018-08-09|archive-url=|archive-date=|language=en-US}}</ref>

=== ICD Diagnostic code===
'''ICD-10'''

The [[World Health Organization]] (WHO) International Classification of Diseases (ICD) lists FM as a "disease of the [[musculoskeletal system]] and connective tissue", under the code M79.7 (WHO ICD-10 Version: 2016).<ref name="ICD10">{{Cite web|url=http://apps.who.int/classifications/icd10/browse/2016/en#/M79.7|title=ICD-10 Version:2016|last=World Health Organization|first=|author-link=World Health Organization|date=2016|website=[[World Health Organization]]|at=M79.7 Fibromyalgia|language=en|archive-url=|archive-date=|access-date=2018-09-15}}</ref> The WHO's ICD-10 does not refer to FM as a syndrome and it is not classified in the category for [[Medically unexplained physical symptoms|medically unexplained symptoms]].<ref name=":37" /><ref name="ICD10" />

*'''M79.7 Fibromyalgia'''
::Fibromyositis
::Fibrositis
::Myofibrositis<ref name="ICD10" />

In 2015, the [[United States|US]] finally adopted ICD-10 and FM as a diagnosis.<ref name=":37">{{Cite web|url=http://www.icd10data.com/ICD10CM/Codes/M00-M99/M70-M79/M79-/M79.7|title=2018 ICD-10-CM Diagnosis Code M79.7: Fibromyalgia|website=www.icd10data.com|language=en|access-date=2018-08-09|date=2018|last=World Health Organization|first=|archive-url=|archive-date=|authorlink=World Health Organization|last2=|first2=|authorlink2=}}</ref> <ref>{{Cite news|url=http://nationalpainreport.com/the-health-care-industry-finally-recognizes-fibromyalgia-8827637.html|title=The Health Care Industry Finally Recognizes Fibromyalgia|last=Liptan|first=Ginevra|date=2015-09-30|work=National Pain Report|access-date=2018-08-09|archive-url=|archive-date=|language=en-US}}</ref>

'''ICD-11 (2019)'''

The [[ICD-11]] (2019) has diagnostic code ''MG30.1 Chronic widespread pain,'' and changed the category from a [[:Category:Musculoskeletal diseases and disorders|Musculoskeletal disease]], to the ''General signs and symptoms category'', sometimes referred to as [[Medically unexplained physical symptoms]].<ref name="ICD11">{{Cite web|url=https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/849253504|title=ICD-11 - Mortality and Morbidity Statistics|website=[[World Health Organization]]|language=en|access-date=2018-08-09}}</ref>

*'''MG30.01 Chronic widespread pain'''

'''Parent'''
::MG30.0 Chronic primary pain

'''Description'''
<blockquote>Chronic widespread pain (CWP) is diffuse pain in at least 4 of 5 body regions and is associated with significant emotional distress (anxiety, anger/frustration or depressed mood) or functional disability (interference in daily life activities and reduced participation in social roles). CWP is multifactorial: biological, psychological and social factors contribute to the pain syndrome. The diagnosis is appropriate when the pain is not directly attributable to a nociceptive process in these regions and there are features consistent with nociplastic pain and identified psychological and social contributors.<ref name="ICD11" /></blockquote>

'''Inclusions'''
:*Fibromyalgia
'''Exclusions'''
:*Acute pain (MG31)<ref name="ICD11" />

== Take the online Fibromyalgia test ==
This [https://www.fibromyalgiaforums.org/get-help/online-fibromyalgia-test online test by fibromyalgiaforums.org] uses the ACR 2010 Criterion to diagnose fibromyalgia.

==Pathophysiology==
"Fibromyalgia (FM) is a [[chronic pain]] disorder with unknown etiology and unclear pathophysiology. There is no evidence that a single event “causes” FM. Rather, many physical and/or emotional [[Stress|stressors]] may trigger or aggravate symptoms. These have included certain [[Infection|infections]], such as a [[Viral infection|viral illness]] or [[Lyme disease]], as well as emotional or physical [[trauma]]."<ref>{{Cite web|url=https://www.uptodate.com/contents/pathogenesis-of-fibromyalgia#!|title=Pathogenesis of fibromyalgia|last=Goldenberg|first=Don L|date=|website=www.uptodate.com|archive-url=|archive-date=|access-date=2018-08-09|authorlink=|last2=Schur|first2=Paul H|authorlink2=|last3=Romain|first3=Paul L}}</ref> The widespread pain is severe, debilitating, and abnormal in processing its pain. There is also [[Sleep dysfunction|sleep disturbance]] and fatigue. Cause or causes are unproven.<ref>{{Cite news|url=https://www.omf.ngo/what-is-mecfs-old/fibromyalgia/|title=What is Fibromyalgia? {{!}} Open Medicine Foundation|work=Open Medicine Foundation|access-date=2018-08-09|language=en-US}}</ref>

*May 2012, [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3394355/ Fibromyalgia Syndrome: An Overview of Pathophysiology, Diagnosis and Management]<ref name="Firdous2012">{{Cite journal|last=Jahan|first=Firdous|last2=Nanji|first2=Kashmira|last3=Qidwai|first3=Waris|last4=Qasim|first4=Rizwan|date=2012|title=Fibromyalgia Syndrome: An Overview of Pathophysiology, Diagnosis and Management|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3394355/|journal=Oman Medical Journal|volume=27|issue=3|pages=192–195|doi=10.5001/omj.2012.44|issn=1999-768X|pmc=|pmid=22811766|via=}}</ref> ''See'' Table 1: "Conditions associated with fibromyalgia." Musculoskeletal, [[genitourinary]], [[Gastrointestinal system|gastrointestinal]], and miscellaneous conditions often exist among fibromyalgia patients.

<blockquote>Pathophysiology: Although the etiology remains unclear, characteristic alterations in the [[Sleep dysfunction|pattern of sleep]] and changes in neuroendocrine transmitters such as [[serotonin]], substance P, growth hormone and [[cortisol]] suggest that regulation of the [[Autonomic nervous system|autonomic]] and neuro-endocrine system appears to be the basis of the syndrome. Fibromyalgia is not a life-threatening, deforming, or [progressive disease. [[Anxiety]] and [[depression]] are the most common association. Aberrant pain processing, which can result in [[chronic pain]], may be the result of several interplaying mechanisms. [[Central sensitization]], blunting of inhibitory pain pathways and alterations in [[neurotransmitter]]s lead to aberrant neuro-chemical processing of sensory signals in the CNS, thus lowering the threshold of pain and amplification of normal sensory signals causing constant pain.<ref name="Firdous2012" /></blockquote>

<blockquote>The frequent co-morbidity of fibromyalgia with [[Mood swings|mood disorders]] suggests a major role for the stress response and for [[neuroendocrine]] abnormalities. The [[hypothalamic pituitary axis]] (HPA) is a critical component of the stress-adaptation response. In FMS, stress adaptation response is disturbed leading to stress induce symptoms. Psychiatric co-morbidity has been associated with FMS and needs to be identified during the consultation process, as this requires special consideration during treatment.<ref name="Firdous2012" /></blockquote>

*May 2018, [https://www.chiropractic.ca/wp-content/uploads/2018/05/107243-2_Chiro_62_1d_Bourgaize.pdf A comparison of the clinical manifestation and pathophysiology of myofascial pain syndrome and fibromyalgia: implications for differential diagnosis and management]

*Jun 2018, [https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0198625 SNPs in inflammatory genes] [[CCL11]], [[CCL4]] and [[MEFV]] in a fibromyalgia family study<ref>{{Cite journal|last=Zhang|first=Zhifang|last2=Feng|first2=Jinong|last3=Mao|first3=Allen|last4=Le|first4=Keith|last5=Placa|first5=Deirdre La|last6=Wu|first6=Xiwei|last7=Longmate|first7=Jeffrey|last8=Marek|first8=Claudia|last9=Amand|first9=R. Paul St|date=2018-06-21|title=SNPs in inflammatory genes CCL11, CCL4 and MEFV in a fibromyalgia family study|url=http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0198625|journal=PLOS ONE|language=en|volume=13|issue=6|pages=e0198625|doi=10.1371/journal.pone.0198625|issn=1932-6203|pmid=29927949|via=}}</ref>

<blockquote>SNPs with significant TDTs were found in 36% of the cohort for CCL11 and 12% for MEFV, along with a protein variant in CCL4 (41%) that affects CCR5 down-regulation, supporting an immune involvement for FM.</blockquote>

*Jul 2018, [https://fibromyalgianewstoday.com/2018/07/31/primary-secondary-fibromyalgia-share-similar-symptom-burden-study/ Primary and Secondary Fibromyalgia Share Same Symptom Burden, Study Suggests]<ref name=":22">{{Cite news|url=https://fibromyalgianewstoday.com/2018/07/31/primary-secondary-fibromyalgia-share-similar-symptom-burden-study/|title=Primary, Secondary Fibromyalgia Share Same Symptom Burden, Study Says|last=Carvalho|first=John|date=2018-07-31|work=Fibromyalgia News Today|access-date=2018-08-09|archive-url=|archive-date=|language=en-US}}</ref>

<blockquote>Fibromyalgia can be considered either primary, or dominant, also known as idiopathic fibromyalgia, or secondary. In the primary form, the causes of the disorder are unknown, but in secondary fibromyalgia, the disorder usually occurs alongside other debilitating medical conditions, such as rheumatoid arthritis (RA), lupus, and multiple sclerosis.<ref name=":22" /></blockquote>

===Immune system research===

Dr. [[Jarred Younger]] believes an overactive [[immune system]] is the cause and will be conducting a study to test this hypothesis.<ref>{{Cite news|url=http://nationalpainreport.com/new-uab-study-could-radically-change-fibromyalgia-treatment-as-we-know-it-8833437.html|title=New UAB Study Could Radically Change Fibromyalgia Treatment As We Know It|last=Gregory Burch|first=Donna|date=2017-04-24|work=National Pain Report|access-date=2018-08-09|archive-url=|archive-date=|language=en-US}}</ref><ref>{{Cite web|url=https://www.youtube.com/watch?v=8e5xKX036bE|title=Testing the fibromyalgia immune system with lipopolysaccharide (LPS)|last=Younger|first=Jarred|date=May 24, 2017|website=YouTube|archive-url=|archive-date=|access-date=|via=Younger Lab}}</ref> An overactive immune system can cause [[inflammation]] and [[chronic pain]].<ref>{{Cite news|url=https://www.epainassist.com/autoimmune/what-is-overactive-immune-system|title=What is Overactive Immune System{{!}}Causes{{!}}Symptoms{{!}}Treatment|last=Kerkar|first=Pramod|date=2016-09-29|work=ePainAssist|access-date=2018-10-04|archive-url=|archive-date=|language=en-gb}}</ref><ref>{{Cite news|url=https://www.webmd.com/a-to-z-guides/autoimmune-diseases|title=Autoimmune Diseases|work=WebMD|access-date=2018-10-04|language=en-US}}</ref>

Dr. William Pridgen's research of [[HSV-1]] (cold sore virus) as being involved in FM has conducted a successful Phase III clinical trial, which had been fast-tracked by the [[Food and Drug Administration]] (FDA), of a combination drug that suppresses this virus and also helps with pain. {{See also|Fibromyalgia drugs|Fibromyalgia drugs (see drug trials section for IMC-1)||||}}

On September 5th, 2018, EpicGenetics announced that Massachusetts General Hospital received approval from the FDA to test the BCG vaccine (an old Tuberculosis vaccine) on patients that tested positive with its FM/a® test.<ref name="painrep201809">{{Cite news|url=http://nationalpainreport.com/can-an-existing-vaccine-help-treat-fibromyalgia-8837139.html|title=Can an Existing Vaccine Help Treat Fibromyalgia?|last=Coghlan|first=Ed|date=2018-09-05|work=National Pain Report|access-date=2018-09-10|archive-url=|archive-date=|language=en-US}}</ref><ref>{{Cite news|url=http://www.prohealth.com/library/showArticle.cfm?libid=30644|title=Century-old Vaccine Gives New Hope to Fibromyalgia Community - Prohealth|last=Gregory Burch|first=Donna|date=2017-08-14|work=Prohealth|access-date=2018-08-09|archive-url=|archive-date=|language=en-US}}</ref>

Recognizing FM may involve activation of the [[immune system]] researchers performed [[Whole exome sequencing|exome sequencing]] on [[chemokine]] genes in a region of chromosome 17 identified in a genome-wide family association study. Their conclusion: "SNPs with significant TDTs were found in 36% of the cohort for [[CCL11]] and 12% for [[MEFV]], along with a protein variant in CCL4 (41%) that affects CCR5 down-regulation, supporting an immune involvement for FM."<ref name="Zhang2018">{{Cite journal|last=Zhang|first=Zhifang|last2=Feng|first2=Jinong|last3=Mao|first3=Allen|last4=Le|first4=Keith|last5=Placa|first5=Deirdre La|last6=Wu|first6=Xiwei|last7=Longmate|first7=Jeffrey|last8=Marek|first8=Claudia|last9=Amand|first9=R. Paul St|date=2018-06-21|title=SNPs in inflammatory genes CCL11, CCL4 and MEFV in a fibromyalgia family study|url=http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0198625|journal=PLOS ONE|language=en|volume=13|issue=6|pages=e0198625|doi=10.1371/journal.pone.0198625|issn=1932-6203|pmid=29927949|via=}}</ref>

Dr David Andersson from the Institute of Psychiatry, Psychology and Neuroscience at King’s College London, led a new study into Fibromyalgia being an immune system disorder.<ref>{{Cite journal|last=Goebel|first=Andreas|last2=Krock|first2=Emerson|last3=Gentry|first3=Clive|last4=Israel|first4=Mathilde R.|last5=Jurczak|first5=Alexandra|last6=Urbina|first6=Carlos Morado|last7=Sandor|first7=Katalin|last8=Vastani|first8=Nisha|last9=Maurer|first9=Margot|date=2021-07-07|title=Passive transfer of fibromyalgia symptoms from patients to mice|url=https://www.jci.org/articles/view/144201?key=51bf6d85e305f6b62f87#SEC4|journal=The Journal of Clinical Investigation|language=en|volume=131|issue=13|doi=10.1172/JCI144201|issn=0021-9738}}</ref><ref name=":0">{{Cite web|url=http://www.theguardian.com/society/2021/jul/01/fibromyalgia-may-be-a-condition-of-the-immune-system-not-the-brain-study|title=Fibromyalgia may be a condition of the immune system not the brain – study|date=2021-07-01|website=the Guardian|language=en|access-date=2021-07-08}}</ref><blockquote>Andersson and his colleagues harvested blood from 44 people with fibromyalgia and injected purified antibodies from each of them into different mice. The mice rapidly became more sensitive to pressure and cold, and displayed reduced grip strength in their paws. Animals injected with antibodies from healthy people were unaffected.<ref name=":0" /></blockquote><blockquote>Prof Camilla Svensson from the Karolinska Institute in Sweden, who was also involved in the study, said: “Antibodies from people with fibromyalgia living in two different countries, the UK and Sweden, gave similar results, which adds enormous strength to our findings.”<ref name=":0" /></blockquote>

=== Brain and spinal cord research ===
A 2004 study by Heffez et al. studied 270 patients with FM and found that 46% had [[cervical spinal stenosis]] and 20% [[chiari malformation]].<ref name="Heffez2004">{{Cite journal|last=Heffez|first=Dan S.|last2=Ross|first2=Ruth E.|last3=Shade-Zeldow|first3=Yvonne|last4=Kostas|first4=Konstantinos|last5=Shah|first5=Sagar|last6=Gottschalk|first6=Robert|last7=Elias|first7=Dean A.|last8=Shepard|first8=Alan|last9=Leurgans|first9=Sue E.|date=2004-04-09|title=Clinical evidence for cervical myelopathy due to Chiari malformation and spinal stenosis in a non-randomized group of patients with the diagnosis of fibromyalgia|url=https://link.springer.com/article/10.1007/s00586-004-0672-x|journal=European Spine Journal|language=en|volume=13|issue=6|pages=516–523|doi=10.1007/s00586-004-0672-x|issn=0940-6719|pmc=|pmid=15083352|via=}}</ref> In 2007, Heffez et al. saw significant improvement in physical and mental well-being was found in patients with cervical stenosis who received surgery.<ref name="Heffez2007">{{Cite journal|last=Heffez|first=Dan S.|last2=Ross|first2=Ruth E.|last3=Shade-Zeldow|first3=Yvonne|last4=Kostas|first4=Konstantinos|last5=Morrissey|first5=Mary|last6=Elias|first6=Dean A.|last7=Shepard|first7=Alan|date=2007|title=Treatment of cervical myelopathy in patients with the fibromyalgia syndrome: outcomes and implications|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2200733/|journal=European Spine Journal|volume=16|issue=9|pages=1423–1433|doi=10.1007/s00586-007-0366-2|issn=0940-6719|pmc=2200733|pmid=17426987|quote=|author-link=|author-link2=|author-link3=|author-link4=|author-link5=|via=}}</ref> A second study in 2007 by Andrew Holman found that 71% had cervical [[spinal cord]] compression.<ref>{{Cite journal|date=2008-07-01|title=Positional Cervical Spinal Cord Compression and Fibromyalgia: A Novel Comorbidity With Important Diagnostic and Treatment Implications|url=https://www.sciencedirect.com/science/article/pii/S1526590008004379|journal=The Journal of Pain|language=en|volume=9|issue=7|pages=613–622|doi=10.1016/j.jpain.2008.01.339|issn=1526-5900|last=|first=|quote=|author-link=Andrew Holman|author-link2=|author-link3=|author-link4=|author-link5=|via=}}</ref> It is important to note that in the past many patients were misdiagnosed with FM when further testing would have revealed the true source of their pain; the 2010 (updated in 2016) ACR criteria has helped curb misdiagnoses.<ref>{{Cite news|title=Fibromyalgia Expert Says Misdiagnosis is Rampant|url=http://nationalpainreport.com/fibromyalgia-expert-says-misdiagnosis-is-rampant-8832803.html|work=National Pain Report|date=2017-02-02|access-date=2018-11-26|language=en-US}}</ref><ref name="misdiagnosis">{{Cite news|title=Common Misdiagnoses of Fibromyalgia|url=https://www.webmd.com/fibromyalgia/guide/common-misdiagnoses-of-fibromyalgia#|work=WebMD|access-date=2018-11-26|language=en-US|last=|first=|date=|archive-url=|archive-date=}}</ref><ref name=":28" />

Various types of brain imaging are being used to research FM. (''See'': [[Fibromyalgia notable studies]] for images.)

In 2002, an [[Functional magnetic resonance imaging|fMRI]] study conducted by Richard Gracely and Daniel Claw found people with FM "have measurable pain signals in their brains, from a gentle finger squeeze that barely feels unpleasant to people without the disease."<ref name="sd2002">{{Cite web|url=https://www.sciencedaily.com/releases/2002/06/020607073056.htm|title=Fibromyalgia Pain Isn't All In Patient's Heads, New Brain Study Finds|last=|first=|date=Jun 7, 2002|website=sciencedaily.com|archive-url=|archive-date=|access-date=2018-08-09}}</ref> A 2007 study by Borsook et al., ''Neuroimaging revolutionizes therapeutic approaches to chronic pain'' found decreased gray matter density relative to controls in cingulate cortex (CC), medial prefrontal cortex (Med. PFC), parahippocampal gyrus (PHG) and insula.<ref name="Borsook2007">{{Cite journal|last=Borsook|first=David|last2=Moulton|first2=Eric A|last3=Schmidt|first3=Karl F|last4=Becerra|first4=Lino R|date=2007-09-11|title=Neuroimaging Revolutionizes Therapeutic Approaches to Chronic Pain|url=https://link.springer.com/article/10.1186/1744-8069-3-25|journal=Molecular Pain|language=en|volume=3|issue=1|pages=1744–8069-3-25|doi=10.1186/1744-8069-3-25|issn=1744-8069|pmid=17848191|via=}}</ref> In 2015, Loggia et al. imaged [[neuroinflammation]] due to [[Glial cell|glial]] activation using MR/PET imaging.<ref name="itn2018">{{Cite news|url=https://www.itnonline.com/article/mrpet-ultimate-imaging-hybrid|title=MR/PET: The Ultimate Imaging Hybrid|last=Ros|first=Pablo R.|date=2012-05-29|work=Imaging Technology News|access-date=2018-10-30|archive-url=|archive-date=|language=en}}</ref><ref name="Loggia2015">{{Cite journal|last=Loggia|first=Marco L.|last2=Chonde|first2=Daniel B.|last3=Akeju|first3=Oluwaseun|last4=Arabasz|first4=Grae|last5=Catana|first5=Ciprian|last6=Edwards|first6=Robert R.|last7=Hill|first7=Elena|last8=Hsu|first8=Shirley|last9=Izquierdo-Garcia|first9=David|date=2015-01-08|title=Evidence for brain glial activation in chronic pain patients|url=https://academic.oup.com/brain/article/138/3/604/333527?searchresult=1|journal=Brain|language=en|volume=138|issue=3|pages=604–615|doi=10.1093/brain/awu377|issn=1460-2156}}</ref> In 2017, López-Solà et al. identified three [[brain]] patterns based on [[Functional magnetic resonance imaging|fMRI]] responses to pressure pain and non-painful multisensory stimulation. "These patterns, taken together, discriminate FM from matched healthy controls with 92% sensitivity and 94% specificity."<ref name=":34">{{Cite journal|last=López-Solà|first=Marina|last2=Woo|first2=Choong-Wan|last3=Pujol|first3=Jesus|last4=Deus|first4=Joan|last5=Harrison|first5=Ben J.|last6=Monfort|first6=Jordi|last7=Wager|first7=Tor D.|date=2017|title=Towards a neurophysiological signature for fibromyalgia|url=https://www.ncbi.nlm.nih.gov/pubmed/27583567|journal=Pain|volume=158|issue=1|pages=34–47|doi=10.1097/j.pain.0000000000000707|issn=1872-6623|pmid=27583567|via=}}</ref> In 2018, Albrecht et al used [[Positron emission tomography|PET]] scans to document [[Glial cell|glial]] activation.<ref name=":52">{{Cite journal|last=Albrecht|first=Daniel S.|last2=Forsberg|first2=Anton|last3=Sandstrom|first3=Angelica|last4=Bergan|first4=Courtney|last5=Kadetoff|first5=Diana|last6=Protsenko|first6=Ekaterina|last7=Lampa|first7=Jon|last8=Lee|first8=Yvonne C.|last9=Höglundi|first9=Caroline Olgart|date=2018-09-14|others=Catana, Ciprian; Cervenka, Simon; Akeju, Oluwaseun; Lekander, Mats; Cohen, George; Halldin, Christer; Taylor, Norman; Kim, Minhae; Hooker, Jacob M.; Loggia, Marco L.|title=Brain glial activation in fibromyalgia – A multi-site positron emission tomography investigation|url=https://www.sciencedirect.com/science/article/pii/S0889159118302423|journal=Brain, Behavior, and Immunity|language=en|volume=|pages=|doi=10.1016/j.bbi.2018.09.018|issn=0889-1591|via=}}</ref> Also in 2018, Martucci et al. found unbalanced activity between the ventral and dorsal cervical spinal cord. Ventral neural processes were increased and dorsal neural processes were decreased which may reflect the presence of [[central sensitization]] contributing to [[fatigue]] and other bodily symptoms in FM.<ref>{{Cite journal|last=Martucci|first=Katherine T|last2=Weber|first2=Kenneth A|last3=Mackey|first3=Sean C|date=2018-10-03|title=Altered Cervical Spinal Cord Resting State Activity in Fibromyalgia|url=https://onlinelibrary.wiley.com/doi/abs/10.1002/art.40746|journal=Arthritis & Rheumatology|language=en|doi=10.1002/art.40746|issn=2326-5191}}</ref>

=== Fibromyalgia is not the same as depression ===
* Oct 24, 2003, [https://www.webmd.com/depression/news/20031024/fibromyalgia-isnt-depression#1 Fibromyalgia Isn't Depression]<ref name="webmd-notdepress" />
<blockquote>[[Depression]] doesn't cause the pain of fibromyalgia, a new study shows.<ref name="webmd-notdepress" /></blockquote>

<blockquote>"People still doubt fibromyalgia is a disease," Giesecke tells WebMD. "Previously, we found that fibromyalgia patients really do have increased central pain processing. Now we can show this is not affected by depression. Something is wrong here, and it is not at all connected with depression."<ref name="webmd-notdepress" /></blockquote>

<blockquote>"Giesecke's group looked at [[brain]] responses to painful stimuli, and then checked to see if there was any difference between depressed and nondepressed fibromyalgia patients. They showed the activation of areas of the brain related to pain were not different in patients with and without depression." But there is a difference between people with and without fibromyalgia, he says.<ref name="webmd-notdepress" /> </blockquote><blockquote>The researchers use an imaging device called [[functional magnetic resonance imaging]], or fMRI, to look at how the brain responds to pain. Study participants get a mildly painful pressure on their thumb, which makes the brain's pain centers "light up" on the image. Thumb pressure -- at a level healthy people hardly feel -- sets off a firestorm in the pain centers of fibromyalgia patients' brains.<ref name="webmd-notdepress" /></blockquote>
* Jun 30, 2013, [https://www.healthcentral.com/article/psychiatrists-admit-fibromyalgia-is-neuropathic-not-a-form-of-depression Psychiatrists Admit Fibromyalgia is Neuropathic - Not a Form of Depression]<ref name=":41">{{Cite web|url=https://www.healthcentral.com/article/psychiatrists-admit-fibromyalgia-is-neuropathic-not-a-form-of-depression|title=Psychiatrists Admit Fibromyalgia is Neuropathic – Not a Form of Depression - Causes - Chronic Pain {{!}} HealthCentral|last=Lee Richards|first=Karen|authorlink=|last2=|first2=|authorlink2=|date=Jun 30, 2013|website=www.healthcentral.com|language=en-US|access-date=2019-04-13}}</ref>
<blockquote>The study the APA referred to was published in the June issue of ''Brain'', a journal of neurology. The researchers investigated the function and structure of small nerve fibers in 25 FM patients, 10 patients with monopolar depression without pain and with healthy control subjects. Using three different methods of testing, the researchers found that compared with control subjects, patients with fibromyalgia, but not patients with depression, had impaired small fiber function.<ref name="brain-1857">http://brain.oxfordjournals.org/content/136/6/1857.abstract</ref><ref name=":41" /></blockquote><blockquote>The study authors stated, "This strengthens the notion that fibromyalgia syndrome is not a variant of depression, but rather represents an independent entity that may be associated with depressive symptoms". The findings also point "towards a neuropathic nature of pain in fibromyalgia syndrome."<ref name=":41" /></blockquote>
* Jan 10, 2019, [https://themighty.com/2019/01/do-i-have-fibromyalgia-or-depression/ 17 Signs You Have Fibromyalgia, Not 'Just' Depression]<ref name=":43">{{Cite web|url=https://themighty.com/2019/01/do-i-have-fibromyalgia-or-depression/|title=17 Signs You Have Fibromyalgia, Not 'Just' Depression|last=|first=|authorlink=|last2=|first2=|authorlink2=|date=Jan 10, 2019|website=The Mighty|language=en-US|archive-url=|archive-date=|access-date=2019-04-13}}</ref>
<blockquote>Fibromyalgia is [https://themighty.com/2018/05/what-fibromyalgia-gets-misdiagnosed-as/ often misdiagnosed as a number of other illnesses]. Though fibro has its own unique set of diagnostic criteria, many of its symptoms can mimic symptoms of other conditions – both physical and mental, acute and chronic.<ref name=":43" /></blockquote><blockquote>One of the most common conditions fibromyalgia gets mistaken for is depression. While each condition causes a unique set of symptoms, many of them may overlap. Like fibro, depression can cause physical symptoms such as pain, fatigue and brain fog. And living with a chronic physical symptoms can have significant effects on your mood, sometimes causing feelings of hopelessness, anxiety or general discontent – which are also symptoms of depression.<ref name=":43" /></blockquote>

== Comorbidities, overlapping conditions, and common symptoms ==
[[File:Fibromyalgia and comorbid conditions.JPG|700px|thumb|center|Comorbid conditions of fibromyalgia (FM) are [[ME/CFS]] which is the most common comorbidity,<ref name="ammes-overlap" /><ref name=":31" /> [[autoimmune disease|autoimmune disease]]s; [[migraine]]s; [[Multiple chemical sensitivity|multiple chemical sensitivities]] (MCS); and [[orthostatic intolerance]] (OI) / [[postural orthostatic tachycardia syndrome]] (POTS).<ref name="ammes-overlap" /><ref name="Firdous2012" /><ref name=":44" /> Overlapping conditions are [[depression]] and [[anxiety]]; [[Digestive problems|digestive conditions]], [[Menstrual|menstrual problems]]; [[Gulf War Illness]] (GWI); [[nervous system]] disorders; [[Hypotension|low blood pressure]] (Low BP); [[Pain#Pain in Fibromyalgia|other pain conditions]]; and [[sleep dysfunction]]/disturbance<ref name="ammes-overlap" /><ref name="Firdous2012" /><ref name="mayocause" />]]

===[[Allodynia]]===
*[http://chronicfatigue.about.com/od/glossary/g/allodynia.htm Allodynia: A Rare & Distinct Type of Pain in Fibromyalgia & ME/CFS]<ref name="Allodynia">{{Cite news|url=https://www.verywellhealth.com/allodynia-definition-and-types-fibromyalgia-715929|title=Allodynia: A Rare & Distinct Type of Pain in Fibromyalgia & ME/CFS|last=Dellwo|first=Adrienne|date=Feb 23, 2018|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=}}</ref> Types of Allodynia: Tactile; Mechanical; and Thermal. "Type of pain, generally on the skin, that's caused by something that wouldn't normally cause pain."<ref name="Allodynia" />
*[[Autoimmune disease]]s "Research suggests that RA and other inflammatory diseases may somehow increase the risk for fibromyalgia."<ref>{{Cite news|url=https://www.health.com/health/gallery/0,,20520705,00.html#restless-legs-0|title=7 Conditions Linked to Fibromyalgia|work=Health.com|access-date=2018-08-19|language=en}}</ref>

===[[Body temperature]]===
{{See also |Small fiber peripheral neuropathy}}
: for [[temperature sensitivity]]; burning, tingling, and prickling due to [[paresthesia]]; [[numbness]]; [[dry eye syndrome|dry eyes]] and [[dry mouth]]; and more.)<ref name=":02">{{Cite news|url=https://www.healthline.com/health/small-fiber-neuropathy#symptoms|title=Small Fiber Neuropathy: Symptoms, Treatment, Causes, and More|last=Vandergriendt|first=Carly|date=Jan 4, 2018|work=Healthline|access-date=2018-10-04|archive-url=|archive-date=|last2=Weatherspoon|first2=Deborah|language=en}}</ref><ref>{{Cite news|url=https://www.webmd.com/brain/understanding-peripheral-neuropathy-basics#3|title=Peripheral Neuropathy -- Symptoms, Types, and Causes of Peripheral Neuropathy|last=|first=|date=|work=WebMD|access-date=2018-10-04|archive-url=|archive-date=|page=3|language=en-US}}</ref>

<blockquote>When you're exposed to heat, does it feel like you're burning up? Does it seem impossible for you to cool off? Or maybe it's cold that bothers you, chilling you to the bone, leaving you unable to warm up? Or are you one of those people with fibromyalgia (FMS) and chronic fatigue syndrome (ME/CFS) who is cold all the time, or hot all the time, or alternately hot or cold while out of sync with the environment?<ref name=":2">{{Cite news|url=https://www.verywellhealth.com/temperature-sensitivity-in-fibromyalgia-and-mecfs-716025|title=Temperature Sensitivity in Fibromyalgia & ME/CFS|last=Dellwo|first=Adrienne|date=Mar 15, 2018|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=}}</ref></blockquote>

=== [[Costochondritis]]===
[[File:Costal cartilages.JPG|200px|thumb|left|Costochondritis is inflammation of the costal cartilages (shown in red) causing chest and ribcage pain. From BodyParts3D/Anatomography (Life Science db.jp), license CC BY-SA 2.1 JP.]]

<blockquote>Costochondritis is a condition that causes pain in the cartilage that connect your ribs to your sternum (breastbone). Cartilage is the tough, bendable tissue that protects your bones where they rub against each other.<ref name=":10">{{Cite web|url=https://www.drugs.com/cg/costochondritis.html|title=Costochondritis - What You Need to Know|website=Drugs.com|language=en|access-date=2020-01-27}}</ref></blockquote>
Costochondritis causes pain in the area where your sternum joins with your ribs. The pain may come and go, and may get worse over time. The pain may be sharp, or dull and aching. It may be painful to touch your chest. The pain may spread to your back, abdomen, or down your arm. It may get worse when you move, breathe deeply, or push or lift an object. The pain may make it hard for you to sleep or do your usual activities.<ref name=":10" /><blockquote>People tend to describe the pain as stabbing, burning, aching, confined to one spot, usually in the very center of the chest, but it may radiate outward.<ref>{{Cite web|url=https://www.medicalnewstoday.com/articles/321635.php|title=Can fibromyalgia cause chest pain?|website=Medical News Today|language=en|access-date=2020-01-27}}</ref></blockquote>

===[[Depression]] and [[anxiety]]===
{{See also|Depression|Depression|Anxiety|Anxiety}}Fibromyalgia sufferers are "up to three times more likely to have depression at the time of their diagnosis than someone without fibromyalgia."<ref name="webmd-depress">{{Cite news|url=https://www.webmd.com/fibromyalgia/fibromyalgia-and-depression#1|title=Fibromyalgia and Depression|work=WebMD|access-date=2018-08-19|language=en-US}}</ref> Up to 20% of Fibromyalgia patients will have either depression or anxiety.<ref name="adaa">{{Cite web|url=https://adaa.org/understanding-anxiety/related-illnesses/other-related-conditions/fibromyalgia|title=Fibromyalgia|website = Anxiety and Depression Association of America|language=en|access-date=2018-08-19}}</ref>

====<span id="depression">Differences between depression and fibromyalgia====

* Depression and anxiety are common in fibromyalgia but are not core diagnostic symptoms, so they are not required for a diagnosis of Fibromyalgia, and a significant number of people with fibromyalgia have never had depression.<ref name="Koroschetz2011-symptoms">{{Cite journal|last=Koroschetz|first=Jana|last2=Rehm|first2=Stefanie E.|last3=Gockel|first3=Ulrich|last4=Brosz|first4=Mathias|last5=Freynhagen|first5=Rainer|last6=Tölle|first6=Thomas R.|last7=Baron|first7=Ralf|date=2011-05-25|title=Fibromyalgia and neuropathic pain - differences and similarities. A comparison of 3057 patients with diabetic painful neuropathy and fibromyalgia|url=https://doi.org/10.1186/1471-2377-11-55|journal=BMC Neurology|volume=11|issue=1|pages=55|doi=10.1186/1471-2377-11-55|issn=1471-2377|pmc=3125308|pmid=21612589}}</ref><ref name="ACR1990" /><ref name="ACR2010" />
* Fibromyalgia is a diagnosis of '''chronic widespread pain''', but pain is not needed for a diagnosis of depression.
*2007, The classification of fibromyalgia syndrome<ref name="Muller2007">{{Cite journal|last=Müller|first=W.|last2=Schneider|first2=E. M.|last3=Stratz|first3=T.|date=2007-09-01|title=The classification of fibromyalgia syndrome|url=https://doi.org/10.1007/s00296-007-0403-9|journal=Rheumatology International|language=en|volume=27|issue=11|pages=1005–1010|doi=10.1007/s00296-007-0403-9|issn=1437-160X}}</ref> [https://link.springer.com/article/10.1007%2Fs00296-007-0403-9 (Abstract)]
*2008, The relationship between fibromyalgia and major depressive disorder: a comprehensive review<ref name="Pae2008">{{Cite journal|last=Pae|first=Chi-Un|author-link=|last2=Luyten|first2=Patrick|author-link2=|last3=Marks|first3=David M.|author-link3=|last4=Han|first4=Changsu|author-link4=|last5=Park|first5=Sung-Hwan|author-link5=|last6=Patkar|first6=Ashwin A.|author-link6=|last7=Masand|first7=Prakash S.|last8=Houdenhove|first8=Boudewijn Van|author-link8=Boudewijn Van Houdenhove|date=2008-08-01|title=The relationship between fibromyalgia and major depressive disorder: a comprehensive review|url=https://doi.org/10.1185/03007990802288338|journal=Current Medical Research and Opinion|volume=24|issue=8|pages=2359–2371|doi=10.1185/03007990802288338|issn=0300-7995|pmc=|pmid=18606054|access-date=|quote=|via=}}</ref> [https://doi.org/10.1185/03007990802288338 (Abstract)]
*2010, Anxiety and depressive symptoms in fibromyalgia are related to poor perception of health but not to pain sensitivity or cerebral processing of pain<ref name="Jensen2010">{{Cite journal|last=Jensen|first=Karin B.|last2=Petzke|first2=Frank|last3=Carville|first3=Serena|last4=Fransson|first4=Peter|last5=Marcus|first5=Hanke|last6=Williams|first6=Steven C. R.|last7=Choy|first7=Ernest|last8=Mainguy|first8=Yves|last9=Gracely|first9=Richard|date=2010|title=Anxiety and depressive symptoms in fibromyalgia are related to poor perception of health but not to pain sensitivity or cerebral processing of pain|url=https://onlinelibrary.wiley.com/doi/abs/10.1002/art.27649|journal=Arthritis & Rheumatism|language=en|volume=62|issue=11|pages=3488–3495|doi=10.1002/art.27649|issn=1529-0131}}</ref> [https://doi.org/10.1002/art.27649 (Abstract)]
*2012, Fibromyalgia a discrete entity?<ref name="Ablin2012">{{cite journal | last=Ablin | first=Jacob N. | last2=Buskila | first2=Dan | last3=Van Houdenhove | first3=Boudewijn | last4=Luyten | first4=Patrick | last5=Atzeni | first5=Fabiola | last6=Sarzi-Puttini | first6=Piercarlo | title=Is fibromyalgia a discrete entity? | journal=Autoimmunity Reviews | url=https://doi.org/10.1016%2Fj.autrev.2011.10.018 | volume=11 | issue=8 | pages = 585–588 | date=Jun 2012 | issn=1568-9972 | doi=10.1016/j.autrev.2011.10.018 }}</ref> [https://onlinelibrary.wiley.com/doi/pdf/10.1002/art.27649 (Full text)]
*2012 [https://www.webmd.com/depression/news/20031024/fibromyalgia-isnt-depression Fibromyalgia isn't depression] - WebMD<ref name="webmd-notdepress">{{Cite web|url=https://www.webmd.com/depression/news/20031024/fibromyalgia-isnt-depression|title=Fibromyalgia Isn't Depression|last=DeNoon|first=Daniel J.|website=WebMD|language=en|access-date=2021-03-27}}</ref>

===[[Dry eye syndrome]]===
<ref name=":110">{{Cite news|url=https://www.news-medical.net/health/Fibromyalgia-and-Dry-Eyes-and-Mouth.aspx|title=Fibromyalgia and Dry Eyes and Mouth|last=Mandal|first=Ananya|date=2013-06-30|work=News-Medical.net|access-date=2018-10-04|archive-url=|archive-date=|last2=Cashin-Garbutt|first2=April|language=en}}</ref>

===[[Fatigue]]===
<blockquote>Fatigue is a universal symptom of fibromyalgia. It is often most marked when arising from sleep in the morning. A typical quote is “''No matter how much sleep I get, it feels like a truck ran me over in the morning'' (20).” Minor activities often seem to aggravate the fatigue.<ref name=":29">{{Cite web|url=https://www.docsopinion.com/2017/11/08/causes-fatigue-tiredness-chronic-fatigue/|title=19 Important Causes of Fatigue - Tiredness and Chronic Fatigue Explained|website=www.docsopinion.com|access-date=2019-01-30}}</ref></blockquote>

===[[Fibro fog]] and [[Cognitive dysfunction]]===
*'Mental confusion along with difficulty in concentration and loss of memory is often termed “[[fibro fog]]"'.<ref name=":3">{{Cite news|url=https://www.news-medical.net/health/What-is-Fibro-Fog-Fibromyalgia-and-Cognitive-Dysfunction.aspx|title=What is Fibro Fog? - Fibromyalgia and Cognitive Dysfunction|last=Mandal|first=Ananya|date=2013-06-03|work=News-Medical.net|access-date=2018-08-09|archive-url=|archive-date=|language=en}}</ref>

===[[Digestive problems|Gastrointestinal problems]]===
*[[Irritable bowel syndrome]]:
:<blockquote>Fibromyalgia, chronic fatigue syndrome and irritable bowel syndrome (IBS) frequently go together. No one really knows why, but we do know that all three conditions can include imbalances of serotonin -- although in fibromyalgia (FMS) and Chronic Fatigue Syndrome (CFS or ME/CFS) it's an imbalance in the brain, while with IBS it's in the gut.<ref name=":4">{{Cite news|url=https://www.verywellhealth.com/irritable-bowel-syndrome-in-fibromyalgia-cfs-716167|title=Irritable Bowel Syndrome in Fibromyalgia & ME/CFS|last=Dellwo|first=Adrienne|date=Jan 28, 2018|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=}}</ref> </blockquote>
===[[Gulf War Illness]]===
GWI increases risk of developing fibromyalgia.<ref name="VA">{{Cite web|url=https://www.publichealth.va.gov/exposures/gulfwar/fibromyalgia.asp|title=Fibromyalgia in Gulf War Veterans - Public Health|last=Administration|first=US Department of Veterans Affairs, Veterans Health|website=www.publichealth.va.gov|language=en|access-date=2018-08-19}}</ref>

===[[Interstitial cystitis]]===
Interstitial cystitis causes a painful bladder.<ref name=":5">{{Cite news|url=https://www.verywellhealth.com/chronic-fatigue-syndrome-interstitial-cystitis-716168|title=Fibromyalgia, Chronic Fatigue Syndrome & Interstitial Cystitis|last=Dellwo|first=Adrienne|date=Feb 16, 2018|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=}}</ref>
:"Fibromyalgia, chronic fatigue syndrome and [[interstitial cystitis]] (IC) -- a painful bladder condition -- frequently occur together. Women may be up to 10 times more likely than men to develop it."<ref name=":5" />
*[Interstitial cystitis]]/painful bladder syndrome and associated medical conditions with an emphasis on irritable bowel syndrome, fibromyalgia and [[Chronic fatigue syndrome|chronic fatigue syndrome.]]<ref name="Nickel2010">{{Cite journal|last=Nickel|first=J. Curtis|last2=Tripp|first2=Dean A.|last3=Pontari|first3=Michel|last4=Moldwin|first4=Robert|last5=Mayer|first5=Robert|last6=Carr|first6=Lesley K.|last7=Doggweiler|first7=Ragi|last8=Yang|first8=Claire C.|last9=Mishra|first9=Nagendra|date=2010|title=Interstitial cystitis/painful bladder syndrome and associated medical conditions with an emphasis on irritable bowel syndrome, fibromyalgia and chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/20719340|journal=The Journal of Urology|volume=184|issue=4|pages=1358–1363|doi=10.1016/j.juro.2010.06.005|issn=1527-3792|pmid=20719340|via=}}</ref>

===Language Impairment or word problems===
*[[Word-finding problems]]
:*"Searching their brains for simple words that they just can't remember. On other occasions, individuals with these diagnoses may find it hard to write or even understand language."<ref name=":6">{{Cite news|url=https://www.verywellhealth.com/language-impairment-in-fibromyalgia-cfs-716024|title=Language Impairment in Fibromyalgia and Chronic Fatigue Syndrome|last=Dellwo|first=Adrienne|date=Feb 12, 2018|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=}}</ref>
*"The diagnosis of [[aphasia]] is a condition that robs you of the ability to communicate. It can affect your ability to speak, write and understand language, both verbal and written"<ref>{{Cite news|url=http://www.mayoclinic.org/diseases-conditions/aphasia/basics/definition/con-20027061|title=Aphasia - Symptoms and causes|work=Mayo Clinic|access-date=2018-08-09|language=en}}</ref> but with [[dysphasia]] you will have those symptoms and trouble listening and doing numerical calculations.<ref name=":36" />
===[[Migraine]]===
<blockquote>Both fibromyalgia and migraine may reflect problems in the brain’s pain processing center. It is believed that both conditions are caused by excitation of the nervous system or an over-response to stimuli. Stress is usually cited as a trigger for both migraine and fibromyalgia attacks.<ref name=":32">{{Cite news|url=https://migrainecenters.com/blog/migraines-and-fibromyalgia/|title=Migraines and Fibromyalgia - Migraine Centers|date=2016-05-06|work=Migraine Centers|access-date=2018-08-19|language=en-US}}</ref></blockquote>

===[[Multiple chemical sensitivity|Multiple Chemical Sensitivity]] (MCS)===
It is thought that both Fibromyalgia and MCS are [[central sensitization|central sensitization]] syndromes.<ref>{{Cite news|url=https://www.verywellhealth.com/chemical-sensitivity-in-fibromyalgia-716170|title=Multiple Chemical Sensitivity in Fibromyalgia & ME/CFS|last=Dellwo|first=Adrienne|date=Jul 23, 2018|work=Verywell Health|access-date=2018-08-19|archive-url=|archive-date=}}</ref>

===OBGYN===
*[https://www.verywellhealth.com/menstrual-periods-and-fibromyalgia-715596 Menstrual Periods with Fibromyalgia: Personal Stories]
<blockquote>You may have heard about a possible link between gynecologic surgery (such as a hysterectomy) and the development of fibromyalgia, and doctors have long suspected that fibromyalgia has strong -[[Hormone|hormonal]] ties and triggers. This does not seem surprising as we've long suspected a link between endocrine disorders, gynecological conditions, and autoimmune conditions.<ref name=":7">{{Cite news|url=https://www.verywellhealth.com/fibromyalgia-tied-to-hysterectomy-gynecologic-disease-715626|title=Fibromyalgia Tied to Hysterectomy, Gynecologic Disease|last=Dellwo|first=Adrienne|date=Feb 16, 2018|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=}}</ref></blockquote>

===[[Orthostatic intolerance]] (OI)===
[[Postural orthostatic tachycardia syndrome]] (POTS) and other forms of orthostatic intolerance often occur in people with fibromyalgia.<ref name=":44">{{Cite journal|last=Yun|first=Dong Joo|last2=Choi|first2=Han Na|last3=Oh|first3=Gun-Sei|date=2013|title=A Case of Postural Orthostatic Tachycardia Syndrome Associated with Migraine and Fibromyalgia|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3710947/|journal=The Korean Journal of Pain|volume=26|issue=3|pages=303–306|doi=10.3344/kjp.2013.26.3.303|issn=2005-9159|pmid=23862007|via=}}</ref> Symptoms can include [[hypotension|low blood pressure]] and/or sudden high blood pressure, [[dizziness]], [[syncope|fainting]].
*Dr Charles Lapp found that fibromyalgia ymptoms and ME/CFS symptoms predicted the outcome of [[Tilt Table Testing]] foe [[orthostatic intolerance]].<ref>{{Cite web|url=http://drlapp.com/wp-content/uploads/TTT_symptoms.pdf|title=Symptoms Predict the Outcome of Tilt Table Testing in CFS/ME/FM|last=Lapp|first=Charles W.|last2=Black|first2=Laura|date=|website=drlapp.com|archive-url=|archive-date=|access-date=|last3=Smith|first3=Rebekah S.}}</ref>
*Orthostatic intolerance may often be l overlooked in fibromyalgia patients.<ref>{{Cite news|url=https://www.healthrising.org/blog/2017/09/21/fibromyalgia-problems-standing-orthostatic-intolerance/|title=An Overlooked Issue in Fibromyalgia? Study Highlights Orthostatic Intolerance - Problems Standing - Health Rising|last=Johnson|first=Cort|date=2017-09-21|work=Health Rising|access-date=2018-08-09|archive-url=|archive-date=|language=en-US}}</ref>
===[[Raynaud's syndrome]]===
<blockquote>In Raynaud's syndrome, the blood vessels constrict more than they should, which allows less blood to get through. That not only makes your extremities cold, it makes them extremely difficult to warm up. The most commonly affected body parts are the fingers and toes, but your lips, nose, ear lobes, knees, and nipples may also be involved.</blockquote>
<blockquote>Raynaud's isn't all about the cold, though. The diminished blood flow can cause pain in the affected areas, and it may also cause the skin there to turn blue. Skin ulcers (sores) are possible, since prolonged episodes of low blood flow can damage your tissues.<ref name="reynaulds">{{Cite web|url=https://www.verywellhealth.com/raynauds-syndrome-chronic-fatigue-716185|title=Cold Hands & Feet? Raynaud's Syndrome in Fibromyalgia & ME/CFS|last=Dellwo|first=Adrienne|date=Jan 28, 2018|work=Verywell Health|access-date=2018-10-11|archive-url=|archive-date=}}</ref></blockquote>

===[[Sleep dysfunction]]===
*Vatthauer et al. (2015) found that sleep was associated with task-negative [[brain]] activity in fibromyalgia participants with comorbid chronic [[insomnia]].<ref name="Vatthauer2015">{{Cite journal|last=Vatthauer|first=Karlyn E|last2=Craggs|first2=Jason G|last3=Robinson|first3=Michael E|last4=Staud|first4=Roland|last5=Berry|first5=Richard B|last6=Perlstein|first6=William M|last7=McCrae|first7=Christina S|date=2015-11-12|title=Sleep is associated with task-negative brain activity in fibromyalgia participants with comorbid chronic insomnia|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4648619/|journal=Journal of Pain Research|volume=8|pages=819–827|doi=10.2147/JPR.S87501|issn=1178-7090|pmc=|pmid=26648751|via=|issue=|quote=|author-link=|author-link2=|author-link3=|author-link4=Roland Staud|author-link5=}}</ref>
<blockquote>The present results of this study suggest that long-term, comorbid pain and sleep disturbance may be associated with increased activation in core default mode brain areas that is above and beyond long-term pain disturbance alone.<ref name="Vatthauer2015" /></blockquote>

*"Most people with fibromyalgia have an associated sleep disorder that makes it difficult for them to get the deep, restorative sleep they need."<ref name=":8">{{Cite news|url=https://www.prohealth.com/library/fibromyalgia-and-sleep-38954|title=Fibromyalgia and Sleep - Prohealth|date=2016-01-11|work=Prohealth|access-date=2018-08-09|language=en-US}}</ref>

===[[Temporomandibular joint disorder]] (TMJ/TMD) ===
[[File:Skull_diagram.png|350px|thumb|right|The temporomandibular joint is the joint between the mandible (light blue) and the temporal bone (orange) of the skull]]
* [https://www.sciencedirect.com/science/article/pii/S2255502114001758 Temporomandibular disorders in fibromyalgia syndrome: a short-communication]<ref>{{Cite journal|last=Soares Gui|first=Maisa|last2=Pimentel|first2=Marcele Jardim|last3=Rizzatti-Barbosa|first3=C'elia Marisa|date=2015-03-01|title=Temporomandibular disorders in fibromyalgia syndrome: a short-communication|url=https://www.sciencedirect.com/science/article/pii/S2255502114001758|journal=Revista Brasileira de Reumatologia (English Edition)|language=en|volume=55|issue=2|pages=189–194|doi=10.1016/j.rbre.2014.07.004|issn=2255-5021|via=ScienceDirect}}</ref><ref>{{Cite news|url=https://www.whitesmilesforlife.com/blog/study-probes-pain-link-between-tmj-fibromyalgia/|title=Study Probes Pain Link Between TMJ, Fibromyalgia|date=2016-05-03|work=Kent E. White, DDS|access-date=2018-08-19|language=en-US}}</ref>

Other than [[headache]]s, the symptoms of TMJ/TMD are quite distinct from symptoms of FMS and ME/CFS. They include:
*Jaw pain
*Discomfort or difficulty chewing
*Painful clicking in the jaw
*Difficulty opening or closing the mouth
*Headaches
*Locking jaw
*Teeth that don't come together properly<ref>{{Cite news|url=https://www.verywellhealth.com/tmj-in-fibromyalgia-chronic-fatigue-syndrome-716175|title=TMJ in Fibromyalgia and Chronic Fatigue Syndrome|last=Dellwo|first=Adrienne|date=Mar 31, 2018|work=Verywell Health|access-date=2018-08-22|archive-url=|archive-date=}}</ref>

===[[Thyroid disease]]===
<blockquote>People with [[Hashimoto's thyroiditis (hypothyroidism)|Hashimoto's autoimmune thyroid disease]] often experience significant fatigue and body aches. While these symptoms are common in Hashimoto's, they can also be markers of other diseases, like chronic fatigue syndrome or fibromyalgia.<ref name=":9">{{Cite news|url=https://www.verywellhealth.com/relationship-between-cfs-fibromyalgia-and-aitd-3231677|title=A Comparison of Chronic Fatigue, Fibromyalgia, and Thyroid Disease|last=Shomon|first=Mary|date=Feb 21, 2018|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=}}</ref> </blockquote>

===Other symptoms===
*[http://chronicfatigue.about.com/od/whatisfibromyalgia/a/fibrosymptoms.htm Symptoms of Fibromyalgia]<ref>{{Cite news|url=https://www.verywellhealth.com/fibromyalgia-symptoms-716139|title=Symptoms of Fibromyalgia|last=Dellwo|first=Adrienne|date=May 16, 2018|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=}}</ref> (On all the many symptoms and conditions of and related to fibromyalgia.)
*Fibromyalgia Syndrome: An Overview of Pathophysiology, Diagnosis and Management [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3394355/ Conditions associated with fibromyalgia. (Table 1)]<ref name="Firdous2012" />

==Treatment==

===United States===
'''Rheumatology and primary care providers: Diagnosing and treatment'''

*2012, [https://www.mayoclinicproceedings.org/article/S0025-6196(12)00299-6/abstract A Framework for Fibromyalgia Management for Primary Care Providers]<ref>{{Cite journal|last=Arnold|first=Lesley M.|last2=Clauw|first2=Daniel J.|last3=Dunegan|first3=L. Jean|last4=Turk|first4=Dennis C.|date=2012|title=A Framework for Fibromyalgia Management for Primary Care Providers|url=https://www.mayoclinicproceedings.org/article/S0025-6196(12)00299-6/abstract|journal=Mayo Clinic Proceedings|language=English|volume=87|issue=5|pages=488–496|doi=10.1016/j.mayocp.2012.02.010|issn=0025-6196|via=}}</ref> Rheumatologists stopped treating fibromyalgia patients and primary care providers began treatment managment although rheumatologists are most often the specialist to diagnose.
{{See also|Fibromyalgia disability process}}

===Drugs===
{{Main article |page_name = Fibromyalgia drugs}}

=== Therapies ===

==== Exercise ====
''Please Note'': These treatments are for fibromyalgia patients and '''not''' [[ME/CFS]] sufferers due to it's hallmark symptom of [[post-exertional malaise]].
[[File:Warm water exercise.JPG|200px|thumb|left|Warm water exercise is best for fibromyalgia. Start slow and don't push through the pain<ref name=":11" />]]

*[https://www.verywellhealth.com/warm-water-exercise-for-fibromyalgia-716059 Warm Water Exercise for Fibromyalgia]<ref name=":11">{{Cite news|url=http://chronicfatigue.about.com/od/treatingfmscfs/a/warmwaterFMS.htm|title=Warm Water Exercise for Fibromyalgia|last=Dellwo|first=Adrienne|date=Nov 19, 2017|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=}}</ref><ref>{{Cite journal|last=Munguía-Izquierdo|first=D.|last2=Legaz-Arrese|first2=A.|date=2007|title=Exercise in warm water decreases pain and improves cognitive function in middle-aged women with fibromyalgia|url=https://www.ncbi.nlm.nih.gov/pubmed/18173915|journal=Clinical and Experimental Rheumatology|volume=25|issue=6|pages=823–830|issn=0392-856X|pmid=18173915|via=}}</ref><ref>{{Cite news|url=https://www.prohealth.com/fibromyalgia/library/aquatic-exercise-training-fibromyalgia-85081?|title=Aquatic exercise training for fibromyalgia|date=2018-08-29|work=Prohealth|access-date=2018-09-01|language=en-US}}</ref><ref>{{Cite journal|last=Bidonde|first=Julia|last2=Busch|first2=Angela J.|last3=Webber|first3=Sandra C.|last4=Schachter|first4=Candice L.|last5=Danyliw|first5=Adrienne|last6=Overend|first6=Tom J.|last7=Richards|first7=Rachel S.|last8=Rader|first8=Tamara|date=2014-10-28|title=Aquatic exercise training for fibromyalgia|url=https://www.ncbi.nlm.nih.gov/pubmed/25350761|journal=The Cochrane Database of Systematic Reviews|issue=10|pages=CD011336|doi=10.1002/14651858.CD011336|issn=1469-493X|pmid=25350761}}</ref>

<blockquote>Several studies have found that warm-water pool exercise is a beneficial treatment for fibromyalgia. A very large survey of patients found that 26% have used pool therapy, rating it as very effective.<ref name=":45">{{Cite journal|last=Bennett|first=Robert M.|author-link=|last2=Jones|first2=Jessie|author-link2=|last3=Turk|first3=Dennis C.|author-link3=|last4=Russell|first4=I. Jon|author-link4=|last5=Matallana|first5=Lynne|author-link5=|date=Mar 9, 2007|title=An internet survey of 2,596 people with fibromyalgia|url=https://doi.org/10.1186/1471-2474-8-27|journal=BMC Musculoskeletal Disorders|volume=8|issue=1|pages=27|doi=10.1186/1471-2474-8-27|issn=1471-2474|pmc=1829161|pmid=17349056|quote=|via=}}</ref> The same survey found 74% of patients found heat helpful - either warm water or heat packs.<ref name=":45" /> Warm water especially important in FMS because many people with the condition are intolerant of cold. A warm-water pool is one that's kept around 89.6 degrees Fahrenheit (32 Celsius), which is several degrees warmer than most heated pools.<ref name=":11" /></blockquote>

* Moderate aerobic exercise and weights with six to eight reps and then a day or two of rest in between. Do not start a program if you are in a flare.<ref>{{Cite web|url=http://www.arthritis.org/living-with-arthritis/tools-resources/expert-q-a/fibromyalgia-questions/fibromyalgia-exercise.php|title=Fibromyalgia Exercise {{!}} Exercising with Fibromyalgia|last=Ronenn|first=Roubenoff|date=|website=www.arthritis.org|archive-url=|archive-date=|access-date=2018-08-09}}</ref>

*[https://www.youtube.com/watch?v=BauJYuJwFsI Easy fibromyalgia exercises and motivation to keep you healthy!]<ref>{{Cite web|url=https://www.youtube.com/watch?v=BauJYuJwFsI|title=Easy Fibromyalgia exercises and motivation to keep you healthy!|last=Suarez|first=Eric|date=Jun 21, 2011|website=YouTube|archive-url=|archive-date=|access-date=Aug 9, 2018}}</ref> Video

*[http://chronicfatigue.about.com/od/whatisfibromyalgia/a/Fibromyalgia-Myth-Vs-Fact.htm Fibromyalgia Myth vs. Fact]<ref name=":15">{{Cite news|url=https://www.verywellhealth.com/fibromyalgia-myth-vs-fact-716131|title=Fibromyalgia: What's Myth, What's Fact?|last=Dellwo|first=Adrienne|date=Jun 8, 2016|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=|at=Myth #3 People With Fibromyalgia Need More Exercise}}</ref> Heading: ''Myth #3: People With Fibromyalgia Need More Exercise''. Appropriate exercise, which each patient needs to gauge for themselves.<ref name=":15" />

==== Massage ====

*2014, [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3930706/ Massage Therapy for Fibromyalgia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials]<ref>{{Cite journal|last=Li|first=Yan-hui|last2=Wang|first2=Feng-yun|last3=Feng|first3=Chun-qing|last4=Yang|first4=Xia-feng|last5=Sun|first5=Yi-hua|date=2014-02-20|title=Massage Therapy for Fibromyalgia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3930706/|journal=PLoS ONE|volume=9|issue=2|doi=10.1371/journal.pone.0089304|issn=1932-6203|pmc=|pmid=24586677|pages=|via=}}</ref>

*2016, [http://chronicfatigue.about.com/od/alternativetreatments/a/bodywork.htm Massage, Rolfing & Other Bodywork - Are They Effective Fibromyalgia & Chronic Fatigue Syndrome Treatments?]<ref>{{Cite news|url=https://www.verywellhealth.com/massage-rolfing-other-bodywork-715645|title=Massage, Rolfing, Reiki: Do They Work for Fibromyalgia & ME/CFS?|last=Dellwo|first=Adrienne|date=Aug 10, 2017|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=}}</ref>

==== Acupuncture ====

*2004, [[U.S. Department of Health and Human Services]] (HHS) and Centers for Medicare and Medicaid Services (CMS) ruled April 16, 2004, a noncoverage determination for acupuncture.<ref>{{Cite web|url=https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R11NCD.pdf|title=CMS Manual System Pub. 100-03 Medicare National Coverage Determinations|last=|first=|date=Apr 16, 2004|website=CMS.gov|format=PDF|archive-url=|archive-date=|access-date=}}</ref>

*2005, [http://acupunctureschoolonline.com/acupuncture-good-for-fibromyalgia.html Acupuncture Good for Fibromyalgia?] <ref name=":16">{{Cite web|url=http://acupunctureschoolonline.com/acupuncture-good-for-fibromyalgia.html|title=Acupuncture Good for Fibromyalgia?|last=|first=|date=Oct 2, 2012|website=Acupuncture School Online|archive-url=|archive-date=|access-date=2018-08-09}}</ref> "Acupuncture gave no significant pain relief to fibromyalgia patients."<ref name=":16" />

*2016, [http://www.sciencedirect.com/science/article/pii/S2095496416602352 Short-term complementary and alternative medicine on quality of life in women with fibromyalgia] <ref name=":25">{{Cite journal|date=2016-01-01|title=Short-term complementary and alternative medicine on quality of life in women with fibromyalgia|url=https://www.sciencedirect.com/science/article/pii/S2095496416602352|journal=Journal of Integrative Medicine|language=en|volume=14|issue=1|pages=29–35|doi=10.1016/S2095-4964(16)60235-2|issn=2095-4964}}</ref> "There was no significant improvement in pain or reduction of tender points in any of the groups studied, at the end of the 8th session."<ref name=":25" />

*2016, [https://fibromyalgianewstoday.com/2016/02/01/acupuncture-does-not-reduce-pain-for-women-with-fibromyalgia/ Acupuncture Does Not Appear to Relieve Pain in Fibromyalgia Patients]<ref>{{Cite news|url=https://fibromyalgianewstoday.com/2016/02/01/acupuncture-does-not-reduce-pain-for-women-with-fibromyalgia/|title=Acupuncture Does Not Appear to Relieve Pain in Fibromyalgia Patients - Fibromyalgia News Today|last=Semedo|first=Daniela|date=2016-02-01|work=Fibromyalgia News Today|access-date=2018-08-09|archive-url=|archive-date=|language=en-US}}</ref>

== Controversy ==
=== Dr. Frederick Wolfe ===
Dr. [http://rheummd.org/members/fwolfe Frederick Wolfe], the director of the [https://www.arthritis-research.org/ National Databank for Rheumatic Diseases] and the lead author of the 1990 paper that first defined the diagnostic guidelines for fibromyalgia, says he has become cynical and discouraged about the diagnosis. He now considers the condition a physical response to stress, depression, and economic and social anxiety.<ref>{{Cite journal|last=Wolfe|first=Frederick|last2=Walitt|first2=Brian|date=2016|title=Fibromyalgia: A Short Commentary|url=http://headache.imedpub.com/fibromyalgia-a-short-commentary.pdf|journal=Journal of Headache & Pain Management|volume=1|issue= 3|pages=27|via=iMedPubJournals}}</ref><ref>{{Cite news|url=https://www.news-medical.net/news/20130322/Fibromyalgia-an-interview-with-Dr-Frederick-Wolfe-University-of-Kansas-School-of-Medicine.aspx|title=Fibromyalgia: an interview with Dr Frederick Wolfe, University of Kansas School of Medicine|last=Cashin-Garbutt|first=April|date=2013-03-22|work=News-Medical.net|access-date=2018-08-09|archive-url=|archive-date=|language=en}}</ref>

=== Fibromyalgia vs Chiari malformation ===
Some individuals diagnosed with FMS were undergoing surgery for [[chiari malformation]] (CM). These are two separate conditions; FMS cannot be resolved by undergoing a risky CM surgery.

*2011, [https://www.ncbi.nlm.nih.gov/pubmed/21135714 Is Chiari I malformation associated with fibromyalgia?]<ref>{{Cite journal|last=Watson|first=Nathaniel F.|last2=Buchwald|first2=Dedra|last3=Goldberg|first3=Jack|last4=Maravilla|first4=Kenneth R.|last5=Noonan|first5=Carolyn|last6=Guan|first6=Qingyan|last7=Ellenbogen|first7=Richard G.|date=2011|title=Is Chiari I malformation associated with fibromyalgia?|url=https://www.ncbi.nlm.nih.gov/pubmed/21135714|journal=Neurosurgery|volume=68|issue=2|pages=443–448; discussion 448–449|doi=10.1227/NEU.0b013e3182039a31|issn=1524-4040|pmid=21135714|via=}}</ref>
::Conclusion: Most patients with FM do not have [[CIM]] pathology. Future studies should focus on dynamic neuroimaging of craniocervical neuroanatomy in patients with FM.
*2015, [https://www.massmecfs.org/resource-library/9-treatment/172-cfidsfm-and-chiari-malformation-surgery CFS/FM and Chiari Malformation Surgery]<ref>{{Cite web|url=https://www.massmecfs.org/resource-library/9-treatment/172-cfidsfm-and-chiari-malformation-surgery|title=CFS/FM and Chiari Malformation Surgery|last=Casanova|first=Ken|date=Nov 15, 2015|website=www.massmecfs.org|language=en-GB|archive-url=|archive-date=|access-date=2018-08-09}}</ref>

==Disability: SSI/SSD and LT==
{{Main article |page_name = Fibromyalgia disability process}}

==Notable studies ==
{{Main article |page_name = Fibromyalgia notable studies}}

==See also==
*[[Fibromyalgia disability process]]
* [[Fibromyalgia drugs]]
* [[Fibromyalgia notable studies]]
* [[Influenza vaccine]]
*[[Lady Gaga]]
*''[[Mayo Clinic Guide to Fibromyalgia: Strategies to Take Back Your Life]] - Medical guide book (2019)''

== Learn more ==
*[https://dx.doi.org/10.4065%2Fmcp.2011.0206 The Science of Fibromyalgia] - Daniel Clauw, Lesley Arnold, and Bill McCarber for the FibroCollaborative
*[http://fmtest.com/ FM/a® test]
*[https://www.s4me.info/forums/fibromyalgia-and-connective-tissue-disorders.35/ Forum: Fibromyalgia and Connective Tissue Disorders] at [[Science for ME]]

=== Diagnosing and categorizing fibromyalgia===
*2014, [http://www.medpagetoday.com/Rheumatology/Fibromyalgia/49114 Lyme Disease, Fibromyalgia Link Evaporates] (See also: [[Chronic lyme disease]])
*2015, [http://www.news-medical.net/news/20150518/Fibromyalgia-now-considered-as-a-lifelong-central-nervous-system-disorder.aspx Fibromyalgia now considered as a lifelong central nervous system disorder]
*2015, [http://nationalpainreport.com/foundation-of-fibromyalgia-is-altered-central-nervous-system-new-study-validates-8827896.html Foundation of Fibromyalgia Is Altered Central Nervous System, New Study Validates]
*2016, [http://fibromyalgianewstoday.com/2016/09/09/fibromyalgia-diagnosis-using-noninvasive-eye-examination Diagnosing Fibromyalgia May Be Possible Using Noninvasive Eye Examination]
*2016, [http://simmaronresearch.com/2016/03/are-chronic-fatigue-syndrome-mecfs-and-fibromyalgia-immune-exhaustion-disorders/ Are Chronic Fatigue Syndrome (ME/CFS) and Fibromyalgia Immune Exhaustion Disorders?]
*2017, [http://nationalpainreport.com/study-reveals-new-treatment-target-for-fibromyalgia-inflammation-in-the-brain-8833354.html Study Reveals New Treatment Target for Fibromyalgia: Inflammation in the Brain]
*2017, [https://qz.com/1349854/ai-can-spot-the-pain-from-a-disease-some-doctors-still-think-is-fake/? AI can spot the pain from a disease some doctors still think is fake]
*2018, [https://www.verywellhealth.com/fibromyalgia-pain-physiological-evidence-716141 Understanding the Pathophysiology of Fibromyalgia]
*2018, [https://www.prohealth.com/fibromyalgia/library/fibromyalgia-central-sensitization-syndrome-87957? Fibromyalgia: Central Sensitization Syndrome - Characterizing classes of fibromyalgia within the continuum of central sensitization syndrome]

=== Blood tests ===
*2013, [http://nationalpainreport.com/new-fibromyalgia-blood-test-is-99-accurate-8821072.html New Fibromyalgia Blood Test is 99% Accurate]
*2014, [http://www.prohealth.com/library/showarticle.cfm?libid=18837 Pridgen Reports Fibromyalgia Antiviral Trial Results “Very Positive”: Predicts New Approach Will Be “Game-Changer”]
*2016, [https://www.celestecooper.com/2016/05/blood-test-for-fibromyalgia-fma-test-is.html Blood Test for Fibromyalgia: FM/a Test Ⓡ is now available, Q&A]
*2016, [http://www.liveinsurancenews.com/fibromyalgia-blood-testing-covered-rising-number-insurance-companies/ Fibromyalgia blood testing covered by rising number of insurance companies]
*2017, [http://www.businesswire.com/news/home/20170419005324/en/EpicGenetics-Assistance-Leading-Medical-Centers-Expands-Clinical EpicGenetics, with the Assistance of Leading Medical Centers, Expands Clinical Study of FM/a® Test to Diagnose Fibromyalgia, Identify Genetic Markers Unique to the Disorder and Explore Direct Treatment Approaches]

=== Brain scans ===
*2002, [http://www.anapsid.org/cnd/diagnosis/brainpain.html Fibromyalgia Pain Isn't All In Patient's Heads, New Brain Study Finds]
*2012, [https://www.sciencedaily.com/releases/2012/11/121111153426.htm Fibromyalgia and the brain: New clues reveal how pain and therapies are processed]
*2018, [https://ki.se/en/news/people-with-fibromyalgia-have-inflammation-of-the-brain People with fibromyalgia have inflammation of the brain]
*2018, [https://fibromyalgianewstoday.com/2018/10/11/brain-inflammation-imaged-first-time-fibromyalgia-patients-study/ Brain Inflammation Imaged for First Time in Fibromyalgia Patients, Study Reports]<

==References==
{{reflist}}

[[Category:Diagnoses]]
[[Category:Potential comorbidities]]
[[Category:Musculoskeletal diseases and disorders]]
[[Category:Neurological diseases and disorders]]

Fibromyalgia

2021-07-21T17:24:42Z

Loopy:/* Sleep study */ Online Test

{{Cleanup|date=Mar 2021|reason=Check science guidelines are met, e.g. no blogs or unreferenced articles for citations regarding general health information. Image captions should state author and copyright license. See [[help:Images%23Displaying_an_image_on_a_page]].}}

[[Fibromyalgia]] '''(FM/FMS)''' is a chronic disorder characterized by widespread [[Musculoskeletal system|musculoskeletal]] pain, [[fatigue]], and tenderness in localized areas. [[Myalgia|Muscle pain]] is widespread, on both sides of the body, and above and below the waist.<ref name="ACR1990" /><ref name="excerpt2" /><ref name="ACR2010" /><ref name="excerpt" />

Sufferers are fatigued and tired even when sleeping for long periods of time, and sleep is often disrupted by pain. Many FM sufferers have [[Sleep dysfunction|sleep disorders]] like [[sleep apnea]] and [[restless legs syndrome]] (RLS).<ref name="webmd-guide" /><ref name="mayo" /><ref name=":35" /> [[Cognitive impairment]], when one cannot focus or pay attention and the patient has difficulty concentrating on mental tasks, is known by FM sufferers as "[[fibro fog]]".<ref name="webmd-guide" /><ref name="mayo" /><ref name=":35" /> Some experience [[depression]], [[headache]]s, and lower [[abdominal pain]] or muscle cramp. Other symptoms include [[Paresthesia|tingling]] or [[numbness]] in hands and feet, pain in jaw and disorders of the jaw such as [[temporomandibular joint disorder|temporomandibular joint disorder]] (TMJ/TMD), [[Menstrual cycle#Health effects in other conditions|menstrual cycle]] cramps, and [[digestive problems]] like [[irritable bowel syndrome]] (IBS).<ref name="webmd-guide">{{Cite news|url=https://www.webmd.com/fibromyalgia/guide/fibromyalgia-symptoms#1|title=Fibromyalgia Symptoms|work=WebMD|access-date=2018-08-09|language=en-US}}</ref><ref name="mayo">{{Cite news|url=https://www.mayoclinic.org/diseases-conditions/fibromyalgia/symptoms-causes/syc-20354780|title=Fibromyalgia - Symptoms and causes|work=Mayo Clinic|access-date=2018-08-09|language=en}}</ref><ref name=":35" />

[[Pain#Pain in Fibromyalgia|Other pain conditions are associated with FM]], such as [[rheumatoid arthritis]] (RA), [[systemic lupus erythematosus]] (Lupus), ankylosing spondylitis, [[interstitial cystitis]], and more.<ref name="mayocause">{{Cite web|url=https://www.mayoclinic.org/diseases-conditions/fibromyalgia/symptoms-causes/syc-20354780|title=Fibromyalgia - Symptoms and causes|website=Mayo Clinic|language=en|access-date=2019-05-03}}</ref>

The [[United Kingdom|United Kingdom]] (UK) [[National Health Service]] (NHS) lists FM as one of 20 most painful conditions.<ref>{{Cite web|url=https://www.newsweek.com/20-most-painful-conditions-nhs-1191081|title=Here are 20 of the most painful health conditions you can get|last=EDT|first=Hannah Osborne On 10/29/18 at 7:14 AM|date=2018-10-29|website=Newsweek|language=en|access-date=2019-03-26}}</ref><ref name=":39">{{Cite web|url=https://www.cambridge-news.co.uk/news/uk-world-news/nhs-gout-ulcer-endometriosis-arthritis-15339123|title=The NHS says these are the 20 most painful health conditions you can suffer from|last=Campbell|first=James|last2=Pengelly|first2=Ella|date=2019-03-26|website=cambridgenews|access-date=2019-03-26}}</ref> The NHS describes the pain as diffuse aching or burning, head to toe, and can be worse at some times than at others. The pain can change location. "The fatigue ranges from feeling tired, to the exhaustion of a [[flu-like illness]]."<ref name=":39" /> The [[United States|United States]] (US) [[Centers for Disease Control and Prevention]] (CDC) states FM "can cause pain, [[Fibromyalgia disability process|disability, and lower quality of life]]."<ref name=":35" /> The medical guide book [[Mayo Clinic Guide to Fibromyalgia: Strategies to Take Back Your Life|''Mayo Clinic Guide to'' ''Fibromyalgia: Strategies to Take Back Your Life'']] describes fibromyalgia as "a [[Central sensitization|sensory disorder]] caused by a miscommunication between the [[Nervous system|nerves through your body and your brain]]."<ref>{{Cite web|url=https://www.amazon.com/Mayo-Clinic-Guide-Fibromyalgia-Strategies/dp/1893005496/ref=sr_1_1|title=Mayo Clinic Guide to Fibromyalgia: Strategies to Take Back Your Life|last=Abril, M.D.|first=Andy|authorlink=|last2=Bruce Ph.D. L.P.|first2=Barbara K.|authorlink2=|date=2019|website=www.amazon.com|publisher=Mayo Clinic Press; Paperback Original edition|page=15|archive-url=|archive-date=|access-date=2019-11-13}}</ref>

The [[American_College_of_Rheumatology|American College of Rheumatology]] (ACR) created and updates the diagnostic criteria for FM.<ref name="ACR1990" /><ref name="ACR2010">{{Cite journal|url=https://www.rheumatology.org/Portals/0/Files/2010_Preliminary_Diagnostic_Criteria.pdf|title=American College of Rheumatology (ACR) Preliminary Diagnostic Criteria for Fibromyalgia|last=Wolfe|first=Frederick|date=May 2010|volume =62 | issue = 5 | pages= 600–610| doi = 10.1002/acr.20140|type=PDF|archive-url=|archive-date=|access-date=|authorlink=|last2=Clauw|first2=Daniel|authorlink2=|journal=Arthritis Care & Research|last3=Fitzcharles|first3=Mary-Ann|first4=Don|last5=Katz|last4=Goldenberg|first5=Robert|last6=Mease|first6=Philip|last7=Russel|first7=Anthony|last8=Russel|first8=I. Jon|first9=John|last9=Winfield|first10=Muhammad|last10=Yunus|quote=The reference list consisted of: [[myalgia|muscle pain]], [[irritable bowel syndrome]], [[fatigue]]/tiredness, [[cognitive dysfunction|thinking or remembering problem]], [[paresis|muscle weakness]], [[headache]], pain/cramps in the abdomen, [[paresthesia|numbness/tingling]], [[dizziness]], [[insomnia]], [[depression]], [[constipation]], pain in the upper abdomen, [[nausea]], nervousness, [[chest pain]], [[blurred vision]], [[fever]], [[diarrhea]], dry mouth, [[skin itch|itching]], wheezing, [[Raynaud's syndrome|Raynaud’s phenomenon]], [[hives|hives/welts]], [[tinnitus|ringing in ears]], [[vomiting]], [[heartburn]], oral ulcers, loss of/change in taste, [[seizure]]s, [[dry eye syndrome|dry eyes]], [[dyspnea|shortness of breath]], [[anorexia (appetite loss)|loss of appetite]], [[skin rash|rash]], [[photophobia|sun sensitivity]], hearing difficulties, easy [[bruising]], [[hair loss]], frequent urination, [[painful bladder syndrome|painful urination]], and bladder spasms.}}</ref><ref name="ACR1990" /><ref name="excerpt2" /><ref name="ACR2010" /><ref name="excerpt">{{Cite web|url=https://www.rheumatology.org/Portals/0/Files/2010%20Fibromyalgia%20Diagnostic%20Criteria_Excerpt.pdf|title=2010 Fibromyalgia Diagnostic Criteria - Excerpt|last=|first=|authorlink=|last2=|first2=|website=rheumatology.org|page=|archive-url=|archive-date=|access-date=}}</ref> See: [[Fibromyalgia#Diagnosis|Fibromyalgia (Diagnosis)]].

[[File:Fibro_Tender_Points.png|400px|thumb|right|<span id="ACR1990-image">1990 ACR Diagnostic Criteria: 18 Tender Points</span><ref name="ACR1990">{{Cite journal|last=Wolfe|first=Frederick|author-link=Frederick Wolfe|last2=Smythe|first2=Hugh|author-link2=|last3=Yunus|first3=Muhammad|author-link3=Muhammad Yunnus|last4=Bennett|first4=Robert|author-link4=|last5=Bombardier|first5=Claire|author-link5=|last6=Goldenberg|first6=Don|author-link6=|last7=Tugwell|first7=Peter|author-link7=|last8=Campbell|first8=Stephen|author-link8=|last9=Abeles|first9=Micha|author-link9=|others=P Clark; A Fam; S Farber; J Fiechtner; CM Franklin; R Gatter; D Hamaty; J Lessard; A Lichtbroun; A Masi; G McCain; WJ Reynolds; T Romano; IJ Russell; R Sheon|date =1990|title=The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia|url=https://www.rheumatology.org/Portals/0/Files/1990_Criteria_for_Classification_Fibro.pdf|journal=Arthritis and Rheumatism|publisher=The American College of Rheumatology|volume=33|issue=2|pages=160-172|quote=|via=}}</ref><ref name="excerpt2">{{Cite web|url=https://www.rheumatology.org/Portals/0/Files/1990%20Fibromyalgia_Excerpt.pdf|title=1990 Fibromyalgia Excerpt|last=Wolfe|first=Frederick|authorlink=|last2=|first2=|authorlink2=|date=1990|website=rheumatology.org|archive-url=|archive-date=|access-date=}}</ref>]]
[[File:Fibro_Widespread_Pain.png|400px|thumb|right|<span id="ACR1990-image">2010 ACR Preliminatry Diagnostic Criteria:</span> '''Widespread Pain Index (WPI'''), 19 Tender Point Areas<ref name="ACR2010" /><ref name="excerpt" />]]

==Prevalence==
FM is the second most common rheumatic disorder behind [[osteoarthritis]] and is "now considered to be a lifelong [[central nervous system]] disorder."<ref>{{Cite web|url=https://www.sciencedaily.com/releases/2015/05/150517071813.htm|title=Fibromyalgia has central nervous system origins|last=|first=|authorlink=|last2=|first2=|authorlink2=|date=May 17, 2015|website=ScienceDaily|at=Summary|language=en|archive-url=|archive-date=|access-date=2019-11-13|quote=now considered to be a lifelong central nervous system disorder}}</ref><ref>{{Cite news|url=https://naidw.org/blog/members-myblogs/fibromyalgia-now-considered-as-a-lifelong-central-nervous-system-disorder|title=Fibromyalgia now considered as a lifelong central nervous system disorder|work=NAIDW.org®|access-date=2018-08-09|language=en-gb}}</ref> An estimated 10 million people in the US and 3-6% of the world population have FM. It is seen in women, men, children, and all ethnic groups. It is often seen in families and diagnosed between the ages of 20 to 50 years; incidence increases with age.<ref>{{Cite news|url=http://www.fmaware.org/about-fibromyalgia/prevalence/|title=Prevalence - National Fibromyalgia Association (NFA)|work=National Fibromyalgia Association (NFA)|access-date=2018-08-09|language=en-US}}</ref>

FM has a female:male 7:1 ratio under the ''American College of Rheumatology (ACR) 1990 Diagnostic Criteria''<ref name="ACR1990" /><ref name="excerpt2" /> and 2:1 when the ACR 2010 Preliminary Diagnostic Criteria<ref name="ACR2010" /><ref name="excerpt" /> is used.<ref>{{Cite journal|last=Boomershine|first=Chad|date=Nov 4, 2017|title=Fibromyalgia: Practice Essentials, Background, Pathophysiology|url=http://emedicine.medscape.com/article/329838-overview#a5|journal=Medscape|volume=|pages=|via=|publisher=|editor-last=Diamond|editor-first=Herbert|at=Sex-related differences in incidence}}</ref> See: [[Fibromyalgia#American College of Rheumatology (ACR) Criteria|Fibromyalgia (''American College of Rheumatology (ACR) Criteria'')]]. A September 2018, Wolfe et al study ''Fibromyalgia diagnosis and biased assessment: Sex, prevalence and bias''<ref name=":28" /> found fewer women and more men are diagnosed under the 2010/11 criteria (this criterion further updated in 2016<ref>{{Cite journal|date=2016-12-01|title=2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria|url=https://www.sciencedirect.com/science/article/pii/S0049017216302086|journal=Seminars in Arthritis and Rheumatism|language=en|volume=46|issue=3|pages=319–329|doi=10.1016/j.semarthrit.2016.08.012|issn=0049-0172}}</ref>). They found the ratio is F/M 1.5:1.<ref name=":28">{{Cite journal|last=Wolfe|first=Frederick|last2=Walitt|first2=Brian|last3=Perrot|first3=Serge|last4=Rasker|first4=Johannes J.|last5=Häuser|first5=Winfried|date=2018-09-13|title=Fibromyalgia diagnosis and biased assessment: Sex, prevalence and bias|url=https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0203755|journal=PLOS ONE|language=en|volume=13|issue=9|pages=e0203755|doi=10.1371/journal.pone.0203755|issn=1932-6203|pmc=|pmid=30212526|via=}}</ref><blockquote>What we did not find in our unbiased CritFM samples was 9:1 female to male fibromyalgia ratios that are widely described by expert sources [11–13]. We believe that such findings only occur in the presence of selection bias or biased ascertainment.<ref name=":28" /></blockquote><blockquote>As unbiased epidemiological studies show only a small increase in the female to male sex ratio (~1.5:1) as opposed to the observed ratio in clinical studies of 9:1, we believe that the over-identification of fibromyalgia in women and the consequent under-identification of men is the result of bias.<ref name=":28" /></blockquote>

==Fibromyalgia in ME/CFS==
"The most common overlapping condition with [[ME/CFS]] is fibromyalgia."<ref name="ammes-overlap">{{Cite web|url=https://ammes.org/overlapping-conditions/|title=Overlapping Conditions|website = [[American Myalgic Encephalomyelitis and Chronic Fatigue Syndrome Society]]|last=|first=|date=|language=en-US|archive-url=|archive-date=|access-date=2018-08-12}}</ref><ref>{{Cite web|url=http://www.ayushveda.com/healthcare/dysphasia.htm|title=Dysphasia - Causes, Symptoms & Treatment|website=www.ayushveda.com|access-date=2018-08-09}}</ref> See also: [[Dyscalculia]].
* [[ME/CFS]]<ref name="ammes-overlap" /><ref name="ICC2011primer">{{citation
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| 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=":31">{{Cite journal|last=Jason|first=Leonard|last2=Taylor|first2=R.R.|last3=Kennedy|first3=C.L.|last4=Song|first4=S|last5=Johnson|first5=D|last6=Torres|first6=S.R.|date=2001-01-01|title=Chronic fatigue syndrome: Comorbidity with fibromyalgia and psychiatric illness|url=https://www.researchgate.net/publication/285787383_Chronic_fatigue_syndrome_Comorbidity_with_fibromyalgia_and_psychiatric_illness|journal=Medicine and Psychiatry|volume=4|pages=29–34}}</ref> While some have posited ME/CFS and FM are variants of the same illness, [[Benjamin Natelson]], MD summoned considerable amounts of data that suggest the two illnesses differ with different pathophysiologic processes leading to different treatments.<ref name=":36">{{Cite journal|last=Natelson|first=Benjamin H.|date=2019-02-19|title=Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Fibromyalgia: Definitions, Similarities, and Differences|url=https://www.clinicaltherapeutics.com/article/S0149-2918(19)30003-7/abstract|journal=Clinical Therapeutics|language=English|volume=41|issue=4|pages=612|doi=10.1016/j.clinthera.2018.12.016|issn=0149-2918|pmid=30795933}}</ref>

Dr. [[Jarred Younger]] has said that many patients that meet the criteria for FM also meet criteria for [[chronic fatigue syndrome]] (CFS) but the reverse is not necessarily true as a lot of people with [[CFS]] do not have [[chronic pain]].<ref>{{Cite web|url=https://www.youtube.com/watch?v=wJB95m4FLa0#t=57m27s|title=Webinar with Jarred Younger, Ph.D.|last=Younger|first=Jarred|date=May 20, 2016|website=YouTube|at=57:27|via=|archive-url=|archive-date=|access-date=|publisher=SolveCFS|type=Video}}</ref> However, the [[Canadian Consensus Criteria]] (CCC) requires the symptom of pain to diagnose ME/CFS.<ref name="Carruthers, 2003">{{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
| url = http://phoenixrising.me/wp-content/uploads/Canadian-definition.pdf
}}</ref> It is the pattern (on both sides of the body, and above and below the waist) of chronic widespread [[Musculoskeletal system|musculoskeletal]] pain (involving muscle, cartilage, ligaments, and connective tissue) in FM that sets it apart from other diseases that have pain; it also causes [[cognitive symptoms]] and [[unrefreshing sleep]].<ref name="webmd-guide" /><ref name="mayo" />

A Swedish study of 234 ME/CFS patients meeting the [[Canadian Consensus Criteria]] found that 96% had trigger point pain consistent with fibromyalgia and 67% met the diagnostic criteria for fibromyalgia.<ref>{{Cite web|url=https://osf.io/qwn5h/|website=Center for Open Science|access-date=2019-12-03|title=Bragee Bertilson et al. - ME CFS and Intracranial Hypertension|date=Nov 27, 2019|last=|first=|authorlink=|last2=|first2=|authorlink2=|archive-url=|archive-date=}}</ref>

==Health complications==
FM is not a progressive disease but according to Dr. [[Daniel Clauw|Dan Clauw]] the "slow gradual worsening of chronic pain patients over time is due to downstream consequences of poorly controlled pain and other symptoms, wherein individuals then progressively get less active, sleep worse, are under more stress and unknowingly develop bad habits which worsen pain and other symptoms."<ref>{{Cite news|url=http://nationalpainreport.com/ask-the-dctors-is-fibromyalgia-progressive-8831105.html|title=Ask the Doctors: Is Fibromyalgia Progressive?|date=2016-08-09|work=National Pain Report|access-date=2018-08-09|language=en-US}}</ref>

*[https://www.sharecare.com/health/fibromyalgia-effects Fibromyalgia Complications]<ref name=":19" />

:<blockquote>People who have fibromyalgia frequently complain of a variety of symptoms that affect other parts of the body. Many people complain of [[gastrointestinal]] issues and restless legs syndrome (RLS). Additionally, the [[chronic pain]] and discomfort of fibromyalgia may lead to [[depression]].<ref name=":19">{{Cite news|url=https://www.sharecare.com/health/fibromyalgia-effects|title=Fibromyalgia Complications - Fibromyalgia - Joint Health|work=Sharecare|access-date=2018-08-09|language=en}}</ref></blockquote>

*[https://www.sharecare.com/health/fibromyalgia-effects/can-fibromyalgia-cause-medical-conditions Can fibromyalgia cause other medical conditions?]<ref name=":20" />

:<blockquote>Fibromyalgia is not known to cause other medical conditions. However, people who have fibromyalgia seem to be at high risk for developing other painful conditions, including osteoarthritis (the common type of arthritis caused by wear and tear on the joints) as well as other related conditions, such as rheumatoid arthritis, lupus, and ankylosing spondylitis. Also, people with fibromyalgia are frequently diagnosed with chronic fatigue syndrome, [[irritable bowel syndrome]] (IBS), and temporomandibular joint (TMJ) disorder.<ref name=":20">{{Cite web|url=https://www.sharecare.com/health/fibromyalgia-effects/can-fibromyalgia-cause-medical-conditions|title=Can fibromyalgia cause other medical conditions? {{!}} Fibromyalgia Complications|last=Honor Society of Nursing|first=|date=|website=Sharecare|language=en|archive-url=|archive-date=|access-date=2018-08-09}}</ref></blockquote>

==Risk factors==
[[Lupus]] and [[rheumatoid arthritis]] (RA) are risk factors in developing FM. Car accidents, [[post-traumatic stress disorder]] (PTSD), [[Carpal tunnel syndrome|repetitive injuries]], illness such as a [[virus]], family history, and obesity have all been linked to FM.<ref name=":35">{{Cite web|url=https://www.cdc.gov/arthritis/basics/fibromyalgia.htm|title=Fibromyalgia {{!}} Arthritis|date=2018-04-03|website=[[Centers for Disease Control]]|language=en-us|access-date=2018-08-09}}</ref><ref>{{Cite news|url=https://www.niams.nih.gov/health_info/Fibromyalgia/|title=Fibromyalgia What Causes it?|last=Director|first=Nancy Garrick, Deputy|work=National Institute of Arthritis and Musculoskeletal and Skin Diseases|access-date=2018-08-09|archive-url=|archive-date=|language=en}}</ref><ref>{{Cite news|url=http://www.prohealth.com/library/showarticle.cfm?libid=22315|title=When Fibromyalgia Is More than Pain - Prohealth|date=2016-01-08|work=Prohealth|access-date=2018-08-09|language=en-US}}</ref>

==Diagnosis==
Tender points, not [trigger points]], are used to diagnose FM.<ref>{{Cite web|url=http://www.healthcentral.com/chronic-pain/c/662034/176031/fibromyalgia-trigger/|title=The Difference Between Fibromyalgia Tender Points and Myofascial Trigger Points - Chronic Pain {{!}} HealthCentral|last=Cooper|first=Celeste|date=May 8, 2015|website=www.healthcentral.com|language=en-US|archive-url=|archive-date=|access-date=2018-08-09}}</ref> Tender points will be above and below the waist and on both sides of the body. (See: 1990 ACR and 2010 ACR images above right depicting tender points.) It is important to check for other conditions that could be causing pain such as [[hypothyroidism]], RA or lupus, osteoarthritis, ankylosing spondylitis, and polymyalgia rheumatica.<ref>{{Cite news|url=https://www.webmd.com/fibromyalgia/guide/fibromyalgia-diagnosis-and-misdiagnosis#1|title=How Is Fibromyalgia Diagnosed?|work=WebMD|access-date=2018-08-12|language=en-US}}</ref>

===United States===
=====<span id="bloodtest"> Blood test </span>=====
EpicGenetics has a blood test that is identifying the presence of specific [[Leucocyte|white blood cell]] abnormalities of patients diagnosed with FM and has partnered with two universities to offer whole exome sequencing free of charge to those who test positive with their '''FM/a® test'''.<ref>{{Cite news|url=http://www.businesswire.com/news/home/20170419005324/en/EpicGenetics-Assistance-Leading-Medical-Centers-Expands-Clinical|title=EpicGenetics, with the Assistance of Leading Medical Centers, Expands Clinical Study of FM/a® Test to Diagnose Fibromyalgia, Identify Genetic Markers Unique to the Disorder and Explore Direct Treatment Approaches|last=|first=|date=Apr 19, 2017|work=|access-date=2018-08-09|archive-url=|archive-date=|language=en}}</ref><ref name=":38">{{Cite web|url=http://fmtest.com/|title=Home|last=|website=EpicGenetics' FM/a® Test is FDA-compliant and has successfully diagnosed patients with fibromyalgia since 2012.|language=en-US|access-date=2019-03-25}}</ref> Most insurance companies will cover the test.<ref>{{Cite web|url=https://www.painnewsnetwork.org/stories/2015/5/27/fibromyalgia-blood-test-gets-insurance-coverage|title=Fibromyalgia Blood Test Gets Insurance Coverage|last=Anson|first=Pat|authorlink=|last2=|first2=|authorlink2=|date=May 27, 2015|website=Pain News Network|language=en-US|archive-url=|archive-date=|access-date=2019-03-25}}</ref><ref>{{Cite web|url=http://nationalpainreport.com/more-insurance-companies-now-paying-for-fibromyalgia-blood-test-8829994.html|title=More Insurance Companies Now Paying for Fibromyalgia Blood Test|last=Gregory-Burch|first=Donna|authorlink=|last2=|first2=|authorlink2=|date=2016-04-04|website=National Pain Report|language=en-US|archive-url=|archive-date=|access-date=2019-03-25}}</ref> EpicGenetics offers help to determine if your insurance will cover their test.<ref name=":38" />

==== American College of Rheumatology (ACR) Criteria ====

=====1990 ACR criteria=====

*1990, [http://www.rheumatology.org/Portals/0/Files/1990_Criteria_for_Classification_Fibro.pdf The American College Of Rheumatology 1990 Criteria For The Classification Of Fibromyalgia]<ref name="ACR1990" /><ref name="excerpt2" /> "American College of Rheumatology guidelines suggest that people with fibromyalgia have pain in at least 11 of these tender points when a doctor applies a certain amount of pressure."<ref>{{Cite news|url=http://www.health.com/health/gallery/0,,20345635,00.html|title=18 Points Used to Diagnose Fibromyalgia|last=|first=|date=Feb 4, 2011|work=Health.com|access-date=2018-08-09|archive-url=|archive-date=|language=en}}</ref><ref>{{Cite web|url=https://www.masscfids.org/8-resource-library/diagnosis/266-tender-points-might-no-longer-be-used-for-diagnosis-of-fibromyalgia|title=Tender Points might no longer be used for diagnosis of Fibromyalgia|last=Proskauer|first=Charmian|date=Feb 2011|website=www.masscfids.org|language=en-GB|archive-url=|archive-date=|access-date=2018-08-09}}</ref>

=====2010 ACR criteria=====

*2010, The [https://www.rheumatology.org/Portals/0/Files/2010_Preliminary_Diagnostic_Criteria.pdf 2010 American College of Rheumatology (ACR) Preliminary Diagnostic Criteria for Fibromyalgia: Overview]<ref name="ACR2010" /><ref name="excerpt" /> was proposed and modified in 2011<ref>{{Cite news|url=http://www.rheumatologynetwork.com/fibromyalgia/new-and-modified-fibromyalgia-diagnostic-criteria|title=New and Modified Fibromyalgia Diagnostic Criteria|last=Garg|first=Neha|date=Feb 9, 2012|work=Rheumatology Network|access-date=Aug 9, 2017|archive-url=|archive-date=|last2=Deodhar|first2=Atul}}</ref> with the modification being validated in 2013 and published in 2014.<ref>{{Cite journal|last=Bennett|first=Robert M.|last2=Friend|first2=Ronald|last3=Marcus|first3=Dawn|last4=Bernstein|first4=Cheryl|last5=Han|first5=Bobby Kwanghoon|last6=Yachoui|first6=Ralph|last7=Deodhar|first7=Atul|last8=Kaell|first8=Alan|last9=Bonafede|first9=Peter|date=2014|title=Criteria for the diagnosis of fibromyalgia: validation of the modified 2010 preliminary American College of Rheumatology criteria and the development of alternative criteria|url=https://www.ncbi.nlm.nih.gov/pubmed/24497443|journal=Arthritis Care & Research|volume=66|issue=9|pages=1364–1373|doi=10.1002/acr.22301|issn=2151-4658|pmid=24497443|via=}}</ref> September of 2016, another revision has been made.<ref name=":14">{{Cite news|url=http://acrabstracts.org/abstract/2016-revisions-to-the-20102011-fibromyalgia-diagnostic-criteria/|title=2016 Revisions to the 2010/2011 Fibromyalgia Diagnostic Criteria - ACR Meeting Abstracts|last=|first=|date=Sep 28, 2016|work=ACR Meeting Abstracts|access-date=2018-08-09|archive-url=|archive-date=|language=en-US}}</ref>

:Men do not seem to form the tender points needed for diagnosis under the 1990 criteria,<ref>{{Cite news|url=http://www.webmd.com/fibromyalgia/features/how-fibromyalgia-affects-men#2|title=How Fibromyalgia Affects Men: Symptoms and Diagnosis|work=WebMD|access-date=2018-08-09|language=en-US}}</ref> the 2010 proposed criteria diagnoses more men with a F/M ratio of 2:1.<ref>{{Cite journal|last=Boomershine|first=Chad|date=Nov 4, 2017|title=Fibromyalgia: Practice Essentials, Background, Pathophysiology|url=http://emedicine.medscape.com/article/329838-overview#a5|journal=Medscape|volume=|pages=|via=}}</ref>
:Tender points were used to diagnose with the 1990 criteria, however "considerable skill is needed to correctly check for a patient’s tender points (i.e., digital palpation that is done with certain amount of applied pressure), yet this technique is not typically taught at most medical schools."<ref name="masscfids">{{Cite web|url=https://www.masscfids.org/8-resource-library/diagnosis/266-tender-points-might-no-longer-be-used-for-diagnosis-of-fibromyalgia#2|title=Tender Points might no longer be used for diagnosis of Fibromyalgia|last=Proskauer|first=Charmian|date=Feb 5, 2011|website=www.masscfids.org|language=en-GB|archive-url=|archive-date=|access-date=2018-08-09}}</ref>
:The new standards were designed to:
:*eliminate the use of a tender point examination
:*include a severity scale by which to identify and measure characteristic FM symptoms
:*utilize an index by which to rate pain<ref name="masscfids" />

There are 19 tender point areas in the widespread pain index (WPI), whereas the 1990 criteria had 18 tender points.<ref name="masscfids" />

====== Widespread pain index and Symptom severity ======

The '''Widespread Pain Index''' (WPI) and '''Symptom Severity''' (SS) are explained in the study ''Fibromyalgia Syndrome: An Overview of Pathophysiology, Diagnosis and Management''.<ref name="Firdous2012" />
[[File:Widespread Pain Index Areas with numbers.svg|200px|thumb|right|'''WPI''' 19 areas of pain. Count 1 point for each area of pain<ref name="Firdous2012" /><ref name="ACR2010" /><ref name="excerpt" />]]
<blockquote>In place of the tender point count, patients (or their physician) may endorse 19 body regions in which pain has been experienced during the past week. One point is given for each area, so the score is between 0-19. This number is referred to as the '''Widespread Pain Index (WPI)''' and it is one of the two required scores needed for a doctor to make a diagnosis of fibromyalgia.</blockquote><blockquote>The second part of the score required to assess the diagnosis of fibromyalgia involves the evaluation of a person's symptoms. The patient ranks specific symptoms on a scale of 0-3. These symptoms include: [[Fatigue]], [[Unrefreshing sleep|Waking unrefreshed]], [[Cognitive dysfunction|Cognitive symptoms]], Somatic (physical) symptoms in general (such as [[headache]], weakness, [[Gastrointestinal system|bowel problems]], [[nausea]], [[dizziness]], [[numbness]] / [[Paresthesia|tingling]], [[hair loss]], [[Dry eye syndrome|dry eyes]], [[Raynaud's syndrome|Raynaud's]] phenomenon, painful urination, and more).<ref name="Firdous2012" /><ref name="ACR2010" /> The numbers assigned to each are added up, for a total of 0-12.</blockquote><blockquote>The diagnosis is based on both the '''WPI''' score and the '''SS''' score either:</blockquote>
::'''WPI''' of at least 7 and '''SS''' scale score of at least 5, ''or''
::'''WPI''' of 4-6<ref name=":14" /> and '''SS''' scale score of at least 9.<ref name="Firdous2012" />

[[File:WPI SS Fibro.JPG|600px|thumb|center|Table 2: '''SS''' scale score. Add a 4th column for Somatic (physical) symptoms in general (such as Headache, weakness, bowel problems, nausea, dizziness, numbness/tingling, hair loss, dry eyes, Raynaud's phenomenon, painful urination, and more).<ref name="Firdous2012" /><ref name="ACR2010" /> The patient ranks specific symptoms on a scale of 0-3. The numbers assigned to each column are added up, for a total of 0-12.<ref name="Firdous2012" /> ]]

The [[Social Security Administration]] (SSA) accepts a diagnosis of FM with the 1990<ref name="ACR1990" /><ref name="excerpt2" /> or 2010<ref name="ACR2010" /><ref name="excerpt" /> ACR criteria.<ref name="ssa">{{Cite web|url=https://www.ssa.gov/OP_Home/rulings/di/01/SSR2012-02-di-01.html|title=Social Security Ruling: SSR 12-2p|last=ORDP|last2=OPPS|first=|date=Jul 25, 2012|website=www.ssa.gov|language=en|archive-url=|archive-date=|access-date=2018-08-09}}</ref>
{{See also|Fibromyalgia disability process}}

=== Sleep study ===
[[Sleep dysfunction]] is often involved in FM. Treating a sleep disorder can help with FM symptoms. A diagnosed sleep disorder is also helpful if one needs to [[Fibromyalgia disability process|file for disability]].<ref>{{Cite news|url=https://www.sciencedaily.com/releases/2008/09/080903134311.htm|title=What A Sleep Study Can Reveal About Fibromyalgia|work=ScienceDaily|access-date=2018-08-09|language=en}}</ref><ref>{{Cite news|url=http://linkis.com/nationalpainreport.com/lzYea|title=Fibromyalgia Sufferers Have Difficulty Maintaining Continuous Sleep, Study Says|last=|first=|date=Mar 25, 2016|work=National Pain Report|access-date=2018-08-09|archive-url=|archive-date=|language=en-US}}</ref>

=== ICD Diagnostic code===
'''ICD-10'''

The [[World Health Organization]] (WHO) International Classification of Diseases (ICD) lists FM as a "disease of the [[musculoskeletal system]] and connective tissue", under the code M79.7 (WHO ICD-10 Version: 2016).<ref name="ICD10">{{Cite web|url=http://apps.who.int/classifications/icd10/browse/2016/en#/M79.7|title=ICD-10 Version:2016|last=World Health Organization|first=|author-link=World Health Organization|date=2016|website=[[World Health Organization]]|at=M79.7 Fibromyalgia|language=en|archive-url=|archive-date=|access-date=2018-09-15}}</ref> The WHO's ICD-10 does not refer to FM as a syndrome and it is not classified in the category for [[Medically unexplained physical symptoms|medically unexplained symptoms]].<ref name=":37" /><ref name="ICD10" />

*'''M79.7 Fibromyalgia'''
::Fibromyositis
::Fibrositis
::Myofibrositis<ref name="ICD10" />

In 2015, the [[United States|US]] finally adopted ICD-10 and FM as a diagnosis.<ref name=":37">{{Cite web|url=http://www.icd10data.com/ICD10CM/Codes/M00-M99/M70-M79/M79-/M79.7|title=2018 ICD-10-CM Diagnosis Code M79.7: Fibromyalgia|website=www.icd10data.com|language=en|access-date=2018-08-09|date=2018|last=World Health Organization|first=|archive-url=|archive-date=|authorlink=World Health Organization|last2=|first2=|authorlink2=}}</ref> <ref>{{Cite news|url=http://nationalpainreport.com/the-health-care-industry-finally-recognizes-fibromyalgia-8827637.html|title=The Health Care Industry Finally Recognizes Fibromyalgia|last=Liptan|first=Ginevra|date=2015-09-30|work=National Pain Report|access-date=2018-08-09|archive-url=|archive-date=|language=en-US}}</ref>

'''ICD-11 (2019)'''

The [[ICD-11]] (2019) has diagnostic code ''MG30.1 Chronic widespread pain,'' and changed the category from a [[:Category:Musculoskeletal diseases and disorders|Musculoskeletal disease]], to the ''General signs and symptoms category'', sometimes referred to as [[Medically unexplained physical symptoms]].<ref name="ICD11">{{Cite web|url=https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/849253504|title=ICD-11 - Mortality and Morbidity Statistics|website=[[World Health Organization]]|language=en|access-date=2018-08-09}}</ref>

*'''MG30.01 Chronic widespread pain'''

'''Parent'''
::MG30.0 Chronic primary pain

'''Description'''
<blockquote>Chronic widespread pain (CWP) is diffuse pain in at least 4 of 5 body regions and is associated with significant emotional distress (anxiety, anger/frustration or depressed mood) or functional disability (interference in daily life activities and reduced participation in social roles). CWP is multifactorial: biological, psychological and social factors contribute to the pain syndrome. The diagnosis is appropriate when the pain is not directly attributable to a nociceptive process in these regions and there are features consistent with nociplastic pain and identified psychological and social contributors.<ref name="ICD11" /></blockquote>

'''Inclusions'''
:*Fibromyalgia
'''Exclusions'''
:*Acute pain (MG31)<ref name="ICD11" />

== Take the Online Fibromyalgia Test ==
This [https://www.fibromyalgiaforums.org/get-help/online-fibromyalgia-test online test by fibromyalgiaforums.org] uses the ACR 2010 Criterion to diagnose fibromyalgia.

==Pathophysiology==
"Fibromyalgia (FM) is a [[chronic pain]] disorder with unknown etiology and unclear pathophysiology. There is no evidence that a single event “causes” FM. Rather, many physical and/or emotional [[Stress|stressors]] may trigger or aggravate symptoms. These have included certain [[Infection|infections]], such as a [[Viral infection|viral illness]] or [[Lyme disease]], as well as emotional or physical [[trauma]]."<ref>{{Cite web|url=https://www.uptodate.com/contents/pathogenesis-of-fibromyalgia#!|title=Pathogenesis of fibromyalgia|last=Goldenberg|first=Don L|date=|website=www.uptodate.com|archive-url=|archive-date=|access-date=2018-08-09|authorlink=|last2=Schur|first2=Paul H|authorlink2=|last3=Romain|first3=Paul L}}</ref> The widespread pain is severe, debilitating, and abnormal in processing its pain. There is also [[Sleep dysfunction|sleep disturbance]] and fatigue. Cause or causes are unproven.<ref>{{Cite news|url=https://www.omf.ngo/what-is-mecfs-old/fibromyalgia/|title=What is Fibromyalgia? {{!}} Open Medicine Foundation|work=Open Medicine Foundation|access-date=2018-08-09|language=en-US}}</ref>

*May 2012, [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3394355/ Fibromyalgia Syndrome: An Overview of Pathophysiology, Diagnosis and Management]<ref name="Firdous2012">{{Cite journal|last=Jahan|first=Firdous|last2=Nanji|first2=Kashmira|last3=Qidwai|first3=Waris|last4=Qasim|first4=Rizwan|date=2012|title=Fibromyalgia Syndrome: An Overview of Pathophysiology, Diagnosis and Management|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3394355/|journal=Oman Medical Journal|volume=27|issue=3|pages=192–195|doi=10.5001/omj.2012.44|issn=1999-768X|pmc=|pmid=22811766|via=}}</ref> ''See'' Table 1: "Conditions associated with fibromyalgia." Musculoskeletal, [[genitourinary]], [[Gastrointestinal system|gastrointestinal]], and miscellaneous conditions often exist among fibromyalgia patients.

<blockquote>Pathophysiology: Although the etiology remains unclear, characteristic alterations in the [[Sleep dysfunction|pattern of sleep]] and changes in neuroendocrine transmitters such as [[serotonin]], substance P, growth hormone and [[cortisol]] suggest that regulation of the [[Autonomic nervous system|autonomic]] and neuro-endocrine system appears to be the basis of the syndrome. Fibromyalgia is not a life-threatening, deforming, or [progressive disease. [[Anxiety]] and [[depression]] are the most common association. Aberrant pain processing, which can result in [[chronic pain]], may be the result of several interplaying mechanisms. [[Central sensitization]], blunting of inhibitory pain pathways and alterations in [[neurotransmitter]]s lead to aberrant neuro-chemical processing of sensory signals in the CNS, thus lowering the threshold of pain and amplification of normal sensory signals causing constant pain.<ref name="Firdous2012" /></blockquote>

<blockquote>The frequent co-morbidity of fibromyalgia with [[Mood swings|mood disorders]] suggests a major role for the stress response and for [[neuroendocrine]] abnormalities. The [[hypothalamic pituitary axis]] (HPA) is a critical component of the stress-adaptation response. In FMS, stress adaptation response is disturbed leading to stress induce symptoms. Psychiatric co-morbidity has been associated with FMS and needs to be identified during the consultation process, as this requires special consideration during treatment.<ref name="Firdous2012" /></blockquote>

*May 2018, [https://www.chiropractic.ca/wp-content/uploads/2018/05/107243-2_Chiro_62_1d_Bourgaize.pdf A comparison of the clinical manifestation and pathophysiology of myofascial pain syndrome and fibromyalgia: implications for differential diagnosis and management]

*Jun 2018, [https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0198625 SNPs in inflammatory genes] [[CCL11]], [[CCL4]] and [[MEFV]] in a fibromyalgia family study<ref>{{Cite journal|last=Zhang|first=Zhifang|last2=Feng|first2=Jinong|last3=Mao|first3=Allen|last4=Le|first4=Keith|last5=Placa|first5=Deirdre La|last6=Wu|first6=Xiwei|last7=Longmate|first7=Jeffrey|last8=Marek|first8=Claudia|last9=Amand|first9=R. Paul St|date=2018-06-21|title=SNPs in inflammatory genes CCL11, CCL4 and MEFV in a fibromyalgia family study|url=http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0198625|journal=PLOS ONE|language=en|volume=13|issue=6|pages=e0198625|doi=10.1371/journal.pone.0198625|issn=1932-6203|pmid=29927949|via=}}</ref>

<blockquote>SNPs with significant TDTs were found in 36% of the cohort for CCL11 and 12% for MEFV, along with a protein variant in CCL4 (41%) that affects CCR5 down-regulation, supporting an immune involvement for FM.</blockquote>

*Jul 2018, [https://fibromyalgianewstoday.com/2018/07/31/primary-secondary-fibromyalgia-share-similar-symptom-burden-study/ Primary and Secondary Fibromyalgia Share Same Symptom Burden, Study Suggests]<ref name=":22">{{Cite news|url=https://fibromyalgianewstoday.com/2018/07/31/primary-secondary-fibromyalgia-share-similar-symptom-burden-study/|title=Primary, Secondary Fibromyalgia Share Same Symptom Burden, Study Says|last=Carvalho|first=John|date=2018-07-31|work=Fibromyalgia News Today|access-date=2018-08-09|archive-url=|archive-date=|language=en-US}}</ref>

<blockquote>Fibromyalgia can be considered either primary, or dominant, also known as idiopathic fibromyalgia, or secondary. In the primary form, the causes of the disorder are unknown, but in secondary fibromyalgia, the disorder usually occurs alongside other debilitating medical conditions, such as rheumatoid arthritis (RA), lupus, and multiple sclerosis.<ref name=":22" /></blockquote>

===Immune system research===

Dr. [[Jarred Younger]] believes an overactive [[immune system]] is the cause and will be conducting a study to test this hypothesis.<ref>{{Cite news|url=http://nationalpainreport.com/new-uab-study-could-radically-change-fibromyalgia-treatment-as-we-know-it-8833437.html|title=New UAB Study Could Radically Change Fibromyalgia Treatment As We Know It|last=Gregory Burch|first=Donna|date=2017-04-24|work=National Pain Report|access-date=2018-08-09|archive-url=|archive-date=|language=en-US}}</ref><ref>{{Cite web|url=https://www.youtube.com/watch?v=8e5xKX036bE|title=Testing the fibromyalgia immune system with lipopolysaccharide (LPS)|last=Younger|first=Jarred|date=May 24, 2017|website=YouTube|archive-url=|archive-date=|access-date=|via=Younger Lab}}</ref> An overactive immune system can cause [[inflammation]] and [[chronic pain]].<ref>{{Cite news|url=https://www.epainassist.com/autoimmune/what-is-overactive-immune-system|title=What is Overactive Immune System{{!}}Causes{{!}}Symptoms{{!}}Treatment|last=Kerkar|first=Pramod|date=2016-09-29|work=ePainAssist|access-date=2018-10-04|archive-url=|archive-date=|language=en-gb}}</ref><ref>{{Cite news|url=https://www.webmd.com/a-to-z-guides/autoimmune-diseases|title=Autoimmune Diseases|work=WebMD|access-date=2018-10-04|language=en-US}}</ref>

Dr. William Pridgen's research of [[HSV-1]] (cold sore virus) as being involved in FM has conducted a successful Phase III clinical trial, which had been fast-tracked by the [[Food and Drug Administration]] (FDA), of a combination drug that suppresses this virus and also helps with pain. {{See also|Fibromyalgia drugs|Fibromyalgia drugs (see drug trials section for IMC-1)||||}}

On September 5th, 2018, EpicGenetics announced that Massachusetts General Hospital received approval from the FDA to test the BCG vaccine (an old Tuberculosis vaccine) on patients that tested positive with its FM/a® test.<ref name="painrep201809">{{Cite news|url=http://nationalpainreport.com/can-an-existing-vaccine-help-treat-fibromyalgia-8837139.html|title=Can an Existing Vaccine Help Treat Fibromyalgia?|last=Coghlan|first=Ed|date=2018-09-05|work=National Pain Report|access-date=2018-09-10|archive-url=|archive-date=|language=en-US}}</ref><ref>{{Cite news|url=http://www.prohealth.com/library/showArticle.cfm?libid=30644|title=Century-old Vaccine Gives New Hope to Fibromyalgia Community - Prohealth|last=Gregory Burch|first=Donna|date=2017-08-14|work=Prohealth|access-date=2018-08-09|archive-url=|archive-date=|language=en-US}}</ref>

Recognizing FM may involve activation of the [[immune system]] researchers performed [[Whole exome sequencing|exome sequencing]] on [[chemokine]] genes in a region of chromosome 17 identified in a genome-wide family association study. Their conclusion: "SNPs with significant TDTs were found in 36% of the cohort for [[CCL11]] and 12% for [[MEFV]], along with a protein variant in CCL4 (41%) that affects CCR5 down-regulation, supporting an immune involvement for FM."<ref name="Zhang2018">{{Cite journal|last=Zhang|first=Zhifang|last2=Feng|first2=Jinong|last3=Mao|first3=Allen|last4=Le|first4=Keith|last5=Placa|first5=Deirdre La|last6=Wu|first6=Xiwei|last7=Longmate|first7=Jeffrey|last8=Marek|first8=Claudia|last9=Amand|first9=R. Paul St|date=2018-06-21|title=SNPs in inflammatory genes CCL11, CCL4 and MEFV in a fibromyalgia family study|url=http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0198625|journal=PLOS ONE|language=en|volume=13|issue=6|pages=e0198625|doi=10.1371/journal.pone.0198625|issn=1932-6203|pmid=29927949|via=}}</ref>

Dr David Andersson from the Institute of Psychiatry, Psychology and Neuroscience at King’s College London, led a new study into Fibromyalgia being an immune system disorder.<ref>{{Cite journal|last=Goebel|first=Andreas|last2=Krock|first2=Emerson|last3=Gentry|first3=Clive|last4=Israel|first4=Mathilde R.|last5=Jurczak|first5=Alexandra|last6=Urbina|first6=Carlos Morado|last7=Sandor|first7=Katalin|last8=Vastani|first8=Nisha|last9=Maurer|first9=Margot|date=2021-07-07|title=Passive transfer of fibromyalgia symptoms from patients to mice|url=https://www.jci.org/articles/view/144201?key=51bf6d85e305f6b62f87#SEC4|journal=The Journal of Clinical Investigation|language=en|volume=131|issue=13|doi=10.1172/JCI144201|issn=0021-9738}}</ref><ref name=":0">{{Cite web|url=http://www.theguardian.com/society/2021/jul/01/fibromyalgia-may-be-a-condition-of-the-immune-system-not-the-brain-study|title=Fibromyalgia may be a condition of the immune system not the brain – study|date=2021-07-01|website=the Guardian|language=en|access-date=2021-07-08}}</ref><blockquote>Andersson and his colleagues harvested blood from 44 people with fibromyalgia and injected purified antibodies from each of them into different mice. The mice rapidly became more sensitive to pressure and cold, and displayed reduced grip strength in their paws. Animals injected with antibodies from healthy people were unaffected.<ref name=":0" /></blockquote><blockquote>Prof Camilla Svensson from the Karolinska Institute in Sweden, who was also involved in the study, said: “Antibodies from people with fibromyalgia living in two different countries, the UK and Sweden, gave similar results, which adds enormous strength to our findings.”<ref name=":0" /></blockquote>

=== Brain and spinal cord research ===
A 2004 study by Heffez et al. studied 270 patients with FM and found that 46% had [[cervical spinal stenosis]] and 20% [[chiari malformation]].<ref name="Heffez2004">{{Cite journal|last=Heffez|first=Dan S.|last2=Ross|first2=Ruth E.|last3=Shade-Zeldow|first3=Yvonne|last4=Kostas|first4=Konstantinos|last5=Shah|first5=Sagar|last6=Gottschalk|first6=Robert|last7=Elias|first7=Dean A.|last8=Shepard|first8=Alan|last9=Leurgans|first9=Sue E.|date=2004-04-09|title=Clinical evidence for cervical myelopathy due to Chiari malformation and spinal stenosis in a non-randomized group of patients with the diagnosis of fibromyalgia|url=https://link.springer.com/article/10.1007/s00586-004-0672-x|journal=European Spine Journal|language=en|volume=13|issue=6|pages=516–523|doi=10.1007/s00586-004-0672-x|issn=0940-6719|pmc=|pmid=15083352|via=}}</ref> In 2007, Heffez et al. saw significant improvement in physical and mental well-being was found in patients with cervical stenosis who received surgery.<ref name="Heffez2007">{{Cite journal|last=Heffez|first=Dan S.|last2=Ross|first2=Ruth E.|last3=Shade-Zeldow|first3=Yvonne|last4=Kostas|first4=Konstantinos|last5=Morrissey|first5=Mary|last6=Elias|first6=Dean A.|last7=Shepard|first7=Alan|date=2007|title=Treatment of cervical myelopathy in patients with the fibromyalgia syndrome: outcomes and implications|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2200733/|journal=European Spine Journal|volume=16|issue=9|pages=1423–1433|doi=10.1007/s00586-007-0366-2|issn=0940-6719|pmc=2200733|pmid=17426987|quote=|author-link=|author-link2=|author-link3=|author-link4=|author-link5=|via=}}</ref> A second study in 2007 by Andrew Holman found that 71% had cervical [[spinal cord]] compression.<ref>{{Cite journal|date=2008-07-01|title=Positional Cervical Spinal Cord Compression and Fibromyalgia: A Novel Comorbidity With Important Diagnostic and Treatment Implications|url=https://www.sciencedirect.com/science/article/pii/S1526590008004379|journal=The Journal of Pain|language=en|volume=9|issue=7|pages=613–622|doi=10.1016/j.jpain.2008.01.339|issn=1526-5900|last=|first=|quote=|author-link=Andrew Holman|author-link2=|author-link3=|author-link4=|author-link5=|via=}}</ref> It is important to note that in the past many patients were misdiagnosed with FM when further testing would have revealed the true source of their pain; the 2010 (updated in 2016) ACR criteria has helped curb misdiagnoses.<ref>{{Cite news|title=Fibromyalgia Expert Says Misdiagnosis is Rampant|url=http://nationalpainreport.com/fibromyalgia-expert-says-misdiagnosis-is-rampant-8832803.html|work=National Pain Report|date=2017-02-02|access-date=2018-11-26|language=en-US}}</ref><ref name="misdiagnosis">{{Cite news|title=Common Misdiagnoses of Fibromyalgia|url=https://www.webmd.com/fibromyalgia/guide/common-misdiagnoses-of-fibromyalgia#|work=WebMD|access-date=2018-11-26|language=en-US|last=|first=|date=|archive-url=|archive-date=}}</ref><ref name=":28" />

Various types of brain imaging are being used to research FM. (''See'': [[Fibromyalgia notable studies]] for images.)

In 2002, an [[Functional magnetic resonance imaging|fMRI]] study conducted by Richard Gracely and Daniel Claw found people with FM "have measurable pain signals in their brains, from a gentle finger squeeze that barely feels unpleasant to people without the disease."<ref name="sd2002">{{Cite web|url=https://www.sciencedaily.com/releases/2002/06/020607073056.htm|title=Fibromyalgia Pain Isn't All In Patient's Heads, New Brain Study Finds|last=|first=|date=Jun 7, 2002|website=sciencedaily.com|archive-url=|archive-date=|access-date=2018-08-09}}</ref> A 2007 study by Borsook et al., ''Neuroimaging revolutionizes therapeutic approaches to chronic pain'' found decreased gray matter density relative to controls in cingulate cortex (CC), medial prefrontal cortex (Med. PFC), parahippocampal gyrus (PHG) and insula.<ref name="Borsook2007">{{Cite journal|last=Borsook|first=David|last2=Moulton|first2=Eric A|last3=Schmidt|first3=Karl F|last4=Becerra|first4=Lino R|date=2007-09-11|title=Neuroimaging Revolutionizes Therapeutic Approaches to Chronic Pain|url=https://link.springer.com/article/10.1186/1744-8069-3-25|journal=Molecular Pain|language=en|volume=3|issue=1|pages=1744–8069-3-25|doi=10.1186/1744-8069-3-25|issn=1744-8069|pmid=17848191|via=}}</ref> In 2015, Loggia et al. imaged [[neuroinflammation]] due to [[Glial cell|glial]] activation using MR/PET imaging.<ref name="itn2018">{{Cite news|url=https://www.itnonline.com/article/mrpet-ultimate-imaging-hybrid|title=MR/PET: The Ultimate Imaging Hybrid|last=Ros|first=Pablo R.|date=2012-05-29|work=Imaging Technology News|access-date=2018-10-30|archive-url=|archive-date=|language=en}}</ref><ref name="Loggia2015">{{Cite journal|last=Loggia|first=Marco L.|last2=Chonde|first2=Daniel B.|last3=Akeju|first3=Oluwaseun|last4=Arabasz|first4=Grae|last5=Catana|first5=Ciprian|last6=Edwards|first6=Robert R.|last7=Hill|first7=Elena|last8=Hsu|first8=Shirley|last9=Izquierdo-Garcia|first9=David|date=2015-01-08|title=Evidence for brain glial activation in chronic pain patients|url=https://academic.oup.com/brain/article/138/3/604/333527?searchresult=1|journal=Brain|language=en|volume=138|issue=3|pages=604–615|doi=10.1093/brain/awu377|issn=1460-2156}}</ref> In 2017, López-Solà et al. identified three [[brain]] patterns based on [[Functional magnetic resonance imaging|fMRI]] responses to pressure pain and non-painful multisensory stimulation. "These patterns, taken together, discriminate FM from matched healthy controls with 92% sensitivity and 94% specificity."<ref name=":34">{{Cite journal|last=López-Solà|first=Marina|last2=Woo|first2=Choong-Wan|last3=Pujol|first3=Jesus|last4=Deus|first4=Joan|last5=Harrison|first5=Ben J.|last6=Monfort|first6=Jordi|last7=Wager|first7=Tor D.|date=2017|title=Towards a neurophysiological signature for fibromyalgia|url=https://www.ncbi.nlm.nih.gov/pubmed/27583567|journal=Pain|volume=158|issue=1|pages=34–47|doi=10.1097/j.pain.0000000000000707|issn=1872-6623|pmid=27583567|via=}}</ref> In 2018, Albrecht et al used [[Positron emission tomography|PET]] scans to document [[Glial cell|glial]] activation.<ref name=":52">{{Cite journal|last=Albrecht|first=Daniel S.|last2=Forsberg|first2=Anton|last3=Sandstrom|first3=Angelica|last4=Bergan|first4=Courtney|last5=Kadetoff|first5=Diana|last6=Protsenko|first6=Ekaterina|last7=Lampa|first7=Jon|last8=Lee|first8=Yvonne C.|last9=Höglundi|first9=Caroline Olgart|date=2018-09-14|others=Catana, Ciprian; Cervenka, Simon; Akeju, Oluwaseun; Lekander, Mats; Cohen, George; Halldin, Christer; Taylor, Norman; Kim, Minhae; Hooker, Jacob M.; Loggia, Marco L.|title=Brain glial activation in fibromyalgia – A multi-site positron emission tomography investigation|url=https://www.sciencedirect.com/science/article/pii/S0889159118302423|journal=Brain, Behavior, and Immunity|language=en|volume=|pages=|doi=10.1016/j.bbi.2018.09.018|issn=0889-1591|via=}}</ref> Also in 2018, Martucci et al. found unbalanced activity between the ventral and dorsal cervical spinal cord. Ventral neural processes were increased and dorsal neural processes were decreased which may reflect the presence of [[central sensitization]] contributing to [[fatigue]] and other bodily symptoms in FM.<ref>{{Cite journal|last=Martucci|first=Katherine T|last2=Weber|first2=Kenneth A|last3=Mackey|first3=Sean C|date=2018-10-03|title=Altered Cervical Spinal Cord Resting State Activity in Fibromyalgia|url=https://onlinelibrary.wiley.com/doi/abs/10.1002/art.40746|journal=Arthritis & Rheumatology|language=en|doi=10.1002/art.40746|issn=2326-5191}}</ref>

=== Fibromyalgia is not the same as depression ===
* Oct 24, 2003, [https://www.webmd.com/depression/news/20031024/fibromyalgia-isnt-depression#1 Fibromyalgia Isn't Depression]<ref name="webmd-notdepress" />
<blockquote>[[Depression]] doesn't cause the pain of fibromyalgia, a new study shows.<ref name="webmd-notdepress" /></blockquote>

<blockquote>"People still doubt fibromyalgia is a disease," Giesecke tells WebMD. "Previously, we found that fibromyalgia patients really do have increased central pain processing. Now we can show this is not affected by depression. Something is wrong here, and it is not at all connected with depression."<ref name="webmd-notdepress" /></blockquote>

<blockquote>"Giesecke's group looked at [[brain]] responses to painful stimuli, and then checked to see if there was any difference between depressed and nondepressed fibromyalgia patients. They showed the activation of areas of the brain related to pain were not different in patients with and without depression." But there is a difference between people with and without fibromyalgia, he says.<ref name="webmd-notdepress" /> </blockquote><blockquote>The researchers use an imaging device called [[functional magnetic resonance imaging]], or fMRI, to look at how the brain responds to pain. Study participants get a mildly painful pressure on their thumb, which makes the brain's pain centers "light up" on the image. Thumb pressure -- at a level healthy people hardly feel -- sets off a firestorm in the pain centers of fibromyalgia patients' brains.<ref name="webmd-notdepress" /></blockquote>
* Jun 30, 2013, [https://www.healthcentral.com/article/psychiatrists-admit-fibromyalgia-is-neuropathic-not-a-form-of-depression Psychiatrists Admit Fibromyalgia is Neuropathic - Not a Form of Depression]<ref name=":41">{{Cite web|url=https://www.healthcentral.com/article/psychiatrists-admit-fibromyalgia-is-neuropathic-not-a-form-of-depression|title=Psychiatrists Admit Fibromyalgia is Neuropathic – Not a Form of Depression - Causes - Chronic Pain {{!}} HealthCentral|last=Lee Richards|first=Karen|authorlink=|last2=|first2=|authorlink2=|date=Jun 30, 2013|website=www.healthcentral.com|language=en-US|access-date=2019-04-13}}</ref>
<blockquote>The study the APA referred to was published in the June issue of ''Brain'', a journal of neurology. The researchers investigated the function and structure of small nerve fibers in 25 FM patients, 10 patients with monopolar depression without pain and with healthy control subjects. Using three different methods of testing, the researchers found that compared with control subjects, patients with fibromyalgia, but not patients with depression, had impaired small fiber function.<ref name="brain-1857">http://brain.oxfordjournals.org/content/136/6/1857.abstract</ref><ref name=":41" /></blockquote><blockquote>The study authors stated, "This strengthens the notion that fibromyalgia syndrome is not a variant of depression, but rather represents an independent entity that may be associated with depressive symptoms". The findings also point "towards a neuropathic nature of pain in fibromyalgia syndrome."<ref name=":41" /></blockquote>
* Jan 10, 2019, [https://themighty.com/2019/01/do-i-have-fibromyalgia-or-depression/ 17 Signs You Have Fibromyalgia, Not 'Just' Depression]<ref name=":43">{{Cite web|url=https://themighty.com/2019/01/do-i-have-fibromyalgia-or-depression/|title=17 Signs You Have Fibromyalgia, Not 'Just' Depression|last=|first=|authorlink=|last2=|first2=|authorlink2=|date=Jan 10, 2019|website=The Mighty|language=en-US|archive-url=|archive-date=|access-date=2019-04-13}}</ref>
<blockquote>Fibromyalgia is [https://themighty.com/2018/05/what-fibromyalgia-gets-misdiagnosed-as/ often misdiagnosed as a number of other illnesses]. Though fibro has its own unique set of diagnostic criteria, many of its symptoms can mimic symptoms of other conditions – both physical and mental, acute and chronic.<ref name=":43" /></blockquote><blockquote>One of the most common conditions fibromyalgia gets mistaken for is depression. While each condition causes a unique set of symptoms, many of them may overlap. Like fibro, depression can cause physical symptoms such as pain, fatigue and brain fog. And living with a chronic physical symptoms can have significant effects on your mood, sometimes causing feelings of hopelessness, anxiety or general discontent – which are also symptoms of depression.<ref name=":43" /></blockquote>

== Comorbidities, overlapping conditions, and common symptoms ==
[[File:Fibromyalgia and comorbid conditions.JPG|700px|thumb|center|Comorbid conditions of fibromyalgia (FM) are [[ME/CFS]] which is the most common comorbidity,<ref name="ammes-overlap" /><ref name=":31" /> [[autoimmune disease|autoimmune disease]]s; [[migraine]]s; [[Multiple chemical sensitivity|multiple chemical sensitivities]] (MCS); and [[orthostatic intolerance]] (OI) / [[postural orthostatic tachycardia syndrome]] (POTS).<ref name="ammes-overlap" /><ref name="Firdous2012" /><ref name=":44" /> Overlapping conditions are [[depression]] and [[anxiety]]; [[Digestive problems|digestive conditions]], [[Menstrual|menstrual problems]]; [[Gulf War Illness]] (GWI); [[nervous system]] disorders; [[Hypotension|low blood pressure]] (Low BP); [[Pain#Pain in Fibromyalgia|other pain conditions]]; and [[sleep dysfunction]]/disturbance<ref name="ammes-overlap" /><ref name="Firdous2012" /><ref name="mayocause" />]]

===[[Allodynia]]===
*[http://chronicfatigue.about.com/od/glossary/g/allodynia.htm Allodynia: A Rare & Distinct Type of Pain in Fibromyalgia & ME/CFS]<ref name="Allodynia">{{Cite news|url=https://www.verywellhealth.com/allodynia-definition-and-types-fibromyalgia-715929|title=Allodynia: A Rare & Distinct Type of Pain in Fibromyalgia & ME/CFS|last=Dellwo|first=Adrienne|date=Feb 23, 2018|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=}}</ref> Types of Allodynia: Tactile; Mechanical; and Thermal. "Type of pain, generally on the skin, that's caused by something that wouldn't normally cause pain."<ref name="Allodynia" />
*[[Autoimmune disease]]s "Research suggests that RA and other inflammatory diseases may somehow increase the risk for fibromyalgia."<ref>{{Cite news|url=https://www.health.com/health/gallery/0,,20520705,00.html#restless-legs-0|title=7 Conditions Linked to Fibromyalgia|work=Health.com|access-date=2018-08-19|language=en}}</ref>

===[[Body temperature]]===
{{See also |Small fiber peripheral neuropathy}}
: for [[temperature sensitivity]]; burning, tingling, and prickling due to [[paresthesia]]; [[numbness]]; [[dry eye syndrome|dry eyes]] and [[dry mouth]]; and more.)<ref name=":02">{{Cite news|url=https://www.healthline.com/health/small-fiber-neuropathy#symptoms|title=Small Fiber Neuropathy: Symptoms, Treatment, Causes, and More|last=Vandergriendt|first=Carly|date=Jan 4, 2018|work=Healthline|access-date=2018-10-04|archive-url=|archive-date=|last2=Weatherspoon|first2=Deborah|language=en}}</ref><ref>{{Cite news|url=https://www.webmd.com/brain/understanding-peripheral-neuropathy-basics#3|title=Peripheral Neuropathy -- Symptoms, Types, and Causes of Peripheral Neuropathy|last=|first=|date=|work=WebMD|access-date=2018-10-04|archive-url=|archive-date=|page=3|language=en-US}}</ref>

<blockquote>When you're exposed to heat, does it feel like you're burning up? Does it seem impossible for you to cool off? Or maybe it's cold that bothers you, chilling you to the bone, leaving you unable to warm up? Or are you one of those people with fibromyalgia (FMS) and chronic fatigue syndrome (ME/CFS) who is cold all the time, or hot all the time, or alternately hot or cold while out of sync with the environment?<ref name=":2">{{Cite news|url=https://www.verywellhealth.com/temperature-sensitivity-in-fibromyalgia-and-mecfs-716025|title=Temperature Sensitivity in Fibromyalgia & ME/CFS|last=Dellwo|first=Adrienne|date=Mar 15, 2018|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=}}</ref></blockquote>

=== [[Costochondritis]]===
[[File:Costal cartilages.JPG|200px|thumb|left|Costochondritis is inflammation of the costal cartilages (shown in red) causing chest and ribcage pain. From BodyParts3D/Anatomography (Life Science db.jp), license CC BY-SA 2.1 JP.]]

<blockquote>Costochondritis is a condition that causes pain in the cartilage that connect your ribs to your sternum (breastbone). Cartilage is the tough, bendable tissue that protects your bones where they rub against each other.<ref name=":10">{{Cite web|url=https://www.drugs.com/cg/costochondritis.html|title=Costochondritis - What You Need to Know|website=Drugs.com|language=en|access-date=2020-01-27}}</ref></blockquote>
Costochondritis causes pain in the area where your sternum joins with your ribs. The pain may come and go, and may get worse over time. The pain may be sharp, or dull and aching. It may be painful to touch your chest. The pain may spread to your back, abdomen, or down your arm. It may get worse when you move, breathe deeply, or push or lift an object. The pain may make it hard for you to sleep or do your usual activities.<ref name=":10" /><blockquote>People tend to describe the pain as stabbing, burning, aching, confined to one spot, usually in the very center of the chest, but it may radiate outward.<ref>{{Cite web|url=https://www.medicalnewstoday.com/articles/321635.php|title=Can fibromyalgia cause chest pain?|website=Medical News Today|language=en|access-date=2020-01-27}}</ref></blockquote>

===[[Depression]] and [[anxiety]]===
{{See also|Depression|Depression|Anxiety|Anxiety}}Fibromyalgia sufferers are "up to three times more likely to have depression at the time of their diagnosis than someone without fibromyalgia."<ref name="webmd-depress">{{Cite news|url=https://www.webmd.com/fibromyalgia/fibromyalgia-and-depression#1|title=Fibromyalgia and Depression|work=WebMD|access-date=2018-08-19|language=en-US}}</ref> Up to 20% of Fibromyalgia patients will have either depression or anxiety.<ref name="adaa">{{Cite web|url=https://adaa.org/understanding-anxiety/related-illnesses/other-related-conditions/fibromyalgia|title=Fibromyalgia|website = Anxiety and Depression Association of America|language=en|access-date=2018-08-19}}</ref>

====<span id="depression">Differences between depression and fibromyalgia====

* Depression and anxiety are common in fibromyalgia but are not core diagnostic symptoms, so they are not required for a diagnosis of Fibromyalgia, and a significant number of people with fibromyalgia have never had depression.<ref name="Koroschetz2011-symptoms">{{Cite journal|last=Koroschetz|first=Jana|last2=Rehm|first2=Stefanie E.|last3=Gockel|first3=Ulrich|last4=Brosz|first4=Mathias|last5=Freynhagen|first5=Rainer|last6=Tölle|first6=Thomas R.|last7=Baron|first7=Ralf|date=2011-05-25|title=Fibromyalgia and neuropathic pain - differences and similarities. A comparison of 3057 patients with diabetic painful neuropathy and fibromyalgia|url=https://doi.org/10.1186/1471-2377-11-55|journal=BMC Neurology|volume=11|issue=1|pages=55|doi=10.1186/1471-2377-11-55|issn=1471-2377|pmc=3125308|pmid=21612589}}</ref><ref name="ACR1990" /><ref name="ACR2010" />
* Fibromyalgia is a diagnosis of '''chronic widespread pain''', but pain is not needed for a diagnosis of depression.
*2007, The classification of fibromyalgia syndrome<ref name="Muller2007">{{Cite journal|last=Müller|first=W.|last2=Schneider|first2=E. M.|last3=Stratz|first3=T.|date=2007-09-01|title=The classification of fibromyalgia syndrome|url=https://doi.org/10.1007/s00296-007-0403-9|journal=Rheumatology International|language=en|volume=27|issue=11|pages=1005–1010|doi=10.1007/s00296-007-0403-9|issn=1437-160X}}</ref> [https://link.springer.com/article/10.1007%2Fs00296-007-0403-9 (Abstract)]
*2008, The relationship between fibromyalgia and major depressive disorder: a comprehensive review<ref name="Pae2008">{{Cite journal|last=Pae|first=Chi-Un|author-link=|last2=Luyten|first2=Patrick|author-link2=|last3=Marks|first3=David M.|author-link3=|last4=Han|first4=Changsu|author-link4=|last5=Park|first5=Sung-Hwan|author-link5=|last6=Patkar|first6=Ashwin A.|author-link6=|last7=Masand|first7=Prakash S.|last8=Houdenhove|first8=Boudewijn Van|author-link8=Boudewijn Van Houdenhove|date=2008-08-01|title=The relationship between fibromyalgia and major depressive disorder: a comprehensive review|url=https://doi.org/10.1185/03007990802288338|journal=Current Medical Research and Opinion|volume=24|issue=8|pages=2359–2371|doi=10.1185/03007990802288338|issn=0300-7995|pmc=|pmid=18606054|access-date=|quote=|via=}}</ref> [https://doi.org/10.1185/03007990802288338 (Abstract)]
*2010, Anxiety and depressive symptoms in fibromyalgia are related to poor perception of health but not to pain sensitivity or cerebral processing of pain<ref name="Jensen2010">{{Cite journal|last=Jensen|first=Karin B.|last2=Petzke|first2=Frank|last3=Carville|first3=Serena|last4=Fransson|first4=Peter|last5=Marcus|first5=Hanke|last6=Williams|first6=Steven C. R.|last7=Choy|first7=Ernest|last8=Mainguy|first8=Yves|last9=Gracely|first9=Richard|date=2010|title=Anxiety and depressive symptoms in fibromyalgia are related to poor perception of health but not to pain sensitivity or cerebral processing of pain|url=https://onlinelibrary.wiley.com/doi/abs/10.1002/art.27649|journal=Arthritis & Rheumatism|language=en|volume=62|issue=11|pages=3488–3495|doi=10.1002/art.27649|issn=1529-0131}}</ref> [https://doi.org/10.1002/art.27649 (Abstract)]
*2012, Fibromyalgia a discrete entity?<ref name="Ablin2012">{{cite journal | last=Ablin | first=Jacob N. | last2=Buskila | first2=Dan | last3=Van Houdenhove | first3=Boudewijn | last4=Luyten | first4=Patrick | last5=Atzeni | first5=Fabiola | last6=Sarzi-Puttini | first6=Piercarlo | title=Is fibromyalgia a discrete entity? | journal=Autoimmunity Reviews | url=https://doi.org/10.1016%2Fj.autrev.2011.10.018 | volume=11 | issue=8 | pages = 585–588 | date=Jun 2012 | issn=1568-9972 | doi=10.1016/j.autrev.2011.10.018 }}</ref> [https://onlinelibrary.wiley.com/doi/pdf/10.1002/art.27649 (Full text)]
*2012 [https://www.webmd.com/depression/news/20031024/fibromyalgia-isnt-depression Fibromyalgia isn't depression] - WebMD<ref name="webmd-notdepress">{{Cite web|url=https://www.webmd.com/depression/news/20031024/fibromyalgia-isnt-depression|title=Fibromyalgia Isn't Depression|last=DeNoon|first=Daniel J.|website=WebMD|language=en|access-date=2021-03-27}}</ref>

===[[Dry eye syndrome]]===
<ref name=":110">{{Cite news|url=https://www.news-medical.net/health/Fibromyalgia-and-Dry-Eyes-and-Mouth.aspx|title=Fibromyalgia and Dry Eyes and Mouth|last=Mandal|first=Ananya|date=2013-06-30|work=News-Medical.net|access-date=2018-10-04|archive-url=|archive-date=|last2=Cashin-Garbutt|first2=April|language=en}}</ref>

===[[Fatigue]]===
<blockquote>Fatigue is a universal symptom of fibromyalgia. It is often most marked when arising from sleep in the morning. A typical quote is “''No matter how much sleep I get, it feels like a truck ran me over in the morning'' (20).” Minor activities often seem to aggravate the fatigue.<ref name=":29">{{Cite web|url=https://www.docsopinion.com/2017/11/08/causes-fatigue-tiredness-chronic-fatigue/|title=19 Important Causes of Fatigue - Tiredness and Chronic Fatigue Explained|website=www.docsopinion.com|access-date=2019-01-30}}</ref></blockquote>

===[[Fibro fog]] and [[Cognitive dysfunction]]===
*'Mental confusion along with difficulty in concentration and loss of memory is often termed “[[fibro fog]]"'.<ref name=":3">{{Cite news|url=https://www.news-medical.net/health/What-is-Fibro-Fog-Fibromyalgia-and-Cognitive-Dysfunction.aspx|title=What is Fibro Fog? - Fibromyalgia and Cognitive Dysfunction|last=Mandal|first=Ananya|date=2013-06-03|work=News-Medical.net|access-date=2018-08-09|archive-url=|archive-date=|language=en}}</ref>

===[[Digestive problems|Gastrointestinal problems]]===
*[[Irritable bowel syndrome]]:
:<blockquote>Fibromyalgia, chronic fatigue syndrome and irritable bowel syndrome (IBS) frequently go together. No one really knows why, but we do know that all three conditions can include imbalances of serotonin -- although in fibromyalgia (FMS) and Chronic Fatigue Syndrome (CFS or ME/CFS) it's an imbalance in the brain, while with IBS it's in the gut.<ref name=":4">{{Cite news|url=https://www.verywellhealth.com/irritable-bowel-syndrome-in-fibromyalgia-cfs-716167|title=Irritable Bowel Syndrome in Fibromyalgia & ME/CFS|last=Dellwo|first=Adrienne|date=Jan 28, 2018|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=}}</ref> </blockquote>
===[[Gulf War Illness]]===
GWI increases risk of developing fibromyalgia.<ref name="VA">{{Cite web|url=https://www.publichealth.va.gov/exposures/gulfwar/fibromyalgia.asp|title=Fibromyalgia in Gulf War Veterans - Public Health|last=Administration|first=US Department of Veterans Affairs, Veterans Health|website=www.publichealth.va.gov|language=en|access-date=2018-08-19}}</ref>

===[[Interstitial cystitis]]===
Interstitial cystitis causes a painful bladder.<ref name=":5">{{Cite news|url=https://www.verywellhealth.com/chronic-fatigue-syndrome-interstitial-cystitis-716168|title=Fibromyalgia, Chronic Fatigue Syndrome & Interstitial Cystitis|last=Dellwo|first=Adrienne|date=Feb 16, 2018|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=}}</ref>
:"Fibromyalgia, chronic fatigue syndrome and [[interstitial cystitis]] (IC) -- a painful bladder condition -- frequently occur together. Women may be up to 10 times more likely than men to develop it."<ref name=":5" />
*[Interstitial cystitis]]/painful bladder syndrome and associated medical conditions with an emphasis on irritable bowel syndrome, fibromyalgia and [[Chronic fatigue syndrome|chronic fatigue syndrome.]]<ref name="Nickel2010">{{Cite journal|last=Nickel|first=J. Curtis|last2=Tripp|first2=Dean A.|last3=Pontari|first3=Michel|last4=Moldwin|first4=Robert|last5=Mayer|first5=Robert|last6=Carr|first6=Lesley K.|last7=Doggweiler|first7=Ragi|last8=Yang|first8=Claire C.|last9=Mishra|first9=Nagendra|date=2010|title=Interstitial cystitis/painful bladder syndrome and associated medical conditions with an emphasis on irritable bowel syndrome, fibromyalgia and chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/20719340|journal=The Journal of Urology|volume=184|issue=4|pages=1358–1363|doi=10.1016/j.juro.2010.06.005|issn=1527-3792|pmid=20719340|via=}}</ref>

===Language Impairment or word problems===
*[[Word-finding problems]]
:*"Searching their brains for simple words that they just can't remember. On other occasions, individuals with these diagnoses may find it hard to write or even understand language."<ref name=":6">{{Cite news|url=https://www.verywellhealth.com/language-impairment-in-fibromyalgia-cfs-716024|title=Language Impairment in Fibromyalgia and Chronic Fatigue Syndrome|last=Dellwo|first=Adrienne|date=Feb 12, 2018|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=}}</ref>
*"The diagnosis of [[aphasia]] is a condition that robs you of the ability to communicate. It can affect your ability to speak, write and understand language, both verbal and written"<ref>{{Cite news|url=http://www.mayoclinic.org/diseases-conditions/aphasia/basics/definition/con-20027061|title=Aphasia - Symptoms and causes|work=Mayo Clinic|access-date=2018-08-09|language=en}}</ref> but with [[dysphasia]] you will have those symptoms and trouble listening and doing numerical calculations.<ref name=":36" />
===[[Migraine]]===
<blockquote>Both fibromyalgia and migraine may reflect problems in the brain’s pain processing center. It is believed that both conditions are caused by excitation of the nervous system or an over-response to stimuli. Stress is usually cited as a trigger for both migraine and fibromyalgia attacks.<ref name=":32">{{Cite news|url=https://migrainecenters.com/blog/migraines-and-fibromyalgia/|title=Migraines and Fibromyalgia - Migraine Centers|date=2016-05-06|work=Migraine Centers|access-date=2018-08-19|language=en-US}}</ref></blockquote>

===[[Multiple chemical sensitivity|Multiple Chemical Sensitivity]] (MCS)===
It is thought that both Fibromyalgia and MCS are [[central sensitization|central sensitization]] syndromes.<ref>{{Cite news|url=https://www.verywellhealth.com/chemical-sensitivity-in-fibromyalgia-716170|title=Multiple Chemical Sensitivity in Fibromyalgia & ME/CFS|last=Dellwo|first=Adrienne|date=Jul 23, 2018|work=Verywell Health|access-date=2018-08-19|archive-url=|archive-date=}}</ref>

===OBGYN===
*[https://www.verywellhealth.com/menstrual-periods-and-fibromyalgia-715596 Menstrual Periods with Fibromyalgia: Personal Stories]
<blockquote>You may have heard about a possible link between gynecologic surgery (such as a hysterectomy) and the development of fibromyalgia, and doctors have long suspected that fibromyalgia has strong -[[Hormone|hormonal]] ties and triggers. This does not seem surprising as we've long suspected a link between endocrine disorders, gynecological conditions, and autoimmune conditions.<ref name=":7">{{Cite news|url=https://www.verywellhealth.com/fibromyalgia-tied-to-hysterectomy-gynecologic-disease-715626|title=Fibromyalgia Tied to Hysterectomy, Gynecologic Disease|last=Dellwo|first=Adrienne|date=Feb 16, 2018|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=}}</ref></blockquote>

===[[Orthostatic intolerance]] (OI)===
[[Postural orthostatic tachycardia syndrome]] (POTS) and other forms of orthostatic intolerance often occur in people with fibromyalgia.<ref name=":44">{{Cite journal|last=Yun|first=Dong Joo|last2=Choi|first2=Han Na|last3=Oh|first3=Gun-Sei|date=2013|title=A Case of Postural Orthostatic Tachycardia Syndrome Associated with Migraine and Fibromyalgia|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3710947/|journal=The Korean Journal of Pain|volume=26|issue=3|pages=303–306|doi=10.3344/kjp.2013.26.3.303|issn=2005-9159|pmid=23862007|via=}}</ref> Symptoms can include [[hypotension|low blood pressure]] and/or sudden high blood pressure, [[dizziness]], [[syncope|fainting]].
*Dr Charles Lapp found that fibromyalgia ymptoms and ME/CFS symptoms predicted the outcome of [[Tilt Table Testing]] foe [[orthostatic intolerance]].<ref>{{Cite web|url=http://drlapp.com/wp-content/uploads/TTT_symptoms.pdf|title=Symptoms Predict the Outcome of Tilt Table Testing in CFS/ME/FM|last=Lapp|first=Charles W.|last2=Black|first2=Laura|date=|website=drlapp.com|archive-url=|archive-date=|access-date=|last3=Smith|first3=Rebekah S.}}</ref>
*Orthostatic intolerance may often be l overlooked in fibromyalgia patients.<ref>{{Cite news|url=https://www.healthrising.org/blog/2017/09/21/fibromyalgia-problems-standing-orthostatic-intolerance/|title=An Overlooked Issue in Fibromyalgia? Study Highlights Orthostatic Intolerance - Problems Standing - Health Rising|last=Johnson|first=Cort|date=2017-09-21|work=Health Rising|access-date=2018-08-09|archive-url=|archive-date=|language=en-US}}</ref>
===[[Raynaud's syndrome]]===
<blockquote>In Raynaud's syndrome, the blood vessels constrict more than they should, which allows less blood to get through. That not only makes your extremities cold, it makes them extremely difficult to warm up. The most commonly affected body parts are the fingers and toes, but your lips, nose, ear lobes, knees, and nipples may also be involved.</blockquote>
<blockquote>Raynaud's isn't all about the cold, though. The diminished blood flow can cause pain in the affected areas, and it may also cause the skin there to turn blue. Skin ulcers (sores) are possible, since prolonged episodes of low blood flow can damage your tissues.<ref name="reynaulds">{{Cite web|url=https://www.verywellhealth.com/raynauds-syndrome-chronic-fatigue-716185|title=Cold Hands & Feet? Raynaud's Syndrome in Fibromyalgia & ME/CFS|last=Dellwo|first=Adrienne|date=Jan 28, 2018|work=Verywell Health|access-date=2018-10-11|archive-url=|archive-date=}}</ref></blockquote>

===[[Sleep dysfunction]]===
*Vatthauer et al. (2015) found that sleep was associated with task-negative [[brain]] activity in fibromyalgia participants with comorbid chronic [[insomnia]].<ref name="Vatthauer2015">{{Cite journal|last=Vatthauer|first=Karlyn E|last2=Craggs|first2=Jason G|last3=Robinson|first3=Michael E|last4=Staud|first4=Roland|last5=Berry|first5=Richard B|last6=Perlstein|first6=William M|last7=McCrae|first7=Christina S|date=2015-11-12|title=Sleep is associated with task-negative brain activity in fibromyalgia participants with comorbid chronic insomnia|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4648619/|journal=Journal of Pain Research|volume=8|pages=819–827|doi=10.2147/JPR.S87501|issn=1178-7090|pmc=|pmid=26648751|via=|issue=|quote=|author-link=|author-link2=|author-link3=|author-link4=Roland Staud|author-link5=}}</ref>
<blockquote>The present results of this study suggest that long-term, comorbid pain and sleep disturbance may be associated with increased activation in core default mode brain areas that is above and beyond long-term pain disturbance alone.<ref name="Vatthauer2015" /></blockquote>

*"Most people with fibromyalgia have an associated sleep disorder that makes it difficult for them to get the deep, restorative sleep they need."<ref name=":8">{{Cite news|url=https://www.prohealth.com/library/fibromyalgia-and-sleep-38954|title=Fibromyalgia and Sleep - Prohealth|date=2016-01-11|work=Prohealth|access-date=2018-08-09|language=en-US}}</ref>

===[[Temporomandibular joint disorder]] (TMJ/TMD) ===
[[File:Skull_diagram.png|350px|thumb|right|The temporomandibular joint is the joint between the mandible (light blue) and the temporal bone (orange) of the skull]]
* [https://www.sciencedirect.com/science/article/pii/S2255502114001758 Temporomandibular disorders in fibromyalgia syndrome: a short-communication]<ref>{{Cite journal|last=Soares Gui|first=Maisa|last2=Pimentel|first2=Marcele Jardim|last3=Rizzatti-Barbosa|first3=C'elia Marisa|date=2015-03-01|title=Temporomandibular disorders in fibromyalgia syndrome: a short-communication|url=https://www.sciencedirect.com/science/article/pii/S2255502114001758|journal=Revista Brasileira de Reumatologia (English Edition)|language=en|volume=55|issue=2|pages=189–194|doi=10.1016/j.rbre.2014.07.004|issn=2255-5021|via=ScienceDirect}}</ref><ref>{{Cite news|url=https://www.whitesmilesforlife.com/blog/study-probes-pain-link-between-tmj-fibromyalgia/|title=Study Probes Pain Link Between TMJ, Fibromyalgia|date=2016-05-03|work=Kent E. White, DDS|access-date=2018-08-19|language=en-US}}</ref>

Other than [[headache]]s, the symptoms of TMJ/TMD are quite distinct from symptoms of FMS and ME/CFS. They include:
*Jaw pain
*Discomfort or difficulty chewing
*Painful clicking in the jaw
*Difficulty opening or closing the mouth
*Headaches
*Locking jaw
*Teeth that don't come together properly<ref>{{Cite news|url=https://www.verywellhealth.com/tmj-in-fibromyalgia-chronic-fatigue-syndrome-716175|title=TMJ in Fibromyalgia and Chronic Fatigue Syndrome|last=Dellwo|first=Adrienne|date=Mar 31, 2018|work=Verywell Health|access-date=2018-08-22|archive-url=|archive-date=}}</ref>

===[[Thyroid disease]]===
<blockquote>People with [[Hashimoto's thyroiditis (hypothyroidism)|Hashimoto's autoimmune thyroid disease]] often experience significant fatigue and body aches. While these symptoms are common in Hashimoto's, they can also be markers of other diseases, like chronic fatigue syndrome or fibromyalgia.<ref name=":9">{{Cite news|url=https://www.verywellhealth.com/relationship-between-cfs-fibromyalgia-and-aitd-3231677|title=A Comparison of Chronic Fatigue, Fibromyalgia, and Thyroid Disease|last=Shomon|first=Mary|date=Feb 21, 2018|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=}}</ref> </blockquote>

===Other symptoms===
*[http://chronicfatigue.about.com/od/whatisfibromyalgia/a/fibrosymptoms.htm Symptoms of Fibromyalgia]<ref>{{Cite news|url=https://www.verywellhealth.com/fibromyalgia-symptoms-716139|title=Symptoms of Fibromyalgia|last=Dellwo|first=Adrienne|date=May 16, 2018|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=}}</ref> (On all the many symptoms and conditions of and related to fibromyalgia.)
*Fibromyalgia Syndrome: An Overview of Pathophysiology, Diagnosis and Management [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3394355/ Conditions associated with fibromyalgia. (Table 1)]<ref name="Firdous2012" />

==Treatment==

===United States===
'''Rheumatology and primary care providers: Diagnosing and treatment'''

*2012, [https://www.mayoclinicproceedings.org/article/S0025-6196(12)00299-6/abstract A Framework for Fibromyalgia Management for Primary Care Providers]<ref>{{Cite journal|last=Arnold|first=Lesley M.|last2=Clauw|first2=Daniel J.|last3=Dunegan|first3=L. Jean|last4=Turk|first4=Dennis C.|date=2012|title=A Framework for Fibromyalgia Management for Primary Care Providers|url=https://www.mayoclinicproceedings.org/article/S0025-6196(12)00299-6/abstract|journal=Mayo Clinic Proceedings|language=English|volume=87|issue=5|pages=488–496|doi=10.1016/j.mayocp.2012.02.010|issn=0025-6196|via=}}</ref> Rheumatologists stopped treating fibromyalgia patients and primary care providers began treatment managment although rheumatologists are most often the specialist to diagnose.
{{See also|Fibromyalgia disability process}}

===Drugs===
{{Main article |page_name = Fibromyalgia drugs}}

=== Therapies ===

==== Exercise ====
''Please Note'': These treatments are for fibromyalgia patients and '''not''' [[ME/CFS]] sufferers due to it's hallmark symptom of [[post-exertional malaise]].
[[File:Warm water exercise.JPG|200px|thumb|left|Warm water exercise is best for fibromyalgia. Start slow and don't push through the pain<ref name=":11" />]]

*[https://www.verywellhealth.com/warm-water-exercise-for-fibromyalgia-716059 Warm Water Exercise for Fibromyalgia]<ref name=":11">{{Cite news|url=http://chronicfatigue.about.com/od/treatingfmscfs/a/warmwaterFMS.htm|title=Warm Water Exercise for Fibromyalgia|last=Dellwo|first=Adrienne|date=Nov 19, 2017|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=}}</ref><ref>{{Cite journal|last=Munguía-Izquierdo|first=D.|last2=Legaz-Arrese|first2=A.|date=2007|title=Exercise in warm water decreases pain and improves cognitive function in middle-aged women with fibromyalgia|url=https://www.ncbi.nlm.nih.gov/pubmed/18173915|journal=Clinical and Experimental Rheumatology|volume=25|issue=6|pages=823–830|issn=0392-856X|pmid=18173915|via=}}</ref><ref>{{Cite news|url=https://www.prohealth.com/fibromyalgia/library/aquatic-exercise-training-fibromyalgia-85081?|title=Aquatic exercise training for fibromyalgia|date=2018-08-29|work=Prohealth|access-date=2018-09-01|language=en-US}}</ref><ref>{{Cite journal|last=Bidonde|first=Julia|last2=Busch|first2=Angela J.|last3=Webber|first3=Sandra C.|last4=Schachter|first4=Candice L.|last5=Danyliw|first5=Adrienne|last6=Overend|first6=Tom J.|last7=Richards|first7=Rachel S.|last8=Rader|first8=Tamara|date=2014-10-28|title=Aquatic exercise training for fibromyalgia|url=https://www.ncbi.nlm.nih.gov/pubmed/25350761|journal=The Cochrane Database of Systematic Reviews|issue=10|pages=CD011336|doi=10.1002/14651858.CD011336|issn=1469-493X|pmid=25350761}}</ref>

<blockquote>Several studies have found that warm-water pool exercise is a beneficial treatment for fibromyalgia. A very large survey of patients found that 26% have used pool therapy, rating it as very effective.<ref name=":45">{{Cite journal|last=Bennett|first=Robert M.|author-link=|last2=Jones|first2=Jessie|author-link2=|last3=Turk|first3=Dennis C.|author-link3=|last4=Russell|first4=I. Jon|author-link4=|last5=Matallana|first5=Lynne|author-link5=|date=Mar 9, 2007|title=An internet survey of 2,596 people with fibromyalgia|url=https://doi.org/10.1186/1471-2474-8-27|journal=BMC Musculoskeletal Disorders|volume=8|issue=1|pages=27|doi=10.1186/1471-2474-8-27|issn=1471-2474|pmc=1829161|pmid=17349056|quote=|via=}}</ref> The same survey found 74% of patients found heat helpful - either warm water or heat packs.<ref name=":45" /> Warm water especially important in FMS because many people with the condition are intolerant of cold. A warm-water pool is one that's kept around 89.6 degrees Fahrenheit (32 Celsius), which is several degrees warmer than most heated pools.<ref name=":11" /></blockquote>

* Moderate aerobic exercise and weights with six to eight reps and then a day or two of rest in between. Do not start a program if you are in a flare.<ref>{{Cite web|url=http://www.arthritis.org/living-with-arthritis/tools-resources/expert-q-a/fibromyalgia-questions/fibromyalgia-exercise.php|title=Fibromyalgia Exercise {{!}} Exercising with Fibromyalgia|last=Ronenn|first=Roubenoff|date=|website=www.arthritis.org|archive-url=|archive-date=|access-date=2018-08-09}}</ref>

*[https://www.youtube.com/watch?v=BauJYuJwFsI Easy fibromyalgia exercises and motivation to keep you healthy!]<ref>{{Cite web|url=https://www.youtube.com/watch?v=BauJYuJwFsI|title=Easy Fibromyalgia exercises and motivation to keep you healthy!|last=Suarez|first=Eric|date=Jun 21, 2011|website=YouTube|archive-url=|archive-date=|access-date=Aug 9, 2018}}</ref> Video

*[http://chronicfatigue.about.com/od/whatisfibromyalgia/a/Fibromyalgia-Myth-Vs-Fact.htm Fibromyalgia Myth vs. Fact]<ref name=":15">{{Cite news|url=https://www.verywellhealth.com/fibromyalgia-myth-vs-fact-716131|title=Fibromyalgia: What's Myth, What's Fact?|last=Dellwo|first=Adrienne|date=Jun 8, 2016|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=|at=Myth #3 People With Fibromyalgia Need More Exercise}}</ref> Heading: ''Myth #3: People With Fibromyalgia Need More Exercise''. Appropriate exercise, which each patient needs to gauge for themselves.<ref name=":15" />

==== Massage ====

*2014, [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3930706/ Massage Therapy for Fibromyalgia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials]<ref>{{Cite journal|last=Li|first=Yan-hui|last2=Wang|first2=Feng-yun|last3=Feng|first3=Chun-qing|last4=Yang|first4=Xia-feng|last5=Sun|first5=Yi-hua|date=2014-02-20|title=Massage Therapy for Fibromyalgia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3930706/|journal=PLoS ONE|volume=9|issue=2|doi=10.1371/journal.pone.0089304|issn=1932-6203|pmc=|pmid=24586677|pages=|via=}}</ref>

*2016, [http://chronicfatigue.about.com/od/alternativetreatments/a/bodywork.htm Massage, Rolfing & Other Bodywork - Are They Effective Fibromyalgia & Chronic Fatigue Syndrome Treatments?]<ref>{{Cite news|url=https://www.verywellhealth.com/massage-rolfing-other-bodywork-715645|title=Massage, Rolfing, Reiki: Do They Work for Fibromyalgia & ME/CFS?|last=Dellwo|first=Adrienne|date=Aug 10, 2017|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=}}</ref>

==== Acupuncture ====

*2004, [[U.S. Department of Health and Human Services]] (HHS) and Centers for Medicare and Medicaid Services (CMS) ruled April 16, 2004, a noncoverage determination for acupuncture.<ref>{{Cite web|url=https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R11NCD.pdf|title=CMS Manual System Pub. 100-03 Medicare National Coverage Determinations|last=|first=|date=Apr 16, 2004|website=CMS.gov|format=PDF|archive-url=|archive-date=|access-date=}}</ref>

*2005, [http://acupunctureschoolonline.com/acupuncture-good-for-fibromyalgia.html Acupuncture Good for Fibromyalgia?] <ref name=":16">{{Cite web|url=http://acupunctureschoolonline.com/acupuncture-good-for-fibromyalgia.html|title=Acupuncture Good for Fibromyalgia?|last=|first=|date=Oct 2, 2012|website=Acupuncture School Online|archive-url=|archive-date=|access-date=2018-08-09}}</ref> "Acupuncture gave no significant pain relief to fibromyalgia patients."<ref name=":16" />

*2016, [http://www.sciencedirect.com/science/article/pii/S2095496416602352 Short-term complementary and alternative medicine on quality of life in women with fibromyalgia] <ref name=":25">{{Cite journal|date=2016-01-01|title=Short-term complementary and alternative medicine on quality of life in women with fibromyalgia|url=https://www.sciencedirect.com/science/article/pii/S2095496416602352|journal=Journal of Integrative Medicine|language=en|volume=14|issue=1|pages=29–35|doi=10.1016/S2095-4964(16)60235-2|issn=2095-4964}}</ref> "There was no significant improvement in pain or reduction of tender points in any of the groups studied, at the end of the 8th session."<ref name=":25" />

*2016, [https://fibromyalgianewstoday.com/2016/02/01/acupuncture-does-not-reduce-pain-for-women-with-fibromyalgia/ Acupuncture Does Not Appear to Relieve Pain in Fibromyalgia Patients]<ref>{{Cite news|url=https://fibromyalgianewstoday.com/2016/02/01/acupuncture-does-not-reduce-pain-for-women-with-fibromyalgia/|title=Acupuncture Does Not Appear to Relieve Pain in Fibromyalgia Patients - Fibromyalgia News Today|last=Semedo|first=Daniela|date=2016-02-01|work=Fibromyalgia News Today|access-date=2018-08-09|archive-url=|archive-date=|language=en-US}}</ref>

== Controversy ==
=== Dr. Frederick Wolfe ===
Dr. [http://rheummd.org/members/fwolfe Frederick Wolfe], the director of the [https://www.arthritis-research.org/ National Databank for Rheumatic Diseases] and the lead author of the 1990 paper that first defined the diagnostic guidelines for fibromyalgia, says he has become cynical and discouraged about the diagnosis. He now considers the condition a physical response to stress, depression, and economic and social anxiety.<ref>{{Cite journal|last=Wolfe|first=Frederick|last2=Walitt|first2=Brian|date=2016|title=Fibromyalgia: A Short Commentary|url=http://headache.imedpub.com/fibromyalgia-a-short-commentary.pdf|journal=Journal of Headache & Pain Management|volume=1|issue= 3|pages=27|via=iMedPubJournals}}</ref><ref>{{Cite news|url=https://www.news-medical.net/news/20130322/Fibromyalgia-an-interview-with-Dr-Frederick-Wolfe-University-of-Kansas-School-of-Medicine.aspx|title=Fibromyalgia: an interview with Dr Frederick Wolfe, University of Kansas School of Medicine|last=Cashin-Garbutt|first=April|date=2013-03-22|work=News-Medical.net|access-date=2018-08-09|archive-url=|archive-date=|language=en}}</ref>

=== Fibromyalgia vs Chiari malformation ===
Some individuals diagnosed with FMS were undergoing surgery for [[chiari malformation]] (CM). These are two separate conditions; FMS cannot be resolved by undergoing a risky CM surgery.

*2011, [https://www.ncbi.nlm.nih.gov/pubmed/21135714 Is Chiari I malformation associated with fibromyalgia?]<ref>{{Cite journal|last=Watson|first=Nathaniel F.|last2=Buchwald|first2=Dedra|last3=Goldberg|first3=Jack|last4=Maravilla|first4=Kenneth R.|last5=Noonan|first5=Carolyn|last6=Guan|first6=Qingyan|last7=Ellenbogen|first7=Richard G.|date=2011|title=Is Chiari I malformation associated with fibromyalgia?|url=https://www.ncbi.nlm.nih.gov/pubmed/21135714|journal=Neurosurgery|volume=68|issue=2|pages=443–448; discussion 448–449|doi=10.1227/NEU.0b013e3182039a31|issn=1524-4040|pmid=21135714|via=}}</ref>
::Conclusion: Most patients with FM do not have [[CIM]] pathology. Future studies should focus on dynamic neuroimaging of craniocervical neuroanatomy in patients with FM.
*2015, [https://www.massmecfs.org/resource-library/9-treatment/172-cfidsfm-and-chiari-malformation-surgery CFS/FM and Chiari Malformation Surgery]<ref>{{Cite web|url=https://www.massmecfs.org/resource-library/9-treatment/172-cfidsfm-and-chiari-malformation-surgery|title=CFS/FM and Chiari Malformation Surgery|last=Casanova|first=Ken|date=Nov 15, 2015|website=www.massmecfs.org|language=en-GB|archive-url=|archive-date=|access-date=2018-08-09}}</ref>

==Disability: SSI/SSD and LT==
{{Main article |page_name = Fibromyalgia disability process}}

==Notable studies ==
{{Main article |page_name = Fibromyalgia notable studies}}

==See also==
*[[Fibromyalgia disability process]]
* [[Fibromyalgia drugs]]
* [[Fibromyalgia notable studies]]
* [[Influenza vaccine]]
*[[Lady Gaga]]
*''[[Mayo Clinic Guide to Fibromyalgia: Strategies to Take Back Your Life]] - Medical guide book (2019)''

== Learn more ==
*[https://dx.doi.org/10.4065%2Fmcp.2011.0206 The Science of Fibromyalgia] - Daniel Clauw, Lesley Arnold, and Bill McCarber for the FibroCollaborative
*[http://fmtest.com/ FM/a® test]
*[https://www.s4me.info/forums/fibromyalgia-and-connective-tissue-disorders.35/ Forum: Fibromyalgia and Connective Tissue Disorders] at [[Science for ME]]

=== Diagnosing and categorizing fibromyalgia===
*2014, [http://www.medpagetoday.com/Rheumatology/Fibromyalgia/49114 Lyme Disease, Fibromyalgia Link Evaporates] (See also: [[Chronic lyme disease]])
*2015, [http://www.news-medical.net/news/20150518/Fibromyalgia-now-considered-as-a-lifelong-central-nervous-system-disorder.aspx Fibromyalgia now considered as a lifelong central nervous system disorder]
*2015, [http://nationalpainreport.com/foundation-of-fibromyalgia-is-altered-central-nervous-system-new-study-validates-8827896.html Foundation of Fibromyalgia Is Altered Central Nervous System, New Study Validates]
*2016, [http://fibromyalgianewstoday.com/2016/09/09/fibromyalgia-diagnosis-using-noninvasive-eye-examination Diagnosing Fibromyalgia May Be Possible Using Noninvasive Eye Examination]
*2016, [http://simmaronresearch.com/2016/03/are-chronic-fatigue-syndrome-mecfs-and-fibromyalgia-immune-exhaustion-disorders/ Are Chronic Fatigue Syndrome (ME/CFS) and Fibromyalgia Immune Exhaustion Disorders?]
*2017, [http://nationalpainreport.com/study-reveals-new-treatment-target-for-fibromyalgia-inflammation-in-the-brain-8833354.html Study Reveals New Treatment Target for Fibromyalgia: Inflammation in the Brain]
*2017, [https://qz.com/1349854/ai-can-spot-the-pain-from-a-disease-some-doctors-still-think-is-fake/? AI can spot the pain from a disease some doctors still think is fake]
*2018, [https://www.verywellhealth.com/fibromyalgia-pain-physiological-evidence-716141 Understanding the Pathophysiology of Fibromyalgia]
*2018, [https://www.prohealth.com/fibromyalgia/library/fibromyalgia-central-sensitization-syndrome-87957? Fibromyalgia: Central Sensitization Syndrome - Characterizing classes of fibromyalgia within the continuum of central sensitization syndrome]

=== Blood tests ===
*2013, [http://nationalpainreport.com/new-fibromyalgia-blood-test-is-99-accurate-8821072.html New Fibromyalgia Blood Test is 99% Accurate]
*2014, [http://www.prohealth.com/library/showarticle.cfm?libid=18837 Pridgen Reports Fibromyalgia Antiviral Trial Results “Very Positive”: Predicts New Approach Will Be “Game-Changer”]
*2016, [https://www.celestecooper.com/2016/05/blood-test-for-fibromyalgia-fma-test-is.html Blood Test for Fibromyalgia: FM/a Test Ⓡ is now available, Q&A]
*2016, [http://www.liveinsurancenews.com/fibromyalgia-blood-testing-covered-rising-number-insurance-companies/ Fibromyalgia blood testing covered by rising number of insurance companies]
*2017, [http://www.businesswire.com/news/home/20170419005324/en/EpicGenetics-Assistance-Leading-Medical-Centers-Expands-Clinical EpicGenetics, with the Assistance of Leading Medical Centers, Expands Clinical Study of FM/a® Test to Diagnose Fibromyalgia, Identify Genetic Markers Unique to the Disorder and Explore Direct Treatment Approaches]

=== Brain scans ===
*2002, [http://www.anapsid.org/cnd/diagnosis/brainpain.html Fibromyalgia Pain Isn't All In Patient's Heads, New Brain Study Finds]
*2012, [https://www.sciencedaily.com/releases/2012/11/121111153426.htm Fibromyalgia and the brain: New clues reveal how pain and therapies are processed]
*2018, [https://ki.se/en/news/people-with-fibromyalgia-have-inflammation-of-the-brain People with fibromyalgia have inflammation of the brain]
*2018, [https://fibromyalgianewstoday.com/2018/10/11/brain-inflammation-imaged-first-time-fibromyalgia-patients-study/ Brain Inflammation Imaged for First Time in Fibromyalgia Patients, Study Reports]<

==References==
{{reflist}}

[[Category:Diagnoses]]
[[Category:Potential comorbidities]]
[[Category:Musculoskeletal diseases and disorders]]
[[Category:Neurological diseases and disorders]]

Fibromyalgia

2021-07-14T15:14:03Z

Loopy:/* Diagnosis */ confusing direction to images

{{Cleanup|date=Mar 2021|reason=Check science guidelines are met, e.g. no blogs or unreferenced articles for citations regarding general health information. Image captions should state author and copyright license. See [[help:Images%23Displaying_an_image_on_a_page]].}}

[[Fibromyalgia]] '''(FM/FMS)''' is a chronic disorder characterized by widespread [[Musculoskeletal system|musculoskeletal]] pain, [[fatigue]], and tenderness in localized areas. [[Myalgia|Muscle pain]] is widespread, on both sides of the body, and above and below the waist.<ref name="ACR1990" /><ref name="excerpt2" /><ref name="ACR2010" /><ref name="excerpt" />

Sufferers are fatigued and tired even when sleeping for long periods of time, and sleep is often disrupted by pain. Many FM sufferers have [[Sleep dysfunction|sleep disorders]] like [[sleep apnea]] and [[restless legs syndrome]] (RLS).<ref name="webmd-guide" /><ref name="mayo" /><ref name=":35" /> [[Cognitive impairment]], when one cannot focus or pay attention and the patient has difficulty concentrating on mental tasks, is known by FM sufferers as "[[fibro fog]]".<ref name="webmd-guide" /><ref name="mayo" /><ref name=":35" /> Some experience [[depression]], [[headache]]s, and lower [[abdominal pain]] or muscle cramp. Other symptoms include [[Paresthesia|tingling]] or [[numbness]] in hands and feet, pain in jaw and disorders of the jaw such as [[temporomandibular joint disorder|temporomandibular joint disorder]] (TMJ/TMD), [[Menstrual cycle#Health effects in other conditions|menstrual cycle]] cramps, and [[digestive problems]] like [[irritable bowel syndrome]] (IBS).<ref name="webmd-guide">{{Cite news|url=https://www.webmd.com/fibromyalgia/guide/fibromyalgia-symptoms#1|title=Fibromyalgia Symptoms|work=WebMD|access-date=2018-08-09|language=en-US}}</ref><ref name="mayo">{{Cite news|url=https://www.mayoclinic.org/diseases-conditions/fibromyalgia/symptoms-causes/syc-20354780|title=Fibromyalgia - Symptoms and causes|work=Mayo Clinic|access-date=2018-08-09|language=en}}</ref><ref name=":35" />

[[Pain#Pain in Fibromyalgia|Other pain conditions are associated with FM]], such as [[rheumatoid arthritis]] (RA), [[systemic lupus erythematosus]] (Lupus), ankylosing spondylitis, [[interstitial cystitis]], and more.<ref name="mayocause">{{Cite web|url=https://www.mayoclinic.org/diseases-conditions/fibromyalgia/symptoms-causes/syc-20354780|title=Fibromyalgia - Symptoms and causes|website=Mayo Clinic|language=en|access-date=2019-05-03}}</ref>

The [[United Kingdom|United Kingdom]] (UK) [[National Health Service]] (NHS) lists FM as one of 20 most painful conditions.<ref>{{Cite web|url=https://www.newsweek.com/20-most-painful-conditions-nhs-1191081|title=Here are 20 of the most painful health conditions you can get|last=EDT|first=Hannah Osborne On 10/29/18 at 7:14 AM|date=2018-10-29|website=Newsweek|language=en|access-date=2019-03-26}}</ref><ref name=":39">{{Cite web|url=https://www.cambridge-news.co.uk/news/uk-world-news/nhs-gout-ulcer-endometriosis-arthritis-15339123|title=The NHS says these are the 20 most painful health conditions you can suffer from|last=Campbell|first=James|last2=Pengelly|first2=Ella|date=2019-03-26|website=cambridgenews|access-date=2019-03-26}}</ref> The NHS describes the pain as diffuse aching or burning, head to toe, and can be worse at some times than at others. The pain can change location. "The fatigue ranges from feeling tired, to the exhaustion of a [[flu-like illness]]."<ref name=":39" /> The [[United States|United States]] (US) [[Centers for Disease Control and Prevention]] (CDC) states FM "can cause pain, [[Fibromyalgia disability process|disability, and lower quality of life]]."<ref name=":35" /> The medical guide book [[Mayo Clinic Guide to Fibromyalgia: Strategies to Take Back Your Life|''Mayo Clinic Guide to'' ''Fibromyalgia: Strategies to Take Back Your Life'']] describes fibromyalgia as "a [[Central sensitization|sensory disorder]] caused by a miscommunication between the [[Nervous system|nerves through your body and your brain]]."<ref>{{Cite web|url=https://www.amazon.com/Mayo-Clinic-Guide-Fibromyalgia-Strategies/dp/1893005496/ref=sr_1_1|title=Mayo Clinic Guide to Fibromyalgia: Strategies to Take Back Your Life|last=Abril, M.D.|first=Andy|authorlink=|last2=Bruce Ph.D. L.P.|first2=Barbara K.|authorlink2=|date=2019|website=www.amazon.com|publisher=Mayo Clinic Press; Paperback Original edition|page=15|archive-url=|archive-date=|access-date=2019-11-13}}</ref>

The [[American_College_of_Rheumatology|American College of Rheumatology]] (ACR) created and updates the diagnostic criteria for FM.<ref name="ACR1990" /><ref name="ACR2010">{{Cite journal|url=https://www.rheumatology.org/Portals/0/Files/2010_Preliminary_Diagnostic_Criteria.pdf|title=American College of Rheumatology (ACR) Preliminary Diagnostic Criteria for Fibromyalgia|last=Wolfe|first=Frederick|date=May 2010|volume =62 | issue = 5 | pages= 600–610| doi = 10.1002/acr.20140|type=PDF|archive-url=|archive-date=|access-date=|authorlink=|last2=Clauw|first2=Daniel|authorlink2=|journal=Arthritis Care & Research|last3=Fitzcharles|first3=Mary-Ann|first4=Don|last5=Katz|last4=Goldenberg|first5=Robert|last6=Mease|first6=Philip|last7=Russel|first7=Anthony|last8=Russel|first8=I. Jon|first9=John|last9=Winfield|first10=Muhammad|last10=Yunus|quote=The reference list consisted of: [[myalgia|muscle pain]], [[irritable bowel syndrome]], [[fatigue]]/tiredness, [[cognitive dysfunction|thinking or remembering problem]], [[paresis|muscle weakness]], [[headache]], pain/cramps in the abdomen, [[paresthesia|numbness/tingling]], [[dizziness]], [[insomnia]], [[depression]], [[constipation]], pain in the upper abdomen, [[nausea]], nervousness, [[chest pain]], [[blurred vision]], [[fever]], [[diarrhea]], dry mouth, [[skin itch|itching]], wheezing, [[Raynaud's syndrome|Raynaud’s phenomenon]], [[hives|hives/welts]], [[tinnitus|ringing in ears]], [[vomiting]], [[heartburn]], oral ulcers, loss of/change in taste, [[seizure]]s, [[dry eye syndrome|dry eyes]], [[dyspnea|shortness of breath]], [[anorexia (appetite loss)|loss of appetite]], [[skin rash|rash]], [[photophobia|sun sensitivity]], hearing difficulties, easy [[bruising]], [[hair loss]], frequent urination, [[painful bladder syndrome|painful urination]], and bladder spasms.}}</ref><ref name="ACR1990" /><ref name="excerpt2" /><ref name="ACR2010" /><ref name="excerpt">{{Cite web|url=https://www.rheumatology.org/Portals/0/Files/2010%20Fibromyalgia%20Diagnostic%20Criteria_Excerpt.pdf|title=2010 Fibromyalgia Diagnostic Criteria - Excerpt|last=|first=|authorlink=|last2=|first2=|website=rheumatology.org|page=|archive-url=|archive-date=|access-date=}}</ref> See: [[Fibromyalgia#Diagnosis|Fibromyalgia (Diagnosis)]].

[[File:Fibro_Tender_Points.png|400px|thumb|right|<span id="ACR1990-image">1990 ACR Diagnostic Criteria: 18 Tender Points</span><ref name="ACR1990">{{Cite journal|last=Wolfe|first=Frederick|author-link=Frederick Wolfe|last2=Smythe|first2=Hugh|author-link2=|last3=Yunus|first3=Muhammad|author-link3=Muhammad Yunnus|last4=Bennett|first4=Robert|author-link4=|last5=Bombardier|first5=Claire|author-link5=|last6=Goldenberg|first6=Don|author-link6=|last7=Tugwell|first7=Peter|author-link7=|last8=Campbell|first8=Stephen|author-link8=|last9=Abeles|first9=Micha|author-link9=|others=P Clark; A Fam; S Farber; J Fiechtner; CM Franklin; R Gatter; D Hamaty; J Lessard; A Lichtbroun; A Masi; G McCain; WJ Reynolds; T Romano; IJ Russell; R Sheon|date =1990|title=The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia|url=https://www.rheumatology.org/Portals/0/Files/1990_Criteria_for_Classification_Fibro.pdf|journal=Arthritis and Rheumatism|publisher=The American College of Rheumatology|volume=33|issue=2|pages=160-172|quote=|via=}}</ref><ref name="excerpt2">{{Cite web|url=https://www.rheumatology.org/Portals/0/Files/1990%20Fibromyalgia_Excerpt.pdf|title=1990 Fibromyalgia Excerpt|last=Wolfe|first=Frederick|authorlink=|last2=|first2=|authorlink2=|date=1990|website=rheumatology.org|archive-url=|archive-date=|access-date=}}</ref>]]
[[File:Fibro_Widespread_Pain.png|400px|thumb|right|<span id="ACR1990-image">2010 ACR Preliminatry Diagnostic Criteria:</span> '''Widespread Pain Index (WPI'''), 19 Tender Point Areas<ref name="ACR2010" /><ref name="excerpt" />]]

==Prevalence==
FM is the second most common rheumatic disorder behind [[osteoarthritis]] and is "now considered to be a lifelong [[central nervous system]] disorder."<ref>{{Cite web|url=https://www.sciencedaily.com/releases/2015/05/150517071813.htm|title=Fibromyalgia has central nervous system origins|last=|first=|authorlink=|last2=|first2=|authorlink2=|date=May 17, 2015|website=ScienceDaily|at=Summary|language=en|archive-url=|archive-date=|access-date=2019-11-13|quote=now considered to be a lifelong central nervous system disorder}}</ref><ref>{{Cite news|url=https://naidw.org/blog/members-myblogs/fibromyalgia-now-considered-as-a-lifelong-central-nervous-system-disorder|title=Fibromyalgia now considered as a lifelong central nervous system disorder|work=NAIDW.org®|access-date=2018-08-09|language=en-gb}}</ref> An estimated 10 million people in the US and 3-6% of the world population have FM. It is seen in women, men, children, and all ethnic groups. It is often seen in families and diagnosed between the ages of 20 to 50 years; incidence increases with age.<ref>{{Cite news|url=http://www.fmaware.org/about-fibromyalgia/prevalence/|title=Prevalence - National Fibromyalgia Association (NFA)|work=National Fibromyalgia Association (NFA)|access-date=2018-08-09|language=en-US}}</ref>

FM has a female:male 7:1 ratio under the ''American College of Rheumatology (ACR) 1990 Diagnostic Criteria''<ref name="ACR1990" /><ref name="excerpt2" /> and 2:1 when the ACR 2010 Preliminary Diagnostic Criteria<ref name="ACR2010" /><ref name="excerpt" /> is used.<ref>{{Cite journal|last=Boomershine|first=Chad|date=Nov 4, 2017|title=Fibromyalgia: Practice Essentials, Background, Pathophysiology|url=http://emedicine.medscape.com/article/329838-overview#a5|journal=Medscape|volume=|pages=|via=|publisher=|editor-last=Diamond|editor-first=Herbert|at=Sex-related differences in incidence}}</ref> See: [[Fibromyalgia#American College of Rheumatology (ACR) Criteria|Fibromyalgia (''American College of Rheumatology (ACR) Criteria'')]]. A September 2018, Wolfe et al study ''Fibromyalgia diagnosis and biased assessment: Sex, prevalence and bias''<ref name=":28" /> found fewer women and more men are diagnosed under the 2010/11 criteria (this criterion further updated in 2016<ref>{{Cite journal|date=2016-12-01|title=2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria|url=https://www.sciencedirect.com/science/article/pii/S0049017216302086|journal=Seminars in Arthritis and Rheumatism|language=en|volume=46|issue=3|pages=319–329|doi=10.1016/j.semarthrit.2016.08.012|issn=0049-0172}}</ref>). They found the ratio is F/M 1.5:1.<ref name=":28">{{Cite journal|last=Wolfe|first=Frederick|last2=Walitt|first2=Brian|last3=Perrot|first3=Serge|last4=Rasker|first4=Johannes J.|last5=Häuser|first5=Winfried|date=2018-09-13|title=Fibromyalgia diagnosis and biased assessment: Sex, prevalence and bias|url=https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0203755|journal=PLOS ONE|language=en|volume=13|issue=9|pages=e0203755|doi=10.1371/journal.pone.0203755|issn=1932-6203|pmc=|pmid=30212526|via=}}</ref><blockquote>What we did not find in our unbiased CritFM samples was 9:1 female to male fibromyalgia ratios that are widely described by expert sources [11–13]. We believe that such findings only occur in the presence of selection bias or biased ascertainment.<ref name=":28" /></blockquote><blockquote>As unbiased epidemiological studies show only a small increase in the female to male sex ratio (~1.5:1) as opposed to the observed ratio in clinical studies of 9:1, we believe that the over-identification of fibromyalgia in women and the consequent under-identification of men is the result of bias.<ref name=":28" /></blockquote>

==Fibromyalgia in ME/CFS==
"The most common overlapping condition with [[ME/CFS]] is fibromyalgia."<ref name="ammes-overlap">{{Cite web|url=https://ammes.org/overlapping-conditions/|title=Overlapping Conditions|website = [[American Myalgic Encephalomyelitis and Chronic Fatigue Syndrome Society]]|last=|first=|date=|language=en-US|archive-url=|archive-date=|access-date=2018-08-12}}</ref><ref>{{Cite web|url=http://www.ayushveda.com/healthcare/dysphasia.htm|title=Dysphasia - Causes, Symptoms & Treatment|website=www.ayushveda.com|access-date=2018-08-09}}</ref> See also: [[Dyscalculia]].
* [[ME/CFS]]<ref name="ammes-overlap" /><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=":31">{{Cite journal|last=Jason|first=Leonard|last2=Taylor|first2=R.R.|last3=Kennedy|first3=C.L.|last4=Song|first4=S|last5=Johnson|first5=D|last6=Torres|first6=S.R.|date=2001-01-01|title=Chronic fatigue syndrome: Comorbidity with fibromyalgia and psychiatric illness|url=https://www.researchgate.net/publication/285787383_Chronic_fatigue_syndrome_Comorbidity_with_fibromyalgia_and_psychiatric_illness|journal=Medicine and Psychiatry|volume=4|pages=29–34}}</ref> While some have posited ME/CFS and FM are variants of the same illness, [[Benjamin Natelson]], MD summoned considerable amounts of data that suggest the two illnesses differ with different pathophysiologic processes leading to different treatments.<ref name=":36">{{Cite journal|last=Natelson|first=Benjamin H.|date=2019-02-19|title=Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Fibromyalgia: Definitions, Similarities, and Differences|url=https://www.clinicaltherapeutics.com/article/S0149-2918(19)30003-7/abstract|journal=Clinical Therapeutics|language=English|volume=41|issue=4|pages=612|doi=10.1016/j.clinthera.2018.12.016|issn=0149-2918|pmid=30795933}}</ref>

Dr. [[Jarred Younger]] has said that many patients that meet the criteria for FM also meet criteria for [[chronic fatigue syndrome]] (CFS) but the reverse is not necessarily true as a lot of people with [[CFS]] do not have [[chronic pain]].<ref>{{Cite web|url=https://www.youtube.com/watch?v=wJB95m4FLa0#t=57m27s|title=Webinar with Jarred Younger, Ph.D.|last=Younger|first=Jarred|date=May 20, 2016|website=YouTube|at=57:27|via=|archive-url=|archive-date=|access-date=|publisher=SolveCFS|type=Video}}</ref> However, the [[Canadian Consensus Criteria]] (CCC) requires the symptom of pain to diagnose ME/CFS.<ref name="Carruthers, 2003">{{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
| url = http://phoenixrising.me/wp-content/uploads/Canadian-definition.pdf
}}</ref> It is the pattern (on both sides of the body, and above and below the waist) of chronic widespread [[Musculoskeletal system|musculoskeletal]] pain (involving muscle, cartilage, ligaments, and connective tissue) in FM that sets it apart from other diseases that have pain; it also causes [[cognitive symptoms]] and [[unrefreshing sleep]].<ref name="webmd-guide" /><ref name="mayo" />

A Swedish study of 234 ME/CFS patients meeting the [[Canadian Consensus Criteria]] found that 96% had trigger point pain consistent with fibromyalgia and 67% met the diagnostic criteria for fibromyalgia.<ref>{{Cite web|url=https://osf.io/qwn5h/|website=Center for Open Science|access-date=2019-12-03|title=Bragee Bertilson et al. - ME CFS and Intracranial Hypertension|date=Nov 27, 2019|last=|first=|authorlink=|last2=|first2=|authorlink2=|archive-url=|archive-date=}}</ref>

==Health complications==
FM is not a progressive disease but according to Dr. [[Daniel Clauw|Dan Clauw]] the "slow gradual worsening of chronic pain patients over time is due to downstream consequences of poorly controlled pain and other symptoms, wherein individuals then progressively get less active, sleep worse, are under more stress and unknowingly develop bad habits which worsen pain and other symptoms."<ref>{{Cite news|url=http://nationalpainreport.com/ask-the-dctors-is-fibromyalgia-progressive-8831105.html|title=Ask the Doctors: Is Fibromyalgia Progressive?|date=2016-08-09|work=National Pain Report|access-date=2018-08-09|language=en-US}}</ref>

*[https://www.sharecare.com/health/fibromyalgia-effects Fibromyalgia Complications]<ref name=":19" />

:<blockquote>People who have fibromyalgia frequently complain of a variety of symptoms that affect other parts of the body. Many people complain of [[gastrointestinal]] issues and restless legs syndrome (RLS). Additionally, the [[chronic pain]] and discomfort of fibromyalgia may lead to [[depression]].<ref name=":19">{{Cite news|url=https://www.sharecare.com/health/fibromyalgia-effects|title=Fibromyalgia Complications - Fibromyalgia - Joint Health|work=Sharecare|access-date=2018-08-09|language=en}}</ref></blockquote>

*[https://www.sharecare.com/health/fibromyalgia-effects/can-fibromyalgia-cause-medical-conditions Can fibromyalgia cause other medical conditions?]<ref name=":20" />

:<blockquote>Fibromyalgia is not known to cause other medical conditions. However, people who have fibromyalgia seem to be at high risk for developing other painful conditions, including osteoarthritis (the common type of arthritis caused by wear and tear on the joints) as well as other related conditions, such as rheumatoid arthritis, lupus, and ankylosing spondylitis. Also, people with fibromyalgia are frequently diagnosed with chronic fatigue syndrome, [[irritable bowel syndrome]] (IBS), and temporomandibular joint (TMJ) disorder.<ref name=":20">{{Cite web|url=https://www.sharecare.com/health/fibromyalgia-effects/can-fibromyalgia-cause-medical-conditions|title=Can fibromyalgia cause other medical conditions? {{!}} Fibromyalgia Complications|last=Honor Society of Nursing|first=|date=|website=Sharecare|language=en|archive-url=|archive-date=|access-date=2018-08-09}}</ref></blockquote>

==Risk factors==
[[Lupus]] and [[rheumatoid arthritis]] (RA) are risk factors in developing FM. Car accidents, [[post-traumatic stress disorder]] (PTSD), [[Carpal tunnel syndrome|repetitive injuries]], illness such as a [[virus]], family history, and obesity have all been linked to FM.<ref name=":35">{{Cite web|url=https://www.cdc.gov/arthritis/basics/fibromyalgia.htm|title=Fibromyalgia {{!}} Arthritis|date=2018-04-03|website=[[Centers for Disease Control]]|language=en-us|access-date=2018-08-09}}</ref><ref>{{Cite news|url=https://www.niams.nih.gov/health_info/Fibromyalgia/|title=Fibromyalgia What Causes it?|last=Director|first=Nancy Garrick, Deputy|work=National Institute of Arthritis and Musculoskeletal and Skin Diseases|access-date=2018-08-09|archive-url=|archive-date=|language=en}}</ref><ref>{{Cite news|url=http://www.prohealth.com/library/showarticle.cfm?libid=22315|title=When Fibromyalgia Is More than Pain - Prohealth|date=2016-01-08|work=Prohealth|access-date=2018-08-09|language=en-US}}</ref>

==Diagnosis==
Tender points, not [trigger points]], are used to diagnose FM.<ref>{{Cite web|url=http://www.healthcentral.com/chronic-pain/c/662034/176031/fibromyalgia-trigger/|title=The Difference Between Fibromyalgia Tender Points and Myofascial Trigger Points - Chronic Pain {{!}} HealthCentral|last=Cooper|first=Celeste|date=May 8, 2015|website=www.healthcentral.com|language=en-US|archive-url=|archive-date=|access-date=2018-08-09}}</ref> Tender points will be above and below the waist and on both sides of the body. (See: 1990 ACR and 2010 ACR images above right depicting tender points.) It is important to check for other conditions that could be causing pain such as [[hypothyroidism]], RA or lupus, osteoarthritis, ankylosing spondylitis, and polymyalgia rheumatica.<ref>{{Cite news|url=https://www.webmd.com/fibromyalgia/guide/fibromyalgia-diagnosis-and-misdiagnosis#1|title=How Is Fibromyalgia Diagnosed?|work=WebMD|access-date=2018-08-12|language=en-US}}</ref>

===United States===
=====<span id="bloodtest"> Blood test </span>=====
EpicGenetics has a blood test that is identifying the presence of specific [[Leucocyte|white blood cell]] abnormalities of patients diagnosed with FM and has partnered with two universities to offer whole exome sequencing free of charge to those who test positive with their '''FM/a® test'''.<ref>{{Cite news|url=http://www.businesswire.com/news/home/20170419005324/en/EpicGenetics-Assistance-Leading-Medical-Centers-Expands-Clinical|title=EpicGenetics, with the Assistance of Leading Medical Centers, Expands Clinical Study of FM/a® Test to Diagnose Fibromyalgia, Identify Genetic Markers Unique to the Disorder and Explore Direct Treatment Approaches|last=|first=|date=Apr 19, 2017|work=|access-date=2018-08-09|archive-url=|archive-date=|language=en}}</ref><ref name=":38">{{Cite web|url=http://fmtest.com/|title=Home|last=|website=EpicGenetics' FM/a® Test is FDA-compliant and has successfully diagnosed patients with fibromyalgia since 2012.|language=en-US|access-date=2019-03-25}}</ref> Most insurance companies will cover the test.<ref>{{Cite web|url=https://www.painnewsnetwork.org/stories/2015/5/27/fibromyalgia-blood-test-gets-insurance-coverage|title=Fibromyalgia Blood Test Gets Insurance Coverage|last=Anson|first=Pat|authorlink=|last2=|first2=|authorlink2=|date=May 27, 2015|website=Pain News Network|language=en-US|archive-url=|archive-date=|access-date=2019-03-25}}</ref><ref>{{Cite web|url=http://nationalpainreport.com/more-insurance-companies-now-paying-for-fibromyalgia-blood-test-8829994.html|title=More Insurance Companies Now Paying for Fibromyalgia Blood Test|last=Gregory-Burch|first=Donna|authorlink=|last2=|first2=|authorlink2=|date=2016-04-04|website=National Pain Report|language=en-US|archive-url=|archive-date=|access-date=2019-03-25}}</ref> EpicGenetics offers help to determine if your insurance will cover their test.<ref name=":38" />

==== American College of Rheumatology (ACR) Criteria ====

=====1990 ACR criteria=====

*1990, [http://www.rheumatology.org/Portals/0/Files/1990_Criteria_for_Classification_Fibro.pdf The American College Of Rheumatology 1990 Criteria For The Classification Of Fibromyalgia]<ref name="ACR1990" /><ref name="excerpt2" /> "American College of Rheumatology guidelines suggest that people with fibromyalgia have pain in at least 11 of these tender points when a doctor applies a certain amount of pressure."<ref>{{Cite news|url=http://www.health.com/health/gallery/0,,20345635,00.html|title=18 Points Used to Diagnose Fibromyalgia|last=|first=|date=Feb 4, 2011|work=Health.com|access-date=2018-08-09|archive-url=|archive-date=|language=en}}</ref><ref>{{Cite web|url=https://www.masscfids.org/8-resource-library/diagnosis/266-tender-points-might-no-longer-be-used-for-diagnosis-of-fibromyalgia|title=Tender Points might no longer be used for diagnosis of Fibromyalgia|last=Proskauer|first=Charmian|date=Feb 2011|website=www.masscfids.org|language=en-GB|archive-url=|archive-date=|access-date=2018-08-09}}</ref>

=====2010 ACR criteria=====

*2010, The [https://www.rheumatology.org/Portals/0/Files/2010_Preliminary_Diagnostic_Criteria.pdf 2010 American College of Rheumatology (ACR) Preliminary Diagnostic Criteria for Fibromyalgia: Overview]<ref name="ACR2010" /><ref name="excerpt" /> was proposed and modified in 2011<ref>{{Cite news|url=http://www.rheumatologynetwork.com/fibromyalgia/new-and-modified-fibromyalgia-diagnostic-criteria|title=New and Modified Fibromyalgia Diagnostic Criteria|last=Garg|first=Neha|date=Feb 9, 2012|work=Rheumatology Network|access-date=Aug 9, 2017|archive-url=|archive-date=|last2=Deodhar|first2=Atul}}</ref> with the modification being validated in 2013 and published in 2014.<ref>{{Cite journal|last=Bennett|first=Robert M.|last2=Friend|first2=Ronald|last3=Marcus|first3=Dawn|last4=Bernstein|first4=Cheryl|last5=Han|first5=Bobby Kwanghoon|last6=Yachoui|first6=Ralph|last7=Deodhar|first7=Atul|last8=Kaell|first8=Alan|last9=Bonafede|first9=Peter|date=2014|title=Criteria for the diagnosis of fibromyalgia: validation of the modified 2010 preliminary American College of Rheumatology criteria and the development of alternative criteria|url=https://www.ncbi.nlm.nih.gov/pubmed/24497443|journal=Arthritis Care & Research|volume=66|issue=9|pages=1364–1373|doi=10.1002/acr.22301|issn=2151-4658|pmid=24497443|via=}}</ref> September of 2016, another revision has been made.<ref name=":14">{{Cite news|url=http://acrabstracts.org/abstract/2016-revisions-to-the-20102011-fibromyalgia-diagnostic-criteria/|title=2016 Revisions to the 2010/2011 Fibromyalgia Diagnostic Criteria - ACR Meeting Abstracts|last=|first=|date=Sep 28, 2016|work=ACR Meeting Abstracts|access-date=2018-08-09|archive-url=|archive-date=|language=en-US}}</ref>

:Men do not seem to form the tender points needed for diagnosis under the 1990 criteria,<ref>{{Cite news|url=http://www.webmd.com/fibromyalgia/features/how-fibromyalgia-affects-men#2|title=How Fibromyalgia Affects Men: Symptoms and Diagnosis|work=WebMD|access-date=2018-08-09|language=en-US}}</ref> the 2010 proposed criteria diagnoses more men with a F/M ratio of 2:1.<ref>{{Cite journal|last=Boomershine|first=Chad|date=Nov 4, 2017|title=Fibromyalgia: Practice Essentials, Background, Pathophysiology|url=http://emedicine.medscape.com/article/329838-overview#a5|journal=Medscape|volume=|pages=|via=}}</ref>
:Tender points were used to diagnose with the 1990 criteria, however "considerable skill is needed to correctly check for a patient’s tender points (i.e., digital palpation that is done with certain amount of applied pressure), yet this technique is not typically taught at most medical schools."<ref name="masscfids">{{Cite web|url=https://www.masscfids.org/8-resource-library/diagnosis/266-tender-points-might-no-longer-be-used-for-diagnosis-of-fibromyalgia#2|title=Tender Points might no longer be used for diagnosis of Fibromyalgia|last=Proskauer|first=Charmian|date=Feb 5, 2011|website=www.masscfids.org|language=en-GB|archive-url=|archive-date=|access-date=2018-08-09}}</ref>
:The new standards were designed to:
:*eliminate the use of a tender point examination
:*include a severity scale by which to identify and measure characteristic FM symptoms
:*utilize an index by which to rate pain<ref name="masscfids" />

There are 19 tender point areas in the widespread pain index (WPI), whereas the 1990 criteria had 18 tender points.<ref name="masscfids" />

====== Widespread pain index and Symptom severity ======

The '''Widespread Pain Index''' (WPI) and '''Symptom Severity''' (SS) are explained in the study ''Fibromyalgia Syndrome: An Overview of Pathophysiology, Diagnosis and Management''.<ref name="Firdous2012" />
[[File:Widespread Pain Index Areas with numbers.svg|200px|thumb|right|'''WPI''' 19 areas of pain. Count 1 point for each area of pain<ref name="Firdous2012" /><ref name="ACR2010" /><ref name="excerpt" />]]
<blockquote>In place of the tender point count, patients (or their physician) may endorse 19 body regions in which pain has been experienced during the past week. One point is given for each area, so the score is between 0-19. This number is referred to as the '''Widespread Pain Index (WPI)''' and it is one of the two required scores needed for a doctor to make a diagnosis of fibromyalgia.</blockquote><blockquote>The second part of the score required to assess the diagnosis of fibromyalgia involves the evaluation of a person's symptoms. The patient ranks specific symptoms on a scale of 0-3. These symptoms include: [[Fatigue]], [[Unrefreshing sleep|Waking unrefreshed]], [[Cognitive dysfunction|Cognitive symptoms]], Somatic (physical) symptoms in general (such as [[headache]], weakness, [[Gastrointestinal system|bowel problems]], [[nausea]], [[dizziness]], [[numbness]] / [[Paresthesia|tingling]], [[hair loss]], [[Dry eye syndrome|dry eyes]], [[Raynaud's syndrome|Raynaud's]] phenomenon, painful urination, and more).<ref name="Firdous2012" /><ref name="ACR2010" /> The numbers assigned to each are added up, for a total of 0-12.</blockquote><blockquote>The diagnosis is based on both the '''WPI''' score and the '''SS''' score either:</blockquote>
::'''WPI''' of at least 7 and '''SS''' scale score of at least 5, ''or''
::'''WPI''' of 4-6<ref name=":14" /> and '''SS''' scale score of at least 9.<ref name="Firdous2012" />

[[File:WPI SS Fibro.JPG|600px|thumb|center|Table 2: '''SS''' scale score. Add a 4th column for Somatic (physical) symptoms in general (such as Headache, weakness, bowel problems, nausea, dizziness, numbness/tingling, hair loss, dry eyes, Raynaud's phenomenon, painful urination, and more).<ref name="Firdous2012" /><ref name="ACR2010" /> The patient ranks specific symptoms on a scale of 0-3. The numbers assigned to each column are added up, for a total of 0-12.<ref name="Firdous2012" /> ]]

The [[Social Security Administration]] (SSA) accepts a diagnosis of FM with the 1990<ref name="ACR1990" /><ref name="excerpt2" /> or 2010<ref name="ACR2010" /><ref name="excerpt" /> ACR criteria.<ref name="ssa">{{Cite web|url=https://www.ssa.gov/OP_Home/rulings/di/01/SSR2012-02-di-01.html|title=Social Security Ruling: SSR 12-2p|last=ORDP|last2=OPPS|first=|date=Jul 25, 2012|website=www.ssa.gov|language=en|archive-url=|archive-date=|access-date=2018-08-09}}</ref>
{{See also|Fibromyalgia disability process}}

=== Sleep study ===
[[Sleep dysfunction]] is often involved in FM. Treating a sleep disorder can help with FM symptoms. A diagnosed sleep disorder is also helpful if one needs to [[Fibromyalgia disability process|file for disability]].<ref>{{Cite news|url=https://www.sciencedaily.com/releases/2008/09/080903134311.htm|title=What A Sleep Study Can Reveal About Fibromyalgia|work=ScienceDaily|access-date=2018-08-09|language=en}}</ref><ref>{{Cite news|url=http://linkis.com/nationalpainreport.com/lzYea|title=Fibromyalgia Sufferers Have Difficulty Maintaining Continuous Sleep, Study Says|last=|first=|date=Mar 25, 2016|work=National Pain Report|access-date=2018-08-09|archive-url=|archive-date=|language=en-US}}</ref>

=== ICD Diagnostic code===
'''ICD-10'''

The [[World Health Organization]] (WHO) International Classification of Diseases (ICD) lists FM as a "disease of the [[musculoskeletal system]] and connective tissue", under the code M79.7 (WHO ICD-10 Version: 2016).<ref name="ICD10">{{Cite web|url=http://apps.who.int/classifications/icd10/browse/2016/en#/M79.7|title=ICD-10 Version:2016|last=World Health Organization|first=|author-link=World Health Organization|date=2016|website=[[World Health Organization]]|at=M79.7 Fibromyalgia|language=en|archive-url=|archive-date=|access-date=2018-09-15}}</ref> The WHO's ICD-10 does not refer to FM as a syndrome and it is not classified in the category for [[Medically unexplained physical symptoms|medically unexplained symptoms]].<ref name=":37" /><ref name="ICD10" />

*'''M79.7 Fibromyalgia'''
::Fibromyositis
::Fibrositis
::Myofibrositis<ref name="ICD10" />

In 2015, the [[United States|US]] finally adopted ICD-10 and FM as a diagnosis.<ref name=":37">{{Cite web|url=http://www.icd10data.com/ICD10CM/Codes/M00-M99/M70-M79/M79-/M79.7|title=2018 ICD-10-CM Diagnosis Code M79.7: Fibromyalgia|website=www.icd10data.com|language=en|access-date=2018-08-09|date=2018|last=World Health Organization|first=|archive-url=|archive-date=|authorlink=World Health Organization|last2=|first2=|authorlink2=}}</ref> <ref>{{Cite news|url=http://nationalpainreport.com/the-health-care-industry-finally-recognizes-fibromyalgia-8827637.html|title=The Health Care Industry Finally Recognizes Fibromyalgia|last=Liptan|first=Ginevra|date=2015-09-30|work=National Pain Report|access-date=2018-08-09|archive-url=|archive-date=|language=en-US}}</ref>

'''ICD-11 (2019)'''

The [[ICD-11]] (2019) has diagnostic code ''MG30.1 Chronic widespread pain,'' and changed the category from a [[:Category:Musculoskeletal diseases and disorders|Musculoskeletal disease]], to the ''General signs and symptoms category'', sometimes referred to as [[Medically unexplained physical symptoms]].<ref name="ICD11">{{Cite web|url=https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/849253504|title=ICD-11 - Mortality and Morbidity Statistics|website=[[World Health Organization]]|language=en|access-date=2018-08-09}}</ref>

*'''MG30.01 Chronic widespread pain'''

'''Parent'''
::MG30.0 Chronic primary pain

'''Description'''
<blockquote>Chronic widespread pain (CWP) is diffuse pain in at least 4 of 5 body regions and is associated with significant emotional distress (anxiety, anger/frustration or depressed mood) or functional disability (interference in daily life activities and reduced participation in social roles). CWP is multifactorial: biological, psychological and social factors contribute to the pain syndrome. The diagnosis is appropriate when the pain is not directly attributable to a nociceptive process in these regions and there are features consistent with nociplastic pain and identified psychological and social contributors.<ref name="ICD11" /></blockquote>

'''Inclusions'''
:*Fibromyalgia
'''Exclusions'''
:*Acute pain (MG31)<ref name="ICD11" />

==Pathophysiology==
"Fibromyalgia (FM) is a [[chronic pain]] disorder with unknown etiology and unclear pathophysiology. There is no evidence that a single event “causes” FM. Rather, many physical and/or emotional [[Stress|stressors]] may trigger or aggravate symptoms. These have included certain [[Infection|infections]], such as a [[Viral infection|viral illness]] or [[Lyme disease]], as well as emotional or physical [[trauma]]."<ref>{{Cite web|url=https://www.uptodate.com/contents/pathogenesis-of-fibromyalgia#!|title=Pathogenesis of fibromyalgia|last=Goldenberg|first=Don L|date=|website=www.uptodate.com|archive-url=|archive-date=|access-date=2018-08-09|authorlink=|last2=Schur|first2=Paul H|authorlink2=|last3=Romain|first3=Paul L}}</ref> The widespread pain is severe, debilitating, and abnormal in processing its pain. There is also [[Sleep dysfunction|sleep disturbance]] and fatigue. Cause or causes are unproven.<ref>{{Cite news|url=https://www.omf.ngo/what-is-mecfs-old/fibromyalgia/|title=What is Fibromyalgia? {{!}} Open Medicine Foundation|work=Open Medicine Foundation|access-date=2018-08-09|language=en-US}}</ref>

*May 2012, [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3394355/ Fibromyalgia Syndrome: An Overview of Pathophysiology, Diagnosis and Management]<ref name="Firdous2012">{{Cite journal|last=Jahan|first=Firdous|last2=Nanji|first2=Kashmira|last3=Qidwai|first3=Waris|last4=Qasim|first4=Rizwan|date=2012|title=Fibromyalgia Syndrome: An Overview of Pathophysiology, Diagnosis and Management|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3394355/|journal=Oman Medical Journal|volume=27|issue=3|pages=192–195|doi=10.5001/omj.2012.44|issn=1999-768X|pmc=|pmid=22811766|via=}}</ref> ''See'' Table 1: "Conditions associated with fibromyalgia." Musculoskeletal, [[genitourinary]], [[Gastrointestinal system|gastrointestinal]], and miscellaneous conditions often exist among fibromyalgia patients.

<blockquote>Pathophysiology: Although the etiology remains unclear, characteristic alterations in the [[Sleep dysfunction|pattern of sleep]] and changes in neuroendocrine transmitters such as [[serotonin]], substance P, growth hormone and [[cortisol]] suggest that regulation of the [[Autonomic nervous system|autonomic]] and neuro-endocrine system appears to be the basis of the syndrome. Fibromyalgia is not a life-threatening, deforming, or [progressive disease. [[Anxiety]] and [[depression]] are the most common association. Aberrant pain processing, which can result in [[chronic pain]], may be the result of several interplaying mechanisms. [[Central sensitization]], blunting of inhibitory pain pathways and alterations in [[neurotransmitter]]s lead to aberrant neuro-chemical processing of sensory signals in the CNS, thus lowering the threshold of pain and amplification of normal sensory signals causing constant pain.<ref name="Firdous2012" /></blockquote>

<blockquote>The frequent co-morbidity of fibromyalgia with [[Mood swings|mood disorders]] suggests a major role for the stress response and for [[neuroendocrine]] abnormalities. The [[hypothalamic pituitary axis]] (HPA) is a critical component of the stress-adaptation response. In FMS, stress adaptation response is disturbed leading to stress induce symptoms. Psychiatric co-morbidity has been associated with FMS and needs to be identified during the consultation process, as this requires special consideration during treatment.<ref name="Firdous2012" /></blockquote>

*May 2018, [https://www.chiropractic.ca/wp-content/uploads/2018/05/107243-2_Chiro_62_1d_Bourgaize.pdf A comparison of the clinical manifestation and pathophysiology of myofascial pain syndrome and fibromyalgia: implications for differential diagnosis and management]

*Jun 2018, [https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0198625 SNPs in inflammatory genes] [[CCL11]], [[CCL4]] and [[MEFV]] in a fibromyalgia family study<ref>{{Cite journal|last=Zhang|first=Zhifang|last2=Feng|first2=Jinong|last3=Mao|first3=Allen|last4=Le|first4=Keith|last5=Placa|first5=Deirdre La|last6=Wu|first6=Xiwei|last7=Longmate|first7=Jeffrey|last8=Marek|first8=Claudia|last9=Amand|first9=R. Paul St|date=2018-06-21|title=SNPs in inflammatory genes CCL11, CCL4 and MEFV in a fibromyalgia family study|url=http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0198625|journal=PLOS ONE|language=en|volume=13|issue=6|pages=e0198625|doi=10.1371/journal.pone.0198625|issn=1932-6203|pmid=29927949|via=}}</ref>

<blockquote>SNPs with significant TDTs were found in 36% of the cohort for CCL11 and 12% for MEFV, along with a protein variant in CCL4 (41%) that affects CCR5 down-regulation, supporting an immune involvement for FM.</blockquote>

*Jul 2018, [https://fibromyalgianewstoday.com/2018/07/31/primary-secondary-fibromyalgia-share-similar-symptom-burden-study/ Primary and Secondary Fibromyalgia Share Same Symptom Burden, Study Suggests]<ref name=":22">{{Cite news|url=https://fibromyalgianewstoday.com/2018/07/31/primary-secondary-fibromyalgia-share-similar-symptom-burden-study/|title=Primary, Secondary Fibromyalgia Share Same Symptom Burden, Study Says|last=Carvalho|first=John|date=2018-07-31|work=Fibromyalgia News Today|access-date=2018-08-09|archive-url=|archive-date=|language=en-US}}</ref>

<blockquote>Fibromyalgia can be considered either primary, or dominant, also known as idiopathic fibromyalgia, or secondary. In the primary form, the causes of the disorder are unknown, but in secondary fibromyalgia, the disorder usually occurs alongside other debilitating medical conditions, such as rheumatoid arthritis (RA), lupus, and multiple sclerosis.<ref name=":22" /></blockquote>

===Immune system research===

Dr. [[Jarred Younger]] believes an overactive [[immune system]] is the cause and will be conducting a study to test this hypothesis.<ref>{{Cite news|url=http://nationalpainreport.com/new-uab-study-could-radically-change-fibromyalgia-treatment-as-we-know-it-8833437.html|title=New UAB Study Could Radically Change Fibromyalgia Treatment As We Know It|last=Gregory Burch|first=Donna|date=2017-04-24|work=National Pain Report|access-date=2018-08-09|archive-url=|archive-date=|language=en-US}}</ref><ref>{{Cite web|url=https://www.youtube.com/watch?v=8e5xKX036bE|title=Testing the fibromyalgia immune system with lipopolysaccharide (LPS)|last=Younger|first=Jarred|date=May 24, 2017|website=YouTube|archive-url=|archive-date=|access-date=|via=Younger Lab}}</ref> An overactive immune system can cause [[inflammation]] and [[chronic pain]].<ref>{{Cite news|url=https://www.epainassist.com/autoimmune/what-is-overactive-immune-system|title=What is Overactive Immune System{{!}}Causes{{!}}Symptoms{{!}}Treatment|last=Kerkar|first=Pramod|date=2016-09-29|work=ePainAssist|access-date=2018-10-04|archive-url=|archive-date=|language=en-gb}}</ref><ref>{{Cite news|url=https://www.webmd.com/a-to-z-guides/autoimmune-diseases|title=Autoimmune Diseases|work=WebMD|access-date=2018-10-04|language=en-US}}</ref>

Dr. William Pridgen's research of [[HSV-1]] (cold sore virus) as being involved in FM has conducted a successful Phase III clinical trial, which had been fast-tracked by the [[Food and Drug Administration]] (FDA), of a combination drug that suppresses this virus and also helps with pain. {{See also|Fibromyalgia drugs|Fibromyalgia drugs (see drug trials section for IMC-1)||||}}

On September 5th, 2018, EpicGenetics announced that Massachusetts General Hospital received approval from the FDA to test the BCG vaccine (an old Tuberculosis vaccine) on patients that tested positive with its FM/a® test.<ref name="painrep201809">{{Cite news|url=http://nationalpainreport.com/can-an-existing-vaccine-help-treat-fibromyalgia-8837139.html|title=Can an Existing Vaccine Help Treat Fibromyalgia?|last=Coghlan|first=Ed|date=2018-09-05|work=National Pain Report|access-date=2018-09-10|archive-url=|archive-date=|language=en-US}}</ref><ref>{{Cite news|url=http://www.prohealth.com/library/showArticle.cfm?libid=30644|title=Century-old Vaccine Gives New Hope to Fibromyalgia Community - Prohealth|last=Gregory Burch|first=Donna|date=2017-08-14|work=Prohealth|access-date=2018-08-09|archive-url=|archive-date=|language=en-US}}</ref>

Recognizing FM may involve activation of the [[immune system]] researchers performed [[Whole exome sequencing|exome sequencing]] on [[chemokine]] genes in a region of chromosome 17 identified in a genome-wide family association study. Their conclusion: "SNPs with significant TDTs were found in 36% of the cohort for [[CCL11]] and 12% for [[MEFV]], along with a protein variant in CCL4 (41%) that affects CCR5 down-regulation, supporting an immune involvement for FM."<ref name="Zhang2018">{{Cite journal|last=Zhang|first=Zhifang|last2=Feng|first2=Jinong|last3=Mao|first3=Allen|last4=Le|first4=Keith|last5=Placa|first5=Deirdre La|last6=Wu|first6=Xiwei|last7=Longmate|first7=Jeffrey|last8=Marek|first8=Claudia|last9=Amand|first9=R. Paul St|date=2018-06-21|title=SNPs in inflammatory genes CCL11, CCL4 and MEFV in a fibromyalgia family study|url=http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0198625|journal=PLOS ONE|language=en|volume=13|issue=6|pages=e0198625|doi=10.1371/journal.pone.0198625|issn=1932-6203|pmid=29927949|via=}}</ref>

Dr David Andersson from the Institute of Psychiatry, Psychology and Neuroscience at King’s College London, led a new study into Fibromyalgia being an immune system disorder.<ref>{{Cite journal|last=Goebel|first=Andreas|last2=Krock|first2=Emerson|last3=Gentry|first3=Clive|last4=Israel|first4=Mathilde R.|last5=Jurczak|first5=Alexandra|last6=Urbina|first6=Carlos Morado|last7=Sandor|first7=Katalin|last8=Vastani|first8=Nisha|last9=Maurer|first9=Margot|date=2021-07-07|title=Passive transfer of fibromyalgia symptoms from patients to mice|url=https://www.jci.org/articles/view/144201?key=51bf6d85e305f6b62f87#SEC4|journal=The Journal of Clinical Investigation|language=en|volume=131|issue=13|doi=10.1172/JCI144201|issn=0021-9738}}</ref><ref name=":0">{{Cite web|url=http://www.theguardian.com/society/2021/jul/01/fibromyalgia-may-be-a-condition-of-the-immune-system-not-the-brain-study|title=Fibromyalgia may be a condition of the immune system not the brain – study|date=2021-07-01|website=the Guardian|language=en|access-date=2021-07-08}}</ref><blockquote>Andersson and his colleagues harvested blood from 44 people with fibromyalgia and injected purified antibodies from each of them into different mice. The mice rapidly became more sensitive to pressure and cold, and displayed reduced grip strength in their paws. Animals injected with antibodies from healthy people were unaffected.<ref name=":0" /></blockquote><blockquote>Prof Camilla Svensson from the Karolinska Institute in Sweden, who was also involved in the study, said: “Antibodies from people with fibromyalgia living in two different countries, the UK and Sweden, gave similar results, which adds enormous strength to our findings.”<ref name=":0" /></blockquote>

=== Brain and spinal cord research ===
A 2004 study by Heffez et al. studied 270 patients with FM and found that 46% had [[cervical spinal stenosis]] and 20% [[chiari malformation]].<ref name="Heffez2004">{{Cite journal|last=Heffez|first=Dan S.|last2=Ross|first2=Ruth E.|last3=Shade-Zeldow|first3=Yvonne|last4=Kostas|first4=Konstantinos|last5=Shah|first5=Sagar|last6=Gottschalk|first6=Robert|last7=Elias|first7=Dean A.|last8=Shepard|first8=Alan|last9=Leurgans|first9=Sue E.|date=2004-04-09|title=Clinical evidence for cervical myelopathy due to Chiari malformation and spinal stenosis in a non-randomized group of patients with the diagnosis of fibromyalgia|url=https://link.springer.com/article/10.1007/s00586-004-0672-x|journal=European Spine Journal|language=en|volume=13|issue=6|pages=516–523|doi=10.1007/s00586-004-0672-x|issn=0940-6719|pmc=|pmid=15083352|via=}}</ref> In 2007, Heffez et al. saw significant improvement in physical and mental well-being was found in patients with cervical stenosis who received surgery.<ref name="Heffez2007">{{Cite journal|last=Heffez|first=Dan S.|last2=Ross|first2=Ruth E.|last3=Shade-Zeldow|first3=Yvonne|last4=Kostas|first4=Konstantinos|last5=Morrissey|first5=Mary|last6=Elias|first6=Dean A.|last7=Shepard|first7=Alan|date=2007|title=Treatment of cervical myelopathy in patients with the fibromyalgia syndrome: outcomes and implications|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2200733/|journal=European Spine Journal|volume=16|issue=9|pages=1423–1433|doi=10.1007/s00586-007-0366-2|issn=0940-6719|pmc=2200733|pmid=17426987|quote=|author-link=|author-link2=|author-link3=|author-link4=|author-link5=|via=}}</ref> A second study in 2007 by Andrew Holman found that 71% had cervical [[spinal cord]] compression.<ref>{{Cite journal|date=2008-07-01|title=Positional Cervical Spinal Cord Compression and Fibromyalgia: A Novel Comorbidity With Important Diagnostic and Treatment Implications|url=https://www.sciencedirect.com/science/article/pii/S1526590008004379|journal=The Journal of Pain|language=en|volume=9|issue=7|pages=613–622|doi=10.1016/j.jpain.2008.01.339|issn=1526-5900|last=|first=|quote=|author-link=Andrew Holman|author-link2=|author-link3=|author-link4=|author-link5=|via=}}</ref> It is important to note that in the past many patients were misdiagnosed with FM when further testing would have revealed the true source of their pain; the 2010 (updated in 2016) ACR criteria has helped curb misdiagnoses.<ref>{{Cite news|title=Fibromyalgia Expert Says Misdiagnosis is Rampant|url=http://nationalpainreport.com/fibromyalgia-expert-says-misdiagnosis-is-rampant-8832803.html|work=National Pain Report|date=2017-02-02|access-date=2018-11-26|language=en-US}}</ref><ref name="misdiagnosis">{{Cite news|title=Common Misdiagnoses of Fibromyalgia|url=https://www.webmd.com/fibromyalgia/guide/common-misdiagnoses-of-fibromyalgia#|work=WebMD|access-date=2018-11-26|language=en-US|last=|first=|date=|archive-url=|archive-date=}}</ref><ref name=":28" />

Various types of brain imaging are being used to research FM. (''See'': [[Fibromyalgia notable studies]] for images.)

In 2002, an [[Functional magnetic resonance imaging|fMRI]] study conducted by Richard Gracely and Daniel Claw found people with FM "have measurable pain signals in their brains, from a gentle finger squeeze that barely feels unpleasant to people without the disease."<ref name="sd2002">{{Cite web|url=https://www.sciencedaily.com/releases/2002/06/020607073056.htm|title=Fibromyalgia Pain Isn't All In Patient's Heads, New Brain Study Finds|last=|first=|date=Jun 7, 2002|website=sciencedaily.com|archive-url=|archive-date=|access-date=2018-08-09}}</ref> A 2007 study by Borsook et al., ''Neuroimaging revolutionizes therapeutic approaches to chronic pain'' found decreased gray matter density relative to controls in cingulate cortex (CC), medial prefrontal cortex (Med. PFC), parahippocampal gyrus (PHG) and insula.<ref name="Borsook2007">{{Cite journal|last=Borsook|first=David|last2=Moulton|first2=Eric A|last3=Schmidt|first3=Karl F|last4=Becerra|first4=Lino R|date=2007-09-11|title=Neuroimaging Revolutionizes Therapeutic Approaches to Chronic Pain|url=https://link.springer.com/article/10.1186/1744-8069-3-25|journal=Molecular Pain|language=en|volume=3|issue=1|pages=1744–8069-3-25|doi=10.1186/1744-8069-3-25|issn=1744-8069|pmid=17848191|via=}}</ref> In 2015, Loggia et al. imaged [[neuroinflammation]] due to [[Glial cell|glial]] activation using MR/PET imaging.<ref name="itn2018">{{Cite news|url=https://www.itnonline.com/article/mrpet-ultimate-imaging-hybrid|title=MR/PET: The Ultimate Imaging Hybrid|last=Ros|first=Pablo R.|date=2012-05-29|work=Imaging Technology News|access-date=2018-10-30|archive-url=|archive-date=|language=en}}</ref><ref name="Loggia2015">{{Cite journal|last=Loggia|first=Marco L.|last2=Chonde|first2=Daniel B.|last3=Akeju|first3=Oluwaseun|last4=Arabasz|first4=Grae|last5=Catana|first5=Ciprian|last6=Edwards|first6=Robert R.|last7=Hill|first7=Elena|last8=Hsu|first8=Shirley|last9=Izquierdo-Garcia|first9=David|date=2015-01-08|title=Evidence for brain glial activation in chronic pain patients|url=https://academic.oup.com/brain/article/138/3/604/333527?searchresult=1|journal=Brain|language=en|volume=138|issue=3|pages=604–615|doi=10.1093/brain/awu377|issn=1460-2156}}</ref> In 2017, López-Solà et al. identified three [[brain]] patterns based on [[Functional magnetic resonance imaging|fMRI]] responses to pressure pain and non-painful multisensory stimulation. "These patterns, taken together, discriminate FM from matched healthy controls with 92% sensitivity and 94% specificity."<ref name=":34">{{Cite journal|last=López-Solà|first=Marina|last2=Woo|first2=Choong-Wan|last3=Pujol|first3=Jesus|last4=Deus|first4=Joan|last5=Harrison|first5=Ben J.|last6=Monfort|first6=Jordi|last7=Wager|first7=Tor D.|date=2017|title=Towards a neurophysiological signature for fibromyalgia|url=https://www.ncbi.nlm.nih.gov/pubmed/27583567|journal=Pain|volume=158|issue=1|pages=34–47|doi=10.1097/j.pain.0000000000000707|issn=1872-6623|pmid=27583567|via=}}</ref> In 2018, Albrecht et al used [[Positron emission tomography|PET]] scans to document [[Glial cell|glial]] activation.<ref name=":52">{{Cite journal|last=Albrecht|first=Daniel S.|last2=Forsberg|first2=Anton|last3=Sandstrom|first3=Angelica|last4=Bergan|first4=Courtney|last5=Kadetoff|first5=Diana|last6=Protsenko|first6=Ekaterina|last7=Lampa|first7=Jon|last8=Lee|first8=Yvonne C.|last9=Höglundi|first9=Caroline Olgart|date=2018-09-14|others=Catana, Ciprian; Cervenka, Simon; Akeju, Oluwaseun; Lekander, Mats; Cohen, George; Halldin, Christer; Taylor, Norman; Kim, Minhae; Hooker, Jacob M.; Loggia, Marco L.|title=Brain glial activation in fibromyalgia – A multi-site positron emission tomography investigation|url=https://www.sciencedirect.com/science/article/pii/S0889159118302423|journal=Brain, Behavior, and Immunity|language=en|volume=|pages=|doi=10.1016/j.bbi.2018.09.018|issn=0889-1591|via=}}</ref> Also in 2018, Martucci et al. found unbalanced activity between the ventral and dorsal cervical spinal cord. Ventral neural processes were increased and dorsal neural processes were decreased which may reflect the presence of [[central sensitization]] contributing to [[fatigue]] and other bodily symptoms in FM.<ref>{{Cite journal|last=Martucci|first=Katherine T|last2=Weber|first2=Kenneth A|last3=Mackey|first3=Sean C|date=2018-10-03|title=Altered Cervical Spinal Cord Resting State Activity in Fibromyalgia|url=https://onlinelibrary.wiley.com/doi/abs/10.1002/art.40746|journal=Arthritis & Rheumatology|language=en|doi=10.1002/art.40746|issn=2326-5191}}</ref>

=== Fibromyalgia is not the same as depression ===
* Oct 24, 2003, [https://www.webmd.com/depression/news/20031024/fibromyalgia-isnt-depression#1 Fibromyalgia Isn't Depression]<ref name="webmd-notdepress" />
<blockquote>[[Depression]] doesn't cause the pain of fibromyalgia, a new study shows.<ref name="webmd-notdepress" /></blockquote>

<blockquote>"People still doubt fibromyalgia is a disease," Giesecke tells WebMD. "Previously, we found that fibromyalgia patients really do have increased central pain processing. Now we can show this is not affected by depression. Something is wrong here, and it is not at all connected with depression."<ref name="webmd-notdepress" /></blockquote>

<blockquote>"Giesecke's group looked at [[brain]] responses to painful stimuli, and then checked to see if there was any difference between depressed and nondepressed fibromyalgia patients. They showed the activation of areas of the brain related to pain were not different in patients with and without depression." But there is a difference between people with and without fibromyalgia, he says.<ref name="webmd-notdepress" /> </blockquote><blockquote>The researchers use an imaging device called [[functional magnetic resonance imaging]], or fMRI, to look at how the brain responds to pain. Study participants get a mildly painful pressure on their thumb, which makes the brain's pain centers "light up" on the image. Thumb pressure -- at a level healthy people hardly feel -- sets off a firestorm in the pain centers of fibromyalgia patients' brains.<ref name="webmd-notdepress" /></blockquote>
* Jun 30, 2013, [https://www.healthcentral.com/article/psychiatrists-admit-fibromyalgia-is-neuropathic-not-a-form-of-depression Psychiatrists Admit Fibromyalgia is Neuropathic - Not a Form of Depression]<ref name=":41">{{Cite web|url=https://www.healthcentral.com/article/psychiatrists-admit-fibromyalgia-is-neuropathic-not-a-form-of-depression|title=Psychiatrists Admit Fibromyalgia is Neuropathic – Not a Form of Depression - Causes - Chronic Pain {{!}} HealthCentral|last=Lee Richards|first=Karen|authorlink=|last2=|first2=|authorlink2=|date=Jun 30, 2013|website=www.healthcentral.com|language=en-US|access-date=2019-04-13}}</ref>
<blockquote>The study the APA referred to was published in the June issue of ''Brain'', a journal of neurology. The researchers investigated the function and structure of small nerve fibers in 25 FM patients, 10 patients with monopolar depression without pain and with healthy control subjects. Using three different methods of testing, the researchers found that compared with control subjects, patients with fibromyalgia, but not patients with depression, had impaired small fiber function.<ref name="brain-1857">http://brain.oxfordjournals.org/content/136/6/1857.abstract</ref><ref name=":41" /></blockquote><blockquote>The study authors stated, "This strengthens the notion that fibromyalgia syndrome is not a variant of depression, but rather represents an independent entity that may be associated with depressive symptoms". The findings also point "towards a neuropathic nature of pain in fibromyalgia syndrome."<ref name=":41" /></blockquote>
* Jan 10, 2019, [https://themighty.com/2019/01/do-i-have-fibromyalgia-or-depression/ 17 Signs You Have Fibromyalgia, Not 'Just' Depression]<ref name=":43">{{Cite web|url=https://themighty.com/2019/01/do-i-have-fibromyalgia-or-depression/|title=17 Signs You Have Fibromyalgia, Not 'Just' Depression|last=|first=|authorlink=|last2=|first2=|authorlink2=|date=Jan 10, 2019|website=The Mighty|language=en-US|archive-url=|archive-date=|access-date=2019-04-13}}</ref>
<blockquote>Fibromyalgia is [https://themighty.com/2018/05/what-fibromyalgia-gets-misdiagnosed-as/ often misdiagnosed as a number of other illnesses]. Though fibro has its own unique set of diagnostic criteria, many of its symptoms can mimic symptoms of other conditions – both physical and mental, acute and chronic.<ref name=":43" /></blockquote><blockquote>One of the most common conditions fibromyalgia gets mistaken for is depression. While each condition causes a unique set of symptoms, many of them may overlap. Like fibro, depression can cause physical symptoms such as pain, fatigue and brain fog. And living with a chronic physical symptoms can have significant effects on your mood, sometimes causing feelings of hopelessness, anxiety or general discontent – which are also symptoms of depression.<ref name=":43" /></blockquote>

== Comorbidities, overlapping conditions, and common symptoms ==
[[File:Fibromyalgia and comorbid conditions.JPG|700px|thumb|center|Comorbid conditions of fibromyalgia (FM) are [[ME/CFS]] which is the most common comorbidity,<ref name="ammes-overlap" /><ref name=":31" /> [[autoimmune disease|autoimmune disease]]s; [[migraine]]s; [[Multiple chemical sensitivity|multiple chemical sensitivities]] (MCS); and [[orthostatic intolerance]] (OI) / [[postural orthostatic tachycardia syndrome]] (POTS).<ref name="ammes-overlap" /><ref name="Firdous2012" /><ref name=":44" /> Overlapping conditions are [[depression]] and [[anxiety]]; [[Digestive problems|digestive conditions]], [[Menstrual|menstrual problems]]; [[Gulf War Illness]] (GWI); [[nervous system]] disorders; [[Hypotension|low blood pressure]] (Low BP); [[Pain#Pain in Fibromyalgia|other pain conditions]]; and [[sleep dysfunction]]/disturbance<ref name="ammes-overlap" /><ref name="Firdous2012" /><ref name="mayocause" />]]

===[[Allodynia]]===
*[http://chronicfatigue.about.com/od/glossary/g/allodynia.htm Allodynia: A Rare & Distinct Type of Pain in Fibromyalgia & ME/CFS]<ref name="Allodynia">{{Cite news|url=https://www.verywellhealth.com/allodynia-definition-and-types-fibromyalgia-715929|title=Allodynia: A Rare & Distinct Type of Pain in Fibromyalgia & ME/CFS|last=Dellwo|first=Adrienne|date=Feb 23, 2018|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=}}</ref> Types of Allodynia: Tactile; Mechanical; and Thermal. "Type of pain, generally on the skin, that's caused by something that wouldn't normally cause pain."<ref name="Allodynia" />
*[[Autoimmune disease]]s "Research suggests that RA and other inflammatory diseases may somehow increase the risk for fibromyalgia."<ref>{{Cite news|url=https://www.health.com/health/gallery/0,,20520705,00.html#restless-legs-0|title=7 Conditions Linked to Fibromyalgia|work=Health.com|access-date=2018-08-19|language=en}}</ref>

===[[Body temperature]]===
{{See also |Small fiber peripheral neuropathy}}
: for [[temperature sensitivity]]; burning, tingling, and prickling due to [[paresthesia]]; [[numbness]]; [[dry eye syndrome|dry eyes]] and [[dry mouth]]; and more.)<ref name=":02">{{Cite news|url=https://www.healthline.com/health/small-fiber-neuropathy#symptoms|title=Small Fiber Neuropathy: Symptoms, Treatment, Causes, and More|last=Vandergriendt|first=Carly|date=Jan 4, 2018|work=Healthline|access-date=2018-10-04|archive-url=|archive-date=|last2=Weatherspoon|first2=Deborah|language=en}}</ref><ref>{{Cite news|url=https://www.webmd.com/brain/understanding-peripheral-neuropathy-basics#3|title=Peripheral Neuropathy -- Symptoms, Types, and Causes of Peripheral Neuropathy|last=|first=|date=|work=WebMD|access-date=2018-10-04|archive-url=|archive-date=|page=3|language=en-US}}</ref>

<blockquote>When you're exposed to heat, does it feel like you're burning up? Does it seem impossible for you to cool off? Or maybe it's cold that bothers you, chilling you to the bone, leaving you unable to warm up? Or are you one of those people with fibromyalgia (FMS) and chronic fatigue syndrome (ME/CFS) who is cold all the time, or hot all the time, or alternately hot or cold while out of sync with the environment?<ref name=":2">{{Cite news|url=https://www.verywellhealth.com/temperature-sensitivity-in-fibromyalgia-and-mecfs-716025|title=Temperature Sensitivity in Fibromyalgia & ME/CFS|last=Dellwo|first=Adrienne|date=Mar 15, 2018|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=}}</ref></blockquote>

=== [[Costochondritis]]===
[[File:Costal cartilages.JPG|200px|thumb|left|Costochondritis is inflammation of the costal cartilages (shown in red) causing chest and ribcage pain. From BodyParts3D/Anatomography (Life Science db.jp), license CC BY-SA 2.1 JP.]]

<blockquote>Costochondritis is a condition that causes pain in the cartilage that connect your ribs to your sternum (breastbone). Cartilage is the tough, bendable tissue that protects your bones where they rub against each other.<ref name=":10">{{Cite web|url=https://www.drugs.com/cg/costochondritis.html|title=Costochondritis - What You Need to Know|website=Drugs.com|language=en|access-date=2020-01-27}}</ref></blockquote>
Costochondritis causes pain in the area where your sternum joins with your ribs. The pain may come and go, and may get worse over time. The pain may be sharp, or dull and aching. It may be painful to touch your chest. The pain may spread to your back, abdomen, or down your arm. It may get worse when you move, breathe deeply, or push or lift an object. The pain may make it hard for you to sleep or do your usual activities.<ref name=":10" /><blockquote>People tend to describe the pain as stabbing, burning, aching, confined to one spot, usually in the very center of the chest, but it may radiate outward.<ref>{{Cite web|url=https://www.medicalnewstoday.com/articles/321635.php|title=Can fibromyalgia cause chest pain?|website=Medical News Today|language=en|access-date=2020-01-27}}</ref></blockquote>

===[[Depression]] and [[anxiety]]===
{{See also|Depression|Depression|Anxiety|Anxiety}}Fibromyalgia sufferers are "up to three times more likely to have depression at the time of their diagnosis than someone without fibromyalgia."<ref name="webmd-depress">{{Cite news|url=https://www.webmd.com/fibromyalgia/fibromyalgia-and-depression#1|title=Fibromyalgia and Depression|work=WebMD|access-date=2018-08-19|language=en-US}}</ref> Up to 20% of Fibromyalgia patients will have either depression or anxiety.<ref name="adaa">{{Cite web|url=https://adaa.org/understanding-anxiety/related-illnesses/other-related-conditions/fibromyalgia|title=Fibromyalgia|website = Anxiety and Depression Association of America|language=en|access-date=2018-08-19}}</ref>

====<span id="depression">Differences between depression and fibromyalgia====

* Depression and anxiety are common in fibromyalgia but are not core diagnostic symptoms, so they are not required for a diagnosis of Fibromyalgia, and a significant number of people with fibromyalgia have never had depression.<ref name="Koroschetz2011-symptoms">{{Cite journal|last=Koroschetz|first=Jana|last2=Rehm|first2=Stefanie E.|last3=Gockel|first3=Ulrich|last4=Brosz|first4=Mathias|last5=Freynhagen|first5=Rainer|last6=Tölle|first6=Thomas R.|last7=Baron|first7=Ralf|date=2011-05-25|title=Fibromyalgia and neuropathic pain - differences and similarities. A comparison of 3057 patients with diabetic painful neuropathy and fibromyalgia|url=https://doi.org/10.1186/1471-2377-11-55|journal=BMC Neurology|volume=11|issue=1|pages=55|doi=10.1186/1471-2377-11-55|issn=1471-2377|pmc=3125308|pmid=21612589}}</ref><ref name="ACR1990" /><ref name="ACR2010" />
* Fibromyalgia is a diagnosis of '''chronic widespread pain''', but pain is not needed for a diagnosis of depression.
*2007, The classification of fibromyalgia syndrome<ref name="Muller2007">{{Cite journal|last=Müller|first=W.|last2=Schneider|first2=E. M.|last3=Stratz|first3=T.|date=2007-09-01|title=The classification of fibromyalgia syndrome|url=https://doi.org/10.1007/s00296-007-0403-9|journal=Rheumatology International|language=en|volume=27|issue=11|pages=1005–1010|doi=10.1007/s00296-007-0403-9|issn=1437-160X}}</ref> [https://link.springer.com/article/10.1007%2Fs00296-007-0403-9 (Abstract)]
*2008, The relationship between fibromyalgia and major depressive disorder: a comprehensive review<ref name="Pae2008">{{Cite journal|last=Pae|first=Chi-Un|author-link=|last2=Luyten|first2=Patrick|author-link2=|last3=Marks|first3=David M.|author-link3=|last4=Han|first4=Changsu|author-link4=|last5=Park|first5=Sung-Hwan|author-link5=|last6=Patkar|first6=Ashwin A.|author-link6=|last7=Masand|first7=Prakash S.|last8=Houdenhove|first8=Boudewijn Van|author-link8=Boudewijn Van Houdenhove|date=2008-08-01|title=The relationship between fibromyalgia and major depressive disorder: a comprehensive review|url=https://doi.org/10.1185/03007990802288338|journal=Current Medical Research and Opinion|volume=24|issue=8|pages=2359–2371|doi=10.1185/03007990802288338|issn=0300-7995|pmc=|pmid=18606054|access-date=|quote=|via=}}</ref> [https://doi.org/10.1185/03007990802288338 (Abstract)]
*2010, Anxiety and depressive symptoms in fibromyalgia are related to poor perception of health but not to pain sensitivity or cerebral processing of pain<ref name="Jensen2010">{{Cite journal|last=Jensen|first=Karin B.|last2=Petzke|first2=Frank|last3=Carville|first3=Serena|last4=Fransson|first4=Peter|last5=Marcus|first5=Hanke|last6=Williams|first6=Steven C. R.|last7=Choy|first7=Ernest|last8=Mainguy|first8=Yves|last9=Gracely|first9=Richard|date=2010|title=Anxiety and depressive symptoms in fibromyalgia are related to poor perception of health but not to pain sensitivity or cerebral processing of pain|url=https://onlinelibrary.wiley.com/doi/abs/10.1002/art.27649|journal=Arthritis & Rheumatism|language=en|volume=62|issue=11|pages=3488–3495|doi=10.1002/art.27649|issn=1529-0131}}</ref> [https://doi.org/10.1002/art.27649 (Abstract)]
*2012, Fibromyalgia a discrete entity?<ref name="Ablin2012">{{cite journal | last=Ablin | first=Jacob N. | last2=Buskila | first2=Dan | last3=Van Houdenhove | first3=Boudewijn | last4=Luyten | first4=Patrick | last5=Atzeni | first5=Fabiola | last6=Sarzi-Puttini | first6=Piercarlo | title=Is fibromyalgia a discrete entity? | journal=Autoimmunity Reviews | url=https://doi.org/10.1016%2Fj.autrev.2011.10.018 | volume=11 | issue=8 | pages = 585–588 | date=Jun 2012 | issn=1568-9972 | doi=10.1016/j.autrev.2011.10.018 }}</ref> [https://onlinelibrary.wiley.com/doi/pdf/10.1002/art.27649 (Full text)]
*2012 [https://www.webmd.com/depression/news/20031024/fibromyalgia-isnt-depression Fibromyalgia isn't depression] - WebMD<ref name="webmd-notdepress">{{Cite web|url=https://www.webmd.com/depression/news/20031024/fibromyalgia-isnt-depression|title=Fibromyalgia Isn't Depression|last=DeNoon|first=Daniel J.|website=WebMD|language=en|access-date=2021-03-27}}</ref>

===[[Dry eye syndrome]]===
<ref name=":110">{{Cite news|url=https://www.news-medical.net/health/Fibromyalgia-and-Dry-Eyes-and-Mouth.aspx|title=Fibromyalgia and Dry Eyes and Mouth|last=Mandal|first=Ananya|date=2013-06-30|work=News-Medical.net|access-date=2018-10-04|archive-url=|archive-date=|last2=Cashin-Garbutt|first2=April|language=en}}</ref>

===[[Fatigue]]===
<blockquote>Fatigue is a universal symptom of fibromyalgia. It is often most marked when arising from sleep in the morning. A typical quote is “''No matter how much sleep I get, it feels like a truck ran me over in the morning'' (20).” Minor activities often seem to aggravate the fatigue.<ref name=":29">{{Cite web|url=https://www.docsopinion.com/2017/11/08/causes-fatigue-tiredness-chronic-fatigue/|title=19 Important Causes of Fatigue - Tiredness and Chronic Fatigue Explained|website=www.docsopinion.com|access-date=2019-01-30}}</ref></blockquote>

===[[Fibro fog]] and [[Cognitive dysfunction]]===
*'Mental confusion along with difficulty in concentration and loss of memory is often termed “[[fibro fog]]"'.<ref name=":3">{{Cite news|url=https://www.news-medical.net/health/What-is-Fibro-Fog-Fibromyalgia-and-Cognitive-Dysfunction.aspx|title=What is Fibro Fog? - Fibromyalgia and Cognitive Dysfunction|last=Mandal|first=Ananya|date=2013-06-03|work=News-Medical.net|access-date=2018-08-09|archive-url=|archive-date=|language=en}}</ref>

===[[Digestive problems|Gastrointestinal problems]]===
*[[Irritable bowel syndrome]]:
:<blockquote>Fibromyalgia, chronic fatigue syndrome and irritable bowel syndrome (IBS) frequently go together. No one really knows why, but we do know that all three conditions can include imbalances of serotonin -- although in fibromyalgia (FMS) and Chronic Fatigue Syndrome (CFS or ME/CFS) it's an imbalance in the brain, while with IBS it's in the gut.<ref name=":4">{{Cite news|url=https://www.verywellhealth.com/irritable-bowel-syndrome-in-fibromyalgia-cfs-716167|title=Irritable Bowel Syndrome in Fibromyalgia & ME/CFS|last=Dellwo|first=Adrienne|date=Jan 28, 2018|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=}}</ref> </blockquote>
===[[Gulf War Illness]]===
GWI increases risk of developing fibromyalgia.<ref name="VA">{{Cite web|url=https://www.publichealth.va.gov/exposures/gulfwar/fibromyalgia.asp|title=Fibromyalgia in Gulf War Veterans - Public Health|last=Administration|first=US Department of Veterans Affairs, Veterans Health|website=www.publichealth.va.gov|language=en|access-date=2018-08-19}}</ref>

===[[Interstitial cystitis]]===
Interstitial cystitis causes a painful bladder.<ref name=":5">{{Cite news|url=https://www.verywellhealth.com/chronic-fatigue-syndrome-interstitial-cystitis-716168|title=Fibromyalgia, Chronic Fatigue Syndrome & Interstitial Cystitis|last=Dellwo|first=Adrienne|date=Feb 16, 2018|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=}}</ref>
:"Fibromyalgia, chronic fatigue syndrome and [[interstitial cystitis]] (IC) -- a painful bladder condition -- frequently occur together. Women may be up to 10 times more likely than men to develop it."<ref name=":5" />
*[Interstitial cystitis]]/painful bladder syndrome and associated medical conditions with an emphasis on irritable bowel syndrome, fibromyalgia and [[Chronic fatigue syndrome|chronic fatigue syndrome.]]<ref name="Nickel2010">{{Cite journal|last=Nickel|first=J. Curtis|last2=Tripp|first2=Dean A.|last3=Pontari|first3=Michel|last4=Moldwin|first4=Robert|last5=Mayer|first5=Robert|last6=Carr|first6=Lesley K.|last7=Doggweiler|first7=Ragi|last8=Yang|first8=Claire C.|last9=Mishra|first9=Nagendra|date=2010|title=Interstitial cystitis/painful bladder syndrome and associated medical conditions with an emphasis on irritable bowel syndrome, fibromyalgia and chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/20719340|journal=The Journal of Urology|volume=184|issue=4|pages=1358–1363|doi=10.1016/j.juro.2010.06.005|issn=1527-3792|pmid=20719340|via=}}</ref>

===Language Impairment or word problems===
*[[Word-finding problems]]
:*"Searching their brains for simple words that they just can't remember. On other occasions, individuals with these diagnoses may find it hard to write or even understand language."<ref name=":6">{{Cite news|url=https://www.verywellhealth.com/language-impairment-in-fibromyalgia-cfs-716024|title=Language Impairment in Fibromyalgia and Chronic Fatigue Syndrome|last=Dellwo|first=Adrienne|date=Feb 12, 2018|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=}}</ref>
*"The diagnosis of [[aphasia]] is a condition that robs you of the ability to communicate. It can affect your ability to speak, write and understand language, both verbal and written"<ref>{{Cite news|url=http://www.mayoclinic.org/diseases-conditions/aphasia/basics/definition/con-20027061|title=Aphasia - Symptoms and causes|work=Mayo Clinic|access-date=2018-08-09|language=en}}</ref> but with [[dysphasia]] you will have those symptoms and trouble listening and doing numerical calculations.<ref name=":36" />
===[[Migraine]]===
<blockquote>Both fibromyalgia and migraine may reflect problems in the brain’s pain processing center. It is believed that both conditions are caused by excitation of the nervous system or an over-response to stimuli. Stress is usually cited as a trigger for both migraine and fibromyalgia attacks.<ref name=":32">{{Cite news|url=https://migrainecenters.com/blog/migraines-and-fibromyalgia/|title=Migraines and Fibromyalgia - Migraine Centers|date=2016-05-06|work=Migraine Centers|access-date=2018-08-19|language=en-US}}</ref></blockquote>

===[[Multiple chemical sensitivity|Multiple Chemical Sensitivity]] (MCS)===
It is thought that both Fibromyalgia and MCS are [[central sensitization|central sensitization]] syndromes.<ref>{{Cite news|url=https://www.verywellhealth.com/chemical-sensitivity-in-fibromyalgia-716170|title=Multiple Chemical Sensitivity in Fibromyalgia & ME/CFS|last=Dellwo|first=Adrienne|date=Jul 23, 2018|work=Verywell Health|access-date=2018-08-19|archive-url=|archive-date=}}</ref>

===OBGYN===
*[https://www.verywellhealth.com/menstrual-periods-and-fibromyalgia-715596 Menstrual Periods with Fibromyalgia: Personal Stories]
<blockquote>You may have heard about a possible link between gynecologic surgery (such as a hysterectomy) and the development of fibromyalgia, and doctors have long suspected that fibromyalgia has strong -[[Hormone|hormonal]] ties and triggers. This does not seem surprising as we've long suspected a link between endocrine disorders, gynecological conditions, and autoimmune conditions.<ref name=":7">{{Cite news|url=https://www.verywellhealth.com/fibromyalgia-tied-to-hysterectomy-gynecologic-disease-715626|title=Fibromyalgia Tied to Hysterectomy, Gynecologic Disease|last=Dellwo|first=Adrienne|date=Feb 16, 2018|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=}}</ref></blockquote>

===[[Orthostatic intolerance]] (OI)===
[[Postural orthostatic tachycardia syndrome]] (POTS) and other forms of orthostatic intolerance often occur in people with fibromyalgia.<ref name=":44">{{Cite journal|last=Yun|first=Dong Joo|last2=Choi|first2=Han Na|last3=Oh|first3=Gun-Sei|date=2013|title=A Case of Postural Orthostatic Tachycardia Syndrome Associated with Migraine and Fibromyalgia|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3710947/|journal=The Korean Journal of Pain|volume=26|issue=3|pages=303–306|doi=10.3344/kjp.2013.26.3.303|issn=2005-9159|pmid=23862007|via=}}</ref> Symptoms can include [[hypotension|low blood pressure]] and/or sudden high blood pressure, [[dizziness]], [[syncope|fainting]].
*Dr Charles Lapp found that fibromyalgia ymptoms and ME/CFS symptoms predicted the outcome of [[Tilt Table Testing]] foe [[orthostatic intolerance]].<ref>{{Cite web|url=http://drlapp.com/wp-content/uploads/TTT_symptoms.pdf|title=Symptoms Predict the Outcome of Tilt Table Testing in CFS/ME/FM|last=Lapp|first=Charles W.|last2=Black|first2=Laura|date=|website=drlapp.com|archive-url=|archive-date=|access-date=|last3=Smith|first3=Rebekah S.}}</ref>
*Orthostatic intolerance may often be l overlooked in fibromyalgia patients.<ref>{{Cite news|url=https://www.healthrising.org/blog/2017/09/21/fibromyalgia-problems-standing-orthostatic-intolerance/|title=An Overlooked Issue in Fibromyalgia? Study Highlights Orthostatic Intolerance - Problems Standing - Health Rising|last=Johnson|first=Cort|date=2017-09-21|work=Health Rising|access-date=2018-08-09|archive-url=|archive-date=|language=en-US}}</ref>
===[[Raynaud's syndrome]]===
<blockquote>In Raynaud's syndrome, the blood vessels constrict more than they should, which allows less blood to get through. That not only makes your extremities cold, it makes them extremely difficult to warm up. The most commonly affected body parts are the fingers and toes, but your lips, nose, ear lobes, knees, and nipples may also be involved.</blockquote>
<blockquote>Raynaud's isn't all about the cold, though. The diminished blood flow can cause pain in the affected areas, and it may also cause the skin there to turn blue. Skin ulcers (sores) are possible, since prolonged episodes of low blood flow can damage your tissues.<ref name="reynaulds">{{Cite web|url=https://www.verywellhealth.com/raynauds-syndrome-chronic-fatigue-716185|title=Cold Hands & Feet? Raynaud's Syndrome in Fibromyalgia & ME/CFS|last=Dellwo|first=Adrienne|date=Jan 28, 2018|work=Verywell Health|access-date=2018-10-11|archive-url=|archive-date=}}</ref></blockquote>

===[[Sleep dysfunction]]===
*Vatthauer et al. (2015) found that sleep was associated with task-negative [[brain]] activity in fibromyalgia participants with comorbid chronic [[insomnia]].<ref name="Vatthauer2015">{{Cite journal|last=Vatthauer|first=Karlyn E|last2=Craggs|first2=Jason G|last3=Robinson|first3=Michael E|last4=Staud|first4=Roland|last5=Berry|first5=Richard B|last6=Perlstein|first6=William M|last7=McCrae|first7=Christina S|date=2015-11-12|title=Sleep is associated with task-negative brain activity in fibromyalgia participants with comorbid chronic insomnia|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4648619/|journal=Journal of Pain Research|volume=8|pages=819–827|doi=10.2147/JPR.S87501|issn=1178-7090|pmc=|pmid=26648751|via=|issue=|quote=|author-link=|author-link2=|author-link3=|author-link4=Roland Staud|author-link5=}}</ref>
<blockquote>The present results of this study suggest that long-term, comorbid pain and sleep disturbance may be associated with increased activation in core default mode brain areas that is above and beyond long-term pain disturbance alone.<ref name="Vatthauer2015" /></blockquote>

*"Most people with fibromyalgia have an associated sleep disorder that makes it difficult for them to get the deep, restorative sleep they need."<ref name=":8">{{Cite news|url=https://www.prohealth.com/library/fibromyalgia-and-sleep-38954|title=Fibromyalgia and Sleep - Prohealth|date=2016-01-11|work=Prohealth|access-date=2018-08-09|language=en-US}}</ref>

===[[Temporomandibular joint disorder]] (TMJ/TMD) ===
[[File:Skull_diagram.png|350px|thumb|right|The temporomandibular joint is the joint between the mandible (light blue) and the temporal bone (orange) of the skull]]
* [https://www.sciencedirect.com/science/article/pii/S2255502114001758 Temporomandibular disorders in fibromyalgia syndrome: a short-communication]<ref>{{Cite journal|last=Soares Gui|first=Maisa|last2=Pimentel|first2=Marcele Jardim|last3=Rizzatti-Barbosa|first3=C'elia Marisa|date=2015-03-01|title=Temporomandibular disorders in fibromyalgia syndrome: a short-communication|url=https://www.sciencedirect.com/science/article/pii/S2255502114001758|journal=Revista Brasileira de Reumatologia (English Edition)|language=en|volume=55|issue=2|pages=189–194|doi=10.1016/j.rbre.2014.07.004|issn=2255-5021|via=ScienceDirect}}</ref><ref>{{Cite news|url=https://www.whitesmilesforlife.com/blog/study-probes-pain-link-between-tmj-fibromyalgia/|title=Study Probes Pain Link Between TMJ, Fibromyalgia|date=2016-05-03|work=Kent E. White, DDS|access-date=2018-08-19|language=en-US}}</ref>

Other than [[headache]]s, the symptoms of TMJ/TMD are quite distinct from symptoms of FMS and ME/CFS. They include:
*Jaw pain
*Discomfort or difficulty chewing
*Painful clicking in the jaw
*Difficulty opening or closing the mouth
*Headaches
*Locking jaw
*Teeth that don't come together properly<ref>{{Cite news|url=https://www.verywellhealth.com/tmj-in-fibromyalgia-chronic-fatigue-syndrome-716175|title=TMJ in Fibromyalgia and Chronic Fatigue Syndrome|last=Dellwo|first=Adrienne|date=Mar 31, 2018|work=Verywell Health|access-date=2018-08-22|archive-url=|archive-date=}}</ref>

===[[Thyroid disease]]===
<blockquote>People with [[Hashimoto's thyroiditis (hypothyroidism)|Hashimoto's autoimmune thyroid disease]] often experience significant fatigue and body aches. While these symptoms are common in Hashimoto's, they can also be markers of other diseases, like chronic fatigue syndrome or fibromyalgia.<ref name=":9">{{Cite news|url=https://www.verywellhealth.com/relationship-between-cfs-fibromyalgia-and-aitd-3231677|title=A Comparison of Chronic Fatigue, Fibromyalgia, and Thyroid Disease|last=Shomon|first=Mary|date=Feb 21, 2018|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=}}</ref> </blockquote>

===Other symptoms===
*[http://chronicfatigue.about.com/od/whatisfibromyalgia/a/fibrosymptoms.htm Symptoms of Fibromyalgia]<ref>{{Cite news|url=https://www.verywellhealth.com/fibromyalgia-symptoms-716139|title=Symptoms of Fibromyalgia|last=Dellwo|first=Adrienne|date=May 16, 2018|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=}}</ref> (On all the many symptoms and conditions of and related to fibromyalgia.)
*Fibromyalgia Syndrome: An Overview of Pathophysiology, Diagnosis and Management [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3394355/ Conditions associated with fibromyalgia. (Table 1)]<ref name="Firdous2012" />

==Treatment==

===United States===
'''Rheumatology and primary care providers: Diagnosing and treatment'''

*2012, [https://www.mayoclinicproceedings.org/article/S0025-6196(12)00299-6/abstract A Framework for Fibromyalgia Management for Primary Care Providers]<ref>{{Cite journal|last=Arnold|first=Lesley M.|last2=Clauw|first2=Daniel J.|last3=Dunegan|first3=L. Jean|last4=Turk|first4=Dennis C.|date=2012|title=A Framework for Fibromyalgia Management for Primary Care Providers|url=https://www.mayoclinicproceedings.org/article/S0025-6196(12)00299-6/abstract|journal=Mayo Clinic Proceedings|language=English|volume=87|issue=5|pages=488–496|doi=10.1016/j.mayocp.2012.02.010|issn=0025-6196|via=}}</ref> Rheumatologists stopped treating fibromyalgia patients and primary care providers began treatment managment although rheumatologists are most often the specialist to diagnose.
{{See also|Fibromyalgia disability process}}

===Drugs===
{{Main article |page_name = Fibromyalgia drugs}}

=== Therapies ===

==== Exercise ====
''Please Note'': These treatments are for fibromyalgia patients and '''not''' [[ME/CFS]] sufferers due to it's hallmark symptom of [[post-exertional malaise]].
[[File:Warm water exercise.JPG|200px|thumb|left|Warm water exercise is best for fibromyalgia. Start slow and don't push through the pain<ref name=":11" />]]

*[https://www.verywellhealth.com/warm-water-exercise-for-fibromyalgia-716059 Warm Water Exercise for Fibromyalgia]<ref name=":11">{{Cite news|url=http://chronicfatigue.about.com/od/treatingfmscfs/a/warmwaterFMS.htm|title=Warm Water Exercise for Fibromyalgia|last=Dellwo|first=Adrienne|date=Nov 19, 2017|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=}}</ref><ref>{{Cite journal|last=Munguía-Izquierdo|first=D.|last2=Legaz-Arrese|first2=A.|date=2007|title=Exercise in warm water decreases pain and improves cognitive function in middle-aged women with fibromyalgia|url=https://www.ncbi.nlm.nih.gov/pubmed/18173915|journal=Clinical and Experimental Rheumatology|volume=25|issue=6|pages=823–830|issn=0392-856X|pmid=18173915|via=}}</ref><ref>{{Cite news|url=https://www.prohealth.com/fibromyalgia/library/aquatic-exercise-training-fibromyalgia-85081?|title=Aquatic exercise training for fibromyalgia|date=2018-08-29|work=Prohealth|access-date=2018-09-01|language=en-US}}</ref><ref>{{Cite journal|last=Bidonde|first=Julia|last2=Busch|first2=Angela J.|last3=Webber|first3=Sandra C.|last4=Schachter|first4=Candice L.|last5=Danyliw|first5=Adrienne|last6=Overend|first6=Tom J.|last7=Richards|first7=Rachel S.|last8=Rader|first8=Tamara|date=2014-10-28|title=Aquatic exercise training for fibromyalgia|url=https://www.ncbi.nlm.nih.gov/pubmed/25350761|journal=The Cochrane Database of Systematic Reviews|issue=10|pages=CD011336|doi=10.1002/14651858.CD011336|issn=1469-493X|pmid=25350761}}</ref>

<blockquote>Several studies have found that warm-water pool exercise is a beneficial treatment for fibromyalgia. A very large survey of patients found that 26% have used pool therapy, rating it as very effective.<ref name=":45">{{Cite journal|last=Bennett|first=Robert M.|author-link=|last2=Jones|first2=Jessie|author-link2=|last3=Turk|first3=Dennis C.|author-link3=|last4=Russell|first4=I. Jon|author-link4=|last5=Matallana|first5=Lynne|author-link5=|date=Mar 9, 2007|title=An internet survey of 2,596 people with fibromyalgia|url=https://doi.org/10.1186/1471-2474-8-27|journal=BMC Musculoskeletal Disorders|volume=8|issue=1|pages=27|doi=10.1186/1471-2474-8-27|issn=1471-2474|pmc=1829161|pmid=17349056|quote=|via=}}</ref> The same survey found 74% of patients found heat helpful - either warm water or heat packs.<ref name=":45" /> Warm water especially important in FMS because many people with the condition are intolerant of cold. A warm-water pool is one that's kept around 89.6 degrees Fahrenheit (32 Celsius), which is several degrees warmer than most heated pools.<ref name=":11" /></blockquote>

* Moderate aerobic exercise and weights with six to eight reps and then a day or two of rest in between. Do not start a program if you are in a flare.<ref>{{Cite web|url=http://www.arthritis.org/living-with-arthritis/tools-resources/expert-q-a/fibromyalgia-questions/fibromyalgia-exercise.php|title=Fibromyalgia Exercise {{!}} Exercising with Fibromyalgia|last=Ronenn|first=Roubenoff|date=|website=www.arthritis.org|archive-url=|archive-date=|access-date=2018-08-09}}</ref>

*[https://www.youtube.com/watch?v=BauJYuJwFsI Easy fibromyalgia exercises and motivation to keep you healthy!]<ref>{{Cite web|url=https://www.youtube.com/watch?v=BauJYuJwFsI|title=Easy Fibromyalgia exercises and motivation to keep you healthy!|last=Suarez|first=Eric|date=Jun 21, 2011|website=YouTube|archive-url=|archive-date=|access-date=Aug 9, 2018}}</ref> Video

*[http://chronicfatigue.about.com/od/whatisfibromyalgia/a/Fibromyalgia-Myth-Vs-Fact.htm Fibromyalgia Myth vs. Fact]<ref name=":15">{{Cite news|url=https://www.verywellhealth.com/fibromyalgia-myth-vs-fact-716131|title=Fibromyalgia: What's Myth, What's Fact?|last=Dellwo|first=Adrienne|date=Jun 8, 2016|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=|at=Myth #3 People With Fibromyalgia Need More Exercise}}</ref> Heading: ''Myth #3: People With Fibromyalgia Need More Exercise''. Appropriate exercise, which each patient needs to gauge for themselves.<ref name=":15" />

==== Massage ====

*2014, [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3930706/ Massage Therapy for Fibromyalgia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials]<ref>{{Cite journal|last=Li|first=Yan-hui|last2=Wang|first2=Feng-yun|last3=Feng|first3=Chun-qing|last4=Yang|first4=Xia-feng|last5=Sun|first5=Yi-hua|date=2014-02-20|title=Massage Therapy for Fibromyalgia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3930706/|journal=PLoS ONE|volume=9|issue=2|doi=10.1371/journal.pone.0089304|issn=1932-6203|pmc=|pmid=24586677|pages=|via=}}</ref>

*2016, [http://chronicfatigue.about.com/od/alternativetreatments/a/bodywork.htm Massage, Rolfing & Other Bodywork - Are They Effective Fibromyalgia & Chronic Fatigue Syndrome Treatments?]<ref>{{Cite news|url=https://www.verywellhealth.com/massage-rolfing-other-bodywork-715645|title=Massage, Rolfing, Reiki: Do They Work for Fibromyalgia & ME/CFS?|last=Dellwo|first=Adrienne|date=Aug 10, 2017|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=}}</ref>

==== Acupuncture ====

*2004, [[U.S. Department of Health and Human Services]] (HHS) and Centers for Medicare and Medicaid Services (CMS) ruled April 16, 2004, a noncoverage determination for acupuncture.<ref>{{Cite web|url=https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R11NCD.pdf|title=CMS Manual System Pub. 100-03 Medicare National Coverage Determinations|last=|first=|date=Apr 16, 2004|website=CMS.gov|format=PDF|archive-url=|archive-date=|access-date=}}</ref>

*2005, [http://acupunctureschoolonline.com/acupuncture-good-for-fibromyalgia.html Acupuncture Good for Fibromyalgia?] <ref name=":16">{{Cite web|url=http://acupunctureschoolonline.com/acupuncture-good-for-fibromyalgia.html|title=Acupuncture Good for Fibromyalgia?|last=|first=|date=Oct 2, 2012|website=Acupuncture School Online|archive-url=|archive-date=|access-date=2018-08-09}}</ref> "Acupuncture gave no significant pain relief to fibromyalgia patients."<ref name=":16" />

*2016, [http://www.sciencedirect.com/science/article/pii/S2095496416602352 Short-term complementary and alternative medicine on quality of life in women with fibromyalgia] <ref name=":25">{{Cite journal|date=2016-01-01|title=Short-term complementary and alternative medicine on quality of life in women with fibromyalgia|url=https://www.sciencedirect.com/science/article/pii/S2095496416602352|journal=Journal of Integrative Medicine|language=en|volume=14|issue=1|pages=29–35|doi=10.1016/S2095-4964(16)60235-2|issn=2095-4964}}</ref> "There was no significant improvement in pain or reduction of tender points in any of the groups studied, at the end of the 8th session."<ref name=":25" />

*2016, [https://fibromyalgianewstoday.com/2016/02/01/acupuncture-does-not-reduce-pain-for-women-with-fibromyalgia/ Acupuncture Does Not Appear to Relieve Pain in Fibromyalgia Patients]<ref>{{Cite news|url=https://fibromyalgianewstoday.com/2016/02/01/acupuncture-does-not-reduce-pain-for-women-with-fibromyalgia/|title=Acupuncture Does Not Appear to Relieve Pain in Fibromyalgia Patients - Fibromyalgia News Today|last=Semedo|first=Daniela|date=2016-02-01|work=Fibromyalgia News Today|access-date=2018-08-09|archive-url=|archive-date=|language=en-US}}</ref>

== Controversy ==
=== Dr. Frederick Wolfe ===
Dr. [http://rheummd.org/members/fwolfe Frederick Wolfe], the director of the [https://www.arthritis-research.org/ National Databank for Rheumatic Diseases] and the lead author of the 1990 paper that first defined the diagnostic guidelines for fibromyalgia, says he has become cynical and discouraged about the diagnosis. He now considers the condition a physical response to stress, depression, and economic and social anxiety.<ref>{{Cite journal|last=Wolfe|first=Frederick|last2=Walitt|first2=Brian|date=2016|title=Fibromyalgia: A Short Commentary|url=http://headache.imedpub.com/fibromyalgia-a-short-commentary.pdf|journal=Journal of Headache & Pain Management|volume=1|issue= 3|pages=27|via=iMedPubJournals}}</ref><ref>{{Cite news|url=https://www.news-medical.net/news/20130322/Fibromyalgia-an-interview-with-Dr-Frederick-Wolfe-University-of-Kansas-School-of-Medicine.aspx|title=Fibromyalgia: an interview with Dr Frederick Wolfe, University of Kansas School of Medicine|last=Cashin-Garbutt|first=April|date=2013-03-22|work=News-Medical.net|access-date=2018-08-09|archive-url=|archive-date=|language=en}}</ref>

=== Fibromyalgia vs Chiari malformation ===
Some individuals diagnosed with FMS were undergoing surgery for [[chiari malformation]] (CM). These are two separate conditions; FMS cannot be resolved by undergoing a risky CM surgery.

*2011, [https://www.ncbi.nlm.nih.gov/pubmed/21135714 Is Chiari I malformation associated with fibromyalgia?]<ref>{{Cite journal|last=Watson|first=Nathaniel F.|last2=Buchwald|first2=Dedra|last3=Goldberg|first3=Jack|last4=Maravilla|first4=Kenneth R.|last5=Noonan|first5=Carolyn|last6=Guan|first6=Qingyan|last7=Ellenbogen|first7=Richard G.|date=2011|title=Is Chiari I malformation associated with fibromyalgia?|url=https://www.ncbi.nlm.nih.gov/pubmed/21135714|journal=Neurosurgery|volume=68|issue=2|pages=443–448; discussion 448–449|doi=10.1227/NEU.0b013e3182039a31|issn=1524-4040|pmid=21135714|via=}}</ref>
::Conclusion: Most patients with FM do not have [[CIM]] pathology. Future studies should focus on dynamic neuroimaging of craniocervical neuroanatomy in patients with FM.
*2015, [https://www.massmecfs.org/resource-library/9-treatment/172-cfidsfm-and-chiari-malformation-surgery CFS/FM and Chiari Malformation Surgery]<ref>{{Cite web|url=https://www.massmecfs.org/resource-library/9-treatment/172-cfidsfm-and-chiari-malformation-surgery|title=CFS/FM and Chiari Malformation Surgery|last=Casanova|first=Ken|date=Nov 15, 2015|website=www.massmecfs.org|language=en-GB|archive-url=|archive-date=|access-date=2018-08-09}}</ref>

==Disability: SSI/SSD and LT==
{{Main article |page_name = Fibromyalgia disability process}}

==Notable studies ==
{{Main article |page_name = Fibromyalgia notable studies}}

==See also==
*[[Fibromyalgia disability process]]
* [[Fibromyalgia drugs]]
* [[Fibromyalgia notable studies]]
* [[Influenza vaccine]]
*[[Lady Gaga]]
*''[[Mayo Clinic Guide to Fibromyalgia: Strategies to Take Back Your Life]] - Medical guide book (2019)''

== Learn more ==
*[https://dx.doi.org/10.4065%2Fmcp.2011.0206 The Science of Fibromyalgia] - Daniel Clauw, Lesley Arnold, and Bill McCarber for the FibroCollaborative
*[http://fmtest.com/ FM/a® test]
*[https://www.s4me.info/forums/fibromyalgia-and-connective-tissue-disorders.35/ Forum: Fibromyalgia and Connective Tissue Disorders] at [[Science for ME]]

=== Diagnosing and categorizing fibromyalgia===
*2014, [http://www.medpagetoday.com/Rheumatology/Fibromyalgia/49114 Lyme Disease, Fibromyalgia Link Evaporates] (See also: [[Chronic lyme disease]])
*2015, [http://www.news-medical.net/news/20150518/Fibromyalgia-now-considered-as-a-lifelong-central-nervous-system-disorder.aspx Fibromyalgia now considered as a lifelong central nervous system disorder]
*2015, [http://nationalpainreport.com/foundation-of-fibromyalgia-is-altered-central-nervous-system-new-study-validates-8827896.html Foundation of Fibromyalgia Is Altered Central Nervous System, New Study Validates]
*2016, [http://fibromyalgianewstoday.com/2016/09/09/fibromyalgia-diagnosis-using-noninvasive-eye-examination Diagnosing Fibromyalgia May Be Possible Using Noninvasive Eye Examination]
*2016, [http://simmaronresearch.com/2016/03/are-chronic-fatigue-syndrome-mecfs-and-fibromyalgia-immune-exhaustion-disorders/ Are Chronic Fatigue Syndrome (ME/CFS) and Fibromyalgia Immune Exhaustion Disorders?]
*2017, [http://nationalpainreport.com/study-reveals-new-treatment-target-for-fibromyalgia-inflammation-in-the-brain-8833354.html Study Reveals New Treatment Target for Fibromyalgia: Inflammation in the Brain]
*2017, [https://qz.com/1349854/ai-can-spot-the-pain-from-a-disease-some-doctors-still-think-is-fake/? AI can spot the pain from a disease some doctors still think is fake]
*2018, [https://www.verywellhealth.com/fibromyalgia-pain-physiological-evidence-716141 Understanding the Pathophysiology of Fibromyalgia]
*2018, [https://www.prohealth.com/fibromyalgia/library/fibromyalgia-central-sensitization-syndrome-87957? Fibromyalgia: Central Sensitization Syndrome - Characterizing classes of fibromyalgia within the continuum of central sensitization syndrome]

=== Blood tests ===
*2013, [http://nationalpainreport.com/new-fibromyalgia-blood-test-is-99-accurate-8821072.html New Fibromyalgia Blood Test is 99% Accurate]
*2014, [http://www.prohealth.com/library/showarticle.cfm?libid=18837 Pridgen Reports Fibromyalgia Antiviral Trial Results “Very Positive”: Predicts New Approach Will Be “Game-Changer”]
*2016, [https://www.celestecooper.com/2016/05/blood-test-for-fibromyalgia-fma-test-is.html Blood Test for Fibromyalgia: FM/a Test Ⓡ is now available, Q&A]
*2016, [http://www.liveinsurancenews.com/fibromyalgia-blood-testing-covered-rising-number-insurance-companies/ Fibromyalgia blood testing covered by rising number of insurance companies]
*2017, [http://www.businesswire.com/news/home/20170419005324/en/EpicGenetics-Assistance-Leading-Medical-Centers-Expands-Clinical EpicGenetics, with the Assistance of Leading Medical Centers, Expands Clinical Study of FM/a® Test to Diagnose Fibromyalgia, Identify Genetic Markers Unique to the Disorder and Explore Direct Treatment Approaches]

=== Brain scans ===
*2002, [http://www.anapsid.org/cnd/diagnosis/brainpain.html Fibromyalgia Pain Isn't All In Patient's Heads, New Brain Study Finds]
*2012, [https://www.sciencedaily.com/releases/2012/11/121111153426.htm Fibromyalgia and the brain: New clues reveal how pain and therapies are processed]
*2018, [https://ki.se/en/news/people-with-fibromyalgia-have-inflammation-of-the-brain People with fibromyalgia have inflammation of the brain]
*2018, [https://fibromyalgianewstoday.com/2018/10/11/brain-inflammation-imaged-first-time-fibromyalgia-patients-study/ Brain Inflammation Imaged for First Time in Fibromyalgia Patients, Study Reports]<

==References==
{{reflist}}

[[Category:Diagnoses]]
[[Category:Potential comorbidities]]
[[Category:Musculoskeletal diseases and disorders]]
[[Category:Neurological diseases and disorders]]

Fibromyalgia

2021-07-08T21:34:58Z

Loopy:Immune System Research

{{Cleanup|date=Mar 2021|reason=Check science guidelines are met, e.g. no blogs or unreferenced articles for citations regarding general health information. Image captions should state author and copyright license. See [[help:Images%23Displaying_an_image_on_a_page]].}}

[[Fibromyalgia]] '''(FM/FMS)''' is a chronic disorder characterized by widespread [[Musculoskeletal system|musculoskeletal]] pain, [[fatigue]], and tenderness in localized areas. [[Myalgia|Muscle pain]] is widespread, on both sides of the body, and above and below the waist.<ref name="ACR1990" /><ref name="excerpt2" /><ref name="ACR2010" /><ref name="excerpt" />

Sufferers are fatigued and tired even when sleeping for long periods of time, and sleep is often disrupted by pain. Many FM sufferers have [[Sleep dysfunction|sleep disorders]] like [[sleep apnea]] and [[restless legs syndrome]] (RLS).<ref name="webmd-guide" /><ref name="mayo" /><ref name=":35" /> [[Cognitive impairment]], when one cannot focus or pay attention and the patient has difficulty concentrating on mental tasks, is known by FM sufferers as "[[fibro fog]]".<ref name="webmd-guide" /><ref name="mayo" /><ref name=":35" /> Some experience [[depression]], [[headache]]s, and lower [[abdominal pain]] or muscle cramp. Other symptoms include [[Paresthesia|tingling]] or [[numbness]] in hands and feet, pain in jaw and disorders of the jaw such as [[temporomandibular joint disorder|temporomandibular joint disorder]] (TMJ/TMD), [[Menstrual cycle#Health effects in other conditions|menstrual cycle]] cramps, and [[digestive problems]] like [[irritable bowel syndrome]] (IBS).<ref name="webmd-guide">{{Cite news|url=https://www.webmd.com/fibromyalgia/guide/fibromyalgia-symptoms#1|title=Fibromyalgia Symptoms|work=WebMD|access-date=2018-08-09|language=en-US}}</ref><ref name="mayo">{{Cite news|url=https://www.mayoclinic.org/diseases-conditions/fibromyalgia/symptoms-causes/syc-20354780|title=Fibromyalgia - Symptoms and causes|work=Mayo Clinic|access-date=2018-08-09|language=en}}</ref><ref name=":35" />

[[Pain#Pain in Fibromyalgia|Other pain conditions are associated with FM]], such as [[rheumatoid arthritis]] (RA), [[systemic lupus erythematosus]] (Lupus), ankylosing spondylitis, [[interstitial cystitis]], and more.<ref name="mayocause">{{Cite web|url=https://www.mayoclinic.org/diseases-conditions/fibromyalgia/symptoms-causes/syc-20354780|title=Fibromyalgia - Symptoms and causes|website=Mayo Clinic|language=en|access-date=2019-05-03}}</ref>

The [[United Kingdom|United Kingdom]] (UK) [[National Health Service]] (NHS) lists FM as one of 20 most painful conditions.<ref>{{Cite web|url=https://www.newsweek.com/20-most-painful-conditions-nhs-1191081|title=Here are 20 of the most painful health conditions you can get|last=EDT|first=Hannah Osborne On 10/29/18 at 7:14 AM|date=2018-10-29|website=Newsweek|language=en|access-date=2019-03-26}}</ref><ref name=":39">{{Cite web|url=https://www.cambridge-news.co.uk/news/uk-world-news/nhs-gout-ulcer-endometriosis-arthritis-15339123|title=The NHS says these are the 20 most painful health conditions you can suffer from|last=Campbell|first=James|last2=Pengelly|first2=Ella|date=2019-03-26|website=cambridgenews|access-date=2019-03-26}}</ref> The NHS describes the pain as diffuse aching or burning, head to toe, and can be worse at some times than at others. The pain can change location. "The fatigue ranges from feeling tired, to the exhaustion of a [[flu-like illness]]."<ref name=":39" /> The [[United States|United States]] (US) [[Centers for Disease Control and Prevention]] (CDC) states FM "can cause pain, [[Fibromyalgia disability process|disability, and lower quality of life]]."<ref name=":35" /> The medical guide book [[Mayo Clinic Guide to Fibromyalgia: Strategies to Take Back Your Life|''Mayo Clinic Guide to'' ''Fibromyalgia: Strategies to Take Back Your Life'']] describes fibromyalgia as "a [[Central sensitization|sensory disorder]] caused by a miscommunication between the [[Nervous system|nerves through your body and your brain]]."<ref>{{Cite web|url=https://www.amazon.com/Mayo-Clinic-Guide-Fibromyalgia-Strategies/dp/1893005496/ref=sr_1_1|title=Mayo Clinic Guide to Fibromyalgia: Strategies to Take Back Your Life|last=Abril, M.D.|first=Andy|authorlink=|last2=Bruce Ph.D. L.P.|first2=Barbara K.|authorlink2=|date=2019|website=www.amazon.com|publisher=Mayo Clinic Press; Paperback Original edition|page=15|archive-url=|archive-date=|access-date=2019-11-13}}</ref>

The [[American_College_of_Rheumatology|American College of Rheumatology]] (ACR) created and updates the diagnostic criteria for FM.<ref name="ACR1990" /><ref name="ACR2010">{{Cite journal|url=https://www.rheumatology.org/Portals/0/Files/2010_Preliminary_Diagnostic_Criteria.pdf|title=American College of Rheumatology (ACR) Preliminary Diagnostic Criteria for Fibromyalgia|last=Wolfe|first=Frederick|date=May 2010|volume =62 | issue = 5 | pages= 600–610| doi = 10.1002/acr.20140|type=PDF|archive-url=|archive-date=|access-date=|authorlink=|last2=Clauw|first2=Daniel|authorlink2=|journal=Arthritis Care & Research|last3=Fitzcharles|first3=Mary-Ann|first4=Don|last5=Katz|last4=Goldenberg|first5=Robert|last6=Mease|first6=Philip|last7=Russel|first7=Anthony|last8=Russel|first8=I. Jon|first9=John|last9=Winfield|first10=Muhammad|last10=Yunus|quote=The reference list consisted of: [[myalgia|muscle pain]], [[irritable bowel syndrome]], [[fatigue]]/tiredness, [[cognitive dysfunction|thinking or remembering problem]], [[paresis|muscle weakness]], [[headache]], pain/cramps in the abdomen, [[paresthesia|numbness/tingling]], [[dizziness]], [[insomnia]], [[depression]], [[constipation]], pain in the upper abdomen, [[nausea]], nervousness, [[chest pain]], [[blurred vision]], [[fever]], [[diarrhea]], dry mouth, [[skin itch|itching]], wheezing, [[Raynaud's syndrome|Raynaud’s phenomenon]], [[hives|hives/welts]], [[tinnitus|ringing in ears]], [[vomiting]], [[heartburn]], oral ulcers, loss of/change in taste, [[seizure]]s, [[dry eye syndrome|dry eyes]], [[dyspnea|shortness of breath]], [[anorexia (appetite loss)|loss of appetite]], [[skin rash|rash]], [[photophobia|sun sensitivity]], hearing difficulties, easy [[bruising]], [[hair loss]], frequent urination, [[painful bladder syndrome|painful urination]], and bladder spasms.}}</ref><ref name="ACR1990" /><ref name="excerpt2" /><ref name="ACR2010" /><ref name="excerpt">{{Cite web|url=https://www.rheumatology.org/Portals/0/Files/2010%20Fibromyalgia%20Diagnostic%20Criteria_Excerpt.pdf|title=2010 Fibromyalgia Diagnostic Criteria - Excerpt|last=|first=|authorlink=|last2=|first2=|website=rheumatology.org|page=|archive-url=|archive-date=|access-date=}}</ref> See: [[Fibromyalgia#Diagnosis|Fibromyalgia (Diagnosis)]].

[[File:Fibro_Tender_Points.png|400px|thumb|right|<span id="ACR1990-image">1990 ACR Diagnostic Criteria: 18 Tender Points</span><ref name="ACR1990">{{Cite journal|last=Wolfe|first=Frederick|author-link=Frederick Wolfe|last2=Smythe|first2=Hugh|author-link2=|last3=Yunus|first3=Muhammad|author-link3=Muhammad Yunnus|last4=Bennett|first4=Robert|author-link4=|last5=Bombardier|first5=Claire|author-link5=|last6=Goldenberg|first6=Don|author-link6=|last7=Tugwell|first7=Peter|author-link7=|last8=Campbell|first8=Stephen|author-link8=|last9=Abeles|first9=Micha|author-link9=|others=P Clark; A Fam; S Farber; J Fiechtner; CM Franklin; R Gatter; D Hamaty; J Lessard; A Lichtbroun; A Masi; G McCain; WJ Reynolds; T Romano; IJ Russell; R Sheon|date =1990|title=The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia|url=https://www.rheumatology.org/Portals/0/Files/1990_Criteria_for_Classification_Fibro.pdf|journal=Arthritis and Rheumatism|publisher=The American College of Rheumatology|volume=33|issue=2|pages=160-172|quote=|via=}}</ref><ref name="excerpt2">{{Cite web|url=https://www.rheumatology.org/Portals/0/Files/1990%20Fibromyalgia_Excerpt.pdf|title=1990 Fibromyalgia Excerpt|last=Wolfe|first=Frederick|authorlink=|last2=|first2=|authorlink2=|date=1990|website=rheumatology.org|archive-url=|archive-date=|access-date=}}</ref>]]
[[File:Fibro_Widespread_Pain.png|400px|thumb|right|<span id="ACR1990-image">2010 ACR Preliminatry Diagnostic Criteria:</span> '''Widespread Pain Index (WPI'''), 19 Tender Point Areas<ref name="ACR2010" /><ref name="excerpt" />]]

==Prevalence==
FM is the second most common rheumatic disorder behind [[osteoarthritis]] and is "now considered to be a lifelong [[central nervous system]] disorder."<ref>{{Cite web|url=https://www.sciencedaily.com/releases/2015/05/150517071813.htm|title=Fibromyalgia has central nervous system origins|last=|first=|authorlink=|last2=|first2=|authorlink2=|date=May 17, 2015|website=ScienceDaily|at=Summary|language=en|archive-url=|archive-date=|access-date=2019-11-13|quote=now considered to be a lifelong central nervous system disorder}}</ref><ref>{{Cite news|url=https://naidw.org/blog/members-myblogs/fibromyalgia-now-considered-as-a-lifelong-central-nervous-system-disorder|title=Fibromyalgia now considered as a lifelong central nervous system disorder|work=NAIDW.org®|access-date=2018-08-09|language=en-gb}}</ref> An estimated 10 million people in the US and 3-6% of the world population have FM. It is seen in women, men, children, and all ethnic groups. It is often seen in families and diagnosed between the ages of 20 to 50 years; incidence increases with age.<ref>{{Cite news|url=http://www.fmaware.org/about-fibromyalgia/prevalence/|title=Prevalence - National Fibromyalgia Association (NFA)|work=National Fibromyalgia Association (NFA)|access-date=2018-08-09|language=en-US}}</ref>

FM has a female:male 7:1 ratio under the ''American College of Rheumatology (ACR) 1990 Diagnostic Criteria''<ref name="ACR1990" /><ref name="excerpt2" /> and 2:1 when the ACR 2010 Preliminary Diagnostic Criteria<ref name="ACR2010" /><ref name="excerpt" /> is used.<ref>{{Cite journal|last=Boomershine|first=Chad|date=Nov 4, 2017|title=Fibromyalgia: Practice Essentials, Background, Pathophysiology|url=http://emedicine.medscape.com/article/329838-overview#a5|journal=Medscape|volume=|pages=|via=|publisher=|editor-last=Diamond|editor-first=Herbert|at=Sex-related differences in incidence}}</ref> See: [[Fibromyalgia#American College of Rheumatology (ACR) Criteria|Fibromyalgia (''American College of Rheumatology (ACR) Criteria'')]]. A September 2018, Wolfe et al study ''Fibromyalgia diagnosis and biased assessment: Sex, prevalence and bias''<ref name=":28" /> found fewer women and more men are diagnosed under the 2010/11 criteria (this criterion further updated in 2016<ref>{{Cite journal|date=2016-12-01|title=2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria|url=https://www.sciencedirect.com/science/article/pii/S0049017216302086|journal=Seminars in Arthritis and Rheumatism|language=en|volume=46|issue=3|pages=319–329|doi=10.1016/j.semarthrit.2016.08.012|issn=0049-0172}}</ref>). They found the ratio is F/M 1.5:1.<ref name=":28">{{Cite journal|last=Wolfe|first=Frederick|last2=Walitt|first2=Brian|last3=Perrot|first3=Serge|last4=Rasker|first4=Johannes J.|last5=Häuser|first5=Winfried|date=2018-09-13|title=Fibromyalgia diagnosis and biased assessment: Sex, prevalence and bias|url=https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0203755|journal=PLOS ONE|language=en|volume=13|issue=9|pages=e0203755|doi=10.1371/journal.pone.0203755|issn=1932-6203|pmc=|pmid=30212526|via=}}</ref><blockquote>What we did not find in our unbiased CritFM samples was 9:1 female to male fibromyalgia ratios that are widely described by expert sources [11–13]. We believe that such findings only occur in the presence of selection bias or biased ascertainment.<ref name=":28" /></blockquote><blockquote>As unbiased epidemiological studies show only a small increase in the female to male sex ratio (~1.5:1) as opposed to the observed ratio in clinical studies of 9:1, we believe that the over-identification of fibromyalgia in women and the consequent under-identification of men is the result of bias.<ref name=":28" /></blockquote>

==Fibromyalgia in ME/CFS==
"The most common overlapping condition with [[ME/CFS]] is fibromyalgia."<ref name="ammes-overlap">{{Cite web|url=https://ammes.org/overlapping-conditions/|title=Overlapping Conditions|website = [[American Myalgic Encephalomyelitis and Chronic Fatigue Syndrome Society]]|last=|first=|date=|language=en-US|archive-url=|archive-date=|access-date=2018-08-12}}</ref><ref>{{Cite web|url=http://www.ayushveda.com/healthcare/dysphasia.htm|title=Dysphasia - Causes, Symptoms & Treatment|website=www.ayushveda.com|access-date=2018-08-09}}</ref> See also: [[Dyscalculia]].
* [[ME/CFS]]<ref name="ammes-overlap" /><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=":31">{{Cite journal|last=Jason|first=Leonard|last2=Taylor|first2=R.R.|last3=Kennedy|first3=C.L.|last4=Song|first4=S|last5=Johnson|first5=D|last6=Torres|first6=S.R.|date=2001-01-01|title=Chronic fatigue syndrome: Comorbidity with fibromyalgia and psychiatric illness|url=https://www.researchgate.net/publication/285787383_Chronic_fatigue_syndrome_Comorbidity_with_fibromyalgia_and_psychiatric_illness|journal=Medicine and Psychiatry|volume=4|pages=29–34}}</ref> While some have posited ME/CFS and FM are variants of the same illness, [[Benjamin Natelson]], MD summoned considerable amounts of data that suggest the two illnesses differ with different pathophysiologic processes leading to different treatments.<ref name=":36">{{Cite journal|last=Natelson|first=Benjamin H.|date=2019-02-19|title=Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Fibromyalgia: Definitions, Similarities, and Differences|url=https://www.clinicaltherapeutics.com/article/S0149-2918(19)30003-7/abstract|journal=Clinical Therapeutics|language=English|volume=41|issue=4|pages=612|doi=10.1016/j.clinthera.2018.12.016|issn=0149-2918|pmid=30795933}}</ref>

Dr. [[Jarred Younger]] has said that many patients that meet the criteria for FM also meet criteria for [[chronic fatigue syndrome]] (CFS) but the reverse is not necessarily true as a lot of people with [[CFS]] do not have [[chronic pain]].<ref>{{Cite web|url=https://www.youtube.com/watch?v=wJB95m4FLa0#t=57m27s|title=Webinar with Jarred Younger, Ph.D.|last=Younger|first=Jarred|date=May 20, 2016|website=YouTube|at=57:27|via=|archive-url=|archive-date=|access-date=|publisher=SolveCFS|type=Video}}</ref> However, the [[Canadian Consensus Criteria]] (CCC) requires the symptom of pain to diagnose ME/CFS.<ref name="Carruthers, 2003">{{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
| url = http://phoenixrising.me/wp-content/uploads/Canadian-definition.pdf
}}</ref> It is the pattern (on both sides of the body, and above and below the waist) of chronic widespread [[Musculoskeletal system|musculoskeletal]] pain (involving muscle, cartilage, ligaments, and connective tissue) in FM that sets it apart from other diseases that have pain; it also causes [[cognitive symptoms]] and [[unrefreshing sleep]].<ref name="webmd-guide" /><ref name="mayo" />

A Swedish study of 234 ME/CFS patients meeting the [[Canadian Consensus Criteria]] found that 96% had trigger point pain consistent with fibromyalgia and 67% met the diagnostic criteria for fibromyalgia.<ref>{{Cite web|url=https://osf.io/qwn5h/|website=Center for Open Science|access-date=2019-12-03|title=Bragee Bertilson et al. - ME CFS and Intracranial Hypertension|date=Nov 27, 2019|last=|first=|authorlink=|last2=|first2=|authorlink2=|archive-url=|archive-date=}}</ref>

==Health complications==
FM is not a progressive disease but according to Dr. [[Daniel Clauw|Dan Clauw]] the "slow gradual worsening of chronic pain patients over time is due to downstream consequences of poorly controlled pain and other symptoms, wherein individuals then progressively get less active, sleep worse, are under more stress and unknowingly develop bad habits which worsen pain and other symptoms."<ref>{{Cite news|url=http://nationalpainreport.com/ask-the-dctors-is-fibromyalgia-progressive-8831105.html|title=Ask the Doctors: Is Fibromyalgia Progressive?|date=2016-08-09|work=National Pain Report|access-date=2018-08-09|language=en-US}}</ref>

*[https://www.sharecare.com/health/fibromyalgia-effects Fibromyalgia Complications]<ref name=":19" />

:<blockquote>People who have fibromyalgia frequently complain of a variety of symptoms that affect other parts of the body. Many people complain of [[gastrointestinal]] issues and restless legs syndrome (RLS). Additionally, the [[chronic pain]] and discomfort of fibromyalgia may lead to [[depression]].<ref name=":19">{{Cite news|url=https://www.sharecare.com/health/fibromyalgia-effects|title=Fibromyalgia Complications - Fibromyalgia - Joint Health|work=Sharecare|access-date=2018-08-09|language=en}}</ref></blockquote>

*[https://www.sharecare.com/health/fibromyalgia-effects/can-fibromyalgia-cause-medical-conditions Can fibromyalgia cause other medical conditions?]<ref name=":20" />

:<blockquote>Fibromyalgia is not known to cause other medical conditions. However, people who have fibromyalgia seem to be at high risk for developing other painful conditions, including osteoarthritis (the common type of arthritis caused by wear and tear on the joints) as well as other related conditions, such as rheumatoid arthritis, lupus, and ankylosing spondylitis. Also, people with fibromyalgia are frequently diagnosed with chronic fatigue syndrome, [[irritable bowel syndrome]] (IBS), and temporomandibular joint (TMJ) disorder.<ref name=":20">{{Cite web|url=https://www.sharecare.com/health/fibromyalgia-effects/can-fibromyalgia-cause-medical-conditions|title=Can fibromyalgia cause other medical conditions? {{!}} Fibromyalgia Complications|last=Honor Society of Nursing|first=|date=|website=Sharecare|language=en|archive-url=|archive-date=|access-date=2018-08-09}}</ref></blockquote>

==Risk factors==
[[Lupus]] and [[rheumatoid arthritis]] (RA) are risk factors in developing FM. Car accidents, [[post-traumatic stress disorder]] (PTSD), [[Carpal tunnel syndrome|repetitive injuries]], illness such as a [[virus]], family history, and obesity have all been linked to FM.<ref name=":35">{{Cite web|url=https://www.cdc.gov/arthritis/basics/fibromyalgia.htm|title=Fibromyalgia {{!}} Arthritis|date=2018-04-03|website=[[Centers for Disease Control]]|language=en-us|access-date=2018-08-09}}</ref><ref>{{Cite news|url=https://www.niams.nih.gov/health_info/Fibromyalgia/|title=Fibromyalgia What Causes it?|last=Director|first=Nancy Garrick, Deputy|work=National Institute of Arthritis and Musculoskeletal and Skin Diseases|access-date=2018-08-09|archive-url=|archive-date=|language=en}}</ref><ref>{{Cite news|url=http://www.prohealth.com/library/showarticle.cfm?libid=22315|title=When Fibromyalgia Is More than Pain - Prohealth|date=2016-01-08|work=Prohealth|access-date=2018-08-09|language=en-US}}</ref>

==Diagnosis==
Tender points, not [trigger points]], are used to diagnose FM.<ref>{{Cite web|url=http://www.healthcentral.com/chronic-pain/c/662034/176031/fibromyalgia-trigger/|title=The Difference Between Fibromyalgia Tender Points and Myofascial Trigger Points - Chronic Pain {{!}} HealthCentral|last=Cooper|first=Celeste|date=May 8, 2015|website=www.healthcentral.com|language=en-US|archive-url=|archive-date=|access-date=2018-08-09}}</ref> Tender points will be above and below the waist and on both sides of the body. (See: [#ACR1990-image|1990] and [#ACR2010-image|2010 American College of Rheumatology (ACR) Criteria] images depicting tender points m.) It is important to check for other conditions that could be causing pain such as [[hypothyroidism]], RA or lupus, osteoarthritis, ankylosing spondylitis, and polymyalgia rheumatica.<ref>{{Cite news|url=https://www.webmd.com/fibromyalgia/guide/fibromyalgia-diagnosis-and-misdiagnosis#1|title=How Is Fibromyalgia Diagnosed?|work=WebMD|access-date=2018-08-12|language=en-US}}</ref>

===United States===
=====<span id="bloodtest"> Blood test </span>=====
EpicGenetics has a blood test that is identifying the presence of specific [[Leucocyte|white blood cell]] abnormalities of patients diagnosed with FM and has partnered with two universities to offer whole exome sequencing free of charge to those who test positive with their '''FM/a® test'''.<ref>{{Cite news|url=http://www.businesswire.com/news/home/20170419005324/en/EpicGenetics-Assistance-Leading-Medical-Centers-Expands-Clinical|title=EpicGenetics, with the Assistance of Leading Medical Centers, Expands Clinical Study of FM/a® Test to Diagnose Fibromyalgia, Identify Genetic Markers Unique to the Disorder and Explore Direct Treatment Approaches|last=|first=|date=Apr 19, 2017|work=|access-date=2018-08-09|archive-url=|archive-date=|language=en}}</ref><ref name=":38">{{Cite web|url=http://fmtest.com/|title=Home|last=|website=EpicGenetics' FM/a® Test is FDA-compliant and has successfully diagnosed patients with fibromyalgia since 2012.|language=en-US|access-date=2019-03-25}}</ref> Most insurance companies will cover the test.<ref>{{Cite web|url=https://www.painnewsnetwork.org/stories/2015/5/27/fibromyalgia-blood-test-gets-insurance-coverage|title=Fibromyalgia Blood Test Gets Insurance Coverage|last=Anson|first=Pat|authorlink=|last2=|first2=|authorlink2=|date=May 27, 2015|website=Pain News Network|language=en-US|archive-url=|archive-date=|access-date=2019-03-25}}</ref><ref>{{Cite web|url=http://nationalpainreport.com/more-insurance-companies-now-paying-for-fibromyalgia-blood-test-8829994.html|title=More Insurance Companies Now Paying for Fibromyalgia Blood Test|last=Gregory-Burch|first=Donna|authorlink=|last2=|first2=|authorlink2=|date=2016-04-04|website=National Pain Report|language=en-US|archive-url=|archive-date=|access-date=2019-03-25}}</ref> EpicGenetics offers help to determine if your insurance will cover their test.<ref name=":38" />

==== American College of Rheumatology (ACR) Criteria ====

=====1990 ACR criteria=====

*1990, [http://www.rheumatology.org/Portals/0/Files/1990_Criteria_for_Classification_Fibro.pdf The American College Of Rheumatology 1990 Criteria For The Classification Of Fibromyalgia]<ref name="ACR1990" /><ref name="excerpt2" /> "American College of Rheumatology guidelines suggest that people with fibromyalgia have pain in at least 11 of these tender points when a doctor applies a certain amount of pressure."<ref>{{Cite news|url=http://www.health.com/health/gallery/0,,20345635,00.html|title=18 Points Used to Diagnose Fibromyalgia|last=|first=|date=Feb 4, 2011|work=Health.com|access-date=2018-08-09|archive-url=|archive-date=|language=en}}</ref><ref>{{Cite web|url=https://www.masscfids.org/8-resource-library/diagnosis/266-tender-points-might-no-longer-be-used-for-diagnosis-of-fibromyalgia|title=Tender Points might no longer be used for diagnosis of Fibromyalgia|last=Proskauer|first=Charmian|date=Feb 2011|website=www.masscfids.org|language=en-GB|archive-url=|archive-date=|access-date=2018-08-09}}</ref>

=====2010 ACR criteria=====

*2010, The [https://www.rheumatology.org/Portals/0/Files/2010_Preliminary_Diagnostic_Criteria.pdf 2010 American College of Rheumatology (ACR) Preliminary Diagnostic Criteria for Fibromyalgia: Overview]<ref name="ACR2010" /><ref name="excerpt" /> was proposed and modified in 2011<ref>{{Cite news|url=http://www.rheumatologynetwork.com/fibromyalgia/new-and-modified-fibromyalgia-diagnostic-criteria|title=New and Modified Fibromyalgia Diagnostic Criteria|last=Garg|first=Neha|date=Feb 9, 2012|work=Rheumatology Network|access-date=Aug 9, 2017|archive-url=|archive-date=|last2=Deodhar|first2=Atul}}</ref> with the modification being validated in 2013 and published in 2014.<ref>{{Cite journal|last=Bennett|first=Robert M.|last2=Friend|first2=Ronald|last3=Marcus|first3=Dawn|last4=Bernstein|first4=Cheryl|last5=Han|first5=Bobby Kwanghoon|last6=Yachoui|first6=Ralph|last7=Deodhar|first7=Atul|last8=Kaell|first8=Alan|last9=Bonafede|first9=Peter|date=2014|title=Criteria for the diagnosis of fibromyalgia: validation of the modified 2010 preliminary American College of Rheumatology criteria and the development of alternative criteria|url=https://www.ncbi.nlm.nih.gov/pubmed/24497443|journal=Arthritis Care & Research|volume=66|issue=9|pages=1364–1373|doi=10.1002/acr.22301|issn=2151-4658|pmid=24497443|via=}}</ref> September of 2016, another revision has been made.<ref name=":14">{{Cite news|url=http://acrabstracts.org/abstract/2016-revisions-to-the-20102011-fibromyalgia-diagnostic-criteria/|title=2016 Revisions to the 2010/2011 Fibromyalgia Diagnostic Criteria - ACR Meeting Abstracts|last=|first=|date=Sep 28, 2016|work=ACR Meeting Abstracts|access-date=2018-08-09|archive-url=|archive-date=|language=en-US}}</ref>

:Men do not seem to form the tender points needed for diagnosis under the 1990 criteria,<ref>{{Cite news|url=http://www.webmd.com/fibromyalgia/features/how-fibromyalgia-affects-men#2|title=How Fibromyalgia Affects Men: Symptoms and Diagnosis|work=WebMD|access-date=2018-08-09|language=en-US}}</ref> the 2010 proposed criteria diagnoses more men with a F/M ratio of 2:1.<ref>{{Cite journal|last=Boomershine|first=Chad|date=Nov 4, 2017|title=Fibromyalgia: Practice Essentials, Background, Pathophysiology|url=http://emedicine.medscape.com/article/329838-overview#a5|journal=Medscape|volume=|pages=|via=}}</ref>
:Tender points were used to diagnose with the 1990 criteria, however "considerable skill is needed to correctly check for a patient’s tender points (i.e., digital palpation that is done with certain amount of applied pressure), yet this technique is not typically taught at most medical schools."<ref name="masscfids">{{Cite web|url=https://www.masscfids.org/8-resource-library/diagnosis/266-tender-points-might-no-longer-be-used-for-diagnosis-of-fibromyalgia#2|title=Tender Points might no longer be used for diagnosis of Fibromyalgia|last=Proskauer|first=Charmian|date=Feb 5, 2011|website=www.masscfids.org|language=en-GB|archive-url=|archive-date=|access-date=2018-08-09}}</ref>
:The new standards were designed to:
:*eliminate the use of a tender point examination
:*include a severity scale by which to identify and measure characteristic FM symptoms
:*utilize an index by which to rate pain<ref name="masscfids" />

There are 19 tender point areas in the widespread pain index (WPI), whereas the 1990 criteria had 18 tender points.<ref name="masscfids" />

====== Widespread pain index and Symptom severity ======

The '''Widespread Pain Index''' (WPI) and '''Symptom Severity''' (SS) are explained in the study ''Fibromyalgia Syndrome: An Overview of Pathophysiology, Diagnosis and Management''.<ref name="Firdous2012" />
[[File:Widespread Pain Index Areas with numbers.svg|200px|thumb|right|'''WPI''' 19 areas of pain. Count 1 point for each area of pain<ref name="Firdous2012" /><ref name="ACR2010" /><ref name="excerpt" />]]
<blockquote>In place of the tender point count, patients (or their physician) may endorse 19 body regions in which pain has been experienced during the past week. One point is given for each area, so the score is between 0-19. This number is referred to as the '''Widespread Pain Index (WPI)''' and it is one of the two required scores needed for a doctor to make a diagnosis of fibromyalgia.</blockquote><blockquote>The second part of the score required to assess the diagnosis of fibromyalgia involves the evaluation of a person's symptoms. The patient ranks specific symptoms on a scale of 0-3. These symptoms include: [[Fatigue]], [[Unrefreshing sleep|Waking unrefreshed]], [[Cognitive dysfunction|Cognitive symptoms]], Somatic (physical) symptoms in general (such as [[headache]], weakness, [[Gastrointestinal system|bowel problems]], [[nausea]], [[dizziness]], [[numbness]] / [[Paresthesia|tingling]], [[hair loss]], [[Dry eye syndrome|dry eyes]], [[Raynaud's syndrome|Raynaud's]] phenomenon, painful urination, and more).<ref name="Firdous2012" /><ref name="ACR2010" /> The numbers assigned to each are added up, for a total of 0-12.</blockquote><blockquote>The diagnosis is based on both the '''WPI''' score and the '''SS''' score either:</blockquote>
::'''WPI''' of at least 7 and '''SS''' scale score of at least 5, ''or''
::'''WPI''' of 4-6<ref name=":14" /> and '''SS''' scale score of at least 9.<ref name="Firdous2012" />

[[File:WPI SS Fibro.JPG|600px|thumb|center|Table 2: '''SS''' scale score. Add a 4th column for Somatic (physical) symptoms in general (such as Headache, weakness, bowel problems, nausea, dizziness, numbness/tingling, hair loss, dry eyes, Raynaud's phenomenon, painful urination, and more).<ref name="Firdous2012" /><ref name="ACR2010" /> The patient ranks specific symptoms on a scale of 0-3. The numbers assigned to each column are added up, for a total of 0-12.<ref name="Firdous2012" /> ]]

The [[Social Security Administration]] (SSA) accepts a diagnosis of FM with the 1990<ref name="ACR1990" /><ref name="excerpt2" /> or 2010<ref name="ACR2010" /><ref name="excerpt" /> ACR criteria.<ref name="ssa">{{Cite web|url=https://www.ssa.gov/OP_Home/rulings/di/01/SSR2012-02-di-01.html|title=Social Security Ruling: SSR 12-2p|last=ORDP|last2=OPPS|first=|date=Jul 25, 2012|website=www.ssa.gov|language=en|archive-url=|archive-date=|access-date=2018-08-09}}</ref>
{{See also|Fibromyalgia disability process}}

=== Sleep study ===
[[Sleep dysfunction]] is often involved in FM. Treating a sleep disorder can help with FM symptoms. A diagnosed sleep disorder is also helpful if one needs to [[Fibromyalgia disability process|file for disability]].<ref>{{Cite news|url=https://www.sciencedaily.com/releases/2008/09/080903134311.htm|title=What A Sleep Study Can Reveal About Fibromyalgia|work=ScienceDaily|access-date=2018-08-09|language=en}}</ref><ref>{{Cite news|url=http://linkis.com/nationalpainreport.com/lzYea|title=Fibromyalgia Sufferers Have Difficulty Maintaining Continuous Sleep, Study Says|last=|first=|date=Mar 25, 2016|work=National Pain Report|access-date=2018-08-09|archive-url=|archive-date=|language=en-US}}</ref>

=== ICD Diagnostic code===
'''ICD-10'''

The [[World Health Organization]] (WHO) International Classification of Diseases (ICD) lists FM as a "disease of the [[musculoskeletal system]] and connective tissue", under the code M79.7 (WHO ICD-10 Version: 2016).<ref name="ICD10">{{Cite web|url=http://apps.who.int/classifications/icd10/browse/2016/en#/M79.7|title=ICD-10 Version:2016|last=World Health Organization|first=|author-link=World Health Organization|date=2016|website=[[World Health Organization]]|at=M79.7 Fibromyalgia|language=en|archive-url=|archive-date=|access-date=2018-09-15}}</ref> The WHO's ICD-10 does not refer to FM as a syndrome and it is not classified in the category for [[Medically unexplained physical symptoms|medically unexplained symptoms]].<ref name=":37" /><ref name="ICD10" />

*'''M79.7 Fibromyalgia'''
::Fibromyositis
::Fibrositis
::Myofibrositis<ref name="ICD10" />

In 2015, the [[United States|US]] finally adopted ICD-10 and FM as a diagnosis.<ref name=":37">{{Cite web|url=http://www.icd10data.com/ICD10CM/Codes/M00-M99/M70-M79/M79-/M79.7|title=2018 ICD-10-CM Diagnosis Code M79.7: Fibromyalgia|website=www.icd10data.com|language=en|access-date=2018-08-09|date=2018|last=World Health Organization|first=|archive-url=|archive-date=|authorlink=World Health Organization|last2=|first2=|authorlink2=}}</ref> <ref>{{Cite news|url=http://nationalpainreport.com/the-health-care-industry-finally-recognizes-fibromyalgia-8827637.html|title=The Health Care Industry Finally Recognizes Fibromyalgia|last=Liptan|first=Ginevra|date=2015-09-30|work=National Pain Report|access-date=2018-08-09|archive-url=|archive-date=|language=en-US}}</ref>

'''ICD-11 (2019)'''

The [[ICD-11]] (2019) has diagnostic code ''MG30.1 Chronic widespread pain,'' and changed the category from a [[:Category:Musculoskeletal diseases and disorders|Musculoskeletal disease]], to the ''General signs and symptoms category'', sometimes referred to as [[Medically unexplained physical symptoms]].<ref name="ICD11">{{Cite web|url=https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/849253504|title=ICD-11 - Mortality and Morbidity Statistics|website=[[World Health Organization]]|language=en|access-date=2018-08-09}}</ref>

*'''MG30.01 Chronic widespread pain'''

'''Parent'''
::MG30.0 Chronic primary pain

'''Description'''
<blockquote>Chronic widespread pain (CWP) is diffuse pain in at least 4 of 5 body regions and is associated with significant emotional distress (anxiety, anger/frustration or depressed mood) or functional disability (interference in daily life activities and reduced participation in social roles). CWP is multifactorial: biological, psychological and social factors contribute to the pain syndrome. The diagnosis is appropriate when the pain is not directly attributable to a nociceptive process in these regions and there are features consistent with nociplastic pain and identified psychological and social contributors.<ref name="ICD11" /></blockquote>

'''Inclusions'''
:*Fibromyalgia
'''Exclusions'''
:*Acute pain (MG31)<ref name="ICD11" />

==Pathophysiology==
"Fibromyalgia (FM) is a [[chronic pain]] disorder with unknown etiology and unclear pathophysiology. There is no evidence that a single event “causes” FM. Rather, many physical and/or emotional [[Stress|stressors]] may trigger or aggravate symptoms. These have included certain [[Infection|infections]], such as a [[Viral infection|viral illness]] or [[Lyme disease]], as well as emotional or physical [[trauma]]."<ref>{{Cite web|url=https://www.uptodate.com/contents/pathogenesis-of-fibromyalgia#!|title=Pathogenesis of fibromyalgia|last=Goldenberg|first=Don L|date=|website=www.uptodate.com|archive-url=|archive-date=|access-date=2018-08-09|authorlink=|last2=Schur|first2=Paul H|authorlink2=|last3=Romain|first3=Paul L}}</ref> The widespread pain is severe, debilitating, and abnormal in processing its pain. There is also [[Sleep dysfunction|sleep disturbance]] and fatigue. Cause or causes are unproven.<ref>{{Cite news|url=https://www.omf.ngo/what-is-mecfs-old/fibromyalgia/|title=What is Fibromyalgia? {{!}} Open Medicine Foundation|work=Open Medicine Foundation|access-date=2018-08-09|language=en-US}}</ref>

*May 2012, [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3394355/ Fibromyalgia Syndrome: An Overview of Pathophysiology, Diagnosis and Management]<ref name="Firdous2012">{{Cite journal|last=Jahan|first=Firdous|last2=Nanji|first2=Kashmira|last3=Qidwai|first3=Waris|last4=Qasim|first4=Rizwan|date=2012|title=Fibromyalgia Syndrome: An Overview of Pathophysiology, Diagnosis and Management|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3394355/|journal=Oman Medical Journal|volume=27|issue=3|pages=192–195|doi=10.5001/omj.2012.44|issn=1999-768X|pmc=|pmid=22811766|via=}}</ref> ''See'' Table 1: "Conditions associated with fibromyalgia." Musculoskeletal, [[genitourinary]], [[Gastrointestinal system|gastrointestinal]], and miscellaneous conditions often exist among fibromyalgia patients.

<blockquote>Pathophysiology: Although the etiology remains unclear, characteristic alterations in the [[Sleep dysfunction|pattern of sleep]] and changes in neuroendocrine transmitters such as [[serotonin]], substance P, growth hormone and [[cortisol]] suggest that regulation of the [[Autonomic nervous system|autonomic]] and neuro-endocrine system appears to be the basis of the syndrome. Fibromyalgia is not a life-threatening, deforming, or [progressive disease. [[Anxiety]] and [[depression]] are the most common association. Aberrant pain processing, which can result in [[chronic pain]], may be the result of several interplaying mechanisms. [[Central sensitization]], blunting of inhibitory pain pathways and alterations in [[neurotransmitter]]s lead to aberrant neuro-chemical processing of sensory signals in the CNS, thus lowering the threshold of pain and amplification of normal sensory signals causing constant pain.<ref name="Firdous2012" /></blockquote>

<blockquote>The frequent co-morbidity of fibromyalgia with [[Mood swings|mood disorders]] suggests a major role for the stress response and for [[neuroendocrine]] abnormalities. The [[hypothalamic pituitary axis]] (HPA) is a critical component of the stress-adaptation response. In FMS, stress adaptation response is disturbed leading to stress induce symptoms. Psychiatric co-morbidity has been associated with FMS and needs to be identified during the consultation process, as this requires special consideration during treatment.<ref name="Firdous2012" /></blockquote>

*May 2018, [https://www.chiropractic.ca/wp-content/uploads/2018/05/107243-2_Chiro_62_1d_Bourgaize.pdf A comparison of the clinical manifestation and pathophysiology of myofascial pain syndrome and fibromyalgia: implications for differential diagnosis and management]

*Jun 2018, [https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0198625 SNPs in inflammatory genes] [[CCL11]], [[CCL4]] and [[MEFV]] in a fibromyalgia family study<ref>{{Cite journal|last=Zhang|first=Zhifang|last2=Feng|first2=Jinong|last3=Mao|first3=Allen|last4=Le|first4=Keith|last5=Placa|first5=Deirdre La|last6=Wu|first6=Xiwei|last7=Longmate|first7=Jeffrey|last8=Marek|first8=Claudia|last9=Amand|first9=R. Paul St|date=2018-06-21|title=SNPs in inflammatory genes CCL11, CCL4 and MEFV in a fibromyalgia family study|url=http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0198625|journal=PLOS ONE|language=en|volume=13|issue=6|pages=e0198625|doi=10.1371/journal.pone.0198625|issn=1932-6203|pmid=29927949|via=}}</ref>

<blockquote>SNPs with significant TDTs were found in 36% of the cohort for CCL11 and 12% for MEFV, along with a protein variant in CCL4 (41%) that affects CCR5 down-regulation, supporting an immune involvement for FM.</blockquote>

*Jul 2018, [https://fibromyalgianewstoday.com/2018/07/31/primary-secondary-fibromyalgia-share-similar-symptom-burden-study/ Primary and Secondary Fibromyalgia Share Same Symptom Burden, Study Suggests]<ref name=":22">{{Cite news|url=https://fibromyalgianewstoday.com/2018/07/31/primary-secondary-fibromyalgia-share-similar-symptom-burden-study/|title=Primary, Secondary Fibromyalgia Share Same Symptom Burden, Study Says|last=Carvalho|first=John|date=2018-07-31|work=Fibromyalgia News Today|access-date=2018-08-09|archive-url=|archive-date=|language=en-US}}</ref>

<blockquote>Fibromyalgia can be considered either primary, or dominant, also known as idiopathic fibromyalgia, or secondary. In the primary form, the causes of the disorder are unknown, but in secondary fibromyalgia, the disorder usually occurs alongside other debilitating medical conditions, such as rheumatoid arthritis (RA), lupus, and multiple sclerosis.<ref name=":22" /></blockquote>

===Immune system research===

Dr. [[Jarred Younger]] believes an overactive [[immune system]] is the cause and will be conducting a study to test this hypothesis.<ref>{{Cite news|url=http://nationalpainreport.com/new-uab-study-could-radically-change-fibromyalgia-treatment-as-we-know-it-8833437.html|title=New UAB Study Could Radically Change Fibromyalgia Treatment As We Know It|last=Gregory Burch|first=Donna|date=2017-04-24|work=National Pain Report|access-date=2018-08-09|archive-url=|archive-date=|language=en-US}}</ref><ref>{{Cite web|url=https://www.youtube.com/watch?v=8e5xKX036bE|title=Testing the fibromyalgia immune system with lipopolysaccharide (LPS)|last=Younger|first=Jarred|date=May 24, 2017|website=YouTube|archive-url=|archive-date=|access-date=|via=Younger Lab}}</ref> An overactive immune system can cause [[inflammation]] and [[chronic pain]].<ref>{{Cite news|url=https://www.epainassist.com/autoimmune/what-is-overactive-immune-system|title=What is Overactive Immune System{{!}}Causes{{!}}Symptoms{{!}}Treatment|last=Kerkar|first=Pramod|date=2016-09-29|work=ePainAssist|access-date=2018-10-04|archive-url=|archive-date=|language=en-gb}}</ref><ref>{{Cite news|url=https://www.webmd.com/a-to-z-guides/autoimmune-diseases|title=Autoimmune Diseases|work=WebMD|access-date=2018-10-04|language=en-US}}</ref>

Dr. William Pridgen's research of [[HSV-1]] (cold sore virus) as being involved in FM has conducted a successful Phase III clinical trial, which had been fast-tracked by the [[Food and Drug Administration]] (FDA), of a combination drug that suppresses this virus and also helps with pain. {{See also|Fibromyalgia drugs|Fibromyalgia drugs (see drug trials section for IMC-1)||||}}

On September 5th, 2018, EpicGenetics announced that Massachusetts General Hospital received approval from the FDA to test the BCG vaccine (an old Tuberculosis vaccine) on patients that tested positive with its FM/a® test.<ref name="painrep201809">{{Cite news|url=http://nationalpainreport.com/can-an-existing-vaccine-help-treat-fibromyalgia-8837139.html|title=Can an Existing Vaccine Help Treat Fibromyalgia?|last=Coghlan|first=Ed|date=2018-09-05|work=National Pain Report|access-date=2018-09-10|archive-url=|archive-date=|language=en-US}}</ref><ref>{{Cite news|url=http://www.prohealth.com/library/showArticle.cfm?libid=30644|title=Century-old Vaccine Gives New Hope to Fibromyalgia Community - Prohealth|last=Gregory Burch|first=Donna|date=2017-08-14|work=Prohealth|access-date=2018-08-09|archive-url=|archive-date=|language=en-US}}</ref>

Recognizing FM may involve activation of the [[immune system]] researchers performed [[Whole exome sequencing|exome sequencing]] on [[chemokine]] genes in a region of chromosome 17 identified in a genome-wide family association study. Their conclusion: "SNPs with significant TDTs were found in 36% of the cohort for [[CCL11]] and 12% for [[MEFV]], along with a protein variant in CCL4 (41%) that affects CCR5 down-regulation, supporting an immune involvement for FM."<ref name="Zhang2018">{{Cite journal|last=Zhang|first=Zhifang|last2=Feng|first2=Jinong|last3=Mao|first3=Allen|last4=Le|first4=Keith|last5=Placa|first5=Deirdre La|last6=Wu|first6=Xiwei|last7=Longmate|first7=Jeffrey|last8=Marek|first8=Claudia|last9=Amand|first9=R. Paul St|date=2018-06-21|title=SNPs in inflammatory genes CCL11, CCL4 and MEFV in a fibromyalgia family study|url=http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0198625|journal=PLOS ONE|language=en|volume=13|issue=6|pages=e0198625|doi=10.1371/journal.pone.0198625|issn=1932-6203|pmid=29927949|via=}}</ref>

Dr David Andersson from the Institute of Psychiatry, Psychology and Neuroscience at King’s College London, led a new study into Fibromyalgia being an immune system disorder.<ref>{{Cite journal|last=Goebel|first=Andreas|last2=Krock|first2=Emerson|last3=Gentry|first3=Clive|last4=Israel|first4=Mathilde R.|last5=Jurczak|first5=Alexandra|last6=Urbina|first6=Carlos Morado|last7=Sandor|first7=Katalin|last8=Vastani|first8=Nisha|last9=Maurer|first9=Margot|date=2021-07-07|title=Passive transfer of fibromyalgia symptoms from patients to mice|url=https://www.jci.org/articles/view/144201?key=51bf6d85e305f6b62f87#SEC4|journal=The Journal of Clinical Investigation|language=en|volume=131|issue=13|doi=10.1172/JCI144201|issn=0021-9738}}</ref><ref name=":0">{{Cite web|url=http://www.theguardian.com/society/2021/jul/01/fibromyalgia-may-be-a-condition-of-the-immune-system-not-the-brain-study|title=Fibromyalgia may be a condition of the immune system not the brain – study|date=2021-07-01|website=the Guardian|language=en|access-date=2021-07-08}}</ref><blockquote>Andersson and his colleagues harvested blood from 44 people with fibromyalgia and injected purified antibodies from each of them into different mice. The mice rapidly became more sensitive to pressure and cold, and displayed reduced grip strength in their paws. Animals injected with antibodies from healthy people were unaffected.<ref name=":0" /></blockquote><blockquote>Prof Camilla Svensson from the Karolinska Institute in Sweden, who was also involved in the study, said: “Antibodies from people with fibromyalgia living in two different countries, the UK and Sweden, gave similar results, which adds enormous strength to our findings.”<ref name=":0" /></blockquote>

=== Brain and spinal cord research ===
A 2004 study by Heffez et al. studied 270 patients with FM and found that 46% had [[cervical spinal stenosis]] and 20% [[chiari malformation]].<ref name="Heffez2004">{{Cite journal|last=Heffez|first=Dan S.|last2=Ross|first2=Ruth E.|last3=Shade-Zeldow|first3=Yvonne|last4=Kostas|first4=Konstantinos|last5=Shah|first5=Sagar|last6=Gottschalk|first6=Robert|last7=Elias|first7=Dean A.|last8=Shepard|first8=Alan|last9=Leurgans|first9=Sue E.|date=2004-04-09|title=Clinical evidence for cervical myelopathy due to Chiari malformation and spinal stenosis in a non-randomized group of patients with the diagnosis of fibromyalgia|url=https://link.springer.com/article/10.1007/s00586-004-0672-x|journal=European Spine Journal|language=en|volume=13|issue=6|pages=516–523|doi=10.1007/s00586-004-0672-x|issn=0940-6719|pmc=|pmid=15083352|via=}}</ref> In 2007, Heffez et al. saw significant improvement in physical and mental well-being was found in patients with cervical stenosis who received surgery.<ref name="Heffez2007">{{Cite journal|last=Heffez|first=Dan S.|last2=Ross|first2=Ruth E.|last3=Shade-Zeldow|first3=Yvonne|last4=Kostas|first4=Konstantinos|last5=Morrissey|first5=Mary|last6=Elias|first6=Dean A.|last7=Shepard|first7=Alan|date=2007|title=Treatment of cervical myelopathy in patients with the fibromyalgia syndrome: outcomes and implications|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2200733/|journal=European Spine Journal|volume=16|issue=9|pages=1423–1433|doi=10.1007/s00586-007-0366-2|issn=0940-6719|pmc=2200733|pmid=17426987|quote=|author-link=|author-link2=|author-link3=|author-link4=|author-link5=|via=}}</ref> A second study in 2007 by Andrew Holman found that 71% had cervical [[spinal cord]] compression.<ref>{{Cite journal|date=2008-07-01|title=Positional Cervical Spinal Cord Compression and Fibromyalgia: A Novel Comorbidity With Important Diagnostic and Treatment Implications|url=https://www.sciencedirect.com/science/article/pii/S1526590008004379|journal=The Journal of Pain|language=en|volume=9|issue=7|pages=613–622|doi=10.1016/j.jpain.2008.01.339|issn=1526-5900|last=|first=|quote=|author-link=Andrew Holman|author-link2=|author-link3=|author-link4=|author-link5=|via=}}</ref> It is important to note that in the past many patients were misdiagnosed with FM when further testing would have revealed the true source of their pain; the 2010 (updated in 2016) ACR criteria has helped curb misdiagnoses.<ref>{{Cite news|title=Fibromyalgia Expert Says Misdiagnosis is Rampant|url=http://nationalpainreport.com/fibromyalgia-expert-says-misdiagnosis-is-rampant-8832803.html|work=National Pain Report|date=2017-02-02|access-date=2018-11-26|language=en-US}}</ref><ref name="misdiagnosis">{{Cite news|title=Common Misdiagnoses of Fibromyalgia|url=https://www.webmd.com/fibromyalgia/guide/common-misdiagnoses-of-fibromyalgia#|work=WebMD|access-date=2018-11-26|language=en-US|last=|first=|date=|archive-url=|archive-date=}}</ref><ref name=":28" />

Various types of brain imaging are being used to research FM. (''See'': [[Fibromyalgia notable studies]] for images.)

In 2002, an [[Functional magnetic resonance imaging|fMRI]] study conducted by Richard Gracely and Daniel Claw found people with FM "have measurable pain signals in their brains, from a gentle finger squeeze that barely feels unpleasant to people without the disease."<ref name="sd2002">{{Cite web|url=https://www.sciencedaily.com/releases/2002/06/020607073056.htm|title=Fibromyalgia Pain Isn't All In Patient's Heads, New Brain Study Finds|last=|first=|date=Jun 7, 2002|website=sciencedaily.com|archive-url=|archive-date=|access-date=2018-08-09}}</ref> A 2007 study by Borsook et al., ''Neuroimaging revolutionizes therapeutic approaches to chronic pain'' found decreased gray matter density relative to controls in cingulate cortex (CC), medial prefrontal cortex (Med. PFC), parahippocampal gyrus (PHG) and insula.<ref name="Borsook2007">{{Cite journal|last=Borsook|first=David|last2=Moulton|first2=Eric A|last3=Schmidt|first3=Karl F|last4=Becerra|first4=Lino R|date=2007-09-11|title=Neuroimaging Revolutionizes Therapeutic Approaches to Chronic Pain|url=https://link.springer.com/article/10.1186/1744-8069-3-25|journal=Molecular Pain|language=en|volume=3|issue=1|pages=1744–8069-3-25|doi=10.1186/1744-8069-3-25|issn=1744-8069|pmid=17848191|via=}}</ref> In 2015, Loggia et al. imaged [[neuroinflammation]] due to [[Glial cell|glial]] activation using MR/PET imaging.<ref name="itn2018">{{Cite news|url=https://www.itnonline.com/article/mrpet-ultimate-imaging-hybrid|title=MR/PET: The Ultimate Imaging Hybrid|last=Ros|first=Pablo R.|date=2012-05-29|work=Imaging Technology News|access-date=2018-10-30|archive-url=|archive-date=|language=en}}</ref><ref name="Loggia2015">{{Cite journal|last=Loggia|first=Marco L.|last2=Chonde|first2=Daniel B.|last3=Akeju|first3=Oluwaseun|last4=Arabasz|first4=Grae|last5=Catana|first5=Ciprian|last6=Edwards|first6=Robert R.|last7=Hill|first7=Elena|last8=Hsu|first8=Shirley|last9=Izquierdo-Garcia|first9=David|date=2015-01-08|title=Evidence for brain glial activation in chronic pain patients|url=https://academic.oup.com/brain/article/138/3/604/333527?searchresult=1|journal=Brain|language=en|volume=138|issue=3|pages=604–615|doi=10.1093/brain/awu377|issn=1460-2156}}</ref> In 2017, López-Solà et al. identified three [[brain]] patterns based on [[Functional magnetic resonance imaging|fMRI]] responses to pressure pain and non-painful multisensory stimulation. "These patterns, taken together, discriminate FM from matched healthy controls with 92% sensitivity and 94% specificity."<ref name=":34">{{Cite journal|last=López-Solà|first=Marina|last2=Woo|first2=Choong-Wan|last3=Pujol|first3=Jesus|last4=Deus|first4=Joan|last5=Harrison|first5=Ben J.|last6=Monfort|first6=Jordi|last7=Wager|first7=Tor D.|date=2017|title=Towards a neurophysiological signature for fibromyalgia|url=https://www.ncbi.nlm.nih.gov/pubmed/27583567|journal=Pain|volume=158|issue=1|pages=34–47|doi=10.1097/j.pain.0000000000000707|issn=1872-6623|pmid=27583567|via=}}</ref> In 2018, Albrecht et al used [[Positron emission tomography|PET]] scans to document [[Glial cell|glial]] activation.<ref name=":52">{{Cite journal|last=Albrecht|first=Daniel S.|last2=Forsberg|first2=Anton|last3=Sandstrom|first3=Angelica|last4=Bergan|first4=Courtney|last5=Kadetoff|first5=Diana|last6=Protsenko|first6=Ekaterina|last7=Lampa|first7=Jon|last8=Lee|first8=Yvonne C.|last9=Höglundi|first9=Caroline Olgart|date=2018-09-14|others=Catana, Ciprian; Cervenka, Simon; Akeju, Oluwaseun; Lekander, Mats; Cohen, George; Halldin, Christer; Taylor, Norman; Kim, Minhae; Hooker, Jacob M.; Loggia, Marco L.|title=Brain glial activation in fibromyalgia – A multi-site positron emission tomography investigation|url=https://www.sciencedirect.com/science/article/pii/S0889159118302423|journal=Brain, Behavior, and Immunity|language=en|volume=|pages=|doi=10.1016/j.bbi.2018.09.018|issn=0889-1591|via=}}</ref> Also in 2018, Martucci et al. found unbalanced activity between the ventral and dorsal cervical spinal cord. Ventral neural processes were increased and dorsal neural processes were decreased which may reflect the presence of [[central sensitization]] contributing to [[fatigue]] and other bodily symptoms in FM.<ref>{{Cite journal|last=Martucci|first=Katherine T|last2=Weber|first2=Kenneth A|last3=Mackey|first3=Sean C|date=2018-10-03|title=Altered Cervical Spinal Cord Resting State Activity in Fibromyalgia|url=https://onlinelibrary.wiley.com/doi/abs/10.1002/art.40746|journal=Arthritis & Rheumatology|language=en|doi=10.1002/art.40746|issn=2326-5191}}</ref>

=== Fibromyalgia is not the same as depression ===
* Oct 24, 2003, [https://www.webmd.com/depression/news/20031024/fibromyalgia-isnt-depression#1 Fibromyalgia Isn't Depression]<ref name="webmd-notdepress" />
<blockquote>[[Depression]] doesn't cause the pain of fibromyalgia, a new study shows.<ref name="webmd-notdepress" /></blockquote>

<blockquote>"People still doubt fibromyalgia is a disease," Giesecke tells WebMD. "Previously, we found that fibromyalgia patients really do have increased central pain processing. Now we can show this is not affected by depression. Something is wrong here, and it is not at all connected with depression."<ref name="webmd-notdepress" /></blockquote>

<blockquote>"Giesecke's group looked at [[brain]] responses to painful stimuli, and then checked to see if there was any difference between depressed and nondepressed fibromyalgia patients. They showed the activation of areas of the brain related to pain were not different in patients with and without depression." But there is a difference between people with and without fibromyalgia, he says.<ref name="webmd-notdepress" /> </blockquote><blockquote>The researchers use an imaging device called [[functional magnetic resonance imaging]], or fMRI, to look at how the brain responds to pain. Study participants get a mildly painful pressure on their thumb, which makes the brain's pain centers "light up" on the image. Thumb pressure -- at a level healthy people hardly feel -- sets off a firestorm in the pain centers of fibromyalgia patients' brains.<ref name="webmd-notdepress" /></blockquote>
* Jun 30, 2013, [https://www.healthcentral.com/article/psychiatrists-admit-fibromyalgia-is-neuropathic-not-a-form-of-depression Psychiatrists Admit Fibromyalgia is Neuropathic - Not a Form of Depression]<ref name=":41">{{Cite web|url=https://www.healthcentral.com/article/psychiatrists-admit-fibromyalgia-is-neuropathic-not-a-form-of-depression|title=Psychiatrists Admit Fibromyalgia is Neuropathic – Not a Form of Depression - Causes - Chronic Pain {{!}} HealthCentral|last=Lee Richards|first=Karen|authorlink=|last2=|first2=|authorlink2=|date=Jun 30, 2013|website=www.healthcentral.com|language=en-US|access-date=2019-04-13}}</ref>
<blockquote>The study the APA referred to was published in the June issue of ''Brain'', a journal of neurology. The researchers investigated the function and structure of small nerve fibers in 25 FM patients, 10 patients with monopolar depression without pain and with healthy control subjects. Using three different methods of testing, the researchers found that compared with control subjects, patients with fibromyalgia, but not patients with depression, had impaired small fiber function.<ref name="brain-1857">http://brain.oxfordjournals.org/content/136/6/1857.abstract</ref><ref name=":41" /></blockquote><blockquote>The study authors stated, "This strengthens the notion that fibromyalgia syndrome is not a variant of depression, but rather represents an independent entity that may be associated with depressive symptoms". The findings also point "towards a neuropathic nature of pain in fibromyalgia syndrome."<ref name=":41" /></blockquote>
* Jan 10, 2019, [https://themighty.com/2019/01/do-i-have-fibromyalgia-or-depression/ 17 Signs You Have Fibromyalgia, Not 'Just' Depression]<ref name=":43">{{Cite web|url=https://themighty.com/2019/01/do-i-have-fibromyalgia-or-depression/|title=17 Signs You Have Fibromyalgia, Not 'Just' Depression|last=|first=|authorlink=|last2=|first2=|authorlink2=|date=Jan 10, 2019|website=The Mighty|language=en-US|archive-url=|archive-date=|access-date=2019-04-13}}</ref>
<blockquote>Fibromyalgia is [https://themighty.com/2018/05/what-fibromyalgia-gets-misdiagnosed-as/ often misdiagnosed as a number of other illnesses]. Though fibro has its own unique set of diagnostic criteria, many of its symptoms can mimic symptoms of other conditions – both physical and mental, acute and chronic.<ref name=":43" /></blockquote><blockquote>One of the most common conditions fibromyalgia gets mistaken for is depression. While each condition causes a unique set of symptoms, many of them may overlap. Like fibro, depression can cause physical symptoms such as pain, fatigue and brain fog. And living with a chronic physical symptoms can have significant effects on your mood, sometimes causing feelings of hopelessness, anxiety or general discontent – which are also symptoms of depression.<ref name=":43" /></blockquote>

== Comorbidities, overlapping conditions, and common symptoms ==
[[File:Fibromyalgia and comorbid conditions.JPG|700px|thumb|center|Comorbid conditions of fibromyalgia (FM) are [[ME/CFS]] which is the most common comorbidity,<ref name="ammes-overlap" /><ref name=":31" /> [[autoimmune disease|autoimmune disease]]s; [[migraine]]s; [[Multiple chemical sensitivity|multiple chemical sensitivities]] (MCS); and [[orthostatic intolerance]] (OI) / [[postural orthostatic tachycardia syndrome]] (POTS).<ref name="ammes-overlap" /><ref name="Firdous2012" /><ref name=":44" /> Overlapping conditions are [[depression]] and [[anxiety]]; [[Digestive problems|digestive conditions]], [[Menstrual|menstrual problems]]; [[Gulf War Illness]] (GWI); [[nervous system]] disorders; [[Hypotension|low blood pressure]] (Low BP); [[Pain#Pain in Fibromyalgia|other pain conditions]]; and [[sleep dysfunction]]/disturbance<ref name="ammes-overlap" /><ref name="Firdous2012" /><ref name="mayocause" />]]

===[[Allodynia]]===
*[http://chronicfatigue.about.com/od/glossary/g/allodynia.htm Allodynia: A Rare & Distinct Type of Pain in Fibromyalgia & ME/CFS]<ref name="Allodynia">{{Cite news|url=https://www.verywellhealth.com/allodynia-definition-and-types-fibromyalgia-715929|title=Allodynia: A Rare & Distinct Type of Pain in Fibromyalgia & ME/CFS|last=Dellwo|first=Adrienne|date=Feb 23, 2018|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=}}</ref> Types of Allodynia: Tactile; Mechanical; and Thermal. "Type of pain, generally on the skin, that's caused by something that wouldn't normally cause pain."<ref name="Allodynia" />
*[[Autoimmune disease]]s "Research suggests that RA and other inflammatory diseases may somehow increase the risk for fibromyalgia."<ref>{{Cite news|url=https://www.health.com/health/gallery/0,,20520705,00.html#restless-legs-0|title=7 Conditions Linked to Fibromyalgia|work=Health.com|access-date=2018-08-19|language=en}}</ref>

===[[Body temperature]]===
{{See also |Small fiber peripheral neuropathy}}
: for [[temperature sensitivity]]; burning, tingling, and prickling due to [[paresthesia]]; [[numbness]]; [[dry eye syndrome|dry eyes]] and [[dry mouth]]; and more.)<ref name=":02">{{Cite news|url=https://www.healthline.com/health/small-fiber-neuropathy#symptoms|title=Small Fiber Neuropathy: Symptoms, Treatment, Causes, and More|last=Vandergriendt|first=Carly|date=Jan 4, 2018|work=Healthline|access-date=2018-10-04|archive-url=|archive-date=|last2=Weatherspoon|first2=Deborah|language=en}}</ref><ref>{{Cite news|url=https://www.webmd.com/brain/understanding-peripheral-neuropathy-basics#3|title=Peripheral Neuropathy -- Symptoms, Types, and Causes of Peripheral Neuropathy|last=|first=|date=|work=WebMD|access-date=2018-10-04|archive-url=|archive-date=|page=3|language=en-US}}</ref>

<blockquote>When you're exposed to heat, does it feel like you're burning up? Does it seem impossible for you to cool off? Or maybe it's cold that bothers you, chilling you to the bone, leaving you unable to warm up? Or are you one of those people with fibromyalgia (FMS) and chronic fatigue syndrome (ME/CFS) who is cold all the time, or hot all the time, or alternately hot or cold while out of sync with the environment?<ref name=":2">{{Cite news|url=https://www.verywellhealth.com/temperature-sensitivity-in-fibromyalgia-and-mecfs-716025|title=Temperature Sensitivity in Fibromyalgia & ME/CFS|last=Dellwo|first=Adrienne|date=Mar 15, 2018|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=}}</ref></blockquote>

=== [[Costochondritis]]===
[[File:Costal cartilages.JPG|200px|thumb|left|Costochondritis is inflammation of the costal cartilages (shown in red) causing chest and ribcage pain. From BodyParts3D/Anatomography (Life Science db.jp), license CC BY-SA 2.1 JP.]]

<blockquote>Costochondritis is a condition that causes pain in the cartilage that connect your ribs to your sternum (breastbone). Cartilage is the tough, bendable tissue that protects your bones where they rub against each other.<ref name=":10">{{Cite web|url=https://www.drugs.com/cg/costochondritis.html|title=Costochondritis - What You Need to Know|website=Drugs.com|language=en|access-date=2020-01-27}}</ref></blockquote>
Costochondritis causes pain in the area where your sternum joins with your ribs. The pain may come and go, and may get worse over time. The pain may be sharp, or dull and aching. It may be painful to touch your chest. The pain may spread to your back, abdomen, or down your arm. It may get worse when you move, breathe deeply, or push or lift an object. The pain may make it hard for you to sleep or do your usual activities.<ref name=":10" /><blockquote>People tend to describe the pain as stabbing, burning, aching, confined to one spot, usually in the very center of the chest, but it may radiate outward.<ref>{{Cite web|url=https://www.medicalnewstoday.com/articles/321635.php|title=Can fibromyalgia cause chest pain?|website=Medical News Today|language=en|access-date=2020-01-27}}</ref></blockquote>

===[[Depression]] and [[anxiety]]===
{{See also|Depression|Depression|Anxiety|Anxiety}}Fibromyalgia sufferers are "up to three times more likely to have depression at the time of their diagnosis than someone without fibromyalgia."<ref name="webmd-depress">{{Cite news|url=https://www.webmd.com/fibromyalgia/fibromyalgia-and-depression#1|title=Fibromyalgia and Depression|work=WebMD|access-date=2018-08-19|language=en-US}}</ref> Up to 20% of Fibromyalgia patients will have either depression or anxiety.<ref name="adaa">{{Cite web|url=https://adaa.org/understanding-anxiety/related-illnesses/other-related-conditions/fibromyalgia|title=Fibromyalgia|website = Anxiety and Depression Association of America|language=en|access-date=2018-08-19}}</ref>

====<span id="depression">Differences between depression and fibromyalgia====

* Depression and anxiety are common in fibromyalgia but are not core diagnostic symptoms, so they are not required for a diagnosis of Fibromyalgia, and a significant number of people with fibromyalgia have never had depression.<ref name="Koroschetz2011-symptoms">{{Cite journal|last=Koroschetz|first=Jana|last2=Rehm|first2=Stefanie E.|last3=Gockel|first3=Ulrich|last4=Brosz|first4=Mathias|last5=Freynhagen|first5=Rainer|last6=Tölle|first6=Thomas R.|last7=Baron|first7=Ralf|date=2011-05-25|title=Fibromyalgia and neuropathic pain - differences and similarities. A comparison of 3057 patients with diabetic painful neuropathy and fibromyalgia|url=https://doi.org/10.1186/1471-2377-11-55|journal=BMC Neurology|volume=11|issue=1|pages=55|doi=10.1186/1471-2377-11-55|issn=1471-2377|pmc=3125308|pmid=21612589}}</ref><ref name="ACR1990" /><ref name="ACR2010" />
* Fibromyalgia is a diagnosis of '''chronic widespread pain''', but pain is not needed for a diagnosis of depression.
*2007, The classification of fibromyalgia syndrome<ref name="Muller2007">{{Cite journal|last=Müller|first=W.|last2=Schneider|first2=E. M.|last3=Stratz|first3=T.|date=2007-09-01|title=The classification of fibromyalgia syndrome|url=https://doi.org/10.1007/s00296-007-0403-9|journal=Rheumatology International|language=en|volume=27|issue=11|pages=1005–1010|doi=10.1007/s00296-007-0403-9|issn=1437-160X}}</ref> [https://link.springer.com/article/10.1007%2Fs00296-007-0403-9 (Abstract)]
*2008, The relationship between fibromyalgia and major depressive disorder: a comprehensive review<ref name="Pae2008">{{Cite journal|last=Pae|first=Chi-Un|author-link=|last2=Luyten|first2=Patrick|author-link2=|last3=Marks|first3=David M.|author-link3=|last4=Han|first4=Changsu|author-link4=|last5=Park|first5=Sung-Hwan|author-link5=|last6=Patkar|first6=Ashwin A.|author-link6=|last7=Masand|first7=Prakash S.|last8=Houdenhove|first8=Boudewijn Van|author-link8=Boudewijn Van Houdenhove|date=2008-08-01|title=The relationship between fibromyalgia and major depressive disorder: a comprehensive review|url=https://doi.org/10.1185/03007990802288338|journal=Current Medical Research and Opinion|volume=24|issue=8|pages=2359–2371|doi=10.1185/03007990802288338|issn=0300-7995|pmc=|pmid=18606054|access-date=|quote=|via=}}</ref> [https://doi.org/10.1185/03007990802288338 (Abstract)]
*2010, Anxiety and depressive symptoms in fibromyalgia are related to poor perception of health but not to pain sensitivity or cerebral processing of pain<ref name="Jensen2010">{{Cite journal|last=Jensen|first=Karin B.|last2=Petzke|first2=Frank|last3=Carville|first3=Serena|last4=Fransson|first4=Peter|last5=Marcus|first5=Hanke|last6=Williams|first6=Steven C. R.|last7=Choy|first7=Ernest|last8=Mainguy|first8=Yves|last9=Gracely|first9=Richard|date=2010|title=Anxiety and depressive symptoms in fibromyalgia are related to poor perception of health but not to pain sensitivity or cerebral processing of pain|url=https://onlinelibrary.wiley.com/doi/abs/10.1002/art.27649|journal=Arthritis & Rheumatism|language=en|volume=62|issue=11|pages=3488–3495|doi=10.1002/art.27649|issn=1529-0131}}</ref> [https://doi.org/10.1002/art.27649 (Abstract)]
*2012, Fibromyalgia a discrete entity?<ref name="Ablin2012">{{cite journal | last=Ablin | first=Jacob N. | last2=Buskila | first2=Dan | last3=Van Houdenhove | first3=Boudewijn | last4=Luyten | first4=Patrick | last5=Atzeni | first5=Fabiola | last6=Sarzi-Puttini | first6=Piercarlo | title=Is fibromyalgia a discrete entity? | journal=Autoimmunity Reviews | url=https://doi.org/10.1016%2Fj.autrev.2011.10.018 | volume=11 | issue=8 | pages = 585–588 | date=Jun 2012 | issn=1568-9972 | doi=10.1016/j.autrev.2011.10.018 }}</ref> [https://onlinelibrary.wiley.com/doi/pdf/10.1002/art.27649 (Full text)]
*2012 [https://www.webmd.com/depression/news/20031024/fibromyalgia-isnt-depression Fibromyalgia isn't depression] - WebMD<ref name="webmd-notdepress">{{Cite web|url=https://www.webmd.com/depression/news/20031024/fibromyalgia-isnt-depression|title=Fibromyalgia Isn't Depression|last=DeNoon|first=Daniel J.|website=WebMD|language=en|access-date=2021-03-27}}</ref>

===[[Dry eye syndrome]]===
<ref name=":110">{{Cite news|url=https://www.news-medical.net/health/Fibromyalgia-and-Dry-Eyes-and-Mouth.aspx|title=Fibromyalgia and Dry Eyes and Mouth|last=Mandal|first=Ananya|date=2013-06-30|work=News-Medical.net|access-date=2018-10-04|archive-url=|archive-date=|last2=Cashin-Garbutt|first2=April|language=en}}</ref>

===[[Fatigue]]===
<blockquote>Fatigue is a universal symptom of fibromyalgia. It is often most marked when arising from sleep in the morning. A typical quote is “''No matter how much sleep I get, it feels like a truck ran me over in the morning'' (20).” Minor activities often seem to aggravate the fatigue.<ref name=":29">{{Cite web|url=https://www.docsopinion.com/2017/11/08/causes-fatigue-tiredness-chronic-fatigue/|title=19 Important Causes of Fatigue - Tiredness and Chronic Fatigue Explained|website=www.docsopinion.com|access-date=2019-01-30}}</ref></blockquote>

===[[Fibro fog]] and [[Cognitive dysfunction]]===
*'Mental confusion along with difficulty in concentration and loss of memory is often termed “[[fibro fog]]"'.<ref name=":3">{{Cite news|url=https://www.news-medical.net/health/What-is-Fibro-Fog-Fibromyalgia-and-Cognitive-Dysfunction.aspx|title=What is Fibro Fog? - Fibromyalgia and Cognitive Dysfunction|last=Mandal|first=Ananya|date=2013-06-03|work=News-Medical.net|access-date=2018-08-09|archive-url=|archive-date=|language=en}}</ref>

===[[Digestive problems|Gastrointestinal problems]]===
*[[Irritable bowel syndrome]]:
:<blockquote>Fibromyalgia, chronic fatigue syndrome and irritable bowel syndrome (IBS) frequently go together. No one really knows why, but we do know that all three conditions can include imbalances of serotonin -- although in fibromyalgia (FMS) and Chronic Fatigue Syndrome (CFS or ME/CFS) it's an imbalance in the brain, while with IBS it's in the gut.<ref name=":4">{{Cite news|url=https://www.verywellhealth.com/irritable-bowel-syndrome-in-fibromyalgia-cfs-716167|title=Irritable Bowel Syndrome in Fibromyalgia & ME/CFS|last=Dellwo|first=Adrienne|date=Jan 28, 2018|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=}}</ref> </blockquote>
===[[Gulf War Illness]]===
GWI increases risk of developing fibromyalgia.<ref name="VA">{{Cite web|url=https://www.publichealth.va.gov/exposures/gulfwar/fibromyalgia.asp|title=Fibromyalgia in Gulf War Veterans - Public Health|last=Administration|first=US Department of Veterans Affairs, Veterans Health|website=www.publichealth.va.gov|language=en|access-date=2018-08-19}}</ref>

===[[Interstitial cystitis]]===
Interstitial cystitis causes a painful bladder.<ref name=":5">{{Cite news|url=https://www.verywellhealth.com/chronic-fatigue-syndrome-interstitial-cystitis-716168|title=Fibromyalgia, Chronic Fatigue Syndrome & Interstitial Cystitis|last=Dellwo|first=Adrienne|date=Feb 16, 2018|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=}}</ref>
:"Fibromyalgia, chronic fatigue syndrome and [[interstitial cystitis]] (IC) -- a painful bladder condition -- frequently occur together. Women may be up to 10 times more likely than men to develop it."<ref name=":5" />
*[Interstitial cystitis]]/painful bladder syndrome and associated medical conditions with an emphasis on irritable bowel syndrome, fibromyalgia and [[Chronic fatigue syndrome|chronic fatigue syndrome.]]<ref name="Nickel2010">{{Cite journal|last=Nickel|first=J. Curtis|last2=Tripp|first2=Dean A.|last3=Pontari|first3=Michel|last4=Moldwin|first4=Robert|last5=Mayer|first5=Robert|last6=Carr|first6=Lesley K.|last7=Doggweiler|first7=Ragi|last8=Yang|first8=Claire C.|last9=Mishra|first9=Nagendra|date=2010|title=Interstitial cystitis/painful bladder syndrome and associated medical conditions with an emphasis on irritable bowel syndrome, fibromyalgia and chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/20719340|journal=The Journal of Urology|volume=184|issue=4|pages=1358–1363|doi=10.1016/j.juro.2010.06.005|issn=1527-3792|pmid=20719340|via=}}</ref>

===Language Impairment or word problems===
*[[Word-finding problems]]
:*"Searching their brains for simple words that they just can't remember. On other occasions, individuals with these diagnoses may find it hard to write or even understand language."<ref name=":6">{{Cite news|url=https://www.verywellhealth.com/language-impairment-in-fibromyalgia-cfs-716024|title=Language Impairment in Fibromyalgia and Chronic Fatigue Syndrome|last=Dellwo|first=Adrienne|date=Feb 12, 2018|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=}}</ref>
*"The diagnosis of [[aphasia]] is a condition that robs you of the ability to communicate. It can affect your ability to speak, write and understand language, both verbal and written"<ref>{{Cite news|url=http://www.mayoclinic.org/diseases-conditions/aphasia/basics/definition/con-20027061|title=Aphasia - Symptoms and causes|work=Mayo Clinic|access-date=2018-08-09|language=en}}</ref> but with [[dysphasia]] you will have those symptoms and trouble listening and doing numerical calculations.<ref name=":36" />
===[[Migraine]]===
<blockquote>Both fibromyalgia and migraine may reflect problems in the brain’s pain processing center. It is believed that both conditions are caused by excitation of the nervous system or an over-response to stimuli. Stress is usually cited as a trigger for both migraine and fibromyalgia attacks.<ref name=":32">{{Cite news|url=https://migrainecenters.com/blog/migraines-and-fibromyalgia/|title=Migraines and Fibromyalgia - Migraine Centers|date=2016-05-06|work=Migraine Centers|access-date=2018-08-19|language=en-US}}</ref></blockquote>

===[[Multiple chemical sensitivity|Multiple Chemical Sensitivity]] (MCS)===
It is thought that both Fibromyalgia and MCS are [[central sensitization|central sensitization]] syndromes.<ref>{{Cite news|url=https://www.verywellhealth.com/chemical-sensitivity-in-fibromyalgia-716170|title=Multiple Chemical Sensitivity in Fibromyalgia & ME/CFS|last=Dellwo|first=Adrienne|date=Jul 23, 2018|work=Verywell Health|access-date=2018-08-19|archive-url=|archive-date=}}</ref>

===OBGYN===
*[https://www.verywellhealth.com/menstrual-periods-and-fibromyalgia-715596 Menstrual Periods with Fibromyalgia: Personal Stories]
<blockquote>You may have heard about a possible link between gynecologic surgery (such as a hysterectomy) and the development of fibromyalgia, and doctors have long suspected that fibromyalgia has strong -[[Hormone|hormonal]] ties and triggers. This does not seem surprising as we've long suspected a link between endocrine disorders, gynecological conditions, and autoimmune conditions.<ref name=":7">{{Cite news|url=https://www.verywellhealth.com/fibromyalgia-tied-to-hysterectomy-gynecologic-disease-715626|title=Fibromyalgia Tied to Hysterectomy, Gynecologic Disease|last=Dellwo|first=Adrienne|date=Feb 16, 2018|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=}}</ref></blockquote>

===[[Orthostatic intolerance]] (OI)===
[[Postural orthostatic tachycardia syndrome]] (POTS) and other forms of orthostatic intolerance often occur in people with fibromyalgia.<ref name=":44">{{Cite journal|last=Yun|first=Dong Joo|last2=Choi|first2=Han Na|last3=Oh|first3=Gun-Sei|date=2013|title=A Case of Postural Orthostatic Tachycardia Syndrome Associated with Migraine and Fibromyalgia|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3710947/|journal=The Korean Journal of Pain|volume=26|issue=3|pages=303–306|doi=10.3344/kjp.2013.26.3.303|issn=2005-9159|pmid=23862007|via=}}</ref> Symptoms can include [[hypotension|low blood pressure]] and/or sudden high blood pressure, [[dizziness]], [[syncope|fainting]].
*Dr Charles Lapp found that fibromyalgia ymptoms and ME/CFS symptoms predicted the outcome of [[Tilt Table Testing]] foe [[orthostatic intolerance]].<ref>{{Cite web|url=http://drlapp.com/wp-content/uploads/TTT_symptoms.pdf|title=Symptoms Predict the Outcome of Tilt Table Testing in CFS/ME/FM|last=Lapp|first=Charles W.|last2=Black|first2=Laura|date=|website=drlapp.com|archive-url=|archive-date=|access-date=|last3=Smith|first3=Rebekah S.}}</ref>
*Orthostatic intolerance may often be l overlooked in fibromyalgia patients.<ref>{{Cite news|url=https://www.healthrising.org/blog/2017/09/21/fibromyalgia-problems-standing-orthostatic-intolerance/|title=An Overlooked Issue in Fibromyalgia? Study Highlights Orthostatic Intolerance - Problems Standing - Health Rising|last=Johnson|first=Cort|date=2017-09-21|work=Health Rising|access-date=2018-08-09|archive-url=|archive-date=|language=en-US}}</ref>
===[[Raynaud's syndrome]]===
<blockquote>In Raynaud's syndrome, the blood vessels constrict more than they should, which allows less blood to get through. That not only makes your extremities cold, it makes them extremely difficult to warm up. The most commonly affected body parts are the fingers and toes, but your lips, nose, ear lobes, knees, and nipples may also be involved.</blockquote>
<blockquote>Raynaud's isn't all about the cold, though. The diminished blood flow can cause pain in the affected areas, and it may also cause the skin there to turn blue. Skin ulcers (sores) are possible, since prolonged episodes of low blood flow can damage your tissues.<ref name="reynaulds">{{Cite web|url=https://www.verywellhealth.com/raynauds-syndrome-chronic-fatigue-716185|title=Cold Hands & Feet? Raynaud's Syndrome in Fibromyalgia & ME/CFS|last=Dellwo|first=Adrienne|date=Jan 28, 2018|work=Verywell Health|access-date=2018-10-11|archive-url=|archive-date=}}</ref></blockquote>

===[[Sleep dysfunction]]===
*Vatthauer et al. (2015) found that sleep was associated with task-negative [[brain]] activity in fibromyalgia participants with comorbid chronic [[insomnia]].<ref name="Vatthauer2015">{{Cite journal|last=Vatthauer|first=Karlyn E|last2=Craggs|first2=Jason G|last3=Robinson|first3=Michael E|last4=Staud|first4=Roland|last5=Berry|first5=Richard B|last6=Perlstein|first6=William M|last7=McCrae|first7=Christina S|date=2015-11-12|title=Sleep is associated with task-negative brain activity in fibromyalgia participants with comorbid chronic insomnia|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4648619/|journal=Journal of Pain Research|volume=8|pages=819–827|doi=10.2147/JPR.S87501|issn=1178-7090|pmc=|pmid=26648751|via=|issue=|quote=|author-link=|author-link2=|author-link3=|author-link4=Roland Staud|author-link5=}}</ref>
<blockquote>The present results of this study suggest that long-term, comorbid pain and sleep disturbance may be associated with increased activation in core default mode brain areas that is above and beyond long-term pain disturbance alone.<ref name="Vatthauer2015" /></blockquote>

*"Most people with fibromyalgia have an associated sleep disorder that makes it difficult for them to get the deep, restorative sleep they need."<ref name=":8">{{Cite news|url=https://www.prohealth.com/library/fibromyalgia-and-sleep-38954|title=Fibromyalgia and Sleep - Prohealth|date=2016-01-11|work=Prohealth|access-date=2018-08-09|language=en-US}}</ref>

===[[Temporomandibular joint disorder]] (TMJ/TMD) ===
[[File:Skull_diagram.png|350px|thumb|right|The temporomandibular joint is the joint between the mandible (light blue) and the temporal bone (orange) of the skull]]
* [https://www.sciencedirect.com/science/article/pii/S2255502114001758 Temporomandibular disorders in fibromyalgia syndrome: a short-communication]<ref>{{Cite journal|last=Soares Gui|first=Maisa|last2=Pimentel|first2=Marcele Jardim|last3=Rizzatti-Barbosa|first3=C'elia Marisa|date=2015-03-01|title=Temporomandibular disorders in fibromyalgia syndrome: a short-communication|url=https://www.sciencedirect.com/science/article/pii/S2255502114001758|journal=Revista Brasileira de Reumatologia (English Edition)|language=en|volume=55|issue=2|pages=189–194|doi=10.1016/j.rbre.2014.07.004|issn=2255-5021|via=ScienceDirect}}</ref><ref>{{Cite news|url=https://www.whitesmilesforlife.com/blog/study-probes-pain-link-between-tmj-fibromyalgia/|title=Study Probes Pain Link Between TMJ, Fibromyalgia|date=2016-05-03|work=Kent E. White, DDS|access-date=2018-08-19|language=en-US}}</ref>

Other than [[headache]]s, the symptoms of TMJ/TMD are quite distinct from symptoms of FMS and ME/CFS. They include:
*Jaw pain
*Discomfort or difficulty chewing
*Painful clicking in the jaw
*Difficulty opening or closing the mouth
*Headaches
*Locking jaw
*Teeth that don't come together properly<ref>{{Cite news|url=https://www.verywellhealth.com/tmj-in-fibromyalgia-chronic-fatigue-syndrome-716175|title=TMJ in Fibromyalgia and Chronic Fatigue Syndrome|last=Dellwo|first=Adrienne|date=Mar 31, 2018|work=Verywell Health|access-date=2018-08-22|archive-url=|archive-date=}}</ref>

===[[Thyroid disease]]===
<blockquote>People with [[Hashimoto's thyroiditis (hypothyroidism)|Hashimoto's autoimmune thyroid disease]] often experience significant fatigue and body aches. While these symptoms are common in Hashimoto's, they can also be markers of other diseases, like chronic fatigue syndrome or fibromyalgia.<ref name=":9">{{Cite news|url=https://www.verywellhealth.com/relationship-between-cfs-fibromyalgia-and-aitd-3231677|title=A Comparison of Chronic Fatigue, Fibromyalgia, and Thyroid Disease|last=Shomon|first=Mary|date=Feb 21, 2018|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=}}</ref> </blockquote>

===Other symptoms===
*[http://chronicfatigue.about.com/od/whatisfibromyalgia/a/fibrosymptoms.htm Symptoms of Fibromyalgia]<ref>{{Cite news|url=https://www.verywellhealth.com/fibromyalgia-symptoms-716139|title=Symptoms of Fibromyalgia|last=Dellwo|first=Adrienne|date=May 16, 2018|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=}}</ref> (On all the many symptoms and conditions of and related to fibromyalgia.)
*Fibromyalgia Syndrome: An Overview of Pathophysiology, Diagnosis and Management [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3394355/ Conditions associated with fibromyalgia. (Table 1)]<ref name="Firdous2012" />

==Treatment==

===United States===
'''Rheumatology and primary care providers: Diagnosing and treatment'''

*2012, [https://www.mayoclinicproceedings.org/article/S0025-6196(12)00299-6/abstract A Framework for Fibromyalgia Management for Primary Care Providers]<ref>{{Cite journal|last=Arnold|first=Lesley M.|last2=Clauw|first2=Daniel J.|last3=Dunegan|first3=L. Jean|last4=Turk|first4=Dennis C.|date=2012|title=A Framework for Fibromyalgia Management for Primary Care Providers|url=https://www.mayoclinicproceedings.org/article/S0025-6196(12)00299-6/abstract|journal=Mayo Clinic Proceedings|language=English|volume=87|issue=5|pages=488–496|doi=10.1016/j.mayocp.2012.02.010|issn=0025-6196|via=}}</ref> Rheumatologists stopped treating fibromyalgia patients and primary care providers began treatment managment although rheumatologists are most often the specialist to diagnose.
{{See also|Fibromyalgia disability process}}

===Drugs===
{{Main article |page_name = Fibromyalgia drugs}}

=== Therapies ===

==== Exercise ====
''Please Note'': These treatments are for fibromyalgia patients and '''not''' [[ME/CFS]] sufferers due to it's hallmark symptom of [[post-exertional malaise]].
[[File:Warm water exercise.JPG|200px|thumb|left|Warm water exercise is best for fibromyalgia. Start slow and don't push through the pain<ref name=":11" />]]

*[https://www.verywellhealth.com/warm-water-exercise-for-fibromyalgia-716059 Warm Water Exercise for Fibromyalgia]<ref name=":11">{{Cite news|url=http://chronicfatigue.about.com/od/treatingfmscfs/a/warmwaterFMS.htm|title=Warm Water Exercise for Fibromyalgia|last=Dellwo|first=Adrienne|date=Nov 19, 2017|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=}}</ref><ref>{{Cite journal|last=Munguía-Izquierdo|first=D.|last2=Legaz-Arrese|first2=A.|date=2007|title=Exercise in warm water decreases pain and improves cognitive function in middle-aged women with fibromyalgia|url=https://www.ncbi.nlm.nih.gov/pubmed/18173915|journal=Clinical and Experimental Rheumatology|volume=25|issue=6|pages=823–830|issn=0392-856X|pmid=18173915|via=}}</ref><ref>{{Cite news|url=https://www.prohealth.com/fibromyalgia/library/aquatic-exercise-training-fibromyalgia-85081?|title=Aquatic exercise training for fibromyalgia|date=2018-08-29|work=Prohealth|access-date=2018-09-01|language=en-US}}</ref><ref>{{Cite journal|last=Bidonde|first=Julia|last2=Busch|first2=Angela J.|last3=Webber|first3=Sandra C.|last4=Schachter|first4=Candice L.|last5=Danyliw|first5=Adrienne|last6=Overend|first6=Tom J.|last7=Richards|first7=Rachel S.|last8=Rader|first8=Tamara|date=2014-10-28|title=Aquatic exercise training for fibromyalgia|url=https://www.ncbi.nlm.nih.gov/pubmed/25350761|journal=The Cochrane Database of Systematic Reviews|issue=10|pages=CD011336|doi=10.1002/14651858.CD011336|issn=1469-493X|pmid=25350761}}</ref>

<blockquote>Several studies have found that warm-water pool exercise is a beneficial treatment for fibromyalgia. A very large survey of patients found that 26% have used pool therapy, rating it as very effective.<ref name=":45">{{Cite journal|last=Bennett|first=Robert M.|author-link=|last2=Jones|first2=Jessie|author-link2=|last3=Turk|first3=Dennis C.|author-link3=|last4=Russell|first4=I. Jon|author-link4=|last5=Matallana|first5=Lynne|author-link5=|date=Mar 9, 2007|title=An internet survey of 2,596 people with fibromyalgia|url=https://doi.org/10.1186/1471-2474-8-27|journal=BMC Musculoskeletal Disorders|volume=8|issue=1|pages=27|doi=10.1186/1471-2474-8-27|issn=1471-2474|pmc=1829161|pmid=17349056|quote=|via=}}</ref> The same survey found 74% of patients found heat helpful - either warm water or heat packs.<ref name=":45" /> Warm water especially important in FMS because many people with the condition are intolerant of cold. A warm-water pool is one that's kept around 89.6 degrees Fahrenheit (32 Celsius), which is several degrees warmer than most heated pools.<ref name=":11" /></blockquote>

* Moderate aerobic exercise and weights with six to eight reps and then a day or two of rest in between. Do not start a program if you are in a flare.<ref>{{Cite web|url=http://www.arthritis.org/living-with-arthritis/tools-resources/expert-q-a/fibromyalgia-questions/fibromyalgia-exercise.php|title=Fibromyalgia Exercise {{!}} Exercising with Fibromyalgia|last=Ronenn|first=Roubenoff|date=|website=www.arthritis.org|archive-url=|archive-date=|access-date=2018-08-09}}</ref>

*[https://www.youtube.com/watch?v=BauJYuJwFsI Easy fibromyalgia exercises and motivation to keep you healthy!]<ref>{{Cite web|url=https://www.youtube.com/watch?v=BauJYuJwFsI|title=Easy Fibromyalgia exercises and motivation to keep you healthy!|last=Suarez|first=Eric|date=Jun 21, 2011|website=YouTube|archive-url=|archive-date=|access-date=Aug 9, 2018}}</ref> Video

*[http://chronicfatigue.about.com/od/whatisfibromyalgia/a/Fibromyalgia-Myth-Vs-Fact.htm Fibromyalgia Myth vs. Fact]<ref name=":15">{{Cite news|url=https://www.verywellhealth.com/fibromyalgia-myth-vs-fact-716131|title=Fibromyalgia: What's Myth, What's Fact?|last=Dellwo|first=Adrienne|date=Jun 8, 2016|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=|at=Myth #3 People With Fibromyalgia Need More Exercise}}</ref> Heading: ''Myth #3: People With Fibromyalgia Need More Exercise''. Appropriate exercise, which each patient needs to gauge for themselves.<ref name=":15" />

==== Massage ====

*2014, [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3930706/ Massage Therapy for Fibromyalgia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials]<ref>{{Cite journal|last=Li|first=Yan-hui|last2=Wang|first2=Feng-yun|last3=Feng|first3=Chun-qing|last4=Yang|first4=Xia-feng|last5=Sun|first5=Yi-hua|date=2014-02-20|title=Massage Therapy for Fibromyalgia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3930706/|journal=PLoS ONE|volume=9|issue=2|doi=10.1371/journal.pone.0089304|issn=1932-6203|pmc=|pmid=24586677|pages=|via=}}</ref>

*2016, [http://chronicfatigue.about.com/od/alternativetreatments/a/bodywork.htm Massage, Rolfing & Other Bodywork - Are They Effective Fibromyalgia & Chronic Fatigue Syndrome Treatments?]<ref>{{Cite news|url=https://www.verywellhealth.com/massage-rolfing-other-bodywork-715645|title=Massage, Rolfing, Reiki: Do They Work for Fibromyalgia & ME/CFS?|last=Dellwo|first=Adrienne|date=Aug 10, 2017|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=}}</ref>

==== Acupuncture ====

*2004, [[U.S. Department of Health and Human Services]] (HHS) and Centers for Medicare and Medicaid Services (CMS) ruled April 16, 2004, a noncoverage determination for acupuncture.<ref>{{Cite web|url=https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R11NCD.pdf|title=CMS Manual System Pub. 100-03 Medicare National Coverage Determinations|last=|first=|date=Apr 16, 2004|website=CMS.gov|format=PDF|archive-url=|archive-date=|access-date=}}</ref>

*2005, [http://acupunctureschoolonline.com/acupuncture-good-for-fibromyalgia.html Acupuncture Good for Fibromyalgia?] <ref name=":16">{{Cite web|url=http://acupunctureschoolonline.com/acupuncture-good-for-fibromyalgia.html|title=Acupuncture Good for Fibromyalgia?|last=|first=|date=Oct 2, 2012|website=Acupuncture School Online|archive-url=|archive-date=|access-date=2018-08-09}}</ref> "Acupuncture gave no significant pain relief to fibromyalgia patients."<ref name=":16" />

*2016, [http://www.sciencedirect.com/science/article/pii/S2095496416602352 Short-term complementary and alternative medicine on quality of life in women with fibromyalgia] <ref name=":25">{{Cite journal|date=2016-01-01|title=Short-term complementary and alternative medicine on quality of life in women with fibromyalgia|url=https://www.sciencedirect.com/science/article/pii/S2095496416602352|journal=Journal of Integrative Medicine|language=en|volume=14|issue=1|pages=29–35|doi=10.1016/S2095-4964(16)60235-2|issn=2095-4964}}</ref> "There was no significant improvement in pain or reduction of tender points in any of the groups studied, at the end of the 8th session."<ref name=":25" />

*2016, [https://fibromyalgianewstoday.com/2016/02/01/acupuncture-does-not-reduce-pain-for-women-with-fibromyalgia/ Acupuncture Does Not Appear to Relieve Pain in Fibromyalgia Patients]<ref>{{Cite news|url=https://fibromyalgianewstoday.com/2016/02/01/acupuncture-does-not-reduce-pain-for-women-with-fibromyalgia/|title=Acupuncture Does Not Appear to Relieve Pain in Fibromyalgia Patients - Fibromyalgia News Today|last=Semedo|first=Daniela|date=2016-02-01|work=Fibromyalgia News Today|access-date=2018-08-09|archive-url=|archive-date=|language=en-US}}</ref>

== Controversy ==
=== Dr. Frederick Wolfe ===
Dr. [http://rheummd.org/members/fwolfe Frederick Wolfe], the director of the [https://www.arthritis-research.org/ National Databank for Rheumatic Diseases] and the lead author of the 1990 paper that first defined the diagnostic guidelines for fibromyalgia, says he has become cynical and discouraged about the diagnosis. He now considers the condition a physical response to stress, depression, and economic and social anxiety.<ref>{{Cite journal|last=Wolfe|first=Frederick|last2=Walitt|first2=Brian|date=2016|title=Fibromyalgia: A Short Commentary|url=http://headache.imedpub.com/fibromyalgia-a-short-commentary.pdf|journal=Journal of Headache & Pain Management|volume=1|issue= 3|pages=27|via=iMedPubJournals}}</ref><ref>{{Cite news|url=https://www.news-medical.net/news/20130322/Fibromyalgia-an-interview-with-Dr-Frederick-Wolfe-University-of-Kansas-School-of-Medicine.aspx|title=Fibromyalgia: an interview with Dr Frederick Wolfe, University of Kansas School of Medicine|last=Cashin-Garbutt|first=April|date=2013-03-22|work=News-Medical.net|access-date=2018-08-09|archive-url=|archive-date=|language=en}}</ref>

=== Fibromyalgia vs Chiari malformation ===
Some individuals diagnosed with FMS were undergoing surgery for [[chiari malformation]] (CM). These are two separate conditions; FMS cannot be resolved by undergoing a risky CM surgery.

*2011, [https://www.ncbi.nlm.nih.gov/pubmed/21135714 Is Chiari I malformation associated with fibromyalgia?]<ref>{{Cite journal|last=Watson|first=Nathaniel F.|last2=Buchwald|first2=Dedra|last3=Goldberg|first3=Jack|last4=Maravilla|first4=Kenneth R.|last5=Noonan|first5=Carolyn|last6=Guan|first6=Qingyan|last7=Ellenbogen|first7=Richard G.|date=2011|title=Is Chiari I malformation associated with fibromyalgia?|url=https://www.ncbi.nlm.nih.gov/pubmed/21135714|journal=Neurosurgery|volume=68|issue=2|pages=443–448; discussion 448–449|doi=10.1227/NEU.0b013e3182039a31|issn=1524-4040|pmid=21135714|via=}}</ref>
::Conclusion: Most patients with FM do not have [[CIM]] pathology. Future studies should focus on dynamic neuroimaging of craniocervical neuroanatomy in patients with FM.
*2015, [https://www.massmecfs.org/resource-library/9-treatment/172-cfidsfm-and-chiari-malformation-surgery CFS/FM and Chiari Malformation Surgery]<ref>{{Cite web|url=https://www.massmecfs.org/resource-library/9-treatment/172-cfidsfm-and-chiari-malformation-surgery|title=CFS/FM and Chiari Malformation Surgery|last=Casanova|first=Ken|date=Nov 15, 2015|website=www.massmecfs.org|language=en-GB|archive-url=|archive-date=|access-date=2018-08-09}}</ref>

==Disability: SSI/SSD and LT==
{{Main article |page_name = Fibromyalgia disability process}}

==Notable studies ==
{{Main article |page_name = Fibromyalgia notable studies}}

==See also==
*[[Fibromyalgia disability process]]
* [[Fibromyalgia drugs]]
* [[Fibromyalgia notable studies]]
* [[Influenza vaccine]]
*[[Lady Gaga]]
*''[[Mayo Clinic Guide to Fibromyalgia: Strategies to Take Back Your Life]] - Medical guide book (2019)''

== Learn more ==
*[https://dx.doi.org/10.4065%2Fmcp.2011.0206 The Science of Fibromyalgia] - Daniel Clauw, Lesley Arnold, and Bill McCarber for the FibroCollaborative
*[http://fmtest.com/ FM/a® test]
*[https://www.s4me.info/forums/fibromyalgia-and-connective-tissue-disorders.35/ Forum: Fibromyalgia and Connective Tissue Disorders] at [[Science for ME]]

=== Diagnosing and categorizing fibromyalgia===
*2014, [http://www.medpagetoday.com/Rheumatology/Fibromyalgia/49114 Lyme Disease, Fibromyalgia Link Evaporates] (See also: [[Chronic lyme disease]])
*2015, [http://www.news-medical.net/news/20150518/Fibromyalgia-now-considered-as-a-lifelong-central-nervous-system-disorder.aspx Fibromyalgia now considered as a lifelong central nervous system disorder]
*2015, [http://nationalpainreport.com/foundation-of-fibromyalgia-is-altered-central-nervous-system-new-study-validates-8827896.html Foundation of Fibromyalgia Is Altered Central Nervous System, New Study Validates]
*2016, [http://fibromyalgianewstoday.com/2016/09/09/fibromyalgia-diagnosis-using-noninvasive-eye-examination Diagnosing Fibromyalgia May Be Possible Using Noninvasive Eye Examination]
*2016, [http://simmaronresearch.com/2016/03/are-chronic-fatigue-syndrome-mecfs-and-fibromyalgia-immune-exhaustion-disorders/ Are Chronic Fatigue Syndrome (ME/CFS) and Fibromyalgia Immune Exhaustion Disorders?]
*2017, [http://nationalpainreport.com/study-reveals-new-treatment-target-for-fibromyalgia-inflammation-in-the-brain-8833354.html Study Reveals New Treatment Target for Fibromyalgia: Inflammation in the Brain]
*2017, [https://qz.com/1349854/ai-can-spot-the-pain-from-a-disease-some-doctors-still-think-is-fake/? AI can spot the pain from a disease some doctors still think is fake]
*2018, [https://www.verywellhealth.com/fibromyalgia-pain-physiological-evidence-716141 Understanding the Pathophysiology of Fibromyalgia]
*2018, [https://www.prohealth.com/fibromyalgia/library/fibromyalgia-central-sensitization-syndrome-87957? Fibromyalgia: Central Sensitization Syndrome - Characterizing classes of fibromyalgia within the continuum of central sensitization syndrome]

=== Blood tests ===
*2013, [http://nationalpainreport.com/new-fibromyalgia-blood-test-is-99-accurate-8821072.html New Fibromyalgia Blood Test is 99% Accurate]
*2014, [http://www.prohealth.com/library/showarticle.cfm?libid=18837 Pridgen Reports Fibromyalgia Antiviral Trial Results “Very Positive”: Predicts New Approach Will Be “Game-Changer”]
*2016, [https://www.celestecooper.com/2016/05/blood-test-for-fibromyalgia-fma-test-is.html Blood Test for Fibromyalgia: FM/a Test Ⓡ is now available, Q&A]
*2016, [http://www.liveinsurancenews.com/fibromyalgia-blood-testing-covered-rising-number-insurance-companies/ Fibromyalgia blood testing covered by rising number of insurance companies]
*2017, [http://www.businesswire.com/news/home/20170419005324/en/EpicGenetics-Assistance-Leading-Medical-Centers-Expands-Clinical EpicGenetics, with the Assistance of Leading Medical Centers, Expands Clinical Study of FM/a® Test to Diagnose Fibromyalgia, Identify Genetic Markers Unique to the Disorder and Explore Direct Treatment Approaches]

=== Brain scans ===
*2002, [http://www.anapsid.org/cnd/diagnosis/brainpain.html Fibromyalgia Pain Isn't All In Patient's Heads, New Brain Study Finds]
*2012, [https://www.sciencedaily.com/releases/2012/11/121111153426.htm Fibromyalgia and the brain: New clues reveal how pain and therapies are processed]
*2018, [https://ki.se/en/news/people-with-fibromyalgia-have-inflammation-of-the-brain People with fibromyalgia have inflammation of the brain]
*2018, [https://fibromyalgianewstoday.com/2018/10/11/brain-inflammation-imaged-first-time-fibromyalgia-patients-study/ Brain Inflammation Imaged for First Time in Fibromyalgia Patients, Study Reports]<

==References==
{{reflist}}

[[Category:Diagnoses]]
[[Category:Potential comorbidities]]
[[Category:Musculoskeletal diseases and disorders]]
[[Category:Neurological diseases and disorders]]

User talk:Kmdenmark

2021-04-28T20:04:26Z

Loopy:/* Spelling of Indoleamine-2,3-dioxygenase vs indolamine-2,3-dioxygenase -- Loopy (talk) 20:03, April 28, 2021 (UTC) */

[[/Old messages]]

[[/todolist]]

[[/templates]]

[[/Separate Site Notices]]

[[/Diagnostic biomarkers for ME/CFS]]

[[/EBV-dUTPase]]

[[/EET]]

[[/bulkimport]]

==Leave me a message ==

== Spelling of Indoleamine-2,3-dioxygenase vs indolamine-2,3-dioxygenase -- [[User:Loopy|Loopy]] ([[User talk:Loopy|talk]]) 20:03, April 28, 2021 (UTC) ==

Not certain which spelling is correct.

https://www.mdpi.com/2075-4418/9/3/82

The above link spells IDO as indolamine-2,3-dioxygenase. But the page at MEpedia is [[Indoleamine-2,3-dioxygenase]]. (Note the "e" missing after "indol" on the link above.

Perhaps we need to correct the MEpedia page? For IDO, IDO1, and IDO2?

--[[User:Loopy|Loopy]] ([[User talk:Loopy|talk]]) 20:04, April 28, 2021 (UTC)

User talk:Kmdenmark

2021-04-28T20:03:04Z

Loopy:/* Spelling of Indoleamine-2,3-dioxygenase vs indolamine-2,3-dioxygenase -- ~~~~ */ new section

Genetics of chronic fatigue syndrome

2021-04-28T19:58:51Z

Loopy:/* The IDO Metabolic Trap Hypothesis for the Etiology of ME/CFS */

The '''genetics of chronic fatigue syndrome''' is an area of research as [[ME/CFS]] has been observed in families.<ref name=":0">{{Cite web|url=https://www.cdc.gov/me-cfs/healthcare-providers/presentation-clinical-course/etiology-pathophysiology.html|title=Etiology and Pathophysiology {{!}} Presentation and Clinical Course {{!}} Healthcare Providers {{!}} Myalgic Encephalomyelitis/Chronic Fatigue Syndrome|date=2018-11-08|website=[[Centers for Disease Control]]|language=en-us|access-date=2019-02-08}}</ref> It is unknown if there is a genetic link or common environmental exposure (infectious or toxic). Studies of twins show higher rates of ME/CFS in identical than fraternal twins. The [[Centers for Disease Control and Prevention]] (CDC) notes that specific genetic associations have not been established.<ref name=":0" />

=== The IDO Metabolic Trap Hypothesis for the Etiology of ME/CFS ===
A new hypothesis, the indolamine-2,3-dioxygenase ([[IDO]]) [[metabolic trap]], was developed and formulated as a mathematical model. The historical occurrence of [[List of myalgic encephalomyelitis and chronic fatigue syndrome outbreaks|ME/CFS outbreaks]] is a singular feature of the disease and implies that any predisposing genetic mutation must be common. A database search for common damaging mutations in human enzymes produces 208 hits, including IDO2 with four such mutations. Non-functional IDO2, combined with well-established substrate inhibition of [[IDO1]] and kinetic asymmetry of the large neutral amino acid transporter, LAT1, yielded a mathematical model of tryptophan metabolism that displays both physiological and pathological steady-states. Escape from the pathological one requires an exogenous perturbation. This model also identifies a critical point in cytosolic tryptophan abundance beyond which descent into the pathological steady-state is inevitable.<ref name=":1" />

=== ME/CFS Gene Study ===
The [[ME/CFS Gene Study]] is still collecting data, but the initial pilot study by Perez et al. (2019) found 10 relatively common genes or gene variants were significantly more common in people with ME/CFS.<ref name="Nathanson2019" /> These were [[Cytochrome P450 2D6|CYP2D6]], [[Proline-rich transmembrane protein 4|PRRT4]], [[Serine Protease 56|PRSS56]], [[Armadillo Like Helical Domain Containing 4|C14orf37]], [[Ankyrin Repeat And Death Domain Containing 1B|ANKDD1B]], GPBAR1, LHB, ADAMTS19, VARS2, and CPLX2.<ref name="Nathanson2019" />

=== Utah Population Database study ===
A 2011 study by Albright et al showed evidence of a heritable contribution to [[chronic fatigue syndrome]] (CFS).<ref name="Albright, 2011" /> Using the extensive records of the Utah Population Database (UPDB), the study "shows clear evidence of significant excess familial clustering and significantly elevated risks for [[Chronic fatigue syndrome|CFS]] among first, second, and third degree relatives of CFS cases. The results strongly support a genetic contribution to predisposition to CFS as it is currently defined and diagnosed by clinicians in Utah." Increased outbreak rates in first degree relatives are not automatically assumed to be genetic because the first degree relatives often share the same lifestyle and environment. However, a significantly increased incidence (95% confidence interval) in second and third degree relatives strongly indicated a genetic contribution to CFS, given the much lower likelihood of these relatives sharing common risks and environments.<ref name="Albright, 2011" />
[[File:Genetic Relationship graph.png|center|Albright,2011 study]]

=== Family history and twin studies ===
A 2001 study in the [[United Kingdom|UK]] showed "there were significantly higher rates of CFS in the relatives of CFS cases compared with the relatives of control subjects."<ref>{{Cite journal|last=Walsh|first=C. M.|author-link=|last2=Zainal|first2=N. Z.|author-link2=|last3=Middleton|first3=S. J.|author-link3=|last4=Paykel|first4=E. S.|author-link4=|date=Sep 2001|title=A family history study of chronic fatigue syndrome|url=https://doi.org/10.1097/00041444-200109000-00003|journal=Psychiatric Genetics|language=en|volume=11|issue=3|pages=123–128|doi=10.1097/00041444-200109000-00003|issn=0955-8829|quote=|via=}}</ref> Three twin studies (one in Australia, one in Washington, US, both in 2001, and one in the UK in 2007) showed that the correlations for prolonged and chronic fatigue were significantly higher in monozygotic than dizygotic twins for each definition of chronic fatigue syndrome.<ref name="Buchwald, 2001" /><ref name="Hickie, 2001" /><ref name="Schur, 2007" />

=== Haplogroups ===
One study showed that patients with [[mitochondrial DNA]] from certain haplogroups correlated with variations in [[gastrointestinal]], [[neurological]], and [[inflammatory]] symptoms.<ref name="Hanson2016" />

===HLA alleles===
[[Human leukocyte antigen genes]] associations were investigated by Lande et al. (2020) because these gene variants are considered hallmarks for [[autoimmune hypothesis|autoimmune]] disease; two HLA associations were found to be more common in ME/CFS patients, but the majority of ME/CFS patients did not have these.<ref name="Lande2020" />

==Notable studies==
*2001, A twin study of chronic fatigue<ref name="Buchwald, 2001" /> [https://www.ncbi.nlm.nih.gov/pubmed/11719632 (Abstract)]
*2006, [[pubmed:16610957|Combinations of single nucleotide polymorphisms in neuroendocrine effector and receptor genes]]<ref>{{Cite journal|last=Goertzel|first=Benjamin N.|author-link=Benjamin Goertzel|last2=Pennachin|first2=Cassio|author-link2=Cassio Pennachin|last3=de Souza Coelho|first3=Lucio|author-link3=Lucio de Souza Coelho|last4=Gurbaxani|first4=Brian|author-link4=Brian Gurbaxani|last5=Maloney|first5=Elizabeth M.|author-link5=Elizabeth M. Maloney|last6=Jones|first6=James F.|author-link6=James Jones|date=April 2006|title=Combinations of single nucleotide polymorphisms in neuroendocrine effector and receptor genes predict chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/16610957|journal=Pharmacogenomics|volume=7|issue=3|pages=475–483|doi=10.2217/14622416.7.3.475|issn=1462-2416|pmid=16610957|quote=|via=}}</ref> <blockquote>Three genes were found to be common in a group of people with Chronic Fatigue Syndrome compared to the general population; [[TPH2]] - neuronal [[tryptophan]] hydroxylase, [[COMT]] - catechol-O-methyltransferase, and [[NR3C1]] - nuclear receptor subfamily 3, group C, member 1 [[glucocorticoid]] receptor, together these three have an accuracy of 76%.
*2011, Evidence for a heritable predisposition to Chronic Fatigue Syndrome<ref name="Albright, 2011" /> [http://dx.doi.org/10.1186/1471-2377-11-62 (Abstract)]
*2011, [https://doi.org/10.1111/j.1365-2796.2011.02405.x Gene expression alterations at baseline and following moderate exercise in patients with Chronic Fatigue Syndrome and Fibromyalgia Syndrome]<ref>{{Cite journal|last=Light|first=A. R.|author-link=Alan Light|last2=Bateman|first2=L.|author-link2=Lucinda Bateman|last3=Jo|first3=D.|author-link3=Daehyun Jo|last4=Hughen|first4=R. W.|author-link4=Ronald Hughen|last5=VanHaitsma|first5=T. A.|author-link5=Timothy Vanhaitsma|last6=White|first6=A. T.|author-link6=Andrea White|last7=Light|first7=K. C.|author-link7=Kathleen Light|date=2011-07-13|title=Gene expression alterations at baseline and following moderate exercise in patients with Chronic Fatigue Syndrome and Fibromyalgia Syndrome|url=https://doi.org/10.1111/j.1365-2796.2011.02405.x|journal=Journal of Internal Medicine|language=en|volume=271|issue=1|pages=64–81|doi=10.1111/j.1365-2796.2011.02405.x|issn=0954-6820|pmc=3175315|pmid=21615807|quote=|via=}}</ref>
*2016, Genome-wide association analysis identifies genetic variations in subjects with myalgic encephalomyelitis/chronic fatigue syndrome<ref name="Schlauch, 2016" /> [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4872418/ (Full Text)]
*2016, Mitochondrial DNA variants correlate with symptoms in myalgic encephalomyelitis/chronic fatigue syndrome <ref name="Hanson2016">{{Cite journal|last=Billing-Ross|first=Paul|author-link=Paul Billing-Ross|last2=Germain|first2=Arnaud|author-link2=Arnaud Germain|last3=Ye|first3=Kaixiong|author-link3=Kaixiong Ye|last4=Keinan|first4=Alon|author-link4=Alon Keinan|last5=Gu|first5=Zhenglong|author-link5=Zhenglong Gu|last6=Hanson|first6=Maureen R.|author-link6=Maureen Hanson|date=2016-01-20|title=Mitochondrial DNA variants correlate with symptoms in myalgic encephalomyelitis/chronic fatigue syndrome|url=https://doi.org/10.1186/s12967-016-0771-6|journal=Journal of Translational Medicine|volume=14|issue=1|pages=19|doi=10.1186/s12967-016-0771-6|issn=1479-5876|quote=|via=}}</ref> [http://www.translational-medicine.com/content/14/1/19 (Abstract)]
*2018, Identification of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome-associated DNA methylation patterns<ref name="Trivedi2018">{{Cite journal|last=Trivedi|first=Malav S.|author-link=Malav Trivedi|last2=Oltra|first2=Elisa|author-link2=Elisa Oltra|last3=Sarria|first3=Leonor|author-link3=Leonor Sarria|last4=Rose|first4=Natasha|author-link4=Natasha Rose|last5=Beljanski|first5=Vladimir|author-link5=Vladimir Beljanski|last6=Fletcher|first6=Mary Ann|author-link6=Mary Ann Fletcher|last7=Klimas|first7=Nancy G.|author-link7=Nancy Klimas|last8=Nathanson|first8=Lubov|author-link8=Lubov Nathanson|date=2018|title=Identification of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome-associated DNA methylation patterns|url=https://www.ncbi.nlm.nih.gov/pubmed/30036399|journal=PloS One|volume=13|issue=7|pages=e0201066|doi=10.1371/journal.pone.0201066|issn=1932-6203|pmc=|pmid=30036399|quote=|via=}}</ref> [https://www.ncbi.nlm.nih.gov/pubmed/30036399 (Abstract)]
*2018, Genome-epigenome interactions associated with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.<ref name="Herrera2018">{{Cite journal|last=Herrera|first=Santiago|author-link=Santiago Herrera|last2=de Vega|first2=Wilfred C.|author-link2=Wilfred de Vega|last3=Ashbrook|first3=David|author-link3=David Ashbrook|last4=Vernon|first4=Suzanne D.|author-link4=Suzanne Vernon|last5=McGowan|first5=Patrick O.|author-link5=Patrick McGowan|date=2018-12-05|title=Genome-epigenome interactions associated with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/30516085|journal=Epigenetics|volume=|issue=|pages=1–17|doi=10.1080/15592294.2018.1549769|issn=1559-2308|pmid=30516085|quote=|via=}}</ref> [https://www.ncbi.nlm.nih.gov/pubmed/30516085 (Abstract)]
*2019, Associations between clinical symptoms, plasma norepinephrine and deregulated immune gene networks in subgroups of adolescent with Chronic Fatigue Syndrome.<ref name="Nguyen2019">{{Cite journal|last=Nguyen|first=Chinh Bkrong|author-link=Chinh Bkrong Nguyen|last2=Kumar|first2=Surendra|author-link2=Surendra Kumar|last3=Zucknick|first3=Manuela|author-link3=Manuela Zucknick|last4=Kristensen|first4=Vessela N.|author-link4=Vessela Kirstensen|last5=Gjerstad|first5=Johannes|author-link5=Johannes Gjerstad|last6=Nilsen|first6=Hilde|author-link6=Nilsen Hilde|last7=Wyller|first7=Vegard Bruun|author-link7=Vegard Bruun Wyller|date=Feb 2019|title=Associations between clinical symptoms, plasma norepinephrine and deregulated immune gene networks in subgroups of adolescent with Chronic Fatigue Syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/30419269|journal=Brain, Behavior, and Immunity|volume=76|issue=|pages=82–96|doi=10.1016/j.bbi.2018.11.008|issn=1090-2139|pmid=30419269|quote=|via=}}</ref> [https://www.ncbi.nlm.nih.gov/pubmed/30419269/ (Abstract)]
* 2019, Genetic Predisposition for Immune System, Hormone, and Metabolic Dysfunction in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Pilot Study<ref name="Nathanson2019">{{Cite journal|last=Nathanson|first=Lubov |author-link1=Lubov Nathanson|author-link2=Travis Craddock|last2=Craddock|first2=Travis J. A.|last3=Klimas|first3=Nancy G.|author-link3=Nancy Klimas|author-link4=Kristina Gemayel|last4=Gemayel|first4=Kristina|last5=Del Alamo|first5=Ana|author-link5=Ana Del Alamo|author-link6=Kelly Hilton|last6=Hilton|first6=Kelly|last7=Jaundoo|first7=Rajeev|author-link7=Rajeev Jaundoo|last8=Perez|first8=Melanie|author-link8=Melanie Perez|date=2019|title=Genetic Predisposition for Immune System, Hormone, and Metabolic Dysfunction in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Pilot Study|url=https://www.frontiersin.org/articles/10.3389/fped.2019.00206/full|journal=Frontiers in Pediatrics|language=English|volume=7|doi=10.3389/fped.2019.00206|issn=2296-2360}}</ref> [https://doi.org/10.3389/fped.2019.00206 (Full text)]
* 2019, The IDO Metabolic Trap Hypothesis for the Etiology of ME/CFS<ref name=":1">{{Cite journal|last=Kashi|first=Alex A.|last2=Davis|first2=Ronald W.|last3=Phair|first3=Robert D.|date=2019/9|title=The IDO Metabolic Trap Hypothesis for the Etiology of ME/CFS|url=https://www.mdpi.com/2075-4418/9/3/82|journal=Diagnostics|language=en|volume=9|issue=3|pages=82|doi=10.3390/diagnostics9030082}}</ref> - [https://www.mdpi.com/2075-4418/9/3/82/htm (Full text)]
*2020, Human Leukocyte Antigen alleles associated with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)<ref name="Lande2020">{{Cite journal|last=Lande|first=Asgeir|author-link=Asgeir Lande|last2=Fluge|first2=Øystein|author-link2=Øystein Fluge|last3=Strand|first3=Elin B.|author-link3=Elin Strand|last4=Flåm|first4=Siri T.|author-link4=Siri Flåm|last5=Sosa|first5=Daysi D.|author-link5=Daysi Sosa|last6=Mella|first6=Olav|author-link6=Olav Mella|last7=Egeland|first7=Torstein|author-link7=|last8=Saugstad|first8=Ola D.|author-link8=|last9=Lie|first9=Benedicte A.|author-link9=|date=2020-03-24|title=Human Leukocyte Antigen alleles associated with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)|url=https://www.nature.com/articles/s41598-020-62157-x|journal=Scientific Reports|language=en|volume=10|issue=1|pages=1–8|doi=10.1038/s41598-020-62157-x|issn=2045-2322|pmc=|pmid=|access-date=|quote=|via=}}</ref> - [https://www.nature.com/articles/s41598-020-62157-x (Full text)]
*2020, Unravelling myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS): Gender‐specific changes in the microRNA expression profiling in ME/CFS<ref name="Cheema2020">{{Cite journal|last=Cheema|first=Amanpreet K.|author-link=|last2=Sarria|first2=Leonor|author-link2=|last3=Bekheit|first3=Mina|author-link3=|last4=Collado|first4=Fanny|author-link4=Fanny Collado|last5=Almenar‐Pérez|first5=Eloy|author-link5=|last6=Martín‐Martínez|first6=Eva|author-link6=|last7=Alegre|first7=Jose|author-link7=José Alegre|last8=Castro‐Marrero|first8=Jesus|author-link8=Jesús Castro-Marrero|last9=Fletcher|first9=Mary A.|author-link9=Mary Ann Fletcher|date=Apr 14, 2020|title=Unravelling myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS): Gender-specific changes in the microRNA expression profiling in ME/CFS|url=https://onlinelibrary.wiley.com/doi/abs/10.1111/jcmm.15260|journal=Journal of Cellular and Molecular Medicine|language=en|volume=00|issue=|pages=1-13|doi=10.1111/jcmm.15260|issn=1582-4934|pmc=|pmid=32291908|access-date=|quote=|via=|last10=Klimas|first10=Nancy|author-link10=Nancy Klimas|last11=Oltra|first11=Elisa|author-link11=Elisa Oltra|last12=Nathanson|first12=Lubov|author-link12=Lubov Nathanson}}</ref> - [https://onlinelibrary.wiley.com/doi/full/10.1111/jcmm.15260 (Full text)]

==Media Coverage==
*2016, [http://www.meresearch.org.uk/news/genome-wide-associations/ Genome-wide associations]
*2016, [https://cfsremission.wordpress.com/2016/01/23/new-study-found-snps-for-some-symptoms/ New study found SNPs for some symptoms] ([[CFS Remission]], January 23)

==See also==

*[[:Category:Genes|Genes (category)]]
*[[Gene expression]]
*[[ME/CFS Gene Study]]
*[[Genetic testing]]
*[[Mitochondrion]]
== Learn more ==
*[http://hansonlab.org/research/cfs_me/mitochondria/ Mitochondrial DNA and ME/CFS - A Guide to the Hanson Lab's] - 2016 JTM Publication
*[https://solvecfs.org/the-ido-metabolic-trap-hypothesis-for-me-cfs/ The IDO Metabolic Trap Hypothesis For ME/CFS] - Jul 30, 2019 [[Solve ME/CFS Initiative|Solve M.E.]]
*[https://www.youtube.com/watch?v=rtVtH-cwhBY Dr. Ron Davis Gives an Update on ME/CFS Research]- Sep 26, 2019 [[Open Medicine Foundation]] (Gene Mutation Found)
==References==
<references>
<ref name="Albright, 2011">{{Citation
| last1 = Albright | first1 = Frederick | authorlink1 = Frederick Albright
| last2 = Light | first2 = Kathleen | authorlink2 = Kathleen Light
| last3 = Light | first3 = Alan | authorlink3 = Alan Light
| last4 = Bateman | first4 = Lucinda | authorlink4 = Lucinda Bateman
| last5 = Cannon-Albright | first5 = Lisa A | authorlink5 = Lisa Cannon-Albright
| title = Evidence for a heritable predisposition to Chronic Fatigue Syndrome |url = https://doi.org/10.1111/j.1365-2796.2011.02405.x
| journal = BMC Neurology | volume = 11 | issue = 62 | page =
| date = 2011
| doi = 10.1186/1471-2377-11-62
}}
</ref>
<ref name="Buchwald, 2001">{{Citation
| last1 = Buchwald | first1 = D. | authorlink1 = Dedra Buchwald
| last2 = Herrell | first2 = R. | authorlink2 =
| last3 = Ashton | first3 = S. | authorlink3 =
| last4 = Belcourt | first4 = M. | authorlink4 =
| last5 = Schmaling | first5 = K. | authorlink5 =
| last6 = Sullivan | first6 = P. | authorlink6 =
| last7 = Neale | first7 = M. | authorlink7 =
| last8 = Goldberg | first8 = J. | authorlink8 =
| title = A twin study of chronic fatigue.
| journal = Psychosomatic Medicine | volume = 63 | issue = 6 | page = 936-943
| date = 2001
| pmid = 11719632
| doi =
| url = https://www.ncbi.nlm.nih.gov/pubmed/11719632
}}
</ref>
<ref name="Hickie, 2001">{{Citation
| last1 = Hickie | first1 = IB | authorlink1 =
| last2 = Bansal | first2 = AS | authorlink2 =
| last3 = Kirk | first3 = KM | authorlink3 =
| last4 = Lloyd | first4 = AR | authorlink4 =
| last5 = Martin | first5 = NG | authorlink5 =
| title = A twin study of the etiology of prolonged fatigue and immune activation
| journal = Twin Research | volume = 4 | issue = 2 | page = 94-102
| date = 2001
| doi = 10.1375/1369052012209
}}
</ref>
<ref name="Schlauch, 2016">{{Citation
| last1 = Schlauch | first1 = Karen A. | authorlink1 = Karen Schlauch
| last2 = Khaiboullina | first2 = Svetlana F.| authorlink2 = Svetlana Khaiboullina
| last3 = De Meirleir | first3 = Kenny L. | authorlink3 = Kenny de Meirleir
| last4 = Rawat | first4 = Shanti | authorlink4 = Shanti Rawat
| last5 = Petereit | first5 = J | authorlink5 =
| last6 = Rizvanov | first6 = Albert A | authorlink6 = Albert Rizvanov
| last7 = Blatt | first7 = Nataliya | authorlink7 = Nataliya Blatt
| last8 = Mijatovic | first8 = Tatjana | authorlink8 = Tatjana Mijatovic
| last9 = Kulick | first9 = D | authorlink9 =
| last10 = Palotás | first10 = András | authorlink10 = András Palotás
| last11 = Lombardi | first11 = Vincent C.| authorlink11 = Vincent Lombardi
| title = Genome-wide association analysis identifies genetic variations in subjects with myalgic encephalomyelitis/chronic fatigue syndrome
| journal = Translational Psychiatry | volume = 6 | issue = 2 | page = e730
| date = 2016
| pmid =
| doi = 10.1038/tp.2015.208
}}
</ref>
<ref name="Schur, 2007">{{Citation
| last1 = Schur | first1 = Ellen | authorlink1 =
| last2 = Afari | first2 = Niloofar | authorlink2 =
| last3 = Goldberg | first3 = Jack | authorlink3 =
| last4 = Buchwald | first4 = Dedra | authorlink4 = Dedra Buchwald
| last5 = Sullivan | first5 = Patrick F. | authorlink5 =
| title = Twin analyses of fatigue
| journal = Twin Research and Human Genetics | volume = 10 | issue = 5 | page = 729-733
| date = 2007
| doi = 10.1375/twin.10.5.729
}}
</ref>
</references>
[[Category:Triggers and risk factors]]
[[Category:Genetics]]

User talk:Notjusttired

2021-04-24T13:20:08Z

Loopy:/* Indoleamine-2,3-dioxygenase 1 -- ~~~~ */ new section

== Tagging myself ==
just a test [[User:Notjusttired]]

==subpages==
[[User_talk:Notjusttired/cleanup]]

==Leave me a message ==

Could you explain what you are doing to the [[fatty acid]] and the [[antibody]] pages? You are removing important links that are there to remind us that we need to create these pages. Red links help us to figure out which important pages need to be created, such as the [[fatty acid]] and the [[antibody]] pages. By removing important red links, we lose track of which pages need to be created. All your changes will need to be reverted when the pages are created. If you are looking to simplify things, then we can get rid of the categories, rather than the main pages for the categories. In this case, we would combine all pages in the category into the main page for the category, so that we have one page, rather than a whole category. Please explain.
<br>[[User:Pyrrhus|Pyrrhus]] ([[User talk:Pyrrhus|talk]]) 00:29, October 11, 2019 (EDT)
:I already discussed this with [[User:Kmdenmark]] as I think you've already seen [[Talk:Single_nucleotide_polymorphism here]] - others you tagged earlier did not respond. Those pages won't have enough content to be worthwhile do terms are now added to the glossary. They have been stub pages for many years rather than wanted pages - I have looked for content and there is simply too little to justify a page. Fatty acids is a category that does not need a summary article in my view, plus there are articles for very long chain fatty acids, short chain fatty acids, etc. Please think carefully about making mass reverts without checking. [[User:Pyrrhus]] ~[[User:Notjusttired|Njt]] ([[User talk:Notjusttired|talk]]) 09:26, October 11, 2019 (EDT)

Messages I've seen:

{{collapse top}}
Hi Njt! I just wanted to briefly clarify what I said on Kmdenmark's talk page. I'll use bullet points because I find it easier to organize my thoughts:
* There are three different language settings in MediaWiki:
** The wiki's default language setting (specified in LocalSettings.php)
** The page's content language setting (reflected by the language code suffix such as "/de")
** The reader's preferred language setting (specified in preferences, for now)

* The visible screen in MediaWiki is divided into user interface and content.
** The user interface should always match the reader's preferred language setting.
** The content should always match the page's content language setting.

*Now, template messages mostly count as user interface, not as content, so templates mostly follow the reader's preferred language, not the page's content language. This is why templates use <nowiki>{{int:}} or {{int:lang}}</nowiki>, since these parser functions follow the reader's preferred language, not the page's content language.
*However, when you're editing content inside a regular page, your content should follow the page's content language. In this case, you should use <nowiki>{{PAGELANGUAGE}}, not {{int:}}</nowiki>. Of course, since each language gets their own page via a suffix like "/de", you probably won't need to use either.

*Example: [[Template:Cleanup]] displays a message about the page at the top of the page. This is best considered part of the user interface, not part of the page itself. Therefore, this template will follow the reader's preferred language and use <nowiki>{{int:}}, not {{PAGELANGUAGE}}</nowiki>.
*Example: [[Glossary/de]] is a content page. Therefore anything added to this page should follow the page's content language, not the reader's preferred language. To put it another way, the content of a page ending in "/de" should be in German, no matter what the reader's preferred language is.
*More complicated example: [[Template:Citation needed]] displays a message embedded inside the content of a page. Does this make it part of the user interface or part of the page content itself? If we consider it part of the user interface, then it should use <nowiki>{{int:lang}}</nowiki>. However, if we consider it part of the page content then it should use <nowiki>{{PAGELANGUAGE}} instead of {{int:lang}}</nowiki>. This is kind of a grey area, but the more I think about it, it should probably be considered part of the content, not part of the user interface. Therefore, we should consider switching it from <nowiki>{{int:lang}} to {{PAGELANGUAGE}}</nowiki>.

*NOTE: <nowiki>{{PAGELANGUAGE}}</nowiki> does not yet work, as it needs a developer change in order to make sure that it returns the same language as the "/de" suffix.

Hope this is clear!
<br>[[User:Pyrrhus|Pyrrhus]] ([[User talk:Pyrrhus|talk]]) 00:04, September 7, 2019 (EDT)
:Thanks for the great explanation. Does PAGELANGUAGE use system messages? I guess having a main page in different languages would probably be too much to maintain? Although if it was possible to create them using system messages it might be simple since the page doesn't change often. Do you know if the word Portal is translated in the user interface? I think it might not be. A more recent developer tasks list would be appreciated on Slack since I am not sure if we have requested certain things or not. [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 09:23, September 7, 2019 (EDT)
::PAGELANGUAGE is just a global system variable that returns the page content language of the current page. I don’t think having the main page in different languages will be such a big deal, it’s short and it doesn’t change much. Plus, you don’t need admin privileges to create [[Welcome to MEpedia/de]], like you would need in order to create a system message. But more importantly, if someone chooses to view the German version of the main page using the interlanguage links in the sidebar, then they should expect to see the page in German, not in whatever their reader preferred language setting might be at the time, which is why system messages are to be avoided in a content page. This will all probably become much clearer when the developer changes are made and we can test things out for ourselves. I’ll send you a link on Slack to the “DRAFT Developer Suggestions” as it currently stands. Hope this helps.
::[[User:Pyrrhus|Pyrrhus]] ([[User talk:Pyrrhus|talk]]) 20:41, September 7, 2019 (EDT)
:::Great! My thinking with system messages was to use without '''int:''', eg <nowiki >MediaWiki:mymessage/{{PAGELANGUAGE}}</nowiki > [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 15:51, September 8, 2019 (EDT)
{{collapse bottom}}

==Category banners: Medical hypotheses and Potential treatments ==
{{collapse top}}
'''Compatibility with all skins'''

Both the pivot and Timeless (dark) skins rely on classes being used - without that no banner appears on the Pivot skin and the colors are messed up on Timeless skin (it adds a dark shadow to text to improve contrast: it's also a "low vision" skin). Current banners are created by [[MediaWiki:Common.js]] Javascript using the following classes and css (note: banner position can be moved below heading if "append" is used instead of "prepend").
<pre>
//$(".mw-body-content").css ("background-color","#f8d6c2");
//$(".toc").css ("background-color","#f8d6c2");
$(".firstHeading").prepend ('<div style = "margin:auto;padding:20px;width:100%;text-align:center;background-color:#00ee54;">This is a <a href = "/wiki/Category:Potential_treatments">Potential treatments</a> page</div>');

// pivot fix
$("h1.title"...
</pre>
So any h1 headings should apply <code><nowiki>class="title"</nowiki></code> and text not using the "h1" style should include <code><nowiki>class="firstHeading"</nowiki></code>.
We should probably move these colors to [[MediaWiki:Common.css]], perhaps creating a class for each banner style with the relevant background and font colors.

Suggested new formatting: using low vision sky blue to slightly improve contrast, fixing text color rather than changing depending on if the link has been visited or not, and a text shadow to improve visibly.

Add to [[MediaWiki:Common.css]]
<pre>
.title {
background-color: #56b4e9;
color: white;
margin:auto;
padding:20px;
width:100%;
text-align: center;
font-size: 1.8em;
text-shadow: 1px 1px black;
}
.title a.link:active, .title a.link:hover,
.title a.link:visited, .title a.link,
.title a {
color: white !important;
font-weight: bold;
}
</pre>
Change code on [[MediaWiki:Top-notice-Biopsychosocial model]] to:
<pre>
<div class="title" style="background: #56b4e9">This is a [[:Category:Medical_hypotheses|Medical hypothesis]] page.</div>
</pre>
~[[User:Notjusttired|Njt]] ([[User talk:Notjusttired|talk]]) 16:55, October 25, 2019 (EDT)[[User:Notjusttired|Njt]] ([[User talk:Notjusttired|talk]]) 16:40, October 25, 2019 (EDT)[[User:Notjusttired|Njt]] ([[User talk:Notjusttired|talk]]) 16:08, October 25, 2019 (EDT)

Code now above. I think I over-complicated explanation - won't add new features, just better color contrast and text shadow which works on all skins (light and dark). Once confirmed working small updates needed to [[MediaWiki:Common.js]] for both Potential treatments and Medical hypothesis banners. Pretty much looks like this (but with a link):

<div style="margin:auto; padding:20px; width:100%; text-align:center; background-color:#56b4e9!important; font-size: 1.8em!important; color: #fff!important; text-shadow: 1px 1px black;">This is a <span style="font-weight:bold">Medical hypothesis</span> page.</div>

::[[User:Pyrrhus]] ~[[User:Notjusttired|Njt]] ([[User talk:Notjusttired|talk]]) 16:55, October 25, 2019 (EDT)

:This sounds like a new feature request. You can start a new section for this request at [[MediaWiki talk:Common.js]]. This talk page will be deleted once I am done testing the new banner.
:[[User:Pyrrhus|Pyrrhus]] ([[User talk:Pyrrhus|talk]]) 16:31, October 25, 2019 (EDT)

::I think I understand now. One question: Is "title" a new CSS class or an existing class? If it's a new class, maybe we should choose a more unique name such as "custom-header" or something that won't conflict with other classes? [[User:Notjusttired]]
::[[User:Pyrrhus|Pyrrhus]] ([[User talk:Pyrrhus|talk]]) 18:25, October 25, 2019 (EDT)
{{collapse bottom}}

==Bulk Import==
{{Done}} {{Thanks}} [[User:Kmdenmark]]
{{collapse top}}
<pre >
<mediawiki xmlns="http://www.mediawiki.org/xml/export-0.10/" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="http://www.mediawiki.org/xml/export-0.10/ http://www.mediawiki.org/xml/export-0.10.xsd" version="0.10" xml:lang="en">
<siteinfo>
<sitename>MEpedia</sitename>
<dbname>me_pedia_org_3</dbname>
<base>https://www.me-pedia.org/wiki/Welcome_to_MEpedia</base>
<generator>MediaWiki 1.30.0</generator>
<case>first-letter</case>
<namespaces>
<namespace key="-2" case="first-letter">Media</namespace>
<namespace key="-1" case="first-letter">Special</namespace>
<namespace key="0" case="first-letter" />
<namespace key="1" case="first-letter">Talk</namespace>
<namespace key="2" case="first-letter">User</namespace>
<namespace key="3" case="first-letter">User talk</namespace>
<namespace key="4" case="first-letter">MEpedia</namespace>
<namespace key="5" case="first-letter">MEpedia talk</namespace>
<namespace key="6" case="first-letter">File</namespace>
<namespace key="7" case="first-letter">File talk</namespace>
<namespace key="8" case="first-letter">MediaWiki</namespace>
<namespace key="9" case="first-letter">MediaWiki talk</namespace>
<namespace key="10" case="first-letter">Template</namespace>
<namespace key="11" case="first-letter">Template talk</namespace>
<namespace key="12" case="first-letter">Help</namespace>
<namespace key="13" case="first-letter">Help talk</namespace>
<namespace key="14" case="first-letter">Category</namespace>
<namespace key="15" case="first-letter">Category talk</namespace>
<namespace key="828" case="first-letter">Module</namespace>
<namespace key="829" case="first-letter">Module talk</namespace>
<namespace key="2300" case="first-letter">Gadget</namespace>
<namespace key="2301" case="first-letter">Gadget talk</namespace>
<namespace key="2302" case="case-sensitive">Gadget definition</namespace>
<namespace key="2303" case="case-sensitive">Gadget definition talk</namespace>
<namespace key="3006" case="first-letter">Portal</namespace>
<namespace key="3007" case="first-letter">Portal talk</namespace>
</namespaces>
</siteinfo>
<page>
<title>MediaWiki:Pagetriage-tags-cleanup-desc</title>
<ns>8</ns>
<revision>
<model>wikitext</model>
<format>text/x-wiki</format>
<text xml:space="preserve">This article needs cleanup to meet [[MEpedia:Guidelines|MEpedia's guidelines]].</text>
</revision>
</page>
<page>
<title>MediaWiki:Pagetriage-tags-cleanup-desc/de</title>
<ns>8</ns>
<revision>
<model>wikitext</model>
<format>text/x-wiki</format>
<text xml:space="preserve">Dieser Artikel muss möglicherweise Überarbeitet werden, um die [[MEpedia:Guidelines|Richtlinien von MEpedia]] zu erfüllen.</text>
</revision>
</page>
</mediawiki></pre>
{{collapse bottom}}

==Translations to do ==
Pyrrhus may change footer text or links eg [[MediaWiki:Wikimedia-developers]] and it's URL

{{collapse top}}
Cleanup Reason given is
[[User:Pyrrhus]] can you also do these 3 imports. [[User:Notjusttired|Njt]] ([[User talk:Notjusttired|talk]]) 06:54, September 28, 2019 (EDT)
:{{done}} 181 pages imported. Please check to make sure that all pages were correctly imported.
:[[User:Pyrrhus|Pyrrhus]] ([[User talk:Pyrrhus|talk]]) 19:00, September 30, 2019 (EDT)

::Great, thanks. There's just the German one that I must have got the wrong message in. I've tagged you in the talk page with the right translation. ~[[User:Notjusttired|Njt]] ([[User talk:Notjusttired|talk]])|
:::Cleanup-reason-is all done so code deleted ~[[User:Notjusttired|Njt]] ([[User talk:Notjusttired|talk]]) 20:31, October 6, 2019 (EDT)
{{collapse bottom}}

===No-reason custom message (done)===
Basically an export of Lqt_noreason messages, but with the message name changed. Ready to import [[User:Pyrrhus]]. ~[[User:Notjusttired|Njt]] ([[User talk:Notjusttired|talk]]) 23:45, October 6, 2019 (EDT)
::All done.{{collapse top}}
<pre>

<mediawiki xmlns="http://www.mediawiki.org/xml/export-0.10/" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="http://www.mediawiki.org/xml/export-0.10/ http://www.mediawiki.org/xml/export-0.10.xsd" version="0.10" xml:lang="en">
<siteinfo>
<sitename>translatewiki.net</sitename>
<dbname>translatewiki_net</dbname>
<base>https://translatewiki.net/</base>
<generator>MediaWiki 1.34.0-alpha</generator>
<case>first-letter</case>
<namespaces>
<namespace key="0" case="first-letter" />
<namespace key="14" case="first-letter">Category</namespace>
<namespace key="15" case="first-letter">Category talk</namespace>
<namespace key="208" case="first-letter">Concept</namespace>
<namespace key="209" case="first-letter">Concept talk</namespace>
<namespace key="6" case="first-letter">File</namespace>
<namespace key="7" case="first-letter">File talk</namespace>
<namespace key="106" case="first-letter">Form</namespace>
<namespace key="107" case="first-letter">Form talk</namespace>
<namespace key="2300" case="first-letter">Gadget</namespace>
<namespace key="2302" case="case-sensitive">Gadget definition</namespace>
<namespace key="2303" case="case-sensitive">Gadget definition talk</namespace>
<namespace key="2301" case="first-letter">Gadget talk</namespace>
<namespace key="12" case="first-letter">Help</namespace>
<namespace key="13" case="first-letter">Help talk</namespace>
<namespace key="-2" case="first-letter">Media</namespace>
<namespace key="100" case="first-letter">Portal</namespace>
<namespace key="101" case="first-letter">Portal talk</namespace>
<namespace key="4" case="first-letter">Project</namespace>
<namespace key="5" case="first-letter">Project talk</namespace>
<namespace key="202" case="first-letter">Property</namespace>
<namespace key="203" case="first-letter">Property talk</namespace>
<namespace key="214" case="first-letter">Rule</namespace>
<namespace key="215" case="first-letter">Rule talk</namespace>
<namespace key="212" case="first-letter">smw/schema</namespace>
<namespace key="213" case="first-letter">smw/schema talk</namespace>
<namespace key="-1" case="first-letter">Special</namespace>
<namespace key="92" case="first-letter">Summary</namespace>
<namespace key="93" case="first-letter">Summary talk</namespace>
<namespace key="1" case="first-letter">Talk</namespace>
<namespace key="10" case="first-letter">Template</namespace>
<namespace key="11" case="first-letter">Template talk</namespace>
<namespace key="90" case="first-letter">Thread</namespace>
<namespace key="91" case="first-letter">Thread talk</namespace>
<namespace key="1102" case="first-letter">Translating</namespace>
<namespace key="1103" case="first-letter">Translating talk</namespace>
<namespace key="2" case="first-letter">User</namespace>
<namespace key="3" case="first-letter">User talk</namespace>
<namespace key="1276" case="case-sensitive">Ajapaik</namespace>
<namespace key="1277" case="case-sensitive">Ajapaik talk</namespace>
<namespace key="1256" case="first-letter">Blockly</namespace>
<namespace key="1257" case="first-letter">Blockly talk</namespace>
<namespace key="1214" case="first-letter">Commonist</namespace>
<namespace key="1215" case="first-letter">Commonist talk</namespace>
<namespace key="1272" case="case-sensitive">Dissemin</namespace>
<namespace key="1273" case="case-sensitive">Dissemin talk</namespace>
<namespace key="1264" case="case-sensitive">EntryScape</namespace>
<namespace key="1265" case="case-sensitive">EntryScape talk</namespace>
<namespace key="1242" case="first-letter">EOL</namespace>
<namespace key="1243" case="first-letter">EOL talk</namespace>
<namespace key="1250" case="first-letter">EtherpadLite</namespace>
<namespace key="1251" case="first-letter">EtherpadLite talk</namespace>
<namespace key="1236" case="first-letter">Europeana</namespace>
<namespace key="1237" case="first-letter">Europeana talk</namespace>
<namespace key="1202" case="first-letter">FreeCol</namespace>
<namespace key="1203" case="first-letter">FreeCol talk</namespace>
<namespace key="1218" case="first-letter">FUDforum</namespace>
<namespace key="1219" case="first-letter">FUDforum talk</namespace>
<namespace key="1254" case="first-letter">FUEL</namespace>
<namespace key="1255" case="first-letter">FUEL talk</namespace>
<namespace key="1266" case="case-sensitive">Hivejs</namespace>
<namespace key="1267" case="case-sensitive">Hivejs talk</namespace>
<namespace key="1248" case="first-letter">Huggle</namespace>
<namespace key="1249" case="first-letter">Huggle talk</namespace>
<namespace key="1228" case="first-letter">iHRIS</namespace>
<namespace key="1229" case="first-letter">iHRIS talk</namespace>
<namespace key="1262" case="first-letter">iNaturalist</namespace>
<namespace key="1263" case="first-letter">iNaturalist talk</namespace>
<namespace key="1240" case="first-letter">Intuition</namespace>
<namespace key="1241" case="first-letter">Intuition talk</namespace>
<namespace key="1244" case="first-letter">Kiwix</namespace>
<namespace key="1245" case="first-letter">Kiwix talk</namespace>
<namespace key="1268" case="case-sensitive">lib.reviews</namespace>
<namespace key="1269" case="case-sensitive">lib.reviews talk</namespace>
<namespace key="1278" case="case-sensitive">LibreMesh</namespace>
<namespace key="1279" case="case-sensitive">LibreMesh talk</namespace>
<namespace key="1210" case="first-letter">Mantis</namespace>
<namespace key="1211" case="first-letter">Mantis talk</namespace>
<namespace key="1258" case="first-letter">MathJax</namespace>
<namespace key="1259" case="first-letter">MathJax talk</namespace>
<namespace key="1280" case="case-sensitive">MAZI</namespace>
<namespace key="1281" case="case-sensitive">MAZI talk</namespace>
<namespace key="8" case="first-letter">MediaWiki</namespace>
<namespace key="9" case="first-letter">MediaWiki talk</namespace>
<namespace key="1230" case="first-letter">Mifos</namespace>
<namespace key="1231" case="first-letter">Mifos talk</namespace>
<namespace key="1246" case="first-letter">Mozilla</namespace>
<namespace key="1247" case="first-letter">Mozilla talk</namespace>
<namespace key="1212" case="first-letter">Mwlib</namespace>
<namespace key="1213" case="first-letter">Mwlib talk</namespace>
<namespace key="1260" case="first-letter">NFCRingControl</namespace>
<namespace key="1261" case="first-letter">NFCRingControl talk</namespace>
<namespace key="1204" case="first-letter">Nocc</namespace>
<namespace key="1205" case="first-letter">Nocc talk</namespace>
<namespace key="1220" case="first-letter">Okawix</namespace>
<namespace key="1221" case="first-letter">Okawix talk</namespace>
<namespace key="1234" case="first-letter">OpenImages</namespace>
<namespace key="1235" case="first-letter">OpenImages talk</namespace>
<namespace key="1216" case="first-letter">OpenLayers</namespace>
<namespace key="1217" case="first-letter">OpenLayers talk</namespace>
<namespace key="1270" case="case-sensitive">Oppia</namespace>
<namespace key="1271" case="case-sensitive">Oppia talk</namespace>
<namespace key="1222" case="first-letter">Osm</namespace>
<namespace key="1223" case="first-letter">Osm talk</namespace>
<namespace key="1274" case="case-sensitive">Phabricator</namespace>
<namespace key="1275" case="case-sensitive">Phabricator talk</namespace>
<namespace key="1238" case="first-letter">Pywikibot</namespace>
<namespace key="1239" case="first-letter">Pywikibot talk</namespace>
<namespace key="1226" case="first-letter">Shapado</namespace>
<namespace key="1227" case="first-letter">Shapado talk</namespace>
<namespace key="1208" case="first-letter">StatusNet</namespace>
<namespace key="1209" case="first-letter">StatusNet talk</namespace>
<namespace key="1198" case="first-letter">Translations</namespace>
<namespace key="1199" case="first-letter">Translations talk</namespace>
<namespace key="1252" case="first-letter">Vicuna</namespace>
<namespace key="1253" case="first-letter">Vicuna talk</namespace>
<namespace key="1200" case="first-letter">Voctrain</namespace>
<namespace key="1201" case="first-letter">Voctrain talk</namespace>
<namespace key="1232" case="first-letter">Wikia</namespace>
<namespace key="1233" case="first-letter">Wikia talk</namespace>
<namespace key="1282" case="case-sensitive">Wikidocumentaries</namespace>
<namespace key="1283" case="case-sensitive">Wikidocumentaries talk</namespace>
<namespace key="1206" case="first-letter">Wikimedia</namespace>
<namespace key="1207" case="first-letter">Wikimedia talk</namespace>
<namespace key="1224" case="first-letter">WikiReader</namespace>
<namespace key="1225" case="first-letter">WikiReader talk</namespace>
</namespaces>
</siteinfo>
<page>
<title>MediaWiki:No-reason/ar</title>
<ns>8</ns>
<id>114330</id>
<revision>
<id>161369</id>
<timestamp>2007-11-23T07:44:38Z</timestamp>
<contributor>
<username>Meno25</username>
<id>315</id>
</contributor>
<model>wikitext</model>
<format>text/x-wiki</format>
<text xml:space="preserve" bytes="21">لا سبب معطى.</text>
<sha1>trbxdtbjsbqc6n7do97xtdlikuiljet</sha1>
</revision>
</page>
<page>
<title>MediaWiki:No-reason/da</title>
<ns>8</ns>
<id>2057108</id>
<revision>
<id>2951594</id>
<timestamp>2011-04-25T05:34:11Z</timestamp>
<contributor>
<username>Peter Alberti</username>
<id>3782</id>
</contributor>
<model>wikitext</model>
<format>text/x-wiki</format>
<text xml:space="preserve" bytes="26">Ingen begrundelse angivet.</text>
<sha1>ic5gwik8pqulwwq8x9ubgdkkqt7e68k</sha1>
</revision>
</page>
<page>
<title>MediaWiki:No-reason/fi</title>
<ns>8</ns>
<id>909955</id>
<revision>
<id>1289062</id>
<timestamp>2009-07-02T10:52:16Z</timestamp>
<contributor>
<username>Cimon Avaro</username>
<id>283</id>
</contributor>
<comment>suomeksi</comment>
<model>wikitext</model>
<format>text/x-wiki</format>
<text xml:space="preserve" bytes="19">Ei annettua syytä.</text>
<sha1>0rcsgy11ym0psz051cyj70nan4gwyl7</sha1>
</revision>
</page>
<page>
<title>MediaWiki:No-reason/it</title>
<ns>8</ns>
<id>1033853</id>
<revision>
<id>1460274</id>
<timestamp>2009-08-29T17:10:40Z</timestamp>
<contributor>
<username>Marco 27</username>
<id>2110</id>
</contributor>
<comment>Translate</comment>
<model>wikitext</model>
<format>text/x-wiki</format>
<text xml:space="preserve" bytes="29">Nessuna motivazione indicata.</text>
<sha1>b0nip64qeghwffvyr0463rpzvupwdns</sha1>
</revision>
</page>
<page>
<title>MediaWiki:No-reason/ja</title>
<ns>8</ns>
<id>191005</id>
<revision>
<id>261562</id>
<timestamp>2008-02-17T16:20:46Z</timestamp>
<contributor>
<username>JtFuruhata</username>
<id>791</id>
</contributor>
<comment>translate</comment>
<model>wikitext</model>
<format>text/x-wiki</format>
<text xml:space="preserve" bytes="39">理由は付記されていません。</text>
<sha1>1d2qt9uhieh8c9hoptqqfth6x1waa8f</sha1>
</revision>
</page>
<page>
<title>MediaWiki:No-reason/pl</title>
<ns>8</ns>
<id>215941</id>
<revision>
<id>1491831</id>
<parentid>294155</parentid>
<timestamp>2009-09-15T16:34:01Z</timestamp>
<contributor>
<username>Leinad</username>
<id>921</id>
</contributor>
<model>wikitext</model>
<format>text/x-wiki</format>
<text xml:space="preserve" bytes="18">Nie podano powodu.</text>
<sha1>m5y060qmskof0mqy0j2e61ewfdrtr5i</sha1>
</revision>
</page>
<page>
<title>MediaWiki:No-reason/pt</title>
<ns>8</ns>
<id>178383</id>
<revision>
<id>1727893</id>
<parentid>243351</parentid>
<timestamp>2009-12-05T02:00:11Z</timestamp>
<contributor>
<username>Hamilton Abreu</username>
<id>2715</id>
</contributor>
<model>wikitext</model>
<format>text/x-wiki</format>
<text xml:space="preserve" bytes="36">Não foi especificado nenhum motivo.</text>
<sha1>avtjeyv5wb49krj6tbgx32c1bhdhnhn</sha1>
</revision>
</page>
<page>
<title>MediaWiki:No-reason/ru</title>
<ns>8</ns>
<id>132336</id>
<revision>
<id>1446038</id>
<parentid>183803</parentid>
<timestamp>2009-08-22T07:30:26Z</timestamp>
<contributor>
<username>Kv75</username>
<id>2463</id>
</contributor>
<comment>correction</comment>
<model>wikitext</model>
<format>text/x-wiki</format>
<text xml:space="preserve" bytes="35">Не указана причина.</text>
<sha1>j6tvgosjjberi6m3gqq61eqa0kncte0</sha1>
</revision>
</page>
<page>
<title>MediaWiki:No-reason/sv</title>
<ns>8</ns>
<id>191517</id>
<revision>
<id>262234</id>
<timestamp>2008-02-18T08:13:15Z</timestamp>
<contributor>
<username>M.M.S.</username>
<id>802</id>
</contributor>
<model>wikitext</model>
<format>text/x-wiki</format>
<text xml:space="preserve" bytes="22">Ingen anledning given.</text>
<sha1>cycjvls08gyso44n0t7c0p3os4p3oo6</sha1>
</revision>
</page>
<page>
<title>MediaWiki:No-reason/vi</title>
<ns>8</ns>
<id>254886</id>
<revision>
<id>350621</id>
<timestamp>2008-04-11T03:42:28Z</timestamp>
<contributor>
<username>Vinhtantran</username>
<id>709</id>
</contributor>
<model>wikitext</model>
<format>text/x-wiki</format>
<text xml:space="preserve" bytes="23">Không đưa ra lý do.</text>
<sha1>242zviqquhnat6dle2aurg8pbgs6kin</sha1>
</revision>
</page>
<page>
<title>MediaWiki:No-reason/zh-hans</title>
<ns>8</ns>
<id>512160</id>
<revision>
<id>1445831</id>
<parentid>698700</parentid>
<timestamp>2009-08-22T07:06:14Z</timestamp>
<contributor>
<username>FuzzyBot</username>
<id>646</id>
</contributor>
<comment>Updating translation from external source</comment>
<model>wikitext</model>
<format>text/x-wiki</format>
<text xml:space="preserve" bytes="18">未给出原因。</text>
<sha1>mo3jtv9i5zrlb79gd6tbqc0zu2nh5sa</sha1>
</revision>
</page>
<page>
<title>MediaWiki:No-reason/zh-hant</title>
<ns>8</ns>
<id>125571</id>
<revision>
<id>5561381</id>
<parentid>175199</parentid>
<timestamp>2014-05-26T17:35:19Z</timestamp>
<contributor>
<username>Cwlin0416</username>
<id>4987</id>
</contributor>
<model>wikitext</model>
<format>text/x-wiki</format>
<text xml:space="preserve" bytes="18">未說明原因。</text>
<sha1>fgjh29koetf7sxb79nfbcjfya4p84a0</sha1>
</revision>
</page>
</mediawiki>

</pre>
{{collapse bottom}}

==Stub==

{{System message translations|Pagetriage-tags-stub-label}}
(not ready)

custom messages
*[[MediaWiki:Pagetriage-tags-stub-label/ast]] Entamu
*[[MediaWiki:Pagetriage-tags-stub-label/bg]] Мъниче
*[[MediaWiki:Pagetriage-tags-stub-label/cs]] Pahýl
*[[MediaWiki:Pagetriage-tags-stub-label/el]] Λήμμα προς επέκταση
*[[MediaWiki:Pagetriage-tags-stub-label/hr]] Mrva
*[[MediaWiki:Pagetriage-tags-stub-label/ml]] അപൂർണ്ണം
*[[MediaWiki:Pagetriage-tags-stub-label/mni]] ꯑꯇꯦꯟꯕ
*[[MediaWiki:Pagetriage-tags-stub-label/my]] ဆောင်းပါးတို
*[[MediaWiki:Pagetriage-tags-stub-label/nb]] Stubbe
*[[MediaWiki:Pagetriage-tags-stub-label/no]] Stubbe
*[[MediaWiki:Pagetriage-tags-stub-label/pt]] Esboço
* (change value) [[MediaWiki:Pagetriage-tags-stub-label/pt-br]] Provisória
*[[MediaWiki:Pagetriage-tags-stub-label/qqq]] Translation of the word Stub.
*[[MediaWiki:Pagetriage-tags-stub-label/ro]] Ciot
*[[MediaWiki:Pagetriage-tags-stub-label/sr-ec]] Клица
*[[MediaWiki:Pagetriage-tags-stub-label/uk]] Заготовка

==[[MediaWiki:Moodbar-action-reason-required]] ==
{{collapse top}}
[[User:Kmdenmark]] can you please create these? ~[[User:Notjusttired|Njt]] ([[User talk:Notjusttired|talk]]) 20:27, October 11, 2019 (EDT)
:{{done}} [[User:Kmdenmark|Kmdenmark]] ([[User talk:Kmdenmark|talk]]) 14:52, October 15, 2019 (EDT)

*[[mediawiki:Moodbar-action-reason-required/es]]<pre>
Proporciona una razón.</pre>
*[[MediaWiki:pagetriage-tags-cleanupreorganise-desc/es]]<pre>
Esta página necesita una reorganización para cumplir con las recomendaciones de diseño.</pre>

*[[MediaWiki:pagetriage-tags-cleanupreorganise-desc/fr]]<pre>
Le contenu de cette page a besoin d’être réorganisé pour respecter les recommandations.</pre>

*[[MediaWiki:pagetriage-tags-cleanupreorganise-desc/nl]]<pre>
Deze pagina heeft extra referenties of bronnen nodig voor controleerbaarheid.</pre>
:Great, {{Thank}} ~[[User:Notjusttired|Njt]] ([[User talk:Notjusttired|talk]]) 16:57, October 15, 2019 (EDT)
{{collapse bottom}}
===Navigation translations ===
Done
*[[MediaWiki_talk:Pagetriage-tags-cleanup-desc]] for template:Cleanup
*[[mediawiki:Gettingstarted-lightbulb-heading]] Pages to improve
*[[MediaWiki:Qbbrowse]] Browse
*[[MediaWiki:Externalguidance-specialpage-contribute-title]] Ways to contribute

==Translations: Licenses ==
{{collapse top}}
If anyone of you could help with the translations below I would really appreciate it. It's to help Non-English speakers upload files. [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 06:45, August 16, 2019 (EDT)
[[User:Hannosch]] [[User:sigridjones]] [[User:Sisyphus]] [[User:Guido den Broeder]] [[User:DaviSpain]]

If you want to add languages you speak to your user page you can find user boxes on [[Template:Userbox]] Thank you [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 06:45, August 16, 2019 (EDT)

===License system message test===
* Unknown_copyright|{{int:copyright-i-dont-know}}
* CC-by-sa-3.0|{{int:copyright-own-sa-simple}}
* CC-by-nd-4.0|{{int:copyright-own-nd-simple}}
* CC-zero|{{int:copyright-own-pd-simple}}

* {{int:wm-license-cc-conditions-attribution-header}}{{colon}}
** PD|{{int:copyright-pd}}
** PD-USGov|{{int:Copyright-pd-usgov}}
** GFDL|GFDL{{colon}} GNU Free Documentation License
** LGPL|LGPL{{colon}} GNU Lesser General Public License
** FAL|{{int:wm-license-fal}} (artlibre.org)
** CC-zero|Creative Commons Zero - {{int:copyright-pd}}

* CC Share-Alike:
** CC-by-sa-4.0|Creative Commons ShareAlike 4.0
** CC-by-sa-3.0|Creative Commons ShareAlike 3.0
** CC-by-sa-2.5|Creative Commons ShareAlike 2.5
** CC-by-sa-2.0|Creative Commons ShareAlike 2.0

* CC Attribution only:
** CC-by-4.0|Creative Commons Attribution 4.0
** CC-by-3.0|Creative Commons Attribution 3.0
** CC-by-2.5|Creative Commons Attribution 2.5
** CC-by-2.0|Creative Commons Attribution 2.0

* CC other:
** CC-by-nc-4.0|CC NonCommercial 4.0
** CC-by-nc-3.0|CC NonCommercial 3.0
** CC-by-nc-2.5|CC NonCommercial 2.5
** CC-by-nc-2.0|CC NonCommercial 2.0
** CC-by-nc-nd-4.0|CC NonCommercial No-Derivs 4.0
** CC-by-nd-4.0|CC No-Derivs 4.0

* {{int:Other}}{{Colon}}
** Fair_Use_License|{{int:Copyright-fair-usage}}{{Colon}} {{int:Copyright-explain-exception}}
** Other_license|{{int:Other}}{{Colon}} {{int:Copyright-leave-explanation}}

==English ==
* Unknown copyright
**I don't know exactly
* I created this and anyone can copy it but don't alter it, and credit me as the author
* I created this and anyone can alter or copy it, but credit me as the author
*I created this and I don’t care what anyone does to it, no one has to credit me as the author

* Free licenses:
** Public domain
** Public domain US Government
** Free Art License

* Other:
** Fair Use: Please explain the copyright exception (e.g. scholarship/research)
** Other: Please leave detailed explanation

#[[Template:Used with permission]]
#[[Template:Fair Use License]]
#[[Template:Unknown copyright]]
#[[Template:Copyright violation]]

==Français==
*GFDL: Licence de documentation libre GNU
*LGPL : licence publique générale limitée GNU
* Attribution - Pas d'Utilisation Commerciale - Pas de Modification 4.0 International (CC BY-NC-ND 4.0)

* Unknown copyright
**I don't know exactly
* I created this and anyone can copy it but don't alter it, and credit me as the author
* I created this and anyone can alter or copy it, but credit me as the author
*I created this and I don’t care what anyone does to it, no one has to credit me as the author

* Free licenses:
** Public domain
** Public domain US Government
** Free Art License

* Other:
** Fair Use: Please explain the copyright exception (e.g. scholarship/research)
** Other: Please leave detailed explanation

#[[Template:Used with permission/fr]]
#[[Template:Fair Use License/fr]]
#[[Template:Unknown copyright/fr]]
#[[Template:Copyright violation/fr]]

==Deutsch==
Done

*Nicht kommerziell - Keine Bearbeitungen 4.0 International (CC BY-NC-ND 4.0)
*Nicht kommerziell 4.0 International (CC BY-NC 4.0)
*Keine Bearbeitungen 4.0 International (CC BY-ND 4.0)
*Namensnennung - Attribution
*GFDL - GNU-Lizenz für freie Dokumentation
* wm-license-gfdl-1.3-only plus wm-license-gfdl-1.2-and-later - GFDL text
* wm-license-gpl-text - GFDL explanation
* wm-license-gfdl-wiki-link - GFDL link

{{collapse top}}
* Unbekanntes Copyright
**Ich weiß es nicht sicher
* Ich habe dies erstellt und es darf von jedem genutzt werden, aber bitte verändere es nicht und nenne mich als Autor
* Ich habe dies erstellt und jeder darf es verändern und kopieren, aber bitte nenne mich als Autor
* Ich habe dies erstellt und es ist mir egal, wie es genutzt wird, niemand braucht mich als Autor zu nennen

* Freie Lizenzen:
** Öffentliche Domain
** Öffentliche Domain US-Regierung
** Lizenz für freie Kunst

* Weitere:
** Fairer Gebrauch: Bitte erläutere die Ausnahmen vom Copyright (z.B. Stipendium/Forschung)
** Andere: Bitte detailliert erläutern

#[[Template:Gebrauch mit Erlaubnis]]/de
#[[Template:Lizenz zum fairen Gebrauch]]/de
#[[Template:Unbekanntes Copyright]]/de
#[[Template:Verstoß gegen das Copyright]]/de
{{collapse bottom}}

==Español ==
* Unknown copyright
**I don't know exactly
* I created this and anyone can copy it but don't alter it, and credit me as the author
* I created this and anyone can alter or copy it, but credit me as the author
*I created this and I don’t care what anyone does to it, no one has to credit me as the author

* Free licenses:
** Public domain
** Public domain US Government
** Free Art License

* Other:
** Fair Use: Please explain the copyright exception (e.g. scholarship/research)
** Other: Please leave detailed explanation

#[[Template:Used with permission/es]]
#[[Template:Fair Use License/es]]
#[[Template:Unknown copyright/es]]
#[[Template:Copyright violation/es]]
==Nederland ==
* Unknown copyright
**I don't know exactly
* I created this and anyone can copy it but don't alter it, and credit me as the author
* I created this and anyone can alter or copy it, but credit me as the author
*I created this and I don’t care what anyone does to it, no one has to credit me as the author

* Free licenses:
** Public domain
** Public domain US Government
** Free Art License

* Other:
** Fair Use: Please explain the copyright exception (e.g. scholarship/research)
** Other: Please leave detailed explanation

#[[Template:Used with permission/nl]]
#[[Template:Fair Use License/nl]]
#[[Template:Unknown copyright/nl]]
#[[Template:Copyright violation/nl]]

==Other==
* Unknown copyright
**I don't know exactly
* I created this and anyone can copy it but don't alter it, and credit me as the author
* I created this and anyone can alter or copy it, but credit me as the author
*I created this and I don’t care what anyone does to it, no one has to credit me as the author

* Free licenses:
** Public domain
** Public domain US Government
** Free Art License

* Other:
** Fair Use: Please explain the copyright exception (e.g. scholarship/research)
** Other: Please leave detailed explanation

#[[Template:Used with permission]]
#[[Template:Fair Use License]]
#[[Template:Unknown copyright]]
#[[Template:Copyright violation]]

I've tried to translate it into Dutch an French but it isn't that easy. These Copyright terms are quite specific and ifrequently used in ordinary language. So perhaps you could let other Dutch/French speakers check if it sounds ok. - Sisyphus
:Thanks for your help [[User:Sisyphus]], I will do that with the copyright specific ones. [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 17:50, August 17, 2019 (EDT)

* English
* Dutch
* French

* Unknown copyright
* Auteursrecht ongekend
* Copyright inconnu

* I don't know exactly
* Ik weet het niet precies
* Je ne sais pas exactement

* I created this and anyone can copy it but don't alter it, and credit me as the author
* Ik heb dit gemaakt en iedereen mag het kopiëren, maar wijzig het niet en vermeldt me als auteur
* J'ai créé ceci et tout le monde peut le copier mais ne le modifie pas, et créditez-moi comme auteur

* I created this and anyone can alter or copy it, but credit me as the author
* Ik heb dit gemaakt en iedereen mag het kopiëren en wijzigen, maar vermeldt me als auteur
* J'ai créé ceci et tout le monde peut le copier ou le modifier mais créditez-moi comme auteur

* I created this and I don’t care what anyone does to it, no one has to credit me as the author
* Ik heb dit gemaakt en iedereen mag het gebruiken naar goeddunken; je hoeft me niet als auteur te vermelden
* J'ai créé ceci et tout le monde peut l’utiliser comme il veut ; one ne doit pas me créditer comme auteur.

* Free licences
* Vrije licentie
* Licence libre

* Public domain
* Publiek domein
* Domaine public

* Public domain US Government
* Publiek domein, overheid van de Verenigde Staten van Amerika
* Domaine public, gouvernement des États-Unis

* Free Art License
* Vrijekunstlicentie
* Licence Art Libre

* Fair Use: Please explain the copyright exception (e.g. scholarship/research)
* Faire Use: verduidelijk alstublieft de uitzonderingen op auteursrecht (bijv. voor studiebeurzen/ onderzoek)
* Faire Use: explique les exceptions au droit d’auteur (p. ex. bourse/recherche scientifique)

* Please leave detailed explanation
* Geef alstublieft een gedetailleerde verklaring
* Laissez des explications détaillées

* Template: Used with permission
* Sjabloon: gebruikt met toestemming
* Modèle: utilisé avec permission

* Template:Fair Use License
* Sjabloon: Fair Use licentie
* Modèle: Licence Faire Use

* Template: Unknown copyright
* Sjabloon: ongekend auteursrecht
* Modèle: Copyright inconnu

* Template: Copyright violation
* Sjabloon: Inbreuk tegen het auteursrecht
* Modèle: Atteinte au droit d'auteur

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==Archived messages ==

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===Tweet ===
Hey Njt! I noticed a weird error message regarding the Tweet/doc page at [[:category:Pages_with_incorrect_formatting_templates_use]]. I really don’t know what to make of it, maybe it makes more sense to you... Cheers!
<br>[[User:Pyrrhus|Pyrrhus]] ([[User talk:Pyrrhus|talk]]) 20:07, July 6, 2019 (EDT)
:Do you mean the date script error? I think the Math extension might be needed for that template (which isn't in use yet). It fails because the Extract template it uses doesn't work. [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 15:13, July 7, 2019 (EDT)
:Now fixed [[User:Pyrrhus]] [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 06:29, August 6, 2019 (EDT)

===Re: Leave me a message -- [[User:Sigridjones|sigrid.jones]] ([[User talk:Sigridjones|talk]]) 04:20, August 6, 2019 (EDT)===

Thank you! I just added some user boxes. Happy to be here. Best regards, Sigrid --sigrid.jones (talk) 04:05, August 6, 2019 (EDT)

===Deleting pages problem ===
Hi [[User:Notjusttired|notjusttired]]! I started deleting some of the pages you cited for deletion, however, without them the references no longer populate, so I restored several. Please advise. Thanks, [[User:Kmdenmark|Kmdenmark]] ([[User talk:Kmdenmark|talk]]) 16:44, June 26, 2019 (EDT)
:Hi [[User:Kmdenmark|Kmdenmark]]! I see that the "Articles for deletion" category is broken, and it is showing a number of template pages that were never marked for deletion. I will look into the problem later on today or tomorrow and then I will get back to you. In the meantime, please restore the following templates that still need to be restored: [[Template:Chem2]], [[Template:Chem2/doc]], [[Template:Citation needed/doc]], [[Template:Composition bar]], [[Template:Composition bar/doc]], [[Template:Coord/doc]]. Thanks!
:[[User:Pyrrhus|Pyrrhus]] ([[User talk:Pyrrhus|talk]]) 17:16, June 26, 2019 (EDT)
::[[User:Pyrrhus|Pyrrhus]] Thanks! Take your time with it. I'll restore the ones deleted and will ignore the list until further notice. [[User:Kmdenmark|Kmdenmark]] ([[User talk:Kmdenmark|talk]]) 17:40, June 26, 2019 (EDT)
:::Yikes! [[User:Kmdenmark]] All the ones I marked for deletion today start with "Template:Template:" so those should be fine to delete, and all should have a similarly named page with "Template:" just mentioned once. I can't imagine what happened here. [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 18:05, June 26, 2019 (EDT)
::::Please hold off on deleting anything. There maybe some weird unanticipated link between the templates we want deleted and those we don’t want deleted...
::::[[User:Pyrrhus|Pyrrhus]] ([[User talk:Pyrrhus|talk]]) 18:26, June 26, 2019 (EDT)
:::::[[User:Pyrrhus|Pyrrhus]] and [[User:Notjusttired|notjusttired]], I'll hold off from deleting anything for now. I'm assuming that keeping the pages for now will not interfere with other operations. [[User:Kmdenmark|Kmdenmark]] ([[User talk:Kmdenmark|talk]]) 11:51, June 27, 2019 (EDT)
::::::[[User:Pyrrhus]] [[User:Kmdenmark]] I believe it's fixed now. I accidentally marked 2 templates that are needed for deletion, and they must be transclusions, so they added the deletion category to every template that used them. Can you please add protection to these 2 pages to prevent this happening again - the pages are [[Template:Template_other]] and [[Template:Template_error_report]]. The pages I had intended for deletion all had "Template:" in the name not just "Template", and all should be blank except for the deletion category. Perhaps you can both check if [[:Category:Articles for deletion]] looks right now. I'm really sorry for the problems caused by my mistake. [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 14:16, June 27, 2019 (EDT)
:::::::looks good to me, thanks njt!
:::::::[[User:Pyrrhus|Pyrrhus]] ([[User talk:Pyrrhus|talk]]) 14:48, June 27, 2019 (EDT)

===Pivot===
Hi Njt! Hope you’re enjoying your weekend. In case you missed it, the Pivot skin comes with some configuration variables. For more info, see https://pivot.wikiproject.net/wiki/Pivot_features
<br>Here is some example code you may be interested in:
<pre>
$wgPivotFeatures = [
'navbarIcon' => true,
'addThisPUBID' => 'ra-5cdfe8dacb9028fa'
];
$wgAddThisSidebar = true;
$wgAddThispubid = 'ra-5cdfe8dacb9028fa';
</pre>
(Code obviously comes after <nowiki>wfLoadSkin( 'pivot' );</nowiki>.) Hope this helps.
<br>[[User:Pyrrhus|Pyrrhus]] ([[User talk:Pyrrhus|talk]]) 17:40, May 25, 2019 (EDT)
::I've seen that, thanks. The publisher ID I requested and should sort the sidebar issue. Oddly the side bar setting does not work as you'd expect given the name! The logo setting might be withwhile but only applies to the smallest mobiles and puts the logo in the centre of the top bar! I've swapped the font and style of the title bar for the moment, and got it displayed #MEpedia. See code on [[MediaWiki_talk:Pivot.css]] for .p-logo-text. When the weekend is over In going to put in a request to add the MEAction fonts for ALL skins, which will mean we can use the logo text style anywhere. [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 17:51, May 25, 2019 (EDT)

Hi! Just checking if you need me to make any other changes. Hope all is well [[User:Kmdenmark|Kmdenmark]] ([[User talk:Kmdenmark|talk]]) 17:31, 16 May 2019 (EDT)
:Thank you for the offer of help. I'm making a lot of changes to the 2 new skins so that would be great. Can you do the new code for Timeless, like you did for the Pivot one? It's on here [[MediaWiki_talk:Timeless.css]] and needs to overwrite [[MediaWiki:Timeless.css]] totally, which will be easier than deleting the sections causing layout issues. Thanks again [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 15:41, 17 May 2019 (EDT)

===Archived ===
"Hi Njt! I noticed the following suggestion of yours in the Dev queue of [[MEpedia:Suggested_tasks]]:
<br>"Create custom Special page for tracking pages using NeedsImage template requested by User:Notjusttired"
<br>I was under the impression that this page accomplishes this: [[:Category:Articles_that_need_an_image_or_photo]]
<br>Am I wrong or missing something? Thanks.
<br>[[User:Pyrrhus|Pyrrhus]] ([[User talk:Pyrrhus|talk]]) 19:22, 28 March 2019 (EDT)
::Have done that now. I originally hoped to add or as a Tracking category in special pages so it's easy to find, but there's no simple way to do this. Would rather focus on other dev tasks.
::Have you got any thoughts on different skins? I added some to the Dev queue including a dark one. [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 17:18, 30 March 2019 (EDT)
:::BTW, I recently created a page to collate all those weird special pages together: [[MEpedia:Pages in need]]
:::The idea is that there would be a link in the lefthand sidebar to this "Pages in need" page so that contributors would have quick access to all these weird special pages. I'm pretty clueless on skins, so no opinion here, but I'll try to take a look. Thanks for all your help, Njt!
:::[[User:Pyrrhus|Pyrrhus]] ([[User talk:Pyrrhus|talk]]) 18:47, 30 March 2019 (EDT)
:::okay, I’ve finally taken a look at skins. It looks like you are recommending TimelessDarkCSS as a light-sensitive option and Pivot as the Mobile option. Is this correct?
:::Also, i note that your user page mentions “collapsible lists”. Do you know of any way to do that? That would be ideal for the Contents page...
:::[[User:Pyrrhus|Pyrrhus]] ([[User talk:Pyrrhus|talk]]) 18:59, 10 April 2019 (EDT)

::::Hi Pyrrhus. Yes to the Timeless-DarkCSS for those with photophobia or preferring a dark background.
::::The '''Pivot''' skin is brilliant for mobile devices and tablets but actually looks excellent on a Desktop (in my view) - Timeless without the dark CSS is a serif font I seem to remember and also looks good on mobiles, tablets and desktops. The norm is to default to Vector for wikis but Vector is really hard work on small screens because you can't hide the side menu - either you zoom and scroll a lot or need the most amazing vision.
::::Assuming these get installed and work as well as expected it should be nice to have a button to flip to the dark skin for those '''not logged in '''. I haven't seen the code to do this yet though. [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 16:44, 11 April 2019 (EDT)
:::::okay, here’s what it looks like we should do:
:::::#Install Timeless-DarkCSS and Pivot skins
:::::#Put two links in the lefthand/top sidebar: “Light-sensitive interface” and “Mobile-friendly interface”. These links will bring up instructions for how to switch skins in the user’s Preferences. When we find the code for a not-logged-in-user button, we’ll replace the links with buttons.
:::::#If the Pivot interface turns out to be as good as you say, we should talk about making Pivot the default interface for all devices.
:::::Does that look right?
:::::[[User:Pyrrhus|Pyrrhus]] ([[User talk:Pyrrhus|talk]]) 17:25, 11 April 2019 (EDT)

::::::Yes, that's right, although I think calling it "dark view" or "dark version" would be better. Dark timeless is simply a skin called Timeless with extra CSS, Timeless has almost the same features as Pivot so it might be a case of seeing whether Timeless in white is more popular than Pivot - I prefer Pivot myself. There's 2 different ways to automatically switch skins for mobile users [https://www.mediawiki.org/w/index.php?title=Simple_mobile_skin_auto_change/en&mobileaction=toggle_view_desktop Method 1] and [https://www.mediawiki.org/wiki/Extension:MobileFrontend Mobile Frontend method] which would allow desktop users to stay on Vector automatically. If you want to checkout hope they look on different screen sizes then [https://quirktools.com/screenfly/ Screenfly] is pretty good [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 18:50, 11 April 2019 (EDT)
"

==Renaming?==

I renamed this page to use the US spelling, as per the Manual of Style. [[User:kmdenmark]]
But should the category be renamed to '''British Organizations'''?
This would be easier to browse from [[:Category:Organizations]] because the country make would be first and the name is shorter. The same issue is there for Universities.
This would also fit with the Standard MEpedia country categories eg [[:Category:British research initiatives]].
I've created a temporary [[MEpedia Page Outlines]] for both Universities and Organizations but would welcome input / Ch changes from others. [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 18:14, 20 February 2019 (EST)

::The changes are fine with me. I have no attachment to either way. I think "Organizations based in the United Kingdom" is a bit long and awkward but it's the category title that Wikipedia uses. ([https://en.wikipedia.org/w/index.php?search=Category%3AOrganizations+based+in+the+United+Kingdom&title=Special%3ASearch&profile=advanced&fulltext=1&advancedSearch-current=%7B%22namespaces%22%3A%5B0%5D%7D&ns0=1 Wikipedia page for "Organizations based in the United Kingdom"]) [[User:Kmdenmark|Kmdenmark]] ([[User talk:Kmdenmark|talk]]) 19:03, 21 February 2019 (EST)
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==Categories for UK politicians==
{{Read more|
Hi. Can you avoid removing politicians from the categories for political parties? This is crucial information for advocacy and not held elsewhere. Labour/Co-op members are considered members of both parties so need to be in more than one category. Keeping them as categories allows someone to look for UK adbocates, then use the subcategories to find just politicians for political parties or fod which committee they are on - one committee is investigating the PACE trial Parties cover both MPs and the unelected House of Lords.

::Thank you for explaining the need for categories for politicians. I see your point and will not delete them anymore. [[User:Kmdenmark|Kmdenmark]] ([[User talk:Kmdenmark|talk]]) 14:29, 11 February 2019 (EST)

::::Thanks [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 19:01, 11 February 2019 (EST)

Also please don't mark redirects for deletion - they are there to help from the correctly spelled page - searching the incorrect name means MEpedia then find the correct page name too. notjusttired (talk) 13:06, 7 February 2019 (EST)

::Re: misspellings - I don't think misspellings should be honored with redirects. It is impossible to conceive of every misspelling that someone could use. I think the misspellings clutter the drop down menu in our search engine and make articles harder to find rather than easier. I support using redirects for alternative spellings, but not misspellings. If you can give me an example of one of the redirects you want to stay, it would help me understand your reasoning. I, also, eliminated some redirects where pages were not medically the same and to keep them as such would be inaccurate. A better way to link similar but different pages would be with links in the 'See also' section. (I don't know if you were the author of those redirects, but I wanted to explain why I eliminated those redirects, also.) My best, [[User:Kmdenmark|Kmdenmark]] ([[User talk:Kmdenmark|talk]]) 14:29, 11 February 2019 (EST)

::::It depends on the reason for the mispelling and how common it is. Eg if you delete the redirect for [[Intestinal permiability]] and type of into a search the correct page name won't come up - there's no results. Delete redirects for different spacing in page names and that search phrase may not work any more (eg The M.E. Society vs The ME Society). There's also a few unexpected UK vs US spellings (diarrhoea), and a few researchers with names that are commonly mispelled or have very similar spellings, which sometimes means their research is under several different names (AT Anbu vs Theo Anbu). When it comes to linking redirects have a link icon next to the page name, so it's easy to pick the right one - although perhaps there is a hidden property that can be used.

::I'm fine with trying it your way. Let's watch how the redirects work and see if we get other feedback from users.
:::A couple specific points: Sometimes the search engine is extra slow or temporary not working; that may explain why the correct spelling for [[Intestinal permeability]] didn't come up when you originally searched. I tested it and it came up every time I searched this morning.
:::Re: British spelling. I wholeheartedly agree that redirects for British spellings should have redirects. The main title is to be in American spelling as per MEpedia manual of style. My best, [[User:Kmdenmark|Kmdenmark]] ([[User talk:Kmdenmark|talk]]) 12:01, 12 February 2019 (EST)

:::::::: Thanks [[User:Kmdenmark]] - I've noticed performance problems but that has been loading pages rather than on searches. Maybe there's something else going on.

::::With making redirects for deletion, they need any pages using them to be updated first. The Contents page (which I can't edit) has a non-standard [[List of Quotes]] link, so deleting to use the correct capitalization breaks the link on the Contents page.
}}

==Messages I've seen ==
{{Read more|RE: Csn the Mike Beadsworth page be the main one, with Michael Beadsworth the redirect? Professionally he uses the name Mike far more.
Njt
[[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 13:58, 23 January 2019 (EST)

Sure, sounds good. [[User:Kmdenmark|Kmdenmark]] ([[User talk:Kmdenmark|talk]]) 17:19, 23 January 2019 (EST)

----
Just FYI: On the Pathogen page, you have left the following typo: "_Chia_201dorferi_paper.png"

I can't fix the typo since I'm not sure what it was meant to say...

Best, Pyrrhus

[[User:Pyrrhus|Pyrrhus]] ([[User talk:Pyrrhus|talk]]) 20:36, 10 February 2019 (EST)

Thank you [[User:Pyrrhus|Pyrrhus]] - I'm not sure what image it was supposed to be so I added an alternative and fixed the problem. [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 09:07, 11 February 2019 (EST)
}}
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== Priorities ==
* Image copyrights to organize
* Check copyrights on ICC and other files
* Better symptom photos e.g. malaise, levels of fatigue and disability, symptoms
* Infographics template - XMP CC info, large size, site name only in corner (font as wiki?)
* Infographic & poster creation

== Brain fog tasks ==
* [[Articles that need an image or photo]]
* [[:Category:Articles with unsourced statements]]
* [[Add source and copyright to existing images]]

== Tips ==
* [[Science Guidelines]]
* [[Using the source_code editor]]
* [[Power user/editor tips]]

==Welcome to MEpedia!==
* [[How_to_contribute|How to contribute]]
* If you need ideas of improvements to make to MEpedia, See [[MEpedia_suggestions|suggestions]]
* [[Contents|MEpedia Contents]]

* To create new page, use one an outline: [MEpedia_article_outlines]

To see your contributions history, click Contributions in the top-right corner. To see recent contributions by others, click Recent Changes on the left. Not ready to edit pages, but want to suggest a change? On the page, just click Discussion, and write your suggestion there for others to see.|realName=Anonymous|name=Notjusttired}}

== Random code==
{{bar box
|title=Chronic Fatigue Syndrome: Common Symptoms
|titlebar=#DDD
|left1='''Symptom'''
|right2=%
|width=400px
|bars=
{{bar pixel|Fatigue: persistent or relapsing|#0CBCBC|100}}
{{bar pixel|Symptoms last over 6 months|#0CBCBC|100}}
{{bar pixel|Significant reduction in activities|#0CBCBC|100}}
{{bar pixel|Post-exertional malaise|#0CBCBC|96}}
{{bar pixel|Memory & concentration probs|#0CBCBC|98}}
{{bar pixel|Unrefreshing sleep|#0CBCBC|99}}
{{bar pixel|Headaches - new or different|#0CBCBC|100}}
{{bar pixel|Muscle pain (myalgia)|#0CBCBC|96}}
{{bar pixel|Sore throat|#0CBCBC|81}}
{{bar pixel|Joint pain (arthalgia)|#0CBCBC|86}}
{{bar pixel|Lymph node pain|#0CBCBC|81}}
|caption=Source: Jason et al.
}}‎

{{Bar chart
| title = <div style="font-size:1.4em; margin-bottom: 0.4em;">Common Symptoms in Chronic Fatigue Syndrome</div>
| bar_width = 15
| width = 30
| width_units = em
| label_type = Symptom
| label1 = Fatigue - persist or relapsing*
| label2 = Significant reduction in activities*
| label3 = Symptoms last over 6 months*
| label4 = Post-exertional malaise
| label5 = Memory & concentration probs
| label6 = Unrefreshing sleep
| label7 = Headaches - new or different
| label8 = Muscle pain (myalgia)
| label9 = Sore throat
| color = #0CBCBC
| data_type = Mild to Severe<br> Symptom %
| data_max = 101
| data1 = 100
| data2 = 100
| data3 = 100
| data4 = 96
| data5 = 98
| data6 = 99
| data7 = 90
| data8 = 96
| data9 = 81
| col2_data_type = Moderate to Severe<br> Symptom %
| col2_data_max = 101
| col2_data1 = 95
| col2_data2 = 100
| col2_data3 = 100
| col2_data4 = 86
| col2_data5 = 80
| col2_data6 = 92
| col2_data7 = 50
| col2_data8 = 73
| col2_data9 = 31
|caption= '''Source: Jason et al.'''
}}

===Messages ===
Notjustired: [[Severe and very severe ME]] Chronological order goes from earliest to latest. Citations are not placed under the study and instead, they are cited. If details like pages are necessary, they can be entered into the citation. --[[User:MEcfsFMS|MEcfsFMS]] ([[User talk:MEcfsFMS|talk]]) 09:51, 20 October 2018 (EDT)

Hi. Is that somewhere in the editorial standards? I don't remember reading it. I think it's important to add doi to citations of they aren't already in there. I will look at adding author links to the citations too. I created a talk page for the Severe ME image to discuss ideas.
[[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 10:15, 20 October 2018 (EDT)

:I put doi in and the PMID? But PMC causes an error and I don't think they have figured out why yet. Authors links don't get created and I thought they were in the "Reference" area.--[[User:MEcfsFMS|MEcfsFMS]] ([[User talk:MEcfsFMS|talk]]) 10:39, 20 October 2018 (EDT)

:I see, if the citation automatically creates the citation, authors internal links are created. If they have to be manually input then it does not seem to create them.

:That makes sense. I thought people had been spending ages manually adding them or copying and pasting the code for the most common ones. I normally automatically generate a citation, if it doesn't work I use another link or the doi, then replace the finished link with a full text link if necessary. Links from investinme and researchgate normally don't generate automatically so I use a PubMed link and overwrite the link only after the citation is generated.
Could you update the [[Manual of style]] with anything else that isn't in there?
I'll go back sort the citations I changed. [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 10:53, 20 October 2018 (EDT)

== MOS - Dates ==

Hi Notjusttired:

Somewhere at some point early on, I remember the date format was to be US, Jun 10, 2016, and not 10 Jun 2016. I can't remember where or when I read this but a few of us started changing dates in UK format and going forward we used US format. I think Jen had posted about it but I'm not sure. Also, we were to change any UK spellings to the US spelling unless it was a quote.--[[User:MEcfsFMS|MEcfsFMS]] ([[User talk:MEcfsFMS|talk]]) 14:26, 31 October 2018 (EDT)

ty for letting me know, can you fix what I wrote on [[MOS]] - does the same apply to date in citations? Sometimes they cause an error so I presume I put them in as Jun, 28 2018 now?

:Yes, that is how I write in the citations, but move the comma so it is Jun 28, 2018 or Jun 2018. I will change MOS.--[[User:MEcfsFMS|MEcfsFMS]] ([[User talk:MEcfsFMS|talk]]) 14:43, 31 October 2018 (EDT)
- Will do, do you know about fixing the citation template error at all? Dates generated in the form 2018-06 always give an error when you generate a citation from a link - I presume it's possible to fix this? [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 14:49, 31 October 2018 (EDT)

== Fibromyaliga Page ==

Please be careful where information is added on the [[Fibromyalgia]] page. The blood test information you added should go on the [[Fibromyalgia notable studies]] page as it is not an accepted blood test yet. I moved the EpicGenetics blood test under the subheading "Blood tests" under "United States" and put the study you had added on the ''Fibromyalgia'' discussion page. You can post this research on the ''Fibromyalgia notable studies'' page.

I created and edited most of these pages starting with the username DxCFS. I lost my PW when FF crashed and could not get it back using the PW retrieval as there is something wrong with MEpedia carrying out this task. I have had many usernames because I am really bad with remembering my usernames and usually just use a VPN now.--[[Special:Contributions/77.111.245.10|77.111.245.10]] 12:07, 25 March 2019 (EDT)

:Also, the ''Fibromyalgia'' page became too long to use the "Edit" tab and the "Edit source" tab is not an option due to citations and that is why I broke ''Notable studies'' off. There is an area at the bottom of the ''Fibromyalgia'' page to post news articles about research as people usually want to read about research by media and bloggers and not the hard research.--[[Special:Contributions/77.111.245.10|77.111.245.10]] 12:13, 25 March 2019 (EDT)

:Thanks for the input - I've never edited that page before. I will update the redirects for blood test info - when I searched before adding it the Fibro Notable studies page wasn't near the top of the results (I don't recall seeing it at all). [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 16:49, 25 March 2019 (EDT)

== Simon Wessely Page ==
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Wessely Page - Hi Notjusttired. I'm currently editing the page on Simon Wessely by inserting many references. Please leave the page for a moment otherwise we crosspost and I loose all the changes which is many hours of work. Kind regards, Sisyphus.
:I've just seen your notice. I will leave alone. I am going to put some improved citations on the talk page and leave it at that. [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 08:08, July 16, 2019 (EDT)

Thanks. It's ok now. The references have been inserted (It took a while). Could you delete the warning "This article may require cleanup to meet MEpedia's quality standards"? If not, could you explain which sections or claims you disagree with (for example in the discussion section of the page). Kind regards, Sisyphus.
::I will take a look. Did you see the citations I suggested on the talk page, including the Camelford ones? [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 10:45, July 16, 2019 (EDT)

I used some of them. I only briefly mention Camelford as an example where Wessely controversially pointed towards psychosocial factors in a case that isn't clear. More information about this could be posted on a seperate MEpedia page. I unfortunately do not know the details of this case, so I'll leave it to you and others. - Sisypus.
:[[User:Sisyphus]] Can you explain why so many sections have been removed or pretty much reverted? It was only recently changed about 3 weeks ago. It now reads as if everything Wessely claims via journalists or is in his research is a fact - even though at times he contradicts his previous statements so making it hard to know what he thinks. Eg the fact that Wessely claims CFS is part of MUS is his opinion, not a generally accept fact and that needs to be clear. In fact, one of the controversies around Wessely is him repeatedly making the claim that it can be classed as a psychological condition in the ICD-10 manual - despite confirmation from the World Health Organization that it is explicitly excluded and only classified as neurological. Including the death threats. The carefully phrased sections I added about those contesting his many claims are gone. He is known for saying one thing to one audience and something totally different to another. The links to the 3 pages of quotes complied from him are gone. I haven't seen a reason in the history or a mention of the removals or changes to the headings. Even his retirement claim is not a fact - he carried on publishing CFS research for years after "retiring". Eg police freedom of information act requests contradict that. As far as Wessely's claims of victimization go, we should be reporting "In a 2017 interview, Wessely stated that" but not in a way that suggests that it is factual. Wessely refused to appear before the UK's Gibson Enquiry which was pressing him for answers on his views. [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 11:59, July 17, 2019 (EDT)

I tried to rewrite the page in full text and provide more context to his work and the controversies. I’m sorry if have deleted things without providing a reason why.
Regarding the ICD, I personally think he was trying to say that patients with the symptoms of CFS can be diagnosed as having CFS (G93.3) or neurasthenia/fatigue syndrome (F48.8) and don’t see this as a big issue. If you disagree, perhaps we can make a section on this under controversies. Regarding the quotes: I am not a fan of quotes without context, certainly if it is used to criticize someone or cast someone in a certain light. That’s certainly the case of the links you mention. If you want them restored perhaps we could use them as example of criticism of Wessely rather than as an resource of quotes from him? Regarding the death threats I’m ok with restoring the info for example regarding the freedom of information request. I didn’t think this was vital because the information doesn’t permit us to make conclusions about what happened. And regarding the Gibson Enquiry if Wessely did actually get serious death threats, than I could understand why he prefers not to be questioned about the details on this. So I don't think this means much. If you insist on including more info about this, perhaps there is enough to make a separate page on this (there’s also some relevant info about this from Valerie Eliot Smith’s blog). Kind regards, Sispyhus.
::I'm happy to have the quotes back under a heading "Quotes critical of Wessely" or similar. The classification of ME/CFS is a huge issue because it is part of his claims that it is not a disease / has no disease process and that it is psychological or mostly psychological which justifies the CBT and even GET. He refuses to acknowledge any science he does not like such as mitochondria or immune days. It's quite likely he quit research rather than having his work proved wrong. Same with Michael Sharpe, also from the PACE trial. Peter White of the PACE trial allegedly retired early from clinical practice to avoid GMC complaints that could have removed his license to practice (he was under investigation). Wessely also helped design the PACE trial - a crucial fact now missing from the top of his page. Wessely and his policies largely in control of UK treatment and has been for over a decade. Regular political questions on him and his [[Wessely school]]. Thanks to his attempts to re-classify the illness all UK ME/CFS treatment comes from a mental health health budget, he controls the media via the Science Media Centre, and gives numerous interviews making nasty persons attacks on patients. Wessely and Deale provided the key randomized controlled trial in the 1990s still used as "evidence" for CBT. The Gibson Enquiry was a scientific one, many years before he stated his death threat claims - which some have suggested are simply a way to detect from PACE trial criticism, since that's when they appeared. Absolutely nothing to fear from that except scientific scrutiny. Several Freedom of Information Act requests have shown that PACE trial critics are not harassing let alone threatening anyone. Although they tried to use this argument to prevent the release of the data. <br >
I feel that the page re-write portrays Wessely incorrectly as mostly not controversial, and portrays his science as student accepted, and endorses his views given in newspaper interviews as accurate and unbiased. He will make claims like Gulf War Illness doesn't exist, then later claim to have originally discovered it! He's also a social security advisor and does not believe patients should be entitled to disability benefits.As regards the quotes - they come from several charities and are certainly not taken out of context. It's very hard to see how many of the statements could be out of context given how rude and nasty they often are about patients, who he calls "disgusting" and "not wanting to get better".<br>
What do you think about adding back in the references that were removed, and then working together to tackle a section at once? I think it important to be very careful not to claim Wessely has reported the truth about himself since this is often untrue or contradicted (either by himself or by independent sources). [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 13:35, July 17, 2019 (EDT)

I have thought about your comments but I think we have to be neutral and objective on this. I don’t think the texts of Margaret Williams and Malcolm Hooper should be used as a basis for the MEpedia page for exactly this reason. The page already contains much criticism of Wessely. It says in the introduction that his work is controversial and has been repeatedly criticized and it already contains numerous controversial quotes of him (including the “not wanting to get better” one).
Regarding the quotes out of context: I do think this is a big problem. The one about ME merely being a belief for example has been circulating within the ME community as it were to mean that ME patients are malingering, which isn’t what Wessely was saying. These kinds of misunderstandings are very unfortunate and distract from the real issues with his work.
I also think the MEpedia page should not only be directed towards patients but also to outsiders such as journalists or researchers who want objective information about Wessely. So a link to a list of controversial quotes with comments mocking what he said seems inappropriate. There are plenty of blogs and articles that criticize his work or scrutinize every word he said during his career, looking for inconsistencies or poorly nuanced statements. I don’t think the MEpedia page should be another of these and instead should offer an overview of his work and career like we do with other pages on researchers. If you see further problems with the page, I don’t mind discussing it further. But I think the current version is well balanced. - Sisyphus.
:I think the issue we are disagreeing on here is mostly neutrality. While parts of the previous page were not put across in a way that was fully neutrally totally excluding critical sources has in fact done the opposite. We can look at phrasing at the amount of text given to criticism but removing it is entirely inappropriate. I have an issue with passing off Wessely's views as facts when they are not - such as claiming CFS is part of MUS. We should not be doing that on any researcher's page. There is no doubt that Wessely is controversial - in fact he has given a number of interviews knowing that they would be controversial. "Controversial" is not a negative judgement - the Enterovirus theory is also controversial. ME itself and much of the research is controversial. The fact is his research is controversial too - after all the CDC, NHS and others followed it and the CDC and others then dumped it, plus there was the Stop GET petition too. The Institute of Medicine report disputes it. On neurality, we also can't claim Wessely invented CBT for CFS when he actually was one of 3 - Trudie Chalder has separately claimed to be the inventer. I am going to make some edits today, keeping in mind what you have said, to add in more neutral phrasing on his research "Wessely stated", in "Sir Wessely's view" etc. And add back in some references critical. While Margaret Williams and Malcolm Hooper are very critical, that does not mean they should be totally left off the page - that's not neutrality - but neither should they be emphasized. Patient groups critical of Wessely should certainly be referenced, along with Freedom of Information Act requests since they are neutral and accurate. This might mean overall that less text is critical of Wessely than before, but that there are a large number of sources supporting certain points. Part of the guidelines we are writing for is to allow others to find out more information, so we do need to either reference or link to quotes or Hooper's Mental health movement, but also any articles praising him and summarizing his contribution. If Quotes aren't used as a heading then they could go in Learn more for example. Clearly given the significant time taken to collect all these, they do have significance and may bring people to do the page who are looking for "Weasel words" - in which case they would then see an article more balanced than just those quotes. Perhaps you would like to look for those, or have some in mind. Re: Malingering: Wessely has said exactly that, in fact using the phrase "malinger's charter". Part of the basis of his scientific arguments is that around the "secondary gain" - his work and especially interviews repeatedly make this claim. That doesn't necessarily mean that particular quote needs including, but it is representative of his views. [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 07:12, July 18, 2019 (EDT)

With all the respect notjusttired but I disagree with some of your changes and would prefer the original to be reinstated. I don’t want to use an argument of authority here, but my text does include 135 references, mostly scientific publications. I have worked many months on this and I know what I’m talking about.
For example regarding the Gulf War syndrome: there’s not really a contradiction: his 1999 epidemiological study demonstrated that there was an adverse effect of going to the Gulf war that goes beyond deployed to war or being a soldier at that time period. So his study was one of the most important ones in demonstrating that the health of soldiers who went to the Gulf War was affected by something. But he doesn’t want to say there is a Gulf War Syndrome because there was no evidence for a unique constellation of signs or symptoms – the Gulf war veterans reported more of all the 50 symptoms assessed in the study. That’s his view and it’s unambiguously presented in his publications. It’s only by relying on fragmented quotes or misrepresentations by Hooper and Williams that things get obscure and that’s what I’m trying to avoid on the page.
Malingering is another example. There is no evidence that Wessely thinks CFS patients are malingering. In fact he has repeatedly warned against this idea, saying “there is little evidence to suggest that the fatigue results from impaired motivation, and the use of terms such as ‘malingering’ or ‘hysteria’ is to be deplored.” (Source: https://studylib.net/doc/7895242/chronic-fatigue-syndrome). He made similar arguments about Gulf War Syndrme (see minute 50 of this lecture: https://vimeo.com/52995882).
I can also attest that Wessely developed CBT for CFS: he was to first to publish about this in 1988 and to first to publish a trial on this in 1991. Chalder worked for him at the time so when she says she first developed CBT, she probably meant she was part of the team that did and that team was lead by Wessely. I highly doubt that she would contest that. She has no problem with crediting him, even about the scale that now bears her name: “I think its more Simons research than mine that we developed a fatigue scale, which is now called The Chalder fatigue scale.” (source: https://www.s4me.info/threads/13-march-2019-chalder-%E2%80%98medically-unexplained-symptoms%E2%80%99-my-clinical-and-research-journey-over-30-years.5576/page-3#post-152193)
I have reread the page and don’t understand what you mean by presenting Wesselys' view that CFS is part of MUS as a fact. I constantly use the phrase “they argued…” Williams and Hooper are allready on the page, they are references as examples of criticism of Wessely’s work. And I don’t quite understand why you made a separate heading for the PACE trial: Wessely wasn’t an author of the PACE trial. It seems weird to focus on this. He has published approximately 600 papers, several books and numerous newspaper articles – most which don’t get a mention because of a lack of space.
I’ve waited on editing the Wessely page until I’ve read most of his work and got an overview. By working this way I hoped to achieve a balance in attention each items receives without making the page too long. So please be mindful of that if you change things. Kind regards - Sisyphus.

"CBT is is based on a psychological and fatigue-based approach, with an expectation that exercise would normally be part of the treatment." is also not correct. In contrast to the CBT developed by Bleijenberg and Vercoulen, the CBT model developed at Kings' College does not necessarily include exercise. Instead it is focussed on graded actvity which can be increases in social activities, reading etc. Furthermore it is strange to describe it as a fatigue-based approach as it was inspired by the treatment of chronic pain. Wessely and other CBT-authors acknowledge this repeatedly.
::Do you mind if I move this conversion to the Talk page for Wessely? We are getting into what feels like a stalemate, I think input and suggestions from others would help. There shouldn't be a question on authority here, I would like to achieve a consensus and that should be possible. One of the very difficult issues with Wessely is that he contradicts himself, and these are worth pointing out. He will claim one thing in one place and another to a different audience - "malinger's charter" is a direct quote from him which he later contradicted (just as an example). So we should be careful in claiming his view or one thing or another when he himself has contradicted it elsewhere. The new section I will respond on in a moment, with a paste from the research to clarify.
::I recognize you have worked hard on this, but I think to make huge changes at all once causes issues for other editors. I also have worked extensively in this page, in Nov/Dec, and in March and then in June, plus on related topics recently - eg CBM model, and CBT. I too would prefer a revert to before you made the changes (!) but I think a looking towards a consensus would be a better approach. [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 09:20, July 18, 2019 (EDT)

Yes perhaps it's best to move the conversion to the talk page for Wessely. Perhaps we can just copy paste what we wrote here so that others can follow our conversation?
I also agree in working towards a consensus. But changes need to be carefully argued with good references (not just something someone else has claimed on a blog or tweet). I haven't seen any evidence that Wessely often contradicts himself, excepts perhaps for his statements on not seeing Ean P. Of course if one dissects everything a researcher has said or published in the last 30 years, you'll always find something. But haven't noticed clear contradictions. I'm not aware however where the 'malinger's charter' quote comes from - was this during a lecture?
One option would be to add more detailed criticism and information about Wessely on a seperate page - for example 'Wessely school' and to add a prominent link on the Simon Wessely page to this one for further details on the criticism of his work, including what Hooper and Williams have written.
I apologize if I deleted information you saw as important. I tried to incorporate most in the text I've wrote. I appreciate the hard work you put into MEpedia.
{{collapse bottom}}

== Tagging -- [[User:Brettz9|Brettz9]] ([[User talk:Brettz9|talk]]) 16:06, July 23, 2019 (EDT) ==

Hi there... I'm really too drained and preoccupied to do much these days with the wiki, so if you wouldn't mind only tagging me in cases where I had added the content myself, I'd appreciate it. Thanks! [[User:Brettz9|Brettz9]] ([[User talk:Brettz9|talk]]) 16:06, July 23, 2019 (EDT)
:Sure [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 16:41, July 23, 2019 (EDT)

== Slow down ==

Please slow down with your edits on Dutch topics. You're making lots of mistakes. As I suffer from ME, I can't possibly keep up. [[User:Guido den Broeder|Guido den Broeder]] ([[User talk:Guido den Broeder|talk]]) 21:24, September 12, 2019 (EDT)
:I can slow down editing, although I have no yet seen evidence that I had said anything not supported by references [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 13:18, September 13, 2019 (EDT)
I am now asking you to stay away from the Dutch pages that I'm editing. If you don't do that voluntarily, I will ask for you to be topic-banned. [[User:Guido den Broeder|Guido den Broeder]] ([[User talk:Guido den Broeder|talk]]) 17:25, September 14, 2019 (EDT)
::Explain your reason please. There are several editors reversing your edits, you are not following editorial or science guidelines, and even reversing some manual of style changes at the same time (eg date format). And you have a clear conflict of interest with this topic because you are founder one Dutch charity and wrote here - on MEpedia - that you previously lead a revolt against changes in another. So I find this request of yours quite unexpected. [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 20:03, September 14, 2019 (EDT)
:::This is not Wikipedia. Conflict of interest is not even defined here. If we were to apply the Wikipedia policy I would have a conflict of interest with every topic on this wiki, and so would all knowledgable editors, and the wiki would remain empty. So instead we just do the best we can, because it's important and there are only a few of us. All that you contribute on these pages is a lot of mistakes. That costs too much of my time and energy, so it needs to stop. There is plenty of technical work to do, so why don't you do that and leave the content to others. [[User:Guido den Broeder|Guido den Broeder]] ([[User talk:Guido den Broeder|talk]]) 20:27, September 14, 2019 (EDT)
:::With regard to dates: when I'm creating an article, I avoid using citation templates, because those clutter up the source text so badly that my ME brain can't cope very well. So the date format is irrelevant and I use the same format that I apply everywhere else, again saving time and energy. Content is important, minor differences in style are not. [[User:Guido den Broeder|Guido den Broeder]] ([[User talk:Guido den Broeder|talk]]) 20:51, September 14, 2019 (EDT)
::::So basically, you don't have a reason other than "mistakes". Please see the [[MEpedia:Manual of style]] including the talk page for it on dates. Everything here is US format, with short month names. It is up to you whether you use the Visual editor or not, but it would create ask the citations for you very quickly. Alternatively, just paste in the link as you do now, without the <nowiki >[ ]</nowiki >square brackets , then when you next use the Visual editor click it, and you will get a "Convert" option which will do so the citation for you. The citation template is not optional - but we are always keen to find ways to reduce the concentration needed to edit or read. I am somewhat surprised that you have not edited your own charity page now (I was on the website earlier but can't find some of the standard info we normally add). Brain fog I can never get used to. [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 21:31, September 14, 2019 (EDT)

== Signature in section headers ==

Section headers should not auto-generate a signature in them. Not only does that makes things messy, it affects Google searches. Can you please change that back to default? [[User:Guido den Broeder|Guido den Broeder]] ([[User talk:Guido den Broeder|talk]]) 16:34, September 15, 2019 (EDT)
:This is an automatic feature on MEpedia for editors using the toolbar button. There is no option not to include the name and signature. If you want this to change you need find out how it works and request the change, although it may have been added because inexperienced editors were forgetting to sign their posts. MEpedia talk pages are not indexed. [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 17:45, September 15, 2019 (EDT)
::Not so much inexperienced editors, but you do forget to sign your posts. Apparently, despite offering technical help, you don't have access to the backside of this wiki. That's OK, I will ask elsewhere. Could you explain what your offer of technical assistance means instead? [[User:Guido den Broeder|Guido den Broeder]] ([[User talk:Guido den Broeder|talk]]) 17:55, September 15, 2019 (EDT)

== Manual of style ==

The [[Manual of style]] was in part created by editors that are no longer around, with random edits by you in between. I intend to change it to make it easier for ME patients to contribute, before inviting other ME patients to join this project. For now, just remember that the MoS is not mandatory, especially not on pages that are still work in progress. They are guidance, not policy. Allowing users to contribute in a style that they feel comfortable with has priority. [[User:Guido den Broeder|Guido den Broeder]] ([[User talk:Guido den Broeder|talk]]) 17:36, September 15, 2019 (EDT)
:That is a ridiculous statement. I hope that you did not mean to suggest that the ill health of editors should be used to disregard their views and contributions entirely. It would appear that you have total disdain for the current MOS, editorial guidelines and science guidelines, and the fact that we have over 2,000 pages following these. Repeated uncivil behavior toward several users is also apparent. As I understand from your message here and your repeated failure to follow what has been agreed, you appear to have chosen not to engage with the process and feel that you will just change them as how you choose and without discussion. This is a collaborate project rather than a website you can simply hijack. [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 17:57, September 15, 2019 (EDT)

==Guido den Broeder ==
I refuse to accept further messages from you on my talk page.
You are repeatedly harassing me and edit warring, and at times insulting me. This is not civil behavior.

In future, if you have something to say to me use the relevant article talk page instead. [[User:Guido den Broeder]] [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 17:57, September 15, 2019 (EDT)

== Dorsal root ganglion or Dorsal root ganglia -- [[User:Loopy|Loopy]] ([[User talk:Loopy|talk]]) 08:51, November 18, 2019 (EST) ==

Hi, Notjusttired.

I wanted to ask if you felt that the Dorsal root ganglia page should really be Dorsal root ganglion. I see it both ways but usually Dorsal root ganglion. Wikipedia has a page that uses "ganglion". https://en.wikipedia.org/wiki/Dorsal_root_ganglion

--[[User:Loopy|Loopy]] ([[User talk:Loopy|talk]]) 08:51, November 18, 2019 (EST)
::I'm not really sure to be honest. If you want to rename it, leave the old redirect in place in case anyone searches for the old name. The wiki reference (ref 1) should be replaced with an encyclopedia or similar to meet the Science guidelines. ~[[User:Notjusttired|Njt]] ([[User talk:Notjusttired|talk]]) 13:19, November 18, 2019 (EST)

== Edit Issues? -- [[User:Loopy|Loopy]] ([[User talk:Loopy|talk]]) 05:14, April 17, 2020 (PDT) ==

I am having problems with editing. Only "Edit source" will let me edit, and even this option does not seem to be working well. And suddenly my FF browser will not let me edit here due to it not being an HTTPS site? Are you having problems? Trying to use the "Edit" tab, but keep getting the error "Error loading data from server: apierror-visualeditor-docserver-http-error: (curl error: 7) Couldn't connect to server. Would you like to retry?"
:Hi there. I think we are all getting the same - it's been raised with the developers since it only started after they did a migration. I found that using https allowed editing in the source code, eg https://www.me-pedia.org/wiki/Coronavirus_disease_19 - but it keeps flipping back to http and thinking I am not logged out, so I end up typing https over the top of the address again. This also means we can't get the visual editor to convert links into full references like normal. I am also having issues with editing categories at the bottom of pages - it seems to work but when you go to the category directly, it isn't getting updated (I have moved several pages from the Infectious agents to Infectious diseases categories). I am not sure if others are getting this too. Ben from MEAction is talking with the developers on this. Btw: it should let you edit most pages with http but still show up as an anonymous edit, pages with some protection eg the primers or CFS page soupy need you to log in (and use https). It's very frustrating. ~[[User:Notjusttired|Njt]] ([[User talk:Notjusttired|talk]]) 12:09, April 17, 2020 (PDT)

== Slack -- [[User:Fireballsky|Fireballsky]] ([[User talk:Fireballsky|talk]]) 20:21, October 30, 2020 (UTC) ==

I could check out the Slack for the devs. I don't always get notified when you reply to my messages. So I just now saw your message regarding this.

Thanks

Hi [[User:Fireballsky]]. I think it might be Ben H. who adds people to the Slack channel, there should be contact details on the MEAction website. Some of the things at the top of the list on [[MEpedia:Suggested tasks]] are for the for to upgrade MediaWiki and looking at adding some extra extensions. There's an option in your user preferences to get emailed when someone tags you on a page or for edits to pages you are watching. I usually just check the Talk are on Recent Pages on the left menu myself. There's also a "pages in need" option that suggests small tasks. ~[[User:Notjusttired|Njt]] ([[User talk:Notjusttired|talk]]) 00:18, November 3, 2020 (UTC)

===Re: Slack -- [[User:Fireballsky|Fireballsky]] ([[User talk:Fireballsky|talk]]) 18:08, November 10, 2020 (UTC)===

Ok, sounds good, thx!

== Change to admin -- [[User:Kmdenmark|Kmdenmark]] ([[User talk:Kmdenmark|talk]]) 18:04, March 18, 2021 (UTC) ==

Per request, you are now an admin. It expires on Apr 18. Let me know if you need more time or want to make it permanent. [[User:Kmdenmark|Kmdenmark]] ([[User talk:Kmdenmark|talk]]) 18:04, March 18, 2021 (UTC)

== Indoleamine-2,3-dioxygenase 1 -- [[User:Loopy|Loopy]] ([[User talk:Loopy|talk]]) 13:20, April 24, 2021 (UTC) ==

The page [[Indoleamine-2,3-dioxygenase]] seems to be spelled incorrectly. It should be indolamine-2,3-dioxygenase.

There is an extra "e" for the page name on MEpedia.

See the Abstract info on this study. https://www.mdpi.com/2075-4418/9/3/82/htm

--[[User:Loopy|Loopy]] ([[User talk:Loopy|talk]]) 13:20, April 24, 2021 (UTC)

Genetics of chronic fatigue syndrome

2021-04-24T13:13:05Z

Loopy:Added IDO study

The '''genetics of chronic fatigue syndrome''' is an area of research as [[ME/CFS]] has been observed in families.<ref name=":0">{{Cite web|url=https://www.cdc.gov/me-cfs/healthcare-providers/presentation-clinical-course/etiology-pathophysiology.html|title=Etiology and Pathophysiology {{!}} Presentation and Clinical Course {{!}} Healthcare Providers {{!}} Myalgic Encephalomyelitis/Chronic Fatigue Syndrome|date=2018-11-08|website=[[Centers for Disease Control]]|language=en-us|access-date=2019-02-08}}</ref> It is unknown if there is a genetic link or common environmental exposure (infectious or toxic). Studies of twins show higher rates of ME/CFS in identical than fraternal twins. The [[Centers for Disease Control and Prevention]] (CDC) notes that specific genetic associations have not been established.<ref name=":0" />

=== The IDO Metabolic Trap Hypothesis for the Etiology of ME/CFS ===
A new hypothesis, the indolamine-2,3-dioxygenase ([[IDO]]) [[metabolic trap]], was developed and formulated as a mathematical model. The historical occurrence of [[List of myalgic encephalomyelitis and chronic fatigue syndrome outbreaks|ME/CFS outbreaks]] is a singular feature of the disease and implies that any predisposing genetic mutation must be common. A database search for common damaging mutations in human enzymes produces 208 hits, including IDO2 with four such mutations. Non-functional IDO2, combined with well-established substrate inhibition of [[IDO1]] and kinetic asymmetry of the large neutral amino acid transporter, LAT1, yielded a mathematical model of tryptophan metabolism that displays both physiological and pathological steady-states. Escape from the pathological one requires an exogenous perturbation. This model also identifies a critical point in cytosolic tryptophan abundance beyond which descent into the pathological steady-state is inevitable.

=== ME/CFS Gene Study ===
The [[ME/CFS Gene Study]] is still collecting data, but the initial pilot study by Perez et al. (2019) found 10 relatively common genes or gene variants were significantly more common in people with ME/CFS.<ref name="Nathanson2019" /> These were [[Cytochrome P450 2D6|CYP2D6]], [[Proline-rich transmembrane protein 4|PRRT4]], [[Serine Protease 56|PRSS56]], [[Armadillo Like Helical Domain Containing 4|C14orf37]], [[Ankyrin Repeat And Death Domain Containing 1B|ANKDD1B]], GPBAR1, LHB, ADAMTS19, VARS2, and CPLX2.<ref name="Nathanson2019" />

=== Utah Population Database study ===
A 2011 study by Albright et al showed evidence of a heritable contribution to [[chronic fatigue syndrome]] (CFS).<ref name="Albright, 2011" /> Using the extensive records of the Utah Population Database (UPDB), the study "shows clear evidence of significant excess familial clustering and significantly elevated risks for [[Chronic fatigue syndrome|CFS]] among first, second, and third degree relatives of CFS cases. The results strongly support a genetic contribution to predisposition to CFS as it is currently defined and diagnosed by clinicians in Utah." Increased outbreak rates in first degree relatives are not automatically assumed to be genetic because the first degree relatives often share the same lifestyle and environment. However, a significantly increased incidence (95% confidence interval) in second and third degree relatives strongly indicated a genetic contribution to CFS, given the much lower likelihood of these relatives sharing common risks and environments.<ref name="Albright, 2011" />
[[File:Genetic Relationship graph.png|center|Albright,2011 study]]

=== Family history and twin studies ===
A 2001 study in the [[United Kingdom|UK]] showed "there were significantly higher rates of CFS in the relatives of CFS cases compared with the relatives of control subjects."<ref>{{Cite journal|last=Walsh|first=C. M.|author-link=|last2=Zainal|first2=N. Z.|author-link2=|last3=Middleton|first3=S. J.|author-link3=|last4=Paykel|first4=E. S.|author-link4=|date=Sep 2001|title=A family history study of chronic fatigue syndrome|url=https://doi.org/10.1097/00041444-200109000-00003|journal=Psychiatric Genetics|language=en|volume=11|issue=3|pages=123–128|doi=10.1097/00041444-200109000-00003|issn=0955-8829|quote=|via=}}</ref> Three twin studies (one in Australia, one in Washington, US, both in 2001, and one in the UK in 2007) showed that the correlations for prolonged and chronic fatigue were significantly higher in monozygotic than dizygotic twins for each definition of chronic fatigue syndrome.<ref name="Buchwald, 2001" /><ref name="Hickie, 2001" /><ref name="Schur, 2007" />

=== Haplogroups ===
One study showed that patients with [[mitochondrial DNA]] from certain haplogroups correlated with variations in [[gastrointestinal]], [[neurological]], and [[inflammatory]] symptoms.<ref name="Hanson2016" />

===HLA alleles===
[[Human leukocyte antigen genes]] associations were investigated by Lande et al. (2020) because these gene variants are considered hallmarks for [[autoimmune hypothesis|autoimmune]] disease; two HLA associations were found to be more common in ME/CFS patients, but the majority of ME/CFS patients did not have these.<ref name="Lande2020" />

==Notable studies==
*2001, A twin study of chronic fatigue<ref name="Buchwald, 2001" /> [https://www.ncbi.nlm.nih.gov/pubmed/11719632 (Abstract)]
*2006, [[pubmed:16610957|Combinations of single nucleotide polymorphisms in neuroendocrine effector and receptor genes]]<ref>{{Cite journal|last=Goertzel|first=Benjamin N.|author-link=Benjamin Goertzel|last2=Pennachin|first2=Cassio|author-link2=Cassio Pennachin|last3=de Souza Coelho|first3=Lucio|author-link3=Lucio de Souza Coelho|last4=Gurbaxani|first4=Brian|author-link4=Brian Gurbaxani|last5=Maloney|first5=Elizabeth M.|author-link5=Elizabeth M. Maloney|last6=Jones|first6=James F.|author-link6=James Jones|date=April 2006|title=Combinations of single nucleotide polymorphisms in neuroendocrine effector and receptor genes predict chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/16610957|journal=Pharmacogenomics|volume=7|issue=3|pages=475–483|doi=10.2217/14622416.7.3.475|issn=1462-2416|pmid=16610957|quote=|via=}}</ref> <blockquote>Three genes were found to be common in a group of people with Chronic Fatigue Syndrome compared to the general population; [[TPH2]] - neuronal [[tryptophan]] hydroxylase, [[COMT]] - catechol-O-methyltransferase, and [[NR3C1]] - nuclear receptor subfamily 3, group C, member 1 [[glucocorticoid]] receptor, together these three have an accuracy of 76%.
*2011, Evidence for a heritable predisposition to Chronic Fatigue Syndrome<ref name="Albright, 2011" /> [http://dx.doi.org/10.1186/1471-2377-11-62 (Abstract)]
*2011, [https://doi.org/10.1111/j.1365-2796.2011.02405.x Gene expression alterations at baseline and following moderate exercise in patients with Chronic Fatigue Syndrome and Fibromyalgia Syndrome]<ref>{{Cite journal|last=Light|first=A. R.|author-link=Alan Light|last2=Bateman|first2=L.|author-link2=Lucinda Bateman|last3=Jo|first3=D.|author-link3=Daehyun Jo|last4=Hughen|first4=R. W.|author-link4=Ronald Hughen|last5=VanHaitsma|first5=T. A.|author-link5=Timothy Vanhaitsma|last6=White|first6=A. T.|author-link6=Andrea White|last7=Light|first7=K. C.|author-link7=Kathleen Light|date=2011-07-13|title=Gene expression alterations at baseline and following moderate exercise in patients with Chronic Fatigue Syndrome and Fibromyalgia Syndrome|url=https://doi.org/10.1111/j.1365-2796.2011.02405.x|journal=Journal of Internal Medicine|language=en|volume=271|issue=1|pages=64–81|doi=10.1111/j.1365-2796.2011.02405.x|issn=0954-6820|pmc=3175315|pmid=21615807|quote=|via=}}</ref>
*2016, Genome-wide association analysis identifies genetic variations in subjects with myalgic encephalomyelitis/chronic fatigue syndrome<ref name="Schlauch, 2016" /> [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4872418/ (Full Text)]
*2016, Mitochondrial DNA variants correlate with symptoms in myalgic encephalomyelitis/chronic fatigue syndrome <ref name="Hanson2016">{{Cite journal|last=Billing-Ross|first=Paul|author-link=Paul Billing-Ross|last2=Germain|first2=Arnaud|author-link2=Arnaud Germain|last3=Ye|first3=Kaixiong|author-link3=Kaixiong Ye|last4=Keinan|first4=Alon|author-link4=Alon Keinan|last5=Gu|first5=Zhenglong|author-link5=Zhenglong Gu|last6=Hanson|first6=Maureen R.|author-link6=Maureen Hanson|date=2016-01-20|title=Mitochondrial DNA variants correlate with symptoms in myalgic encephalomyelitis/chronic fatigue syndrome|url=https://doi.org/10.1186/s12967-016-0771-6|journal=Journal of Translational Medicine|volume=14|issue=1|pages=19|doi=10.1186/s12967-016-0771-6|issn=1479-5876|quote=|via=}}</ref> [http://www.translational-medicine.com/content/14/1/19 (Abstract)]
*2018, Identification of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome-associated DNA methylation patterns<ref name="Trivedi2018">{{Cite journal|last=Trivedi|first=Malav S.|author-link=Malav Trivedi|last2=Oltra|first2=Elisa|author-link2=Elisa Oltra|last3=Sarria|first3=Leonor|author-link3=Leonor Sarria|last4=Rose|first4=Natasha|author-link4=Natasha Rose|last5=Beljanski|first5=Vladimir|author-link5=Vladimir Beljanski|last6=Fletcher|first6=Mary Ann|author-link6=Mary Ann Fletcher|last7=Klimas|first7=Nancy G.|author-link7=Nancy Klimas|last8=Nathanson|first8=Lubov|author-link8=Lubov Nathanson|date=2018|title=Identification of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome-associated DNA methylation patterns|url=https://www.ncbi.nlm.nih.gov/pubmed/30036399|journal=PloS One|volume=13|issue=7|pages=e0201066|doi=10.1371/journal.pone.0201066|issn=1932-6203|pmc=|pmid=30036399|quote=|via=}}</ref> [https://www.ncbi.nlm.nih.gov/pubmed/30036399 (Abstract)]
*2018, Genome-epigenome interactions associated with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.<ref name="Herrera2018">{{Cite journal|last=Herrera|first=Santiago|author-link=Santiago Herrera|last2=de Vega|first2=Wilfred C.|author-link2=Wilfred de Vega|last3=Ashbrook|first3=David|author-link3=David Ashbrook|last4=Vernon|first4=Suzanne D.|author-link4=Suzanne Vernon|last5=McGowan|first5=Patrick O.|author-link5=Patrick McGowan|date=2018-12-05|title=Genome-epigenome interactions associated with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/30516085|journal=Epigenetics|volume=|issue=|pages=1–17|doi=10.1080/15592294.2018.1549769|issn=1559-2308|pmid=30516085|quote=|via=}}</ref> [https://www.ncbi.nlm.nih.gov/pubmed/30516085 (Abstract)]
*2019, Associations between clinical symptoms, plasma norepinephrine and deregulated immune gene networks in subgroups of adolescent with Chronic Fatigue Syndrome.<ref name="Nguyen2019">{{Cite journal|last=Nguyen|first=Chinh Bkrong|author-link=Chinh Bkrong Nguyen|last2=Kumar|first2=Surendra|author-link2=Surendra Kumar|last3=Zucknick|first3=Manuela|author-link3=Manuela Zucknick|last4=Kristensen|first4=Vessela N.|author-link4=Vessela Kirstensen|last5=Gjerstad|first5=Johannes|author-link5=Johannes Gjerstad|last6=Nilsen|first6=Hilde|author-link6=Nilsen Hilde|last7=Wyller|first7=Vegard Bruun|author-link7=Vegard Bruun Wyller|date=Feb 2019|title=Associations between clinical symptoms, plasma norepinephrine and deregulated immune gene networks in subgroups of adolescent with Chronic Fatigue Syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/30419269|journal=Brain, Behavior, and Immunity|volume=76|issue=|pages=82–96|doi=10.1016/j.bbi.2018.11.008|issn=1090-2139|pmid=30419269|quote=|via=}}</ref> [https://www.ncbi.nlm.nih.gov/pubmed/30419269/ (Abstract)]
* 2019, Genetic Predisposition for Immune System, Hormone, and Metabolic Dysfunction in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Pilot Study<ref name="Nathanson2019">{{Cite journal|last=Nathanson|first=Lubov |author-link1=Lubov Nathanson|author-link2=Travis Craddock|last2=Craddock|first2=Travis J. A.|last3=Klimas|first3=Nancy G.|author-link3=Nancy Klimas|author-link4=Kristina Gemayel|last4=Gemayel|first4=Kristina|last5=Del Alamo|first5=Ana|author-link5=Ana Del Alamo|author-link6=Kelly Hilton|last6=Hilton|first6=Kelly|last7=Jaundoo|first7=Rajeev|author-link7=Rajeev Jaundoo|last8=Perez|first8=Melanie|author-link8=Melanie Perez|date=2019|title=Genetic Predisposition for Immune System, Hormone, and Metabolic Dysfunction in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Pilot Study|url=https://www.frontiersin.org/articles/10.3389/fped.2019.00206/full|journal=Frontiers in Pediatrics|language=English|volume=7|doi=10.3389/fped.2019.00206|issn=2296-2360}}</ref> [https://doi.org/10.3389/fped.2019.00206 (Full text)]
* 2019, The IDO Metabolic Trap Hypothesis for the Etiology of ME/CFS<ref>{{Cite journal|last=Kashi|first=Alex A.|last2=Davis|first2=Ronald W.|last3=Phair|first3=Robert D.|date=2019/9|title=The IDO Metabolic Trap Hypothesis for the Etiology of ME/CFS|url=https://www.mdpi.com/2075-4418/9/3/82|journal=Diagnostics|language=en|volume=9|issue=3|pages=82|doi=10.3390/diagnostics9030082}}</ref> - [https://www.mdpi.com/2075-4418/9/3/82/htm (Full text)]
*2020, Human Leukocyte Antigen alleles associated with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)<ref name="Lande2020">{{Cite journal|last=Lande|first=Asgeir|author-link=Asgeir Lande|last2=Fluge|first2=Øystein|author-link2=Øystein Fluge|last3=Strand|first3=Elin B.|author-link3=Elin Strand|last4=Flåm|first4=Siri T.|author-link4=Siri Flåm|last5=Sosa|first5=Daysi D.|author-link5=Daysi Sosa|last6=Mella|first6=Olav|author-link6=Olav Mella|last7=Egeland|first7=Torstein|author-link7=|last8=Saugstad|first8=Ola D.|author-link8=|last9=Lie|first9=Benedicte A.|author-link9=|date=2020-03-24|title=Human Leukocyte Antigen alleles associated with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)|url=https://www.nature.com/articles/s41598-020-62157-x|journal=Scientific Reports|language=en|volume=10|issue=1|pages=1–8|doi=10.1038/s41598-020-62157-x|issn=2045-2322|pmc=|pmid=|access-date=|quote=|via=}}</ref> - [https://www.nature.com/articles/s41598-020-62157-x (Full text)]
*2020, Unravelling myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS): Gender‐specific changes in the microRNA expression profiling in ME/CFS<ref name="Cheema2020">{{Cite journal|last=Cheema|first=Amanpreet K.|author-link=|last2=Sarria|first2=Leonor|author-link2=|last3=Bekheit|first3=Mina|author-link3=|last4=Collado|first4=Fanny|author-link4=Fanny Collado|last5=Almenar‐Pérez|first5=Eloy|author-link5=|last6=Martín‐Martínez|first6=Eva|author-link6=|last7=Alegre|first7=Jose|author-link7=José Alegre|last8=Castro‐Marrero|first8=Jesus|author-link8=Jesús Castro-Marrero|last9=Fletcher|first9=Mary A.|author-link9=Mary Ann Fletcher|date=Apr 14, 2020|title=Unravelling myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS): Gender-specific changes in the microRNA expression profiling in ME/CFS|url=https://onlinelibrary.wiley.com/doi/abs/10.1111/jcmm.15260|journal=Journal of Cellular and Molecular Medicine|language=en|volume=00|issue=|pages=1-13|doi=10.1111/jcmm.15260|issn=1582-4934|pmc=|pmid=32291908|access-date=|quote=|via=|last10=Klimas|first10=Nancy|author-link10=Nancy Klimas|last11=Oltra|first11=Elisa|author-link11=Elisa Oltra|last12=Nathanson|first12=Lubov|author-link12=Lubov Nathanson}}</ref> - [https://onlinelibrary.wiley.com/doi/full/10.1111/jcmm.15260 (Full text)]

==Media Coverage==
*2016, [http://www.meresearch.org.uk/news/genome-wide-associations/ Genome-wide associations]
*2016, [https://cfsremission.wordpress.com/2016/01/23/new-study-found-snps-for-some-symptoms/ New study found SNPs for some symptoms] ([[CFS Remission]], January 23)

==See also==

*[[:Category:Genes|Genes (category)]]
*[[Gene expression]]
*[[ME/CFS Gene Study]]
*[[Genetic testing]]
*[[Mitochondrion]]
== Learn more ==
*[http://hansonlab.org/research/cfs_me/mitochondria/ Mitochondrial DNA and ME/CFS - A Guide to the Hanson Lab's] - 2016 JTM Publication
*[https://solvecfs.org/the-ido-metabolic-trap-hypothesis-for-me-cfs/ The IDO Metabolic Trap Hypothesis For ME/CFS] - Jul 30, 2019 [[Solve ME/CFS Initiative|Solve M.E.]]
*[https://www.youtube.com/watch?v=rtVtH-cwhBY Dr. Ron Davis Gives an Update on ME/CFS Research]- Sep 26, 2019 [[Open Medicine Foundation]] (Gene Mutation Found)
==References==
<references>
<ref name="Albright, 2011">{{Citation
| last1 = Albright | first1 = Frederick | authorlink1 = Frederick Albright
| last2 = Light | first2 = Kathleen | authorlink2 = Kathleen Light
| last3 = Light | first3 = Alan | authorlink3 = Alan Light
| last4 = Bateman | first4 = Lucinda | authorlink4 = Lucinda Bateman
| last5 = Cannon-Albright | first5 = Lisa A | authorlink5 = Lisa Cannon-Albright
| title = Evidence for a heritable predisposition to Chronic Fatigue Syndrome |url = https://doi.org/10.1111/j.1365-2796.2011.02405.x
| journal = BMC Neurology | volume = 11 | issue = 62 | page =
| date = 2011
| doi = 10.1186/1471-2377-11-62
}}
</ref>
<ref name="Buchwald, 2001">{{Citation
| last1 = Buchwald | first1 = D. | authorlink1 = Dedra Buchwald
| last2 = Herrell | first2 = R. | authorlink2 =
| last3 = Ashton | first3 = S. | authorlink3 =
| last4 = Belcourt | first4 = M. | authorlink4 =
| last5 = Schmaling | first5 = K. | authorlink5 =
| last6 = Sullivan | first6 = P. | authorlink6 =
| last7 = Neale | first7 = M. | authorlink7 =
| last8 = Goldberg | first8 = J. | authorlink8 =
| title = A twin study of chronic fatigue.
| journal = Psychosomatic Medicine | volume = 63 | issue = 6 | page = 936-943
| date = 2001
| pmid = 11719632
| doi =
| url = https://www.ncbi.nlm.nih.gov/pubmed/11719632
}}
</ref>
<ref name="Hickie, 2001">{{Citation
| last1 = Hickie | first1 = IB | authorlink1 =
| last2 = Bansal | first2 = AS | authorlink2 =
| last3 = Kirk | first3 = KM | authorlink3 =
| last4 = Lloyd | first4 = AR | authorlink4 =
| last5 = Martin | first5 = NG | authorlink5 =
| title = A twin study of the etiology of prolonged fatigue and immune activation
| journal = Twin Research | volume = 4 | issue = 2 | page = 94-102
| date = 2001
| doi = 10.1375/1369052012209
}}
</ref>
<ref name="Schlauch, 2016">{{Citation
| last1 = Schlauch | first1 = Karen A. | authorlink1 = Karen Schlauch
| last2 = Khaiboullina | first2 = Svetlana F.| authorlink2 = Svetlana Khaiboullina
| last3 = De Meirleir | first3 = Kenny L. | authorlink3 = Kenny de Meirleir
| last4 = Rawat | first4 = Shanti | authorlink4 = Shanti Rawat
| last5 = Petereit | first5 = J | authorlink5 =
| last6 = Rizvanov | first6 = Albert A | authorlink6 = Albert Rizvanov
| last7 = Blatt | first7 = Nataliya | authorlink7 = Nataliya Blatt
| last8 = Mijatovic | first8 = Tatjana | authorlink8 = Tatjana Mijatovic
| last9 = Kulick | first9 = D | authorlink9 =
| last10 = Palotás | first10 = András | authorlink10 = András Palotás
| last11 = Lombardi | first11 = Vincent C.| authorlink11 = Vincent Lombardi
| title = Genome-wide association analysis identifies genetic variations in subjects with myalgic encephalomyelitis/chronic fatigue syndrome
| journal = Translational Psychiatry | volume = 6 | issue = 2 | page = e730
| date = 2016
| pmid =
| doi = 10.1038/tp.2015.208
}}
</ref>
<ref name="Schur, 2007">{{Citation
| last1 = Schur | first1 = Ellen | authorlink1 =
| last2 = Afari | first2 = Niloofar | authorlink2 =
| last3 = Goldberg | first3 = Jack | authorlink3 =
| last4 = Buchwald | first4 = Dedra | authorlink4 = Dedra Buchwald
| last5 = Sullivan | first5 = Patrick F. | authorlink5 =
| title = Twin analyses of fatigue
| journal = Twin Research and Human Genetics | volume = 10 | issue = 5 | page = 729-733
| date = 2007
| doi = 10.1375/twin.10.5.729
}}
</ref>
</references>
[[Category:Triggers and risk factors]]
[[Category:Genetics]]

Genetics of chronic fatigue syndrome

2021-04-24T12:59:50Z

Loopy:/* Learn more */ IDO Metabolic Trap

The '''genetics of chronic fatigue syndrome''' is an area of research as [[ME/CFS]] has been observed in families.<ref name=":0">{{Cite web|url=https://www.cdc.gov/me-cfs/healthcare-providers/presentation-clinical-course/etiology-pathophysiology.html|title=Etiology and Pathophysiology {{!}} Presentation and Clinical Course {{!}} Healthcare Providers {{!}} Myalgic Encephalomyelitis/Chronic Fatigue Syndrome|date=2018-11-08|website=[[Centers for Disease Control]]|language=en-us|access-date=2019-02-08}}</ref> It is unknown if there is a genetic link or common environmental exposure (infectious or toxic). Studies of twins show higher rates of ME/CFS in identical than fraternal twins. The [[Centers for Disease Control and Prevention]] (CDC) notes that specific genetic associations have not been established.<ref name=":0" />

=== ME/CFS Gene Study ===
The [[ME/CFS Gene Study]] is still collecting data, but the initial pilot study by Perez et al. (2019) found 10 relatively common genes or gene variants were significantly more common in people with ME/CFS.<ref name="Nathanson2019" /> These were [[Cytochrome P450 2D6|CYP2D6]], [[Proline-rich transmembrane protein 4|PRRT4]], [[Serine Protease 56|PRSS56]], [[Armadillo Like Helical Domain Containing 4|C14orf37]], [[Ankyrin Repeat And Death Domain Containing 1B|ANKDD1B]], GPBAR1, LHB, ADAMTS19, VARS2, and CPLX2.<ref name="Nathanson2019" />

=== Utah Population Database study ===
A 2011 study by Albright et al showed evidence of a heritable contribution to [[chronic fatigue syndrome]] (CFS).<ref name="Albright, 2011" /> Using the extensive records of the Utah Population Database (UPDB), the study "shows clear evidence of significant excess familial clustering and significantly elevated risks for [[Chronic fatigue syndrome|CFS]] among first, second, and third degree relatives of CFS cases. The results strongly support a genetic contribution to predisposition to CFS as it is currently defined and diagnosed by clinicians in Utah." Increased outbreak rates in first degree relatives are not automatically assumed to be genetic because the first degree relatives often share the same lifestyle and environment. However, a significantly increased incidence (95% confidence interval) in second and third degree relatives strongly indicated a genetic contribution to CFS, given the much lower likelihood of these relatives sharing common risks and environments.<ref name="Albright, 2011" />
[[File:Genetic Relationship graph.png|center|Albright,2011 study]]

=== Family history and twin studies ===
A 2001 study in the [[United Kingdom|UK]] showed "there were significantly higher rates of CFS in the relatives of CFS cases compared with the relatives of control subjects."<ref>{{Cite journal|last=Walsh|first=C. M.|author-link=|last2=Zainal|first2=N. Z.|author-link2=|last3=Middleton|first3=S. J.|author-link3=|last4=Paykel|first4=E. S.|author-link4=|date=Sep 2001|title=A family history study of chronic fatigue syndrome|url=https://doi.org/10.1097/00041444-200109000-00003|journal=Psychiatric Genetics|language=en|volume=11|issue=3|pages=123–128|doi=10.1097/00041444-200109000-00003|issn=0955-8829|quote=|via=}}</ref> Three twin studies (one in Australia, one in Washington, US, both in 2001, and one in the UK in 2007) showed that the correlations for prolonged and chronic fatigue were significantly higher in monozygotic than dizygotic twins for each definition of chronic fatigue syndrome.<ref name="Buchwald, 2001" /><ref name="Hickie, 2001" /><ref name="Schur, 2007" />

=== Haplogroups ===
One study showed that patients with [[mitochondrial DNA]] from certain haplogroups correlated with variations in [[gastrointestinal]], [[neurological]], and [[inflammatory]] symptoms.<ref name="Hanson2016" />

===HLA alleles===
[[Human leukocyte antigen genes]] associations were investigated by Lande et al. (2020) because these gene variants are considered hallmarks for [[autoimmune hypothesis|autoimmune]] disease; two HLA associations were found to be more common in ME/CFS patients, but the majority of ME/CFS patients did not have these.<ref name="Lande2020" />

==Notable studies==
*2001, A twin study of chronic fatigue<ref name="Buchwald, 2001" /> [https://www.ncbi.nlm.nih.gov/pubmed/11719632 (Abstract)]
*2006, [[pubmed:16610957|Combinations of single nucleotide polymorphisms in neuroendocrine effector and receptor genes]]<ref>{{Cite journal|last=Goertzel|first=Benjamin N.|author-link=Benjamin Goertzel|last2=Pennachin|first2=Cassio|author-link2=Cassio Pennachin|last3=de Souza Coelho|first3=Lucio|author-link3=Lucio de Souza Coelho|last4=Gurbaxani|first4=Brian|author-link4=Brian Gurbaxani|last5=Maloney|first5=Elizabeth M.|author-link5=Elizabeth M. Maloney|last6=Jones|first6=James F.|author-link6=James Jones|date=April 2006|title=Combinations of single nucleotide polymorphisms in neuroendocrine effector and receptor genes predict chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/16610957|journal=Pharmacogenomics|volume=7|issue=3|pages=475–483|doi=10.2217/14622416.7.3.475|issn=1462-2416|pmid=16610957|quote=|via=}}</ref> <blockquote>Three genes were found to be common in a group of people with Chronic Fatigue Syndrome compared to the general population; [[TPH2]] - neuronal [[tryptophan]] hydroxylase, [[COMT]] - catechol-O-methyltransferase, and [[NR3C1]] - nuclear receptor subfamily 3, group C, member 1 [[glucocorticoid]] receptor, together these three have an accuracy of 76%.
*2011, Evidence for a heritable predisposition to Chronic Fatigue Syndrome<ref name="Albright, 2011" /> [http://dx.doi.org/10.1186/1471-2377-11-62 (Abstract)]
*2011, [https://doi.org/10.1111/j.1365-2796.2011.02405.x Gene expression alterations at baseline and following moderate exercise in patients with Chronic Fatigue Syndrome and Fibromyalgia Syndrome]<ref>{{Cite journal|last=Light|first=A. R.|author-link=Alan Light|last2=Bateman|first2=L.|author-link2=Lucinda Bateman|last3=Jo|first3=D.|author-link3=Daehyun Jo|last4=Hughen|first4=R. W.|author-link4=Ronald Hughen|last5=VanHaitsma|first5=T. A.|author-link5=Timothy Vanhaitsma|last6=White|first6=A. T.|author-link6=Andrea White|last7=Light|first7=K. C.|author-link7=Kathleen Light|date=2011-07-13|title=Gene expression alterations at baseline and following moderate exercise in patients with Chronic Fatigue Syndrome and Fibromyalgia Syndrome|url=https://doi.org/10.1111/j.1365-2796.2011.02405.x|journal=Journal of Internal Medicine|language=en|volume=271|issue=1|pages=64–81|doi=10.1111/j.1365-2796.2011.02405.x|issn=0954-6820|pmc=3175315|pmid=21615807|quote=|via=}}</ref>
*2016, Genome-wide association analysis identifies genetic variations in subjects with myalgic encephalomyelitis/chronic fatigue syndrome<ref name="Schlauch, 2016" /> [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4872418/ (Full Text)]
*2016, Mitochondrial DNA variants correlate with symptoms in myalgic encephalomyelitis/chronic fatigue syndrome <ref name="Hanson2016">{{Cite journal|last=Billing-Ross|first=Paul|author-link=Paul Billing-Ross|last2=Germain|first2=Arnaud|author-link2=Arnaud Germain|last3=Ye|first3=Kaixiong|author-link3=Kaixiong Ye|last4=Keinan|first4=Alon|author-link4=Alon Keinan|last5=Gu|first5=Zhenglong|author-link5=Zhenglong Gu|last6=Hanson|first6=Maureen R.|author-link6=Maureen Hanson|date=2016-01-20|title=Mitochondrial DNA variants correlate with symptoms in myalgic encephalomyelitis/chronic fatigue syndrome|url=https://doi.org/10.1186/s12967-016-0771-6|journal=Journal of Translational Medicine|volume=14|issue=1|pages=19|doi=10.1186/s12967-016-0771-6|issn=1479-5876|quote=|via=}}</ref> [http://www.translational-medicine.com/content/14/1/19 (Abstract)]
*2018, Identification of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome-associated DNA methylation patterns<ref name="Trivedi2018">{{Cite journal|last=Trivedi|first=Malav S.|author-link=Malav Trivedi|last2=Oltra|first2=Elisa|author-link2=Elisa Oltra|last3=Sarria|first3=Leonor|author-link3=Leonor Sarria|last4=Rose|first4=Natasha|author-link4=Natasha Rose|last5=Beljanski|first5=Vladimir|author-link5=Vladimir Beljanski|last6=Fletcher|first6=Mary Ann|author-link6=Mary Ann Fletcher|last7=Klimas|first7=Nancy G.|author-link7=Nancy Klimas|last8=Nathanson|first8=Lubov|author-link8=Lubov Nathanson|date=2018|title=Identification of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome-associated DNA methylation patterns|url=https://www.ncbi.nlm.nih.gov/pubmed/30036399|journal=PloS One|volume=13|issue=7|pages=e0201066|doi=10.1371/journal.pone.0201066|issn=1932-6203|pmc=|pmid=30036399|quote=|via=}}</ref> [https://www.ncbi.nlm.nih.gov/pubmed/30036399 (Abstract)]
*2018, Genome-epigenome interactions associated with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.<ref name="Herrera2018">{{Cite journal|last=Herrera|first=Santiago|author-link=Santiago Herrera|last2=de Vega|first2=Wilfred C.|author-link2=Wilfred de Vega|last3=Ashbrook|first3=David|author-link3=David Ashbrook|last4=Vernon|first4=Suzanne D.|author-link4=Suzanne Vernon|last5=McGowan|first5=Patrick O.|author-link5=Patrick McGowan|date=2018-12-05|title=Genome-epigenome interactions associated with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/30516085|journal=Epigenetics|volume=|issue=|pages=1–17|doi=10.1080/15592294.2018.1549769|issn=1559-2308|pmid=30516085|quote=|via=}}</ref> [https://www.ncbi.nlm.nih.gov/pubmed/30516085 (Abstract)]
*2019, Associations between clinical symptoms, plasma norepinephrine and deregulated immune gene networks in subgroups of adolescent with Chronic Fatigue Syndrome.<ref name="Nguyen2019">{{Cite journal|last=Nguyen|first=Chinh Bkrong|author-link=Chinh Bkrong Nguyen|last2=Kumar|first2=Surendra|author-link2=Surendra Kumar|last3=Zucknick|first3=Manuela|author-link3=Manuela Zucknick|last4=Kristensen|first4=Vessela N.|author-link4=Vessela Kirstensen|last5=Gjerstad|first5=Johannes|author-link5=Johannes Gjerstad|last6=Nilsen|first6=Hilde|author-link6=Nilsen Hilde|last7=Wyller|first7=Vegard Bruun|author-link7=Vegard Bruun Wyller|date=Feb 2019|title=Associations between clinical symptoms, plasma norepinephrine and deregulated immune gene networks in subgroups of adolescent with Chronic Fatigue Syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/30419269|journal=Brain, Behavior, and Immunity|volume=76|issue=|pages=82–96|doi=10.1016/j.bbi.2018.11.008|issn=1090-2139|pmid=30419269|quote=|via=}}</ref> [https://www.ncbi.nlm.nih.gov/pubmed/30419269/ (Abstract)]
* 2019, Genetic Predisposition for Immune System, Hormone, and Metabolic Dysfunction in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Pilot Study<ref name="Nathanson2019">{{Cite journal|last=Nathanson|first=Lubov |author-link1=Lubov Nathanson|author-link2=Travis Craddock|last2=Craddock|first2=Travis J. A.|last3=Klimas|first3=Nancy G.|author-link3=Nancy Klimas|author-link4=Kristina Gemayel|last4=Gemayel|first4=Kristina|last5=Del Alamo|first5=Ana|author-link5=Ana Del Alamo|author-link6=Kelly Hilton|last6=Hilton|first6=Kelly|last7=Jaundoo|first7=Rajeev|author-link7=Rajeev Jaundoo|last8=Perez|first8=Melanie|author-link8=Melanie Perez|date=2019|title=Genetic Predisposition for Immune System, Hormone, and Metabolic Dysfunction in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Pilot Study|url=https://www.frontiersin.org/articles/10.3389/fped.2019.00206/full|journal=Frontiers in Pediatrics|language=English|volume=7|doi=10.3389/fped.2019.00206|issn=2296-2360}}</ref> [https://doi.org/10.3389/fped.2019.00206 (Full text)]
* 2019, The IDO Metabolic Trap Hypothesis for the Etiology of ME/CFS<ref>{{Cite journal|last=Kashi|first=Alex A.|last2=Davis|first2=Ronald W.|last3=Phair|first3=Robert D.|date=2019/9|title=The IDO Metabolic Trap Hypothesis for the Etiology of ME/CFS|url=https://www.mdpi.com/2075-4418/9/3/82|journal=Diagnostics|language=en|volume=9|issue=3|pages=82|doi=10.3390/diagnostics9030082}}</ref> - [https://www.mdpi.com/2075-4418/9/3/82/htm (Full text)]
*2020, Human Leukocyte Antigen alleles associated with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)<ref name="Lande2020">{{Cite journal|last=Lande|first=Asgeir|author-link=Asgeir Lande|last2=Fluge|first2=Øystein|author-link2=Øystein Fluge|last3=Strand|first3=Elin B.|author-link3=Elin Strand|last4=Flåm|first4=Siri T.|author-link4=Siri Flåm|last5=Sosa|first5=Daysi D.|author-link5=Daysi Sosa|last6=Mella|first6=Olav|author-link6=Olav Mella|last7=Egeland|first7=Torstein|author-link7=|last8=Saugstad|first8=Ola D.|author-link8=|last9=Lie|first9=Benedicte A.|author-link9=|date=2020-03-24|title=Human Leukocyte Antigen alleles associated with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)|url=https://www.nature.com/articles/s41598-020-62157-x|journal=Scientific Reports|language=en|volume=10|issue=1|pages=1–8|doi=10.1038/s41598-020-62157-x|issn=2045-2322|pmc=|pmid=|access-date=|quote=|via=}}</ref> - [https://www.nature.com/articles/s41598-020-62157-x (Full text)]
*2020, Unravelling myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS): Gender‐specific changes in the microRNA expression profiling in ME/CFS<ref name="Cheema2020">{{Cite journal|last=Cheema|first=Amanpreet K.|author-link=|last2=Sarria|first2=Leonor|author-link2=|last3=Bekheit|first3=Mina|author-link3=|last4=Collado|first4=Fanny|author-link4=Fanny Collado|last5=Almenar‐Pérez|first5=Eloy|author-link5=|last6=Martín‐Martínez|first6=Eva|author-link6=|last7=Alegre|first7=Jose|author-link7=José Alegre|last8=Castro‐Marrero|first8=Jesus|author-link8=Jesús Castro-Marrero|last9=Fletcher|first9=Mary A.|author-link9=Mary Ann Fletcher|date=Apr 14, 2020|title=Unravelling myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS): Gender-specific changes in the microRNA expression profiling in ME/CFS|url=https://onlinelibrary.wiley.com/doi/abs/10.1111/jcmm.15260|journal=Journal of Cellular and Molecular Medicine|language=en|volume=00|issue=|pages=1-13|doi=10.1111/jcmm.15260|issn=1582-4934|pmc=|pmid=32291908|access-date=|quote=|via=|last10=Klimas|first10=Nancy|author-link10=Nancy Klimas|last11=Oltra|first11=Elisa|author-link11=Elisa Oltra|last12=Nathanson|first12=Lubov|author-link12=Lubov Nathanson}}</ref> - [https://onlinelibrary.wiley.com/doi/full/10.1111/jcmm.15260 (Full text)]

==Media Coverage==
*2016, [http://www.meresearch.org.uk/news/genome-wide-associations/ Genome-wide associations]
*2016, [https://cfsremission.wordpress.com/2016/01/23/new-study-found-snps-for-some-symptoms/ New study found SNPs for some symptoms] ([[CFS Remission]], January 23)

==See also==

*[[:Category:Genes|Genes (category)]]
*[[Gene expression]]
*[[ME/CFS Gene Study]]
*[[Genetic testing]]
*[[Mitochondrion]]
== Learn more ==
*[http://hansonlab.org/research/cfs_me/mitochondria/ Mitochondrial DNA and ME/CFS - A Guide to the Hanson Lab's] - 2016 JTM Publication
*[https://solvecfs.org/the-ido-metabolic-trap-hypothesis-for-me-cfs/ The IDO Metabolic Trap Hypothesis For ME/CFS] - Jul 30, 2019 [[Solve ME/CFS Initiative|Solve M.E.]]
*[https://www.youtube.com/watch?v=rtVtH-cwhBY Dr. Ron Davis Gives an Update on ME/CFS Research]- Sep 26, 2019 [[Open Medicine Foundation]] (Gene Mutation Found)
==References==
<references>
<ref name="Albright, 2011">{{Citation
| last1 = Albright | first1 = Frederick | authorlink1 = Frederick Albright
| last2 = Light | first2 = Kathleen | authorlink2 = Kathleen Light
| last3 = Light | first3 = Alan | authorlink3 = Alan Light
| last4 = Bateman | first4 = Lucinda | authorlink4 = Lucinda Bateman
| last5 = Cannon-Albright | first5 = Lisa A | authorlink5 = Lisa Cannon-Albright
| title = Evidence for a heritable predisposition to Chronic Fatigue Syndrome |url = https://doi.org/10.1111/j.1365-2796.2011.02405.x
| journal = BMC Neurology | volume = 11 | issue = 62 | page =
| date = 2011
| doi = 10.1186/1471-2377-11-62
}}
</ref>
<ref name="Buchwald, 2001">{{Citation
| last1 = Buchwald | first1 = D. | authorlink1 = Dedra Buchwald
| last2 = Herrell | first2 = R. | authorlink2 =
| last3 = Ashton | first3 = S. | authorlink3 =
| last4 = Belcourt | first4 = M. | authorlink4 =
| last5 = Schmaling | first5 = K. | authorlink5 =
| last6 = Sullivan | first6 = P. | authorlink6 =
| last7 = Neale | first7 = M. | authorlink7 =
| last8 = Goldberg | first8 = J. | authorlink8 =
| title = A twin study of chronic fatigue.
| journal = Psychosomatic Medicine | volume = 63 | issue = 6 | page = 936-943
| date = 2001
| pmid = 11719632
| doi =
| url = https://www.ncbi.nlm.nih.gov/pubmed/11719632
}}
</ref>
<ref name="Hickie, 2001">{{Citation
| last1 = Hickie | first1 = IB | authorlink1 =
| last2 = Bansal | first2 = AS | authorlink2 =
| last3 = Kirk | first3 = KM | authorlink3 =
| last4 = Lloyd | first4 = AR | authorlink4 =
| last5 = Martin | first5 = NG | authorlink5 =
| title = A twin study of the etiology of prolonged fatigue and immune activation
| journal = Twin Research | volume = 4 | issue = 2 | page = 94-102
| date = 2001
| doi = 10.1375/1369052012209
}}
</ref>
<ref name="Schlauch, 2016">{{Citation
| last1 = Schlauch | first1 = Karen A. | authorlink1 = Karen Schlauch
| last2 = Khaiboullina | first2 = Svetlana F.| authorlink2 = Svetlana Khaiboullina
| last3 = De Meirleir | first3 = Kenny L. | authorlink3 = Kenny de Meirleir
| last4 = Rawat | first4 = Shanti | authorlink4 = Shanti Rawat
| last5 = Petereit | first5 = J | authorlink5 =
| last6 = Rizvanov | first6 = Albert A | authorlink6 = Albert Rizvanov
| last7 = Blatt | first7 = Nataliya | authorlink7 = Nataliya Blatt
| last8 = Mijatovic | first8 = Tatjana | authorlink8 = Tatjana Mijatovic
| last9 = Kulick | first9 = D | authorlink9 =
| last10 = Palotás | first10 = András | authorlink10 = András Palotás
| last11 = Lombardi | first11 = Vincent C.| authorlink11 = Vincent Lombardi
| title = Genome-wide association analysis identifies genetic variations in subjects with myalgic encephalomyelitis/chronic fatigue syndrome
| journal = Translational Psychiatry | volume = 6 | issue = 2 | page = e730
| date = 2016
| pmid =
| doi = 10.1038/tp.2015.208
}}
</ref>
<ref name="Schur, 2007">{{Citation
| last1 = Schur | first1 = Ellen | authorlink1 =
| last2 = Afari | first2 = Niloofar | authorlink2 =
| last3 = Goldberg | first3 = Jack | authorlink3 =
| last4 = Buchwald | first4 = Dedra | authorlink4 = Dedra Buchwald
| last5 = Sullivan | first5 = Patrick F. | authorlink5 =
| title = Twin analyses of fatigue
| journal = Twin Research and Human Genetics | volume = 10 | issue = 5 | page = 729-733
| date = 2007
| doi = 10.1375/twin.10.5.729
}}
</ref>
</references>
[[Category:Triggers and risk factors]]
[[Category:Genetics]]

Genetics of chronic fatigue syndrome

2021-04-24T12:44:55Z

Loopy:/* Learn more */ gene mutation youtube video OMF

The '''genetics of chronic fatigue syndrome''' is an area of research as [[ME/CFS]] has been observed in families.<ref name=":0">{{Cite web|url=https://www.cdc.gov/me-cfs/healthcare-providers/presentation-clinical-course/etiology-pathophysiology.html|title=Etiology and Pathophysiology {{!}} Presentation and Clinical Course {{!}} Healthcare Providers {{!}} Myalgic Encephalomyelitis/Chronic Fatigue Syndrome|date=2018-11-08|website=[[Centers for Disease Control]]|language=en-us|access-date=2019-02-08}}</ref> It is unknown if there is a genetic link or common environmental exposure (infectious or toxic). Studies of twins show higher rates of ME/CFS in identical than fraternal twins. The [[Centers for Disease Control and Prevention]] (CDC) notes that specific genetic associations have not been established.<ref name=":0" />

=== ME/CFS Gene Study ===
The [[ME/CFS Gene Study]] is still collecting data, but the initial pilot study by Perez et al. (2019) found 10 relatively common genes or gene variants were significantly more common in people with ME/CFS.<ref name="Nathanson2019" /> These were [[Cytochrome P450 2D6|CYP2D6]], [[Proline-rich transmembrane protein 4|PRRT4]], [[Serine Protease 56|PRSS56]], [[Armadillo Like Helical Domain Containing 4|C14orf37]], [[Ankyrin Repeat And Death Domain Containing 1B|ANKDD1B]], GPBAR1, LHB, ADAMTS19, VARS2, and CPLX2.<ref name="Nathanson2019" />

=== Utah Population Database study ===
A 2011 study by Albright et al showed evidence of a heritable contribution to [[chronic fatigue syndrome]] (CFS).<ref name="Albright, 2011" /> Using the extensive records of the Utah Population Database (UPDB), the study "shows clear evidence of significant excess familial clustering and significantly elevated risks for [[Chronic fatigue syndrome|CFS]] among first, second, and third degree relatives of CFS cases. The results strongly support a genetic contribution to predisposition to CFS as it is currently defined and diagnosed by clinicians in Utah." Increased outbreak rates in first degree relatives are not automatically assumed to be genetic because the first degree relatives often share the same lifestyle and environment. However, a significantly increased incidence (95% confidence interval) in second and third degree relatives strongly indicated a genetic contribution to CFS, given the much lower likelihood of these relatives sharing common risks and environments.<ref name="Albright, 2011" />
[[File:Genetic Relationship graph.png|center|Albright,2011 study]]

=== Family history and twin studies ===
A 2001 study in the [[United Kingdom|UK]] showed "there were significantly higher rates of CFS in the relatives of CFS cases compared with the relatives of control subjects."<ref>{{Cite journal|last=Walsh|first=C. M.|author-link=|last2=Zainal|first2=N. Z.|author-link2=|last3=Middleton|first3=S. J.|author-link3=|last4=Paykel|first4=E. S.|author-link4=|date=Sep 2001|title=A family history study of chronic fatigue syndrome|url=https://doi.org/10.1097/00041444-200109000-00003|journal=Psychiatric Genetics|language=en|volume=11|issue=3|pages=123–128|doi=10.1097/00041444-200109000-00003|issn=0955-8829|quote=|via=}}</ref> Three twin studies (one in Australia, one in Washington, US, both in 2001, and one in the UK in 2007) showed that the correlations for prolonged and chronic fatigue were significantly higher in monozygotic than dizygotic twins for each definition of chronic fatigue syndrome.<ref name="Buchwald, 2001" /><ref name="Hickie, 2001" /><ref name="Schur, 2007" />

=== Haplogroups ===
One study showed that patients with [[mitochondrial DNA]] from certain haplogroups correlated with variations in [[gastrointestinal]], [[neurological]], and [[inflammatory]] symptoms.<ref name="Hanson2016" />

===HLA alleles===
[[Human leukocyte antigen genes]] associations were investigated by Lande et al. (2020) because these gene variants are considered hallmarks for [[autoimmune hypothesis|autoimmune]] disease; two HLA associations were found to be more common in ME/CFS patients, but the majority of ME/CFS patients did not have these.<ref name="Lande2020" />

==Notable studies==
*2001, A twin study of chronic fatigue<ref name="Buchwald, 2001" /> [https://www.ncbi.nlm.nih.gov/pubmed/11719632 (Abstract)]
*2006, [[pubmed:16610957|Combinations of single nucleotide polymorphisms in neuroendocrine effector and receptor genes]]<ref>{{Cite journal|last=Goertzel|first=Benjamin N.|author-link=Benjamin Goertzel|last2=Pennachin|first2=Cassio|author-link2=Cassio Pennachin|last3=de Souza Coelho|first3=Lucio|author-link3=Lucio de Souza Coelho|last4=Gurbaxani|first4=Brian|author-link4=Brian Gurbaxani|last5=Maloney|first5=Elizabeth M.|author-link5=Elizabeth M. Maloney|last6=Jones|first6=James F.|author-link6=James Jones|date=April 2006|title=Combinations of single nucleotide polymorphisms in neuroendocrine effector and receptor genes predict chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/16610957|journal=Pharmacogenomics|volume=7|issue=3|pages=475–483|doi=10.2217/14622416.7.3.475|issn=1462-2416|pmid=16610957|quote=|via=}}</ref> <blockquote>Three genes were found to be common in a group of people with Chronic Fatigue Syndrome compared to the general population; [[TPH2]] - neuronal [[tryptophan]] hydroxylase, [[COMT]] - catechol-O-methyltransferase, and [[NR3C1]] - nuclear receptor subfamily 3, group C, member 1 [[glucocorticoid]] receptor, together these three have an accuracy of 76%.
*2011, Evidence for a heritable predisposition to Chronic Fatigue Syndrome<ref name="Albright, 2011" /> [http://dx.doi.org/10.1186/1471-2377-11-62 (Abstract)]
*2011, [https://doi.org/10.1111/j.1365-2796.2011.02405.x Gene expression alterations at baseline and following moderate exercise in patients with Chronic Fatigue Syndrome and Fibromyalgia Syndrome]<ref>{{Cite journal|last=Light|first=A. R.|author-link=Alan Light|last2=Bateman|first2=L.|author-link2=Lucinda Bateman|last3=Jo|first3=D.|author-link3=Daehyun Jo|last4=Hughen|first4=R. W.|author-link4=Ronald Hughen|last5=VanHaitsma|first5=T. A.|author-link5=Timothy Vanhaitsma|last6=White|first6=A. T.|author-link6=Andrea White|last7=Light|first7=K. C.|author-link7=Kathleen Light|date=2011-07-13|title=Gene expression alterations at baseline and following moderate exercise in patients with Chronic Fatigue Syndrome and Fibromyalgia Syndrome|url=https://doi.org/10.1111/j.1365-2796.2011.02405.x|journal=Journal of Internal Medicine|language=en|volume=271|issue=1|pages=64–81|doi=10.1111/j.1365-2796.2011.02405.x|issn=0954-6820|pmc=3175315|pmid=21615807|quote=|via=}}</ref>
*2016, Genome-wide association analysis identifies genetic variations in subjects with myalgic encephalomyelitis/chronic fatigue syndrome<ref name="Schlauch, 2016" /> [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4872418/ (Full Text)]
*2016, Mitochondrial DNA variants correlate with symptoms in myalgic encephalomyelitis/chronic fatigue syndrome <ref name="Hanson2016">{{Cite journal|last=Billing-Ross|first=Paul|author-link=Paul Billing-Ross|last2=Germain|first2=Arnaud|author-link2=Arnaud Germain|last3=Ye|first3=Kaixiong|author-link3=Kaixiong Ye|last4=Keinan|first4=Alon|author-link4=Alon Keinan|last5=Gu|first5=Zhenglong|author-link5=Zhenglong Gu|last6=Hanson|first6=Maureen R.|author-link6=Maureen Hanson|date=2016-01-20|title=Mitochondrial DNA variants correlate with symptoms in myalgic encephalomyelitis/chronic fatigue syndrome|url=https://doi.org/10.1186/s12967-016-0771-6|journal=Journal of Translational Medicine|volume=14|issue=1|pages=19|doi=10.1186/s12967-016-0771-6|issn=1479-5876|quote=|via=}}</ref> [http://www.translational-medicine.com/content/14/1/19 (Abstract)]
*2018, Identification of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome-associated DNA methylation patterns<ref name="Trivedi2018">{{Cite journal|last=Trivedi|first=Malav S.|author-link=Malav Trivedi|last2=Oltra|first2=Elisa|author-link2=Elisa Oltra|last3=Sarria|first3=Leonor|author-link3=Leonor Sarria|last4=Rose|first4=Natasha|author-link4=Natasha Rose|last5=Beljanski|first5=Vladimir|author-link5=Vladimir Beljanski|last6=Fletcher|first6=Mary Ann|author-link6=Mary Ann Fletcher|last7=Klimas|first7=Nancy G.|author-link7=Nancy Klimas|last8=Nathanson|first8=Lubov|author-link8=Lubov Nathanson|date=2018|title=Identification of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome-associated DNA methylation patterns|url=https://www.ncbi.nlm.nih.gov/pubmed/30036399|journal=PloS One|volume=13|issue=7|pages=e0201066|doi=10.1371/journal.pone.0201066|issn=1932-6203|pmc=|pmid=30036399|quote=|via=}}</ref> [https://www.ncbi.nlm.nih.gov/pubmed/30036399 (Abstract)]
*2018, Genome-epigenome interactions associated with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.<ref name="Herrera2018">{{Cite journal|last=Herrera|first=Santiago|author-link=Santiago Herrera|last2=de Vega|first2=Wilfred C.|author-link2=Wilfred de Vega|last3=Ashbrook|first3=David|author-link3=David Ashbrook|last4=Vernon|first4=Suzanne D.|author-link4=Suzanne Vernon|last5=McGowan|first5=Patrick O.|author-link5=Patrick McGowan|date=2018-12-05|title=Genome-epigenome interactions associated with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/30516085|journal=Epigenetics|volume=|issue=|pages=1–17|doi=10.1080/15592294.2018.1549769|issn=1559-2308|pmid=30516085|quote=|via=}}</ref> [https://www.ncbi.nlm.nih.gov/pubmed/30516085 (Abstract)]
*2019, Associations between clinical symptoms, plasma norepinephrine and deregulated immune gene networks in subgroups of adolescent with Chronic Fatigue Syndrome.<ref name="Nguyen2019">{{Cite journal|last=Nguyen|first=Chinh Bkrong|author-link=Chinh Bkrong Nguyen|last2=Kumar|first2=Surendra|author-link2=Surendra Kumar|last3=Zucknick|first3=Manuela|author-link3=Manuela Zucknick|last4=Kristensen|first4=Vessela N.|author-link4=Vessela Kirstensen|last5=Gjerstad|first5=Johannes|author-link5=Johannes Gjerstad|last6=Nilsen|first6=Hilde|author-link6=Nilsen Hilde|last7=Wyller|first7=Vegard Bruun|author-link7=Vegard Bruun Wyller|date=Feb 2019|title=Associations between clinical symptoms, plasma norepinephrine and deregulated immune gene networks in subgroups of adolescent with Chronic Fatigue Syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/30419269|journal=Brain, Behavior, and Immunity|volume=76|issue=|pages=82–96|doi=10.1016/j.bbi.2018.11.008|issn=1090-2139|pmid=30419269|quote=|via=}}</ref> [https://www.ncbi.nlm.nih.gov/pubmed/30419269/ (Abstract)]
* 2019 - Genetic Predisposition for Immune System, Hormone, and Metabolic Dysfunction in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Pilot Study<ref name="Nathanson2019">{{Cite journal|last=Nathanson|first=Lubov |author-link1=Lubov Nathanson|author-link2=Travis Craddock|last2=Craddock|first2=Travis J. A.|last3=Klimas|first3=Nancy G.|author-link3=Nancy Klimas|author-link4=Kristina Gemayel|last4=Gemayel|first4=Kristina|last5=Del Alamo|first5=Ana|author-link5=Ana Del Alamo|author-link6=Kelly Hilton|last6=Hilton|first6=Kelly|last7=Jaundoo|first7=Rajeev|author-link7=Rajeev Jaundoo|last8=Perez|first8=Melanie|author-link8=Melanie Perez|date=2019|title=Genetic Predisposition for Immune System, Hormone, and Metabolic Dysfunction in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Pilot Study|url=https://www.frontiersin.org/articles/10.3389/fped.2019.00206/full|journal=Frontiers in Pediatrics|language=English|volume=7|doi=10.3389/fped.2019.00206|issn=2296-2360}}</ref> [https://doi.org/10.3389/fped.2019.00206 (Full text)]
*2020, Human Leukocyte Antigen alleles associated with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)<ref name="Lande2020">{{Cite journal|last=Lande|first=Asgeir|author-link=Asgeir Lande|last2=Fluge|first2=Øystein|author-link2=Øystein Fluge|last3=Strand|first3=Elin B.|author-link3=Elin Strand|last4=Flåm|first4=Siri T.|author-link4=Siri Flåm|last5=Sosa|first5=Daysi D.|author-link5=Daysi Sosa|last6=Mella|first6=Olav|author-link6=Olav Mella|last7=Egeland|first7=Torstein|author-link7=|last8=Saugstad|first8=Ola D.|author-link8=|last9=Lie|first9=Benedicte A.|author-link9=|date=2020-03-24|title=Human Leukocyte Antigen alleles associated with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)|url=https://www.nature.com/articles/s41598-020-62157-x|journal=Scientific Reports|language=en|volume=10|issue=1|pages=1–8|doi=10.1038/s41598-020-62157-x|issn=2045-2322|pmc=|pmid=|access-date=|quote=|via=}}</ref> - [https://www.nature.com/articles/s41598-020-62157-x (Full text)]
*2020, Unravelling myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS): Gender‐specific changes in the microRNA expression profiling in ME/CFS<ref name="Cheema2020">{{Cite journal|last=Cheema|first=Amanpreet K.|author-link=|last2=Sarria|first2=Leonor|author-link2=|last3=Bekheit|first3=Mina|author-link3=|last4=Collado|first4=Fanny|author-link4=Fanny Collado|last5=Almenar‐Pérez|first5=Eloy|author-link5=|last6=Martín‐Martínez|first6=Eva|author-link6=|last7=Alegre|first7=Jose|author-link7=José Alegre|last8=Castro‐Marrero|first8=Jesus|author-link8=Jesús Castro-Marrero|last9=Fletcher|first9=Mary A.|author-link9=Mary Ann Fletcher|date=Apr 14, 2020|title=Unravelling myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS): Gender-specific changes in the microRNA expression profiling in ME/CFS|url=https://onlinelibrary.wiley.com/doi/abs/10.1111/jcmm.15260|journal=Journal of Cellular and Molecular Medicine|language=en|volume=00|issue=|pages=1-13|doi=10.1111/jcmm.15260|issn=1582-4934|pmc=|pmid=32291908|access-date=|quote=|via=|last10=Klimas|first10=Nancy|author-link10=Nancy Klimas|last11=Oltra|first11=Elisa|author-link11=Elisa Oltra|last12=Nathanson|first12=Lubov|author-link12=Lubov Nathanson}}</ref> - [https://onlinelibrary.wiley.com/doi/full/10.1111/jcmm.15260 (Full text)]

==Media Coverage==
*2016, [http://www.meresearch.org.uk/news/genome-wide-associations/ Genome-wide associations]
*2016, [https://cfsremission.wordpress.com/2016/01/23/new-study-found-snps-for-some-symptoms/ New study found SNPs for some symptoms] ([[CFS Remission]], January 23)

==See also==

*[[:Category:Genes|Genes (category)]]
*[[Gene expression]]
*[[ME/CFS Gene Study]]
*[[Genetic testing]]
*[[Mitochondrion]]
== Learn more ==
*[http://hansonlab.org/research/cfs_me/mitochondria/ Mitochondrial DNA and ME/CFS - A Guide to the Hanson Lab's] - 2016 JTM Publication
*[https://www.youtube.com/watch?v=rtVtH-cwhBY Dr. Ron Davis Gives an Update on ME/CFS Research]- Sep 26, 2019 [[Open Medicine Foundation]] (Gene Mutation Found)
==References==
<references>
<ref name="Albright, 2011">{{Citation
| last1 = Albright | first1 = Frederick | authorlink1 = Frederick Albright
| last2 = Light | first2 = Kathleen | authorlink2 = Kathleen Light
| last3 = Light | first3 = Alan | authorlink3 = Alan Light
| last4 = Bateman | first4 = Lucinda | authorlink4 = Lucinda Bateman
| last5 = Cannon-Albright | first5 = Lisa A | authorlink5 = Lisa Cannon-Albright
| title = Evidence for a heritable predisposition to Chronic Fatigue Syndrome |url = https://doi.org/10.1111/j.1365-2796.2011.02405.x
| journal = BMC Neurology | volume = 11 | issue = 62 | page =
| date = 2011
| doi = 10.1186/1471-2377-11-62
}}
</ref>
<ref name="Buchwald, 2001">{{Citation
| last1 = Buchwald | first1 = D. | authorlink1 = Dedra Buchwald
| last2 = Herrell | first2 = R. | authorlink2 =
| last3 = Ashton | first3 = S. | authorlink3 =
| last4 = Belcourt | first4 = M. | authorlink4 =
| last5 = Schmaling | first5 = K. | authorlink5 =
| last6 = Sullivan | first6 = P. | authorlink6 =
| last7 = Neale | first7 = M. | authorlink7 =
| last8 = Goldberg | first8 = J. | authorlink8 =
| title = A twin study of chronic fatigue.
| journal = Psychosomatic Medicine | volume = 63 | issue = 6 | page = 936-943
| date = 2001
| pmid = 11719632
| doi =
| url = https://www.ncbi.nlm.nih.gov/pubmed/11719632
}}
</ref>
<ref name="Hickie, 2001">{{Citation
| last1 = Hickie | first1 = IB | authorlink1 =
| last2 = Bansal | first2 = AS | authorlink2 =
| last3 = Kirk | first3 = KM | authorlink3 =
| last4 = Lloyd | first4 = AR | authorlink4 =
| last5 = Martin | first5 = NG | authorlink5 =
| title = A twin study of the etiology of prolonged fatigue and immune activation
| journal = Twin Research | volume = 4 | issue = 2 | page = 94-102
| date = 2001
| doi = 10.1375/1369052012209
}}
</ref>
<ref name="Schlauch, 2016">{{Citation
| last1 = Schlauch | first1 = Karen A. | authorlink1 = Karen Schlauch
| last2 = Khaiboullina | first2 = Svetlana F.| authorlink2 = Svetlana Khaiboullina
| last3 = De Meirleir | first3 = Kenny L. | authorlink3 = Kenny de Meirleir
| last4 = Rawat | first4 = Shanti | authorlink4 = Shanti Rawat
| last5 = Petereit | first5 = J | authorlink5 =
| last6 = Rizvanov | first6 = Albert A | authorlink6 = Albert Rizvanov
| last7 = Blatt | first7 = Nataliya | authorlink7 = Nataliya Blatt
| last8 = Mijatovic | first8 = Tatjana | authorlink8 = Tatjana Mijatovic
| last9 = Kulick | first9 = D | authorlink9 =
| last10 = Palotás | first10 = András | authorlink10 = András Palotás
| last11 = Lombardi | first11 = Vincent C.| authorlink11 = Vincent Lombardi
| title = Genome-wide association analysis identifies genetic variations in subjects with myalgic encephalomyelitis/chronic fatigue syndrome
| journal = Translational Psychiatry | volume = 6 | issue = 2 | page = e730
| date = 2016
| pmid =
| doi = 10.1038/tp.2015.208
}}
</ref>
<ref name="Schur, 2007">{{Citation
| last1 = Schur | first1 = Ellen | authorlink1 =
| last2 = Afari | first2 = Niloofar | authorlink2 =
| last3 = Goldberg | first3 = Jack | authorlink3 =
| last4 = Buchwald | first4 = Dedra | authorlink4 = Dedra Buchwald
| last5 = Sullivan | first5 = Patrick F. | authorlink5 =
| title = Twin analyses of fatigue
| journal = Twin Research and Human Genetics | volume = 10 | issue = 5 | page = 729-733
| date = 2007
| doi = 10.1375/twin.10.5.729
}}
</ref>
</references>
[[Category:Triggers and risk factors]]
[[Category:Genetics]]

Onset of ME/CFS

2021-04-24T12:39:24Z

Loopy:mutated gene research update video

The '''onset of ME/CFS''' can be sudden (acute) or gradual.<ref name="Chu" /><ref name=":0">{{Cite web|url=https://www.cdc.gov/me-cfs/healthcare-providers/presentation-clinical-course/index.html|title=Presentation and Clinical Course of ME/CFS {{!}} Information for Healthcare Providers {{!}} Myalgic Encephalomyelitis/Chronic Fatigue Syndrome ME/CFS {{!}} CDC|date=2018-12-12|website=[[Centers for Disease Control]]|language=en-us|access-date=2019-02-07}}</ref> Sudden onset is more common.<ref>{{Cite web|url=https://wol.jw.org/en/wol/d/r1/lp-e/101992602|title=Is CFS a Real Disease? — Watchtower ONLINE LIBRARY|last=|first=|authorlink=|last2=|first2=|authorlink2=|date=Aug 22, 1992|website=wol.jw.org|at=Could CFS Be Depression?|archive-url=|archive-date=|access-date=2019-02-08|quote=sudden onset in 85 percent of patients}}</ref> Dr. [[Melvin Ramsay]] and Dr. [[Byron Hyde]] both describe sudden/acute onsets for [[myalgic encephalomyelitis]] (ME)<ref name=":1">{{Cite journal|last=Evans|first=Meredyth|author-link=Meredyth Evans|author-link2=Leonard Jason|author-link3=|author-link4=|author-link5=|date=2018|title=Onset patterns of chronic fatigue syndrome and myalgic encephalomyelitis|url=https://www.openaccessjournals.com/articles/Onset%20patterns%20of%20chronic%20fatigue%20syndrome%20and%20myalgic%20encephalomyelitis.pdf|journal=Research on Chronic Diseases|volume=|issue=|pages=2|quote=|via=|last2=Jason|first2=Leonard}}</ref> as oppose to [[ME/CFS]] being acute or gradual.<ref name=":0" /> In cases of sudden onset, it is usually easy to identify the trigger of the illness, such as physical trauma, overwhelming stress, or a [[Viral infection|viral]]/[[bacterial infection]].<ref name="Chu" /> Children, particularly adolescents, will more likely have an acute illness like the [[Influenza|flu]] or [[mononucleosis]] as their onset.<ref>{{Cite web|url=https://www.cdc.gov/me-cfs/me-cfs-children/children-symptoms-diagnosis.html|title=Symptoms and Diagnosis of ME/CFS in Children {{!}} Myalgic Encephalomyelitis/Chronic Fatigue Syndrome|date=2019-01-18|website=[[Centers for Disease Control]]|language=en-us|access-date=2019-01-29}}</ref>

Acute symptoms develop over hours to days. 85% of patients report a trigger. 72% of [[ME/CFS]] patients report that [[Bacterial disease onset|a bacterial]] or [[Viral onset hypothesis|a viral infection]] was their onset of ME/CFS; 4.5% [[trauma]]; 4.5% surgery or childbirth; 2.2% [[allergies|allergic reaction]]; 1.7% [[stress]] or trauma.<ref>{{Cite web|url=https://www.cdc.gov/grand-rounds/pp/2016/20160216-presentation-chronic-fatigue-H.pdf|title=CDC Public Health Grand Rounds - Chronic Fatigue Syndrome - Advancing Research and Clinical Education|last=|first=|authorlink=|last2=|first2=|authorlink2=|date=|website=cdc.gov|page=6|archive-url=|archive-date=|access-date=}}</ref>

[[Genetics of chronic fatigue syndrome|Genes]] are being considered for a risk in developing ME/CFS as sometimes several members of the same family will develop ME/CFS.<ref name=":4">{{Cite web|url=https://www.cdc.gov/me-cfs/about/possible-causes.html|title=Possible Causes {{!}} Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) {{!}} CDC|last=|first=|date=2017-07-14|website=[[Centers for Disease Control]]|at=Causes|language=en-us|archive-url=|archive-date=|access-date=2018-10-15}}</ref><ref>{{Citation|title=Dr. Ron Davis Gives an Update on ME/CFS Research|url=https://www.youtube.com/watch?v=rtVtH-cwhBY|language=en|access-date=2021-04-24}}</ref>

== Pre-onset triggers ==
The [[International Consensus Criteria]] (ICC) Primer includes a patient assessment form, which includes factors that may have triggered ME, these can be infectious (for example, a virus), or non-infectious (for example, exposure to chemical [[toxin]]s or severe physical injury).

=== Infectious exposure or events ===
* minor [[Infection|infections]], [[Vaccine|vaccination]], [[Upper respiratory infection|upper respiratory infections]], [[sinusitis]], [[pneumonia]], [[Gastrointestinal tract|gastrointestinal illness]] (after sinusitis or pneumonia), [[Dental infection|dental infections]], [[vaginal infection]], [[cystitis]], [[prostatitis]], [[Blood donation|blood transfusion]]
* exposure to: sick people, unfamiliar [[Infection|infectious]] agents when traveling, particularly following [[Vaccine|vaccinations]], [[contaminated water]], poor quality [[recycled air]]

=== Non-infectious exposure or events ===
* exposure to: chemical toxins, [[heavy metals]], or [[Mold|moulds]]
* severe physical trauma e.g. whiplash/spinal injury/[[Guide for patients having surgery|surgery]]
* anaesthetics
* undue [[stress]]
* [[Steroid|steroids]]
Other triggers have been recognized besides these, and some people report several potential triggers or no known cause.<ref name="Chu" />

== Is ME always caused by a virus ==
A small number of [[Myalgic encephalomyelitis|ME]] patient charities, for example [[The Hummingbirds' Foundation for ME]] hold the view that ME is always caused by a [[virus]], but [[chronic fatigue syndrome]] (CFS) may have non-viral triggers, and do not recognize [[Bacterial infection|bacterial infections]] or non-infectious events as a potential cause or trigger.<ref>{{Cite web|url=http://www.hfme.org/methemedicalfacts.htm|title=M.E.: The medical facts|last=Bassett|first=Jodi|authorlink=Jodi Bassett|last2=|first2=|authorlink2=|date=2010|website=[[The Hummingbirds' Foundation for ME]]|archive-url=|archive-date=|access-date=2019-02-09|quote=Myalgic encephalomyelitis is a systemic acutely acquired illness initiated by a virus infection which is characterised by post encephalitic damage to the brain stem; a nerve centre through which many spinal nerve tracts connect with higher centres in the brain in order to control all vital bodily functions – this is always damaged in M.E. (Hence the name Myalgic Encephalomyelitis.) The CNS is diffusely injured at several levels, these include the cortex, the limbic system, the basal ganglia, the hypothalamus and areas of the spinal cord and its appendages. This persisting multilevel central nervous system (CNS) dysfunction, and in particular, inconsistent CNS dysfunction is undoubtedly both the chief cause of disability in M.E. and the most critical in the definition of the entire disease process.}}</ref>

The onset events recognized as potential causes or triggers in the ICC are based on events prior to illness that have been reported by patients meeting the diagnostic criteria for ICC ME or based on the consensus of experts. The exact cause has not yet been identified in research. [[Lily Chu|Chu]] et al. (2019) reported on pre-onset events for patients meeting the CFS [[Fukuda criteria]] only.<ref name="Chu" />
{{See also|Viral onset hypothesis}}

== Development of ME ==
The [[International Consensus Criteria]] for ME recognizes that ME can develop
* suddenly
* gradually, or
* after an [[Infectious disease|infectious disease]] (for example, viral or bacterial [[List of myalgic encephalomyelitis and chronic fatigue syndrome outbreaks|outbreaks]] within a community)
* have a non-infectious event shortly before onset
* there may not be any potential trigger identified when ME begins

==Criteria==
*In the [[Holmes criteria]], description of the main symptom complex as initially developing over a few hours to a few days is an optional criteria for diagnosis, under the section ''Minor Symptom Criteria''.<ref>[http://www.cfids-me.org/holmes1988.html The 1988 Holmes Definition for CFS]</ref>

==Notable studies ==
* 2019, Onset patterns and course of [[ME/CFS|myalgic encephalomyelitis/chronic fatigue syndrome]]<ref name="Chu">{{Cite journal|last=Chu|first=Lily|author-link=Lily Chu|last2=Valencia|first2=Ian J.|author-link2=Ian Valencia|last3=Garvert|first3=Donn W.|author-link3=|last4=Montoya|first4=Jose G.|author-link4=Jose Montoya|author-link5=|date=14 Jan 2019|title=Onset patterns and course of myalgic encephalomyelitis/ chronic fatigue syndrome|url=https://www.frontiersin.org/articles/10.3389/fped.2019.00012/abstract|journal=Frontiers in Pediatrics|volume=|issue=|pages=|doi=10.3389/fped.2019.00012|quote=|via=}}</ref> [https://www.frontiersin.org/articles/10.3389/fped.2019.00012/abstract (Full text)]
* 2014, Two age peaks in the incidence of chronic fatigue syndrome/myalgic encephalomyelitis: a population-based registry study from Norway 2008-2012<ref name="twin-peaks">{{Cite journal|last=Bakken|first=Inger Johanne|last2=Tveito|first2=Kari|last3=Gunnes|first3=Nina|last4=Ghaderi|first4=Sara|last5=Stoltenberg|first5=Camilla|last6=Trogstad|first6=Lill|last7=Håberg|first7=Siri Eldevik|last8=Magnus|first8=Per|date=2014-10-01|title=Two age peaks in the incidence of chronic fatigue syndrome/myalgic encephalomyelitis: a population-based registry study from Norway 2008-2012|url=http://www.ncbi.nlm.nih.gov/pubmed/25274261|journal=BMC medicine|volume=12|pages=167|doi=10.1186/s12916-014-0167-5|issn=1741-7015|pmc=4189623|pmid=25274261|via=|author-link=Inger Johanne Bakken}}</ref>

==See also ==
* [[Bacterial disease onset]]
* [[Viral onset hypothesis]]
* Possible [[:Category:Infectious agents|Infectious agents]] for ME/CFS onset
* [[Epidemiology of myalgic encephalomyelitis and chronic fatigue syndrome|Epidemiology]]
* [[Risk factors]]
* [[Pediatric myalgic encephalomyelitis and chronic fatigue syndrome|Pediatric]]
* [[Prevalence of myalgic encephalomyelitis and chronic fatigue syndrome|Prevelance]]
* [[Prognosis for myalgic encephalomyelitis and chronic fatigue syndrome|Prognosis]]
* [[Corticosteroids given during acute viral infection may trigger myalgic encephalomyelitis]]
* [[Pesticide exposure link to ME/CFS]]

== Learn more ==
* [https://www.cdc.gov/me-cfs/healthcare-providers/presentation-clinical-course/index.html Presentation and Clinical Course of ME/CFS]<ref name=":0" />
* 2018, [https://www.openaccessjournals.com/articles/Onset%20patterns%20of%20chronic%20fatigue%20syndrome%20and%20myalgic%20encephalomyelitis.pdf Onset patterns of chronic fatigue syndrome and myalgic encephalomyelitis]<ref name=":1" />

==References==
<references />

[[Category:Core topics]]

Lack of stamina

2021-03-10T12:42:58Z

Loopy:Heading

'''Lack of stamina''' is an inability to maintain or sustain prolonged stressful effort or activity.<ref>{{Cite web|url=https://www.merriam-webster.com/dictionary/stamina|title=Definition of STAMINA|website=www.merriam-webster.com|language=en|access-date=2021-03-10}}</ref> However, with a patient suffering from [[Myalgic encephalomyelitis|ME]], the ability to maintain or sustain even minor effort or activity, be it physical or mental, isn't possible.<ref name=":0">{{Cite web|url=https://www.cdc.gov/me-cfs/healthcare-providers/clinical-care-patients-mecfs/severely-affected-patients.html|title=Severely Affected Patients {{!}} Clinical Care of Patients {{!}} Healthcare Providers {{!}} Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) {{!}} CDC|date=2019-11-19|website=www.cdc.gov|language=en-us|access-date=2021-03-10}}</ref> This lack of stamina is more easily quantified in [[severe and very severe ME]].

The [[Centers for Disease Control and Prevention|CDC]] only officially recognizes ME/CFS,<ref>{{Cite web|url=https://www.cdc.gov/me-cfs/index.html|title=Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) {{!}} CDC|date=2021-02-10|website=www.cdc.gov|language=en-us|access-date=2021-03-10}}</ref> so ME patients are sometimes categorized as "severely affected ME/CFS patients"<ref name=":0" /> by them. However, [[ME/CFS]] patients can also be severely affected.<ref name=":0" />

== References ==
<references />

Lack of stamina

2021-03-10T12:42:06Z

Loopy:citations, internal links

Lack of stamina

2021-03-10T12:14:29Z

Loopy:start and populate page

'''Lack of stamina''' is an inability to maintain or sustain prolonged stressful effort or activity. However, with a patient suffering from ME, or ME/CFS, the ability to maintain or sustain even minor effort or activity, be it physical, mental, or emotional, isn't possible.

Post-COVID-19 illness

2020-11-06T18:01:21Z

Loopy:may be disease of blood vessels

[[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> One small 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===
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|last2=|first2=|authorlink2=|date=Sep 7, 2020|website=|archive-url=|archive-date=|dead-url=|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" />

There is evidence that COVID may be a disease of the blood vessels.<ref name=":2">{{Cite journal|last=Ackermann|first=Maximilian|last2=Verleden|first2=Stijn E.|last3=Kuehnel|first3=Mark|last4=Haverich|first4=Axel|last5=Welte|first5=Tobias|last6=Laenger|first6=Florian|last7=Vanstapel|first7=Arno|last8=Werlein|first8=Christopher|last9=Stark|first9=Helge|date=2020-07-09|title=Pulmonary Vascular Endothelialitis, Thrombosis, and Angiogenesis in Covid-19|url=https://doi.org/10.1056/NEJMoa2015432|journal=New England Journal of Medicine|volume=383|issue=2|pages=120–128|doi=10.1056/NEJMoa2015432|issn=0028-4793|pmc=PMC7412750|pmid=32437596}}</ref><ref>{{Cite web|url=https://www.npr.org/sections/health-shots/2020/11/05/917317541/clots-strokes-and-rashes-is-covid-19-a-disease-of-the-blood-vessels|title=Clots, Strokes And Rashes. Is COVID-19 A Disease Of The Blood Vessels?|website=NPR.org|language=en|access-date=2020-11-06}}</ref>
{{See also|Long COVID}}

===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 is uncertainty about whether this is a relapse due to the virus remaining at low levels in the body and bring reactivated, or if this is a reinfection.{{citation needed}}

==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=PMC3071317|pmid=21435231}}</ref>

==Severe COVID-19 survivors==

===<span id="pics">Post-Intensive Care Syndrome</span>===
[[File:Post-COVID-19 ventilators.png|alt=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)|left|frameless]]
{{Clear|both}}
[[File:Post intensive care syndrome.png|thumb|Post Intensive Care Syndrome symptoms. Source: [https://medicaljournals.se/jrm/content/html/10.2340/16501977-2677 J Rehabil Med 2020; 52: jrm00044]. License: CC-BY NC.]]
<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=|dead-url=|access-date=2020-04-23|last3=J|first3=Bickenbach|volume=52|issue=4}}</ref>

===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|last2=|first2=|authorlink2=|date=2020-02-11|website=Centers for Disease Control and Prevention|language=en-us|archive-url=|archive-date=|dead-url=|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.{{citation needed}}

===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|last2=|first2=|authorlink2=|date=2017-10-17|website=nhs.uk|language=en|archive-url=|archive-date=|dead-url=|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===
Invasive ventilation using a mechanical ventilator was needed by 47-71% of patients admitted to Intensive Care Units.<ref name="JH-ABX-540747" />

===COVID-19 complications===
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:
**secondary infections including [[bacteria]]l and [[fungal infection]]s
**thromboembolism
**gastrointestinal bleeding
**critical illness polyneuropathy/myopathy.<ref name="JH-ABX-540747" /><ref name="CDC-clinicalguide" /><ref name="Varatharaj2020a" />

==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.|author-link=Keiji Fukuda|last2=Straus|first2=S. E.|author-link2=Stephen Straus|last3=Hickie|first3=I.|author-link3=Ian Hickie|last4=Sharpe|first4=M. C.|author-link4=Michael Sharpe|last5=Dobbins|first5=J. G.|author-link5=James Dobbins|last6=Komaroff|first6=A.|author-link6=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
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| 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
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| 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
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| doi = 10.1300/J092v11n01_02
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}}</ref><ref name="fukuda1994" />

== 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>

Reuters reported:
<blockquote>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.<br>Previous research has also shown COVID-19 could damage the brain in some patients.<ref name="ReutersJul2020" /><ref name="Varatharaj2020a" /></blockquote>

==Post-viral syndrome==
'''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]], [[Brain fog|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|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=|dead-url=|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 (ME/CFS) {{!}} CDC|date=2019-11-19|website=www.cdc.gov|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=|last2=|first2=|authorlink2=|date=|website=National Academy of Medicine (Formerly the Institute of Medicine)|archive-url=|archive-date=|dead-url=|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==
[[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=www.who.int|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=www.cdc.gov|author-link=Centers for Disease Control|date=|access-date=Apr 17, 2020|first=|last2=|first2=|authorlink2=|archive-url=|archive-date=|dead-url=}}</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)}}

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|Chronic fatigue syndrome}}

==Treatment==
No treatment studies have yet been published, despite this and the uncertainty over long term physical and psychological health consequences of coronavirus disease 19 (COVID-19), some self-help advice has already been published.<ref name="openletter20042020" />

A group of over 20 [[Myalgic encephalomyelitis|ME]] and [[chronic fatigue syndrome]] specialists and patient groups have recommended [[fatigue]] after COVID-19 should be treated/managed using:
*[[pacing]]
*[[nutrition]] and
*[[sleep hygiene]], stating that should help reduce the risk of developing ME/CFS after COVID-19.<ref name="Vink2019">{{Cite journal|last=Vink|last2=Vink-Niese|date=2019-09-20|title=Work Rehabilitation and Medical Retirement for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Patients. A Review and Appraisal of Diagnostic Strategies|url=https://www.mdpi.com/2075-4418/9/4/124|journal=Diagnostics|language=en|volume=9|issue=4|pages=124|doi=10.3390/diagnostics9040124|issn=2075-4418|first=Mark|first2=Alexandra|pmc=|pmid=|author-link=Mark Vink|author-link2=Alexandra Vink-Niese|access-date=|via=}}</ref><ref name="openletter20042020" />

===Pacing===
Less controversially, the self-help leaflet mentions [[pacing]], a symptom-management approach also without evidence for COVID-19 survivors, but which is used by many people with chronic fatigue, chronic pain, and/or persistent illness that limits their everyday activities.<ref name="TullerOx16apr2020" /> ME patient associations surveys have found pacing helped most, but not all, patients.<ref name="forwardme-survey" /><ref name="IIMER-NICE" />{{See also|Pacing}}<div role="note" class="hatnote navigation-not-searchable">{{See also|Pacing}}</div>

===CBT and GET not recommended for fatigue===
The Oxford Health NHS Foundation Trust published a ''Coping with Coronavirus: Fatigue'' leaflet referring to [[chronic fatigue syndrome]], a neurological disease, as a possible ''[[mental health]]'' consequence of COVID-19, and confusing fatigue after COVID-19 illness with [[chronic fatigue syndrome]]. The leaflet recommenddations included the highly controversial use of [[cognitive behavioral therapy]] (CBT) and graded exercise therapy (GET) to address the physical symptoms of chronic fatigue syndrome. The leaflet was withdrawn after public health expert [[David Tuller]] asked for the evidence based used by it, details of its authorship, and strongly criticised the advice given in it. An [[Opposition to Oxford Health NHS Foundation Trust: "Coping with Coronavirus: Fatigue"|open letter opposing the leaflet]] was signed by a large number of medical professionals and UK patient groups at around the same time.<ref name="openletter20042020" />

CBT for fatigue is a psychological therapy focused on treating a presumed [[illness beliefs]] such as a fear of activity and GET is exercise/activity based, both treatments rely on the [[deconditioning|assumption]] that there is no lasting physical damage or underlying illness process that could prevent full recovery. GET is particularly controversial and has been found to cause most patients with [[chronic fatigue syndrome]] (not resulting from COVID-19) to deteriorate, sometimes permanently.<ref name="openletter20042020" /> CBT and GET are no longer recommended by the [[Centers for Disease Control|CDC]], and their use within the UK's [[National Health Service]] is currently under review, with many concerns having been raised about high rates of patient harm resulting from these treatments, and a lack of effectiveness.<ref name="forwardme-survey">{{Cite web|url=https://www.meassociation.org.uk/2019/04/forward-me-and-oxford-brookes-university-announce-results-of-patient-survey-on-cbt-and-get-in-me-cfs-03-april-2019|date=Apr 3, 2019|title=Forward-ME and Oxford Brookes University announce results of Patient Survey on CBT and GET in ME/CFS {{!}} 3 April 2019|last=ME Association|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]], [[MEAction]], 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=actionforme.org.uk}}</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=www.investinme.org|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|last2=|first2=|authorlink2=|date=2017-10-24|website=nhs.uk|language=en|archive-url=|archive-date=|dead-url=|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|last2=|first2=|authorlink2=|date=2018-07-18|website=nhs.uk|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-04-29}}</ref>

{{See also|Cognitive behavioral therapy}}{{See also|Graded exercise therapy}}

==Recovery advice==
* [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] - ME Association ''(May 2020)''
* [https://www.physiosforme.com/covid-19 Post Covid-19 Rehabilitation] - Physios for ME, Workwell Foundation, and ME Association ''(May 2020)''

==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|author-link2=|last3=Ellul|first3=Mark A|author-link3=|last4=Davies|first4=Nicholas W S|author-link4=|last5=Pollak|first5=Thomas A|author-link5=|last6=Tenorio|first6=Elizabeth L|author-link6=|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=|issue=|pages=|doi=10.1016/s2215-0366(20)30287-x|issn=2215-0366|pmc=PMC7316461|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|author-link2=|last3=Barratt|first3=Shaney|author-link3=|last4=Elvers|first4=Karen|author-link4=|last5=Morley|first5=Anna|author-link5=|last6=McKernon|first6=Jorgen|author-link6=|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|language=en|volume=n/a|issue=n/a|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|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.|author-link2=|last3=Milne|first3=Alice|author-link3=|last4=Morley|first4=Anna|author-link4=|last5=Viner|first5=Jason|author-link5=|last6=Attwood|first6=Marie|author-link6=|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===
* '''''Coro''Nerve 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 - [https://www.coronerve.com 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 [[Postviral fatigue syndrome|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 - [https://www.omf.ngo/covid-19-latest-news/ Website]
* '''DISCOVER''' - '''DI'''agnostic and '''S'''everity markers of '''COV'''id-19 to '''E'''nable '''R'''apid triage
::University of Bristol, UK - [http://www.bristol.ac.uk/news/2020/may/discover-study.html DISCOVER announcement]

*'''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]].

* '''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.<ref name="covidence">https://www.qmul.ac.uk/covidence/</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]
::"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

* [https://airtable.com/shrQ1uCYwLYf6uiA9 List of Long Covid studies] - ME Action

==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 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=|dead-url=|issn=1072-7825|quote=|author-link=}}</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=|last2=|first2=|authorlink2=|date=Jul 29, 2020|website=NBC News|language=en|archive-url=|archive-date=|dead-url=|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 1, 2020, [https://www.wsj.com/articles/three-months-in-these-patients-are-still-ravaged-by-covids-fallout-11593612004 Three Months In, These Patients Are Still Ravaged by Covid’s Fallout] - Wall Street Journal
* May 18, 2020, [https://blogs.bmj.com/bmj/2020/05/19/paul-garner-covid-19-and-fatigue-a-game-of-snakes-and-ladders/ Paul Garner: Covid-19 and fatigue—a game of snakes and ladders] - The BMJ
* 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://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.ws}}</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 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 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|last=Lowenstein|first=Fiona|date=2020-04-13|publisher=New York Times|title=We Need to Talk About What Coronavirus Recoveries Look Like}}</ref> - Fiona Lowenstein, 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]]
*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==
*[[COVID-19]] (Coronavirus disease 19)
*[[Long COVID]]
*[[Myalgic encephalomyelitis]]
*[[Chronic fatigue syndrome]] - the neurological disease
*[[Postviral fatigue syndrome]]
*[[Chronic fatigue]] - a symptom of many illnesses
*[[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]]
*[[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=|doi=|oclc=|quote=|archive-url=|archive-date=|location=}}</ref> - Dr Charles Shepherd (book)

==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
* 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=meassociation.org}}</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=|dead-url=|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
* 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 {{!}} 30 April 2020|date=Apr 30, 2020|last=Charles Shepherd|author-link=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://airtable.com/shrQ1uCYwLYf6uiA9 List of Long Covid studies] - ME Action

==References==
{{Reflist}}

[[Category:Diagnoses]]

Long COVID

2020-11-06T17:58:23Z

Loopy:May be evidence that COVID is a disease of the blood vessels.

[[File:Long-COVID.jpg|alt=Long COVID logo with Coronavirus icon |thumb]]
'''Long COVID''', '''long covid''', '''post-acute COVID-19''' and '''ongoing COVID''' are terms used to describe a group of long term health problems that are found in a significant minority of people who were infected with the [[COVID-19]] and remain ill after a number of weeks or months.<ref name="Navabi2020">{{Cite journal|title=Long covid: How to define it and how to manage it|last=Nabavi|first=Nikki|url=https://www.bmj.com/content/370/bmj.m3489|date=Sep 7, 2020|journal=BMJ|volume=370|pages=bmj.m3489}}</ref><ref name="BMJ11Aug2020" /><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=|dead-url=|issn=1072-7825|quote=|author-link=}}</ref><ref name="NIHR.ac.uk15Oct2020">{{Cite web|url=https://www.nihr.ac.uk/news/living-with-covid-nihr-publishes-dynamic-themed-review-into-ongoing-covid/25891|title=Living with COVID: NIHR publishes dynamic themed review into ‘ongoing COVID’|last=National Institute for Health Research|first=|authorlink=|date=|website=www.nihr.ac.uk|archive-url=|archive-date=|dead-url=|access-date=2020-10-15}}</ref>

In February 2020, the World Health Organization stated that the expected recovery time from [[COVID-19]] was 2 weeks for mild cases, and between three and six weeks for severe cases;<ref>{{Cite web|url=https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---24-february-2020|title=WHO Director-General's opening remarks at the media briefing on COVID-19|last=World Health Organization|first=|authorlink=World Health Organization|last2=|first2=|authorlink2=|date=Feb 24, 2020|website=www.who.int|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-09-24}}</ref> follow-up studies then identified a significant number of COVID-19 patients had remained ill much longer than this: those with long COVID.<ref name="Navabi2020" /><ref name="BMJ11Aug2020" />

A similar phenomenon to long COVID occurred after the 2003 outbreak of the similar SARS coronavirus, which lead to a [[Severe acute respiratory syndrome#post-SARS|post-SARS syndrome]] being proposed that included chronic widespread musculoskeletal pain, fatigue, depression and disordered sleep. Another study found a subgroup SARS survivors developed [[chronic fatigue syndrome]] immediately after SARS.<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=PMC3071317|pmid=21435231}}</ref>
<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>

There is evidence that COVID may be a disease of the blood vessels.<ref name=":2" /><ref>{{Cite web|url=https://www.npr.org/sections/health-shots/2020/11/05/917317541/clots-strokes-and-rashes-is-covid-19-a-disease-of-the-blood-vessels|title=Clots, Strokes And Rashes. Is COVID-19 A Disease Of The Blood Vessels?|website=NPR.org|language=en|access-date=2020-11-06}}</ref>

==Long-haulers==
A "long-hauler" is someone with long COVID, meaning someone who became ill with confirmed or suspected [[COVID-19]], who has remained ill with long-term symptoms many weeks or months later after first becoming ill.<ref name="long-haulers-redefining" /><ref name=":1">{{Cite web|url=https://blogs.bmj.com/bmj/2020/10/01/why-we-need-to-keep-using-the-patient-made-term-long-covid/|title=Why we need to keep using the patient made term “Long Covid”|date=2020-10-01|website=The BMJ|language=en-US|access-date=2020-10-11}}</ref>

==What is long COVID==
[[File:Long-COVID-1in10.jpg|alt=Long COVID poster - 1 in 10 people with COVID-19 may develop long COVID|thumb]]
Long COVID appears to be a multisystem disease, and may occur after any severity of COVID-19, including after relatively mild cases.<ref name="BMJ11Aug2020" /><ref name=":1" />

=== Four different syndromes ===
A recent review suggested that long COVID may actually be four different syndromes:
* [[Post-COVID-19 illness#pics|Post-Intensive Care Syndrome]]
* [[Postviral fatigue syndrome|Postviral Fatigue Syndrome]] (ME/CFS)
* Long Term COVID Syndrome
* Permanent organ damage
Patients with long COVID may have several syndromes at once.<ref name="NIHR15Oct2020" />

=== Signs and symptoms ===
Patient surveys have reported that the following symptoms commonly occur in long COVID.
*[[Fatigue]], which may be extreme (profound)
*[[myalgia|Muscle pain]] or body aches
*[[dyspnea|Breathlessness]]
*[[Concentration problems]]
*Inability to [[exercise]]/[[exercise intolerance]]
*[[Headache]]
*[[Insomnia]] or [[sleep dysfunction|problems sleeping]]
*Heavy chest, a feeling of pressure on the chest, or chest pain
Other reported symptoms include:
*[[Anxiety]]
*[[Paresis|Muscle weakness]]
*[[Memory problems]]
*Skin rashes
*[[Sore throat]] and difficulty swallowing
*[[Heart palpitation]]s
*[[Fever]]
*[[Diarrhea]]
*[[Dizziness]]
*The sensation of [[pins and needles]]
*Cough
*[[Low-grade fever]]
*Loss of sense of taste and smell
*[[Joint pain]]
*New onset diabetes<ref name=":0">{{Cite journal|last=Rubino|first=Francesco|last2=Amiel|first2=Stephanie A.|last3=Zimmet|first3=Paul|last4=Alberti|first4=George|last5=Bornstein|first5=Stefan|last6=Eckel|first6=Robert H.|last7=Mingrone|first7=Geltrude|last8=Boehm|first8=Bernhard|last9=Cooper|first9=Mark E.|date=2020-08-20|title=New-Onset Diabetes in Covid-19|url=https://doi.org/10.1056/NEJMc2018688|journal=New England Journal of Medicine|volume=383|issue=8|pages=789–790|doi=10.1056/NEJMc2018688|issn=0028-4793|pmc=PMC7304415|pmid=32530585}}</ref>
*New onset [[Hypertension|high blood pressure]]<ref name="Lambert25Jul2020" /><ref name="Navabi2020" /><ref name="NHSlongSep2020">{{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|last2=|first2=|authorlink2=|date=Sep 7, 2020|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref><ref name="Yellin2020" />

{{Quote box|“A very common feature is the relapsing, remitting nature of the illness, where you feel as though you’ve recovered, then it hits you back|source=Dr. Nisreen Alwan, BMJ, Sep 2020}}

== COVID-19 testing ==
While some people with long COVID did have a positive test result for COVID-19, others were denied tests due to the limited availability of tests at the time, or they tested negative but were found to have clear evidence of COVID-19 from blood count tests or chest X-rays.<ref name="NIHR15Oct2020">{{Cite web|url=https://evidence.nihr.ac.uk/themedreview/living-with-covid19|title=Living with covid-19. A dynamic review of the evidence around ongoing covid-19 symptoms (often called long covid).|last=NIHR|first=|authorlink=|last2=|first2=|authorlink2=|date=October 2020|website=evidence.nihr.ac.uk|language=en-GB|archive-url=|archive-date=|dead-url=|access-date=2020-10-15}}</ref><ref name="Kingstone2020" /> Some people with Long COVID have described never having a cough or fever at the start of their illness, but developed these symptoms later. Long COVID diagnosis does not depend on a previous positive test.<ref name="NIHR15Oct2020" /><ref name="Kingstone2020" />

==Research ==
Surveys of data collected and published by long haulers using social media were the first evidence of what symptoms and health problems were caused by long COVID.<ref name="bodypoliticMay2020" /> Later academic studies confirmed many of the initial long hauler survey findings, although many only involved patients discharged from hospital,<ref name="Puntmann2020" /> patients who had been able to access early testing and tested positive, or patients who had sought medical care in a particular location.<ref name="Arnold2020b" /> People with mild COVID-19 symptoms, leaving people denied testing and those who may have had false negative test results and people who tested positive but were asymptomatic underrepresented in long COVID research.<ref name="bodypoliticMay2020" />

==Treatment==

===Pacing===
Pacing is a method of activity management which aims to adapt everday activities in order to avoid relapses or increased symptoms.
{{See also|Pacing}}

===Exercise therapy ===
ME/CFS patient groups have raised concerns about the use of [[graded exercise therapy]] (GET) in long COVID patients and a similar warning has been issued by [[NICE]] in the [[United Kingdom|UK]].<ref name="GETcovidForwardME" /> Graded exercise therapy, which is sometimes incorrectly referred to as "activity management" involves patients initially reducing their activity levels to a level that prevents regular crashes, and then typically increasing activity by 10% each week regardless of any increased symptoms or worsening illness. In graded exercise patients are told to ignore deterioration or increased symptoms and "push through" them.

====Theory and evidence ====
In graded exercise therapy patients are told that their symptoms are caused only by [[deconditioning|inactivity]] and other "bad habits" rather than an underlying illness. These assumptions have very weak evidence, and significant evidence exists of underlying illness in ME/CFS; there is a lack of research about exercise therapy for long COVID illness<ref name="Navabi2020" /> but some symptoms are inconsistent with this "deconditioning" assumption and some research has found physical abnormalities in some patients weeks or month after infection. Surveys of ME/CFS patients have consistently shown that large numbers of patients deteriorate as a result of graded exercise therapy, and a significant number become severely ill and never return to the level of functioning they had before the treatment.

==ME/CFS==
[[Postviral fatigue syndrome]] is one of the previous names used for Myalgic Encephalomyelitis (ME), sometimes known as Chronic Fatigue Syndrome (CFS), and it commonly begins immediately after events such as a virus, bacterial or other infection.<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> ME/CFS is not normally diagnosed until symptoms have persisted for six months or more, and tests must be run to exclude other possible causes of the symptoms.<ref name="SEID2015">{{Citation|last=Institute of Medicine|author-link=Institute of Medicine|title=Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness|location=Washington, DC|publisher=The National Academies Press|date=2015|url=https://www.ncbi.nlm.nih.gov/books/NBK284902/}}</ref> Some contagious diseases including [[Epstein-Barr virus]], certain [[enterovirus]]es,<ref name="ICC2011primer" /> and the [[Severe acute respiratory syndrome|SARS]] virus,<ref name="Moldofsky2011" /> have caused outbreaks of ME/CFS. It is not yet known how likely it is for ME/CFS to begin immediately after COVID-19 illness, although around 10% people with certain viruses are known to develop ME/CFS, and according to [[the BMJ]] around 10% of people with COVID-19 have developed prolonged illness.<ref name="BMJ11Aug2020" />

==Patient surveys ==
'''Not peer reviewed'''
* May 2020, [https://docs.google.com/document/u/0/d/1KmLkOArlJem-PArnBMbSp-S_E3OozD47UzvRG4qM5Yk/mobilebasic What Does COVID-19 Recovery Actually Look Like? An Analysis of the Prolonged COVID-19 Symptoms Survey by Patient-Led Research Team]<ref name="bodypoliticMay2020">{{Cite web|url=https://docs.google.com/document/u/0/d/1KmLkOArlJem-PArnBMbSp-S_E3OozD47UzvRG4qM5Yk/mobilebasic|title=What Does COVID-19 Recovery Actually Look Like? An Analysis of the Prolonged COVID-19 Symptoms Survey by Patient-Led Research Team|date=May 11, 2020|vauthors=Assaf G, Davis H, McCorkell L, Wei H, O'Neil B, Akrami A, Low R, Mercier J, A A, L T, C A, S M, N L, H N, D JD, S}}</ref> - by Body Politic
::Data collected: Apr 21 - May 2 2020. Respondents: 640

* Jul 2020, [https://static1.squarespace.com/static/5e8b5f63562c031c16e36a93/t/5f459ef7798e8b6037fa6c57/1598398215120/2020+Survivor+Corps+COVID-19+%27Long+Hauler%27+Symptoms+Survey+Report+%28revised+July+25.4%29.pdf COVID-19 “Long Hauler” Symptoms Survey Report]<ref name="Lambert25Jul2020">{{Cite web|url=https://static1.squarespace.com/static/5e8b5f63562c031c16e36a93/t/5f459ef7798e8b6037fa6c57/1598398215120/2020+Survivor+Corps+COVID-19+%27Long+Hauler%27+Symptoms+Survey+Report+%28revised+July+25.4%29.pdf|title=COVID-19 “Long Hauler” Symptoms Survey Report|last=Lambert|first=Natalie J|author-link=Natalie Lambert|last2=Survivor Corps|author-link2=Survivor Corps|publisher=Indiana University School of Medicine|date=Jul 2020}}</ref> - with Survivor Corps
::Data collected: Jul 25, 2020. Respondents: 1,567+

==Notable studies==
* Oct 2020, Finding the 'right' GP: a qualitative study of the experiences of people with long-COVID<ref name="Kingstone2020">{{Cite journal|last=Kingstone|first=Tom|author-link=|last2=Taylor|first2=Anna K.|author-link2=|last3=O'Donnell|first3=Catherine A.|author-link3=|last4=Atherton|first4=Helen|author-link4=|last5=Blane|first5=David N.|author-link5=|last6=Chew-Graham|first6=Carolyn A.|author-link6=Carolyn Chew-Graham|last7=|first7=|last8=|first8=|date=2020-10-14|title=Finding the 'right' GP: a qualitative study of the experiences of people with long-COVID|url=https://bjgpopen.org/content/early/2020/10/12/bjgpopen20X101143|journal=BJGP Open|language=en|volume=|issue=|pages=|doi=10.3399/bjgpopen20X101143|issn=2398-3795|pmc=|pmid=33051223|access-date=|quote=|via=}}</ref> - [https://bjgpopen.org/content/bjgpoa/early/2020/10/12/bjgpopen20X101143.full.pdf (Full text)]

* Oct 1, 2020, Long-term consequences of COVID-19: research needs<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> - [https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30701-5/fulltext (Full text)]
* Aug 20, 2020, New-Onset Diabetes in Covid-19<ref name=":0" /> - [https://www.nejm.org/doi/full/10.1056/NEJMc2018688 (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.|author-link2=|last3=Milne|first3=Alice|author-link3=|last4=Morley|first4=Anna|author-link4=|last5=Viner|first5=Jason|author-link5=|last6=Attwood|first6=Marie|author-link6=|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 11, 2020, Management of post-acute covid-19 in primary care<ref name="BMJ11Aug2020">{{cite journal|title=Management of post-acute covid-19 in primary care|last=Greenhalgh|first=Trisha|first2=Matthew|last2=Knight|first3 =Christine|last3=A'Court|first4=Maria|last4=Buxton|first5= Laiba|last5=Husain|journal=BMJ|date=Aug 11, 2020|volume=370|doi=10.1136/bmj.m3026|pages=m3026|url =https://doi.org/10.1136/bmj.m3026}}</ref> - [https://doi.org/10.1136/bmj.m3026 (Full text)]
*Jul 24, 2020, Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019 (COVID-19)<ref name="Puntmann2020">{{Cite journal|last=Puntmann|first=Valentina O.|last2=Carerj|first2=M. Ludovica|last3=Wieters|first3=Imke|last4=Fahim|first4=Masia|last5=Arendt|first5=Christophe|last6=Hoffmann|first6=Jedrzej|last7=Shchendrygina|first7=Anastasia|last8=Escher|first8=Felicitas|last9=Vasa-Nicotera|first9=Mariuca|date=2020-07-27|title=Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019 (COVID-19)|url=https://jamanetwork.com/journals/jamacardiology/fullarticle/2768916|journal=JAMA Cardiology|language=en|doi=10.1001/jamacardio.2020.3557|issn=2380-6583}}</ref> [https://jamanetwork.com/journals/jamacardiology/fullarticle/2768916 (Full text)]
*May 21, 2020, Pulmonary Vascular Endothelialitis, Thrombosis, and Angiogenesis in Covid-19 <ref name=":2">{{Cite journal|last=Ackermann|first=Maximilian|last2=Verleden|first2=Stijn E.|last3=Kuehnel|first3=Mark|last4=Haverich|first4=Axel|last5=Welte|first5=Tobias|last6=Laenger|first6=Florian|last7=Vanstapel|first7=Arno|last8=Werlein|first8=Christopher|last9=Stark|first9=Helge|date=2020-07-09|title=Pulmonary Vascular Endothelialitis, Thrombosis, and Angiogenesis in Covid-19|url=https://doi.org/10.1056/NEJMoa2015432|journal=New England Journal of Medicine|volume=383|issue=2|pages=120–128|doi=10.1056/NEJMoa2015432|issn=0028-4793|pmc=PMC7412750|pmid=32437596}}</ref> - [https://www.nejm.org/doi/full/10.1056/NEJMoa2015432 (Full Text)]

==Presentations, interviews and videos==
*Aug 2020, [https://solvecfs.org/wp-content/uploads/2020/08/Post-COVID%20ME-to%20Solve.pdf Will Covid-19 lead to ME/CFS in some people?] - presentation - Dr [[Anthony Komaroff]]
*Jul 2020, [https://www.youtube.com/watch?v=IIeOoS_A4c8 Message in a Bottle] video - LongCovidSOS
*Jun 2020, [https://www.biomax.com/lib/press-releases/Initial-Result-Announcment_English.pdf Health of Corona Patients at Home in Alarmingly Poor Health Even After Several Months - Dutch Lung Foundation] - Press release (English translation) - [https://www.ad.nl/binnenland/longfonds-gezondheid-thuiszittende-coronapatienten-schrikbarend-slecht~a45346fe/ Dutch]

==Letters and blogs==
*Oct 2020, [https://blogs.bmj.com/bmj/2020/10/01/why-we-need-to-keep-using-the-patient-made-term-long-covid/ Why we need to keep using the patient made term “Long Covid”] - The BMJ
*Sep 2020, [https://mecfsresearchreview.me/2020/09/17/understanding-long-covid-a-shortcut-to-solving-me-cfs/?#symptoms Understanding Long Covid, A Shortcut to Solving ME/CFS?] Simon McGrath
*Jul 2020, [https://meassociation.org.uk/wp-content/uploads/ForwardME-Letter-re-Covid-19-Management-and-Exercise-Caution-27.08.20.pdf Letter re Covid-19 Management and Exercise Caution]<ref name="GETcovidForwardME">{{Cite web|url=https://meassociation.org.uk/wp-content/uploads/ForwardME-Letter-re-Covid-19-Management-and-Exercise-Caution-27.08.20.pdf|date=2020-08-27|last=Forward-ME|author-link=Forward-ME|title =Letter re Covid-19 Management and Exercise Caution}}</ref> - [[Forward-ME]]

==National and international health bodies==
*[https://doi.org/10.1136/bmj.m2912 NICE cautions against using graded exercise therapy for patients recovering from COVID-19]<ref name="NICEcautionBMJ">{{Cite journal|last=Torjesen|first=Ingrid|date=2020-07-21|title=NICE cautions against using graded exercise therapy for patients recovering from covid-19|url=https://www.bmj.com/content/370/bmj.m2912|journal=BMJ|language=en|volume=370|doi=10.1136/bmj.m2912|issn=1756-1833|pmid=32694164}}</ref>

==News articles ==
* Oct 2020, [https://www.wsj.com/articles/these-doctors-have-long-term-covid-now-theyre-pushing-for-better-care-11603144474 These Doctors Have Long-Term Covid. Now They’re Pushing for Better Care.] - Wall Street Journal
* Oct 2020, [https://time.com/5897992/long-haul-coronavirus-me-cfs/
Have We Been Thinking About Long-Haul Coronavirus All Wrong?] - Time
* Oct 2020, [https://www.nihr.ac.uk/news/living-with-covid-nihr-publishes-dynamic-themed-review-into-ongoing-covid/25891 Living with COVID: NIHR publishes dynamic-themed review into 'ongoing COVID'] - National Institute of Health Research
* Oct 2020, [https://www.theguardian.com/world/2020/oct/04/long-covid-the-evidence-of-lingering-heart-damage Long Covid: the evidence of lingering heart damage] - The Observer
* Sep 2020, [https://www.bbc.co.uk/news/uk-england-leicestershire-54106073 Coronavirus patient unable to work six months on] - BBC News
* Aug 2020, [https://www.huffingtonpost.co.uk/entry/long-term-symptoms-of-covid-19-identified-in-study-of-hospital-patients_uk_5f2bc0f6c5b64d7a55eefcfa The Most Common Long-Term Symptoms Of Covid-19] - HuffPost UK
* Jul 2020, [https://www.sciencemag.org/news/2020/07/brain-fog-heart-damage-covid-19-s-lingering-problems-alarm-scientists From ‘brain fog’ to heart damage, COVID-19’s lingering problems alarm scientists] - Science Mag

==See also==
*[[List of open letters about long COVID]]
*[[Post-COVID-19 illness]]
*[[COVID-19]] coronavirus disease 19
*[[Myalgic encephalomyelitis|Myalgic encephalomyelitis and chronic fatigue syndrome]]
*[[Postviral fatigue syndrome]]
*[[Paul Garner]]
*[[Nisreen Alwan]]

==Learn more==
*[https://www.gov.uk/government/publications/covid-19-long-term-health-effects/covid-19-long-term-health-effects COVID-19 Long Term Health Effects]
*[https://www.bmj.com/sites/default/files/infographics/1353078336/static-infographic/background.png Infographic: "Long covid" in primary care] - BMJ journal
* List of long COVID studies (draft) - [[MEAction|#MEAction]]

==References==
{{reflist}}

[[Category:Potential comorbidities]]
[[Category:Diagnoses]]

Talk:Long COVID

2020-11-06T17:52:30Z

Loopy:/* Date Order -- ~~~~ */ new section

== starting off -- ~[[User:Notjusttired|Njt]] ([[User talk:Notjusttired|talk]]) 23:33, September 15, 2020 (UTC) ==

== Date Order -- [[User:Loopy|Loopy]] ([[User talk:Loopy|talk]]) 17:52, November 6, 2020 (UTC) ==

The dates are in the wrong order. Should be oldest to newest.

Long COVID

2020-11-06T17:51:18Z

Loopy:/* Notable studies */ study

[[File:Long-COVID.jpg|alt=Long COVID logo with Coronavirus icon |thumb]]
'''Long COVID''', '''long covid''', '''post-acute COVID-19''' and '''ongoing COVID''' are terms used to describe a group of long term health problems that are found in a significant minority of people who were infected with the [[COVID-19]] and remain ill after a number of weeks or months.<ref name="Navabi2020">{{Cite journal|title=Long covid: How to define it and how to manage it|last=Nabavi|first=Nikki|url=https://www.bmj.com/content/370/bmj.m3489|date=Sep 7, 2020|journal=BMJ|volume=370|pages=bmj.m3489}}</ref><ref name="BMJ11Aug2020" /><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=|dead-url=|issn=1072-7825|quote=|author-link=}}</ref><ref name="NIHR.ac.uk15Oct2020">{{Cite web|url=https://www.nihr.ac.uk/news/living-with-covid-nihr-publishes-dynamic-themed-review-into-ongoing-covid/25891|title=Living with COVID: NIHR publishes dynamic themed review into ‘ongoing COVID’|last=National Institute for Health Research|first=|authorlink=|date=|website=www.nihr.ac.uk|archive-url=|archive-date=|dead-url=|access-date=2020-10-15}}</ref>

In February 2020, the World Health Organization stated that the expected recovery time from [[COVID-19]] was 2 weeks for mild cases, and between three and six weeks for severe cases;<ref>{{Cite web|url=https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---24-february-2020|title=WHO Director-General's opening remarks at the media briefing on COVID-19|last=World Health Organization|first=|authorlink=World Health Organization|last2=|first2=|authorlink2=|date=Feb 24, 2020|website=www.who.int|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-09-24}}</ref> follow-up studies then identified a significant number of COVID-19 patients had remained ill much longer than this: those with long COVID.<ref name="Navabi2020" /><ref name="BMJ11Aug2020" />

A similar phenomenon to long COVID occurred after the 2003 outbreak of the similar SARS coronavirus, which lead to a [[Severe acute respiratory syndrome#post-SARS|post-SARS syndrome]] being proposed that included chronic widespread musculoskeletal pain, fatigue, depression and disordered sleep. Another study found a subgroup SARS survivors developed [[chronic fatigue syndrome]] immediately after SARS.<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=PMC3071317|pmid=21435231}}</ref>
<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>

==Long-haulers==
A "long-hauler" is someone with long COVID, meaning someone who became ill with confirmed or suspected [[COVID-19]], who has remained ill with long-term symptoms many weeks or months later after first becoming ill.<ref name="long-haulers-redefining" /><ref name=":1">{{Cite web|url=https://blogs.bmj.com/bmj/2020/10/01/why-we-need-to-keep-using-the-patient-made-term-long-covid/|title=Why we need to keep using the patient made term “Long Covid”|date=2020-10-01|website=The BMJ|language=en-US|access-date=2020-10-11}}</ref>

==What is long COVID==
[[File:Long-COVID-1in10.jpg|alt=Long COVID poster - 1 in 10 people with COVID-19 may develop long COVID|thumb]]
Long COVID appears to be a multisystem disease, and may occur after any severity of COVID-19, including after relatively mild cases.<ref name="BMJ11Aug2020" /><ref name=":1" />

=== Four different syndromes ===
A recent review suggested that long COVID may actually be four different syndromes:
* [[Post-COVID-19 illness#pics|Post-Intensive Care Syndrome]]
* [[Postviral fatigue syndrome|Postviral Fatigue Syndrome]] (ME/CFS)
* Long Term COVID Syndrome
* Permanent organ damage
Patients with long COVID may have several syndromes at once.<ref name="NIHR15Oct2020" />

=== Signs and symptoms ===
Patient surveys have reported that the following symptoms commonly occur in long COVID.
*[[Fatigue]], which may be extreme (profound)
*[[myalgia|Muscle pain]] or body aches
*[[dyspnea|Breathlessness]]
*[[Concentration problems]]
*Inability to [[exercise]]/[[exercise intolerance]]
*[[Headache]]
*[[Insomnia]] or [[sleep dysfunction|problems sleeping]]
*Heavy chest, a feeling of pressure on the chest, or chest pain
Other reported symptoms include:
*[[Anxiety]]
*[[Paresis|Muscle weakness]]
*[[Memory problems]]
*Skin rashes
*[[Sore throat]] and difficulty swallowing
*[[Heart palpitation]]s
*[[Fever]]
*[[Diarrhea]]
*[[Dizziness]]
*The sensation of [[pins and needles]]
*Cough
*[[Low-grade fever]]
*Loss of sense of taste and smell
*[[Joint pain]]
*New onset diabetes<ref name=":0">{{Cite journal|last=Rubino|first=Francesco|last2=Amiel|first2=Stephanie A.|last3=Zimmet|first3=Paul|last4=Alberti|first4=George|last5=Bornstein|first5=Stefan|last6=Eckel|first6=Robert H.|last7=Mingrone|first7=Geltrude|last8=Boehm|first8=Bernhard|last9=Cooper|first9=Mark E.|date=2020-08-20|title=New-Onset Diabetes in Covid-19|url=https://doi.org/10.1056/NEJMc2018688|journal=New England Journal of Medicine|volume=383|issue=8|pages=789–790|doi=10.1056/NEJMc2018688|issn=0028-4793|pmc=PMC7304415|pmid=32530585}}</ref>
*New onset [[Hypertension|high blood pressure]]<ref name="Lambert25Jul2020" /><ref name="Navabi2020" /><ref name="NHSlongSep2020">{{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|last2=|first2=|authorlink2=|date=Sep 7, 2020|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref><ref name="Yellin2020" />

{{Quote box|“A very common feature is the relapsing, remitting nature of the illness, where you feel as though you’ve recovered, then it hits you back|source=Dr. Nisreen Alwan, BMJ, Sep 2020}}

== COVID-19 testing ==
While some people with long COVID did have a positive test result for COVID-19, others were denied tests due to the limited availability of tests at the time, or they tested negative but were found to have clear evidence of COVID-19 from blood count tests or chest X-rays.<ref name="NIHR15Oct2020">{{Cite web|url=https://evidence.nihr.ac.uk/themedreview/living-with-covid19|title=Living with covid-19. A dynamic review of the evidence around ongoing covid-19 symptoms (often called long covid).|last=NIHR|first=|authorlink=|last2=|first2=|authorlink2=|date=October 2020|website=evidence.nihr.ac.uk|language=en-GB|archive-url=|archive-date=|dead-url=|access-date=2020-10-15}}</ref><ref name="Kingstone2020" /> Some people with Long COVID have described never having a cough or fever at the start of their illness, but developed these symptoms later. Long COVID diagnosis does not depend on a previous positive test.<ref name="NIHR15Oct2020" /><ref name="Kingstone2020" />

==Research ==
Surveys of data collected and published by long haulers using social media were the first evidence of what symptoms and health problems were caused by long COVID.<ref name="bodypoliticMay2020" /> Later academic studies confirmed many of the initial long hauler survey findings, although many only involved patients discharged from hospital,<ref name="Puntmann2020" /> patients who had been able to access early testing and tested positive, or patients who had sought medical care in a particular location.<ref name="Arnold2020b" /> People with mild COVID-19 symptoms, leaving people denied testing and those who may have had false negative test results and people who tested positive but were asymptomatic underrepresented in long COVID research.<ref name="bodypoliticMay2020" />

==Treatment==

===Pacing===
Pacing is a method of activity management which aims to adapt everday activities in order to avoid relapses or increased symptoms.
{{See also|Pacing}}

===Exercise therapy ===
ME/CFS patient groups have raised concerns about the use of [[graded exercise therapy]] (GET) in long COVID patients and a similar warning has been issued by [[NICE]] in the [[United Kingdom|UK]].<ref name="GETcovidForwardME" /> Graded exercise therapy, which is sometimes incorrectly referred to as "activity management" involves patients initially reducing their activity levels to a level that prevents regular crashes, and then typically increasing activity by 10% each week regardless of any increased symptoms or worsening illness. In graded exercise patients are told to ignore deterioration or increased symptoms and "push through" them.

====Theory and evidence ====
In graded exercise therapy patients are told that their symptoms are caused only by [[deconditioning|inactivity]] and other "bad habits" rather than an underlying illness. These assumptions have very weak evidence, and significant evidence exists of underlying illness in ME/CFS; there is a lack of research about exercise therapy for long COVID illness<ref name="Navabi2020" /> but some symptoms are inconsistent with this "deconditioning" assumption and some research has found physical abnormalities in some patients weeks or month after infection. Surveys of ME/CFS patients have consistently shown that large numbers of patients deteriorate as a result of graded exercise therapy, and a significant number become severely ill and never return to the level of functioning they had before the treatment.

==ME/CFS==
[[Postviral fatigue syndrome]] is one of the previous names used for Myalgic Encephalomyelitis (ME), sometimes known as Chronic Fatigue Syndrome (CFS), and it commonly begins immediately after events such as a virus, bacterial or other infection.<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> ME/CFS is not normally diagnosed until symptoms have persisted for six months or more, and tests must be run to exclude other possible causes of the symptoms.<ref name="SEID2015">{{Citation|last=Institute of Medicine|author-link=Institute of Medicine|title=Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness|location=Washington, DC|publisher=The National Academies Press|date=2015|url=https://www.ncbi.nlm.nih.gov/books/NBK284902/}}</ref> Some contagious diseases including [[Epstein-Barr virus]], certain [[enterovirus]]es,<ref name="ICC2011primer" /> and the [[Severe acute respiratory syndrome|SARS]] virus,<ref name="Moldofsky2011" /> have caused outbreaks of ME/CFS. It is not yet known how likely it is for ME/CFS to begin immediately after COVID-19 illness, although around 10% people with certain viruses are known to develop ME/CFS, and according to [[the BMJ]] around 10% of people with COVID-19 have developed prolonged illness.<ref name="BMJ11Aug2020" />

==Patient surveys ==
'''Not peer reviewed'''
* May 2020, [https://docs.google.com/document/u/0/d/1KmLkOArlJem-PArnBMbSp-S_E3OozD47UzvRG4qM5Yk/mobilebasic What Does COVID-19 Recovery Actually Look Like? An Analysis of the Prolonged COVID-19 Symptoms Survey by Patient-Led Research Team]<ref name="bodypoliticMay2020">{{Cite web|url=https://docs.google.com/document/u/0/d/1KmLkOArlJem-PArnBMbSp-S_E3OozD47UzvRG4qM5Yk/mobilebasic|title=What Does COVID-19 Recovery Actually Look Like? An Analysis of the Prolonged COVID-19 Symptoms Survey by Patient-Led Research Team|date=May 11, 2020|vauthors=Assaf G, Davis H, McCorkell L, Wei H, O'Neil B, Akrami A, Low R, Mercier J, A A, L T, C A, S M, N L, H N, D JD, S}}</ref> - by Body Politic
::Data collected: Apr 21 - May 2 2020. Respondents: 640

* Jul 2020, [https://static1.squarespace.com/static/5e8b5f63562c031c16e36a93/t/5f459ef7798e8b6037fa6c57/1598398215120/2020+Survivor+Corps+COVID-19+%27Long+Hauler%27+Symptoms+Survey+Report+%28revised+July+25.4%29.pdf COVID-19 “Long Hauler” Symptoms Survey Report]<ref name="Lambert25Jul2020">{{Cite web|url=https://static1.squarespace.com/static/5e8b5f63562c031c16e36a93/t/5f459ef7798e8b6037fa6c57/1598398215120/2020+Survivor+Corps+COVID-19+%27Long+Hauler%27+Symptoms+Survey+Report+%28revised+July+25.4%29.pdf|title=COVID-19 “Long Hauler” Symptoms Survey Report|last=Lambert|first=Natalie J|author-link=Natalie Lambert|last2=Survivor Corps|author-link2=Survivor Corps|publisher=Indiana University School of Medicine|date=Jul 2020}}</ref> - with Survivor Corps
::Data collected: Jul 25, 2020. Respondents: 1,567+

==Notable studies==
* Oct 2020, Finding the 'right' GP: a qualitative study of the experiences of people with long-COVID<ref name="Kingstone2020">{{Cite journal|last=Kingstone|first=Tom|author-link=|last2=Taylor|first2=Anna K.|author-link2=|last3=O'Donnell|first3=Catherine A.|author-link3=|last4=Atherton|first4=Helen|author-link4=|last5=Blane|first5=David N.|author-link5=|last6=Chew-Graham|first6=Carolyn A.|author-link6=Carolyn Chew-Graham|last7=|first7=|last8=|first8=|date=2020-10-14|title=Finding the 'right' GP: a qualitative study of the experiences of people with long-COVID|url=https://bjgpopen.org/content/early/2020/10/12/bjgpopen20X101143|journal=BJGP Open|language=en|volume=|issue=|pages=|doi=10.3399/bjgpopen20X101143|issn=2398-3795|pmc=|pmid=33051223|access-date=|quote=|via=}}</ref> - [https://bjgpopen.org/content/bjgpoa/early/2020/10/12/bjgpopen20X101143.full.pdf (Full text)]

* Oct 1, 2020, Long-term consequences of COVID-19: research needs<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> - [https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30701-5/fulltext (Full text)]
* Aug 20, 2020, New-Onset Diabetes in Covid-19<ref name=":0" /> - [https://www.nejm.org/doi/full/10.1056/NEJMc2018688 (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.|author-link2=|last3=Milne|first3=Alice|author-link3=|last4=Morley|first4=Anna|author-link4=|last5=Viner|first5=Jason|author-link5=|last6=Attwood|first6=Marie|author-link6=|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 11, 2020, Management of post-acute covid-19 in primary care<ref name="BMJ11Aug2020">{{cite journal|title=Management of post-acute covid-19 in primary care|last=Greenhalgh|first=Trisha|first2=Matthew|last2=Knight|first3 =Christine|last3=A'Court|first4=Maria|last4=Buxton|first5= Laiba|last5=Husain|journal=BMJ|date=Aug 11, 2020|volume=370|doi=10.1136/bmj.m3026|pages=m3026|url =https://doi.org/10.1136/bmj.m3026}}</ref> - [https://doi.org/10.1136/bmj.m3026 (Full text)]
*Jul 24, 2020, Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019 (COVID-19)<ref name="Puntmann2020">{{Cite journal|last=Puntmann|first=Valentina O.|last2=Carerj|first2=M. Ludovica|last3=Wieters|first3=Imke|last4=Fahim|first4=Masia|last5=Arendt|first5=Christophe|last6=Hoffmann|first6=Jedrzej|last7=Shchendrygina|first7=Anastasia|last8=Escher|first8=Felicitas|last9=Vasa-Nicotera|first9=Mariuca|date=2020-07-27|title=Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019 (COVID-19)|url=https://jamanetwork.com/journals/jamacardiology/fullarticle/2768916|journal=JAMA Cardiology|language=en|doi=10.1001/jamacardio.2020.3557|issn=2380-6583}}</ref> [https://jamanetwork.com/journals/jamacardiology/fullarticle/2768916 (Full text)]
*May 21, 2020, Pulmonary Vascular Endothelialitis, Thrombosis, and Angiogenesis in Covid-19 <ref>{{Cite journal|last=Ackermann|first=Maximilian|last2=Verleden|first2=Stijn E.|last3=Kuehnel|first3=Mark|last4=Haverich|first4=Axel|last5=Welte|first5=Tobias|last6=Laenger|first6=Florian|last7=Vanstapel|first7=Arno|last8=Werlein|first8=Christopher|last9=Stark|first9=Helge|date=2020-07-09|title=Pulmonary Vascular Endothelialitis, Thrombosis, and Angiogenesis in Covid-19|url=https://doi.org/10.1056/NEJMoa2015432|journal=New England Journal of Medicine|volume=383|issue=2|pages=120–128|doi=10.1056/NEJMoa2015432|issn=0028-4793|pmc=PMC7412750|pmid=32437596}}</ref> - [https://www.nejm.org/doi/full/10.1056/NEJMoa2015432 (Full Text)]

==Presentations, interviews and videos==
*Aug 2020, [https://solvecfs.org/wp-content/uploads/2020/08/Post-COVID%20ME-to%20Solve.pdf Will Covid-19 lead to ME/CFS in some people?] - presentation - Dr [[Anthony Komaroff]]
*Jul 2020, [https://www.youtube.com/watch?v=IIeOoS_A4c8 Message in a Bottle] video - LongCovidSOS
*Jun 2020, [https://www.biomax.com/lib/press-releases/Initial-Result-Announcment_English.pdf Health of Corona Patients at Home in Alarmingly Poor Health Even After Several Months - Dutch Lung Foundation] - Press release (English translation) - [https://www.ad.nl/binnenland/longfonds-gezondheid-thuiszittende-coronapatienten-schrikbarend-slecht~a45346fe/ Dutch]

==Letters and blogs==
*Oct 2020, [https://blogs.bmj.com/bmj/2020/10/01/why-we-need-to-keep-using-the-patient-made-term-long-covid/ Why we need to keep using the patient made term “Long Covid”] - The BMJ
*Sep 2020, [https://mecfsresearchreview.me/2020/09/17/understanding-long-covid-a-shortcut-to-solving-me-cfs/?#symptoms Understanding Long Covid, A Shortcut to Solving ME/CFS?] Simon McGrath
*Jul 2020, [https://meassociation.org.uk/wp-content/uploads/ForwardME-Letter-re-Covid-19-Management-and-Exercise-Caution-27.08.20.pdf Letter re Covid-19 Management and Exercise Caution]<ref name="GETcovidForwardME">{{Cite web|url=https://meassociation.org.uk/wp-content/uploads/ForwardME-Letter-re-Covid-19-Management-and-Exercise-Caution-27.08.20.pdf|date=2020-08-27|last=Forward-ME|author-link=Forward-ME|title =Letter re Covid-19 Management and Exercise Caution}}</ref> - [[Forward-ME]]

==National and international health bodies==
*[https://doi.org/10.1136/bmj.m2912 NICE cautions against using graded exercise therapy for patients recovering from COVID-19]<ref name="NICEcautionBMJ">{{Cite journal|last=Torjesen|first=Ingrid|date=2020-07-21|title=NICE cautions against using graded exercise therapy for patients recovering from covid-19|url=https://www.bmj.com/content/370/bmj.m2912|journal=BMJ|language=en|volume=370|doi=10.1136/bmj.m2912|issn=1756-1833|pmid=32694164}}</ref>

==News articles ==
* Oct 2020, [https://www.wsj.com/articles/these-doctors-have-long-term-covid-now-theyre-pushing-for-better-care-11603144474 These Doctors Have Long-Term Covid. Now They’re Pushing for Better Care.] - Wall Street Journal
* Oct 2020, [https://time.com/5897992/long-haul-coronavirus-me-cfs/
Have We Been Thinking About Long-Haul Coronavirus All Wrong?] - Time
* Oct 2020, [https://www.nihr.ac.uk/news/living-with-covid-nihr-publishes-dynamic-themed-review-into-ongoing-covid/25891 Living with COVID: NIHR publishes dynamic-themed review into 'ongoing COVID'] - National Institute of Health Research
* Oct 2020, [https://www.theguardian.com/world/2020/oct/04/long-covid-the-evidence-of-lingering-heart-damage Long Covid: the evidence of lingering heart damage] - The Observer
* Sep 2020, [https://www.bbc.co.uk/news/uk-england-leicestershire-54106073 Coronavirus patient unable to work six months on] - BBC News
* Aug 2020, [https://www.huffingtonpost.co.uk/entry/long-term-symptoms-of-covid-19-identified-in-study-of-hospital-patients_uk_5f2bc0f6c5b64d7a55eefcfa The Most Common Long-Term Symptoms Of Covid-19] - HuffPost UK
* Jul 2020, [https://www.sciencemag.org/news/2020/07/brain-fog-heart-damage-covid-19-s-lingering-problems-alarm-scientists From ‘brain fog’ to heart damage, COVID-19’s lingering problems alarm scientists] - Science Mag

==See also==
*[[List of open letters about long COVID]]
*[[Post-COVID-19 illness]]
*[[COVID-19]] coronavirus disease 19
*[[Myalgic encephalomyelitis|Myalgic encephalomyelitis and chronic fatigue syndrome]]
*[[Postviral fatigue syndrome]]
*[[Paul Garner]]
*[[Nisreen Alwan]]

==Learn more==
*[https://www.gov.uk/government/publications/covid-19-long-term-health-effects/covid-19-long-term-health-effects COVID-19 Long Term Health Effects]
*[https://www.bmj.com/sites/default/files/infographics/1353078336/static-infographic/background.png Infographic: "Long covid" in primary care] - BMJ journal
* List of long COVID studies (draft) - [[MEAction|#MEAction]]

==References==
{{reflist}}

[[Category:Potential comorbidities]]
[[Category:Diagnoses]]

Stigma and discrimination

2020-10-28T12:09:01Z

Loopy:caption

[[File:Rosa SEID.JPG|400px|thumb|Rosa age 25 in 1986 and mildly ill with [[ME/CFS]].|Rosa age 25 in 1986 and mildly ill with ME/CFS's core symptoms. In 2015 the SEID criteria were released. Rosa read about PEM and how it is delayed and makes ME/CFS symptoms like CF, OI, and cognition worse. Her life since age 17 fell into place as she never connected her worsening symptoms with increased physical or mental activity 24-72 hours prior. She believes not understanding PEM made her condition worsen over the years and is now disabled meeting the CCC with PEM "option"]]
'''Stigma''' is "an attribute that links a person to an undesirable stereotype, leading other people to reduce the bearer from a whole and usual person to a tainted, discounted one."<ref>{{Cite book|title=Stigma: notes on the management of spoiled Identity|last=Goffman|first=E.|publisher=Simon and Schuster|year=1983|isbn=|editor-link=|location=New York|page=11|pages=|chapter=|quote=|editor-last2=|editor-link2=}}</ref> People with [[myalgic encephalomyelitis]] (ME) and [[chronic fatigue syndrome]] (CFS) often described feeling stigmatized and '''discriminated''' against.<ref name=":0" /><ref name=":1" /><ref name=":2" /><ref name=":3" />

{{Quote2|Sufferers of ME are often stigmatised and marginalised, as their conditions are not fully recognised by the Government or the medical profession. A number of my constituents suffer from ME. At least two have been bedridden for 30 years because of their condition, and their story is not uncommon.|Mohammad Yasin, MP|Appropriate ME Treatment debate (Jan 24, 2019)<ref name="hansardjan19"/>}}

{{Quote frame |...believing ME/CFS is a condition that can be cured by [[illness beliefs |attitude]] and [[Graded exercise therapy |effort]] is stigmatizing, no matter how carefully you try to frame it. That’s harmful, for individuals who blame themselves (or get blamed) for their suffering, and for the collective of people deeply affected...|author=[[Hilda Bastian]]|source=Consumer-Contested Evidence: Why the ME/CFS Exercise Dispute Matters So Much<ref name ="Bastian2016">{{Cite web|url=https://blogs.plos.org/absolutely-maybe/2019/02/08/consumer-contested-evidence-why-the-me-cfs-exercise-dispute-matters-so-much/|title=Consumer-Contested Evidence: Why the ME/CFS Exercise Dispute Matters So Much|last=Bastian|first=Hilda|authorlink=Hilda Bastian|last2=|first2=|authorlink2=|date=Feb 8, 2019|website=[[PlosOne]]|language=en-US|archive-url=|archive-date=|dead-url=|access-date=2019-03-03}}</ref>}}

=== The Yuppie flu label ===
ME was dismissed as "[[Yuppie Flu|yuppie flu]]" and even "shirker syndrome" in the 1980s and described as a reaction to the stresses of modern life.<ref>{{Cite web|url=http://sacfs.asn.au/download/New%20York%20Times%20article%20(17-07-07).pdf|title=Chronic Fatigue no longer seen as Yuppie Flu|last=Tuller|first=David|authorlink=David Tuller|last2=|first2=|authorlink2=|date=2007|website=New York Times|archive-url=|archive-date=|dead-url=|access-date=2018-12-30}}</ref> Under the label yuppie flu, [[Myalgic encephalomyelitis|ME]] was regarded as only affecting one group in society - young to middle-aged professionals.<ref>{{Cite journal|last=Dowsett|first=Elizabeth G.|author-link=Elizabeth Dowsett|author-link2=|author-link3=|author-link4=|author-link5=|date=Jan 1992|others=P D Welsby|title=Conversation piece. Interview by P. D. Welsby.|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2399326/|journal=Postgraduate Medical Journal|volume=68|issue=795|pages=63–65|issn=0032-5473|pmc=2399326|pmid=1561197|quote=|via=}}</ref>

=== Stigma from the media ===
A number media interviews and newspaper coverage have presented negative views of patients with ME, including representing some reporting legitimate claims through official chanqqnels as harassing, or intimidating researchers described as "vilification" and listed alongside unproven allegations of criminal acts such as sending "death threats".<ref name=":6">{{Cite web|url=http://downloads.bbc.co.uk/bbctrust/assets/files/pdf/appeals/esc_bulletins/2012/feb.pdf|title=“Torrent of abuse” hindering ME research {{!}} Today programme {{!}} BBC Radio 4|last=BBC News Online|first=|authorlink=BBC news|last2=|first2=|authorlink2=|date=July 29, 2011|website=|archive-url=|archive-date=|dead-url=|access-date=2019-03-02}}</ref> Murray et al. (2019) found a significant ''gender bias'' in their analysis of English newspaper articles featuring patients with ME/CFS, women were presented as more emotionally distressed with their physical symptoms minimized, and the impact on social and home functioning was emphasized, while men were portrayed as "action men" prior to their illness, with physical symptoms prominent and the impact on career and sports emphasized.<ref name=":12">{{Cite journal|last=Murray|first=Rebecca|author-link=Rebecca Murray|last2=Day|first2=Katy|author-link2=Katy Day|last3=Tobbell|first3=Jane|author-link3=Jane Tobbell|author-link4=|author-link5=|date=Apr 15, 2019|title=Duvet woman versus action man: the gendered aetiology of Chronic Fatigue Syndrome according to English newspapers|url=https://doi.org/10.1080/14680777.2019.1595694|journal=[[Feminist Media Studies]]|volume=|issue=|pages=1–16|doi=10.1080/14680777.2019.1595694|issn=1468-0777|quote=|via=}}</ref>

In other coverage, treatment success rates have been grossly exaggerated, with the controversial [[graded exercise therapy]] (GET) referred to as simply "[[exercise]]" in headlines rather than a specialist treatment.<ref name="BBCTodayFITNET">{{Cite web|url=https://downloads.bbc.co.uk/bbctrust/assets/files/pdf/appeals/esc_bulletins/2017/mar.pdf|title=Editorial Standards Findings Appeals to the Trust and other editorial issues considered by the Editorial Standards Committee: Decisions by the Head of Editorial Standards, Trust Unit February and March 2017|last=BBC Trust|first=|authorlink=BBC|last2=|first2=|authorlink2=|date=Mar 2017|website=|archive-url=|archive-date=|dead-url=|access-date=2019-03-02}}</ref> A [[BBC news|BBC]] report, believed to be heavily influenced by the biased [[Science Media Centre]] (SMC), "overstated" and made inaccurate claims that the [[Netherlands|Dutch]] [[FITNET trial]] could cure "two-thirds" of [[United Kingdom|[British]]<nowiki>] children with </nowiki>[[Chronic fatigue syndrome|CFS]] within 6 months, when the actual figure was under 40%, with those results heavily disputed due to including very broad diagnostic criteria, and the treatment only being available in 10% of the [[United Kingdom|UK]].<ref name="BBCTodayFITNET" />

A number of charities including [[Invest in ME Research]] and [[The ME Association]] have filed complaints or raised objections, in addition to individual patients.<ref name="IIMEpacebbc">{{Cite web|url=http://investinme.org/IIME-Newslet-1501-02.shtml|title=INVEST IN ME RESPONSE to BBC ARTICLE|last=Invest in ME Research|first=|authorlink=Invest in ME Research|last2=|first2=|authorlink2=|date=Jan 2015|website=[[Invest in ME Research]]|archive-url=|archive-date=|dead-url=|access-date=2019-03-02}}</ref><ref name=":6" /> The exaggerated recovery rates and headlines about "exercise" or a talking treatment have encouraged the public to stereotype patients as lazy, simply lacking the willingness to exercise, or as having [[:Category:Mental disorders|mental health]] problems.

===Stigma from the family, friends and the public ===
Patients with ME/CFS may be judged by friends as extremely lazy rather than ill, and become isolated from friends when they are too ill to spend time with others.<ref name="radio4-2007">{{Cite web|url=https://www.bbc.co.uk/radio4/science/casenotes_tr_20071106.shtml|title=Case notes: Programme number 10 - ME|last=BBC Radio 4|first=|authorlink=BBC radio 4|last2=|first2=|authorlink2=|date=2007|website=|type=Transcript|archive-url=https://web.archive.org/web/20071221221638/https://www.bbc.co.uk/radio4/science/casenotes_tr_20071106.shtml|archive-date=Dec 21, 2007|dead-url=yes|access-date=}}</ref><ref name=":11">{{Cite web|url=https://www.huffingtonpost.co.uk/entry/me-chronic-fatigue_uk_5ca38433e4b0c5dee18bbb33|title=ME Affects Four Times More Women Than Men – Dismissing This Terrifying Illness Is Sexist|last=Richardson|first=Josie|authorlink=Josie Richardson|last2=|first2=|authorlink2=|date=Apr 4, 2019|website=[[Huffington Post]]|language=en|archive-url=|archive-date=|dead-url=|access-date=2019-04-10}}</ref>

Work colleagues may accuse the person of being lazy, teachers may accuse children with ME of "enjoying themselves" when they are too ill to attend school.<ref name=":11" />

=== Stigma from health professionals ===
A number of [[Wessely school|highly influential health professionals]] have made highly stigmatized, dismissive and offensive comments about patients with [[ME/CFS]], which continues to this day. Many patients in the UK and elsewhere in continue to report that their doctor was either openly skeptical about their ones, or expressed disbelief.<ref name="Deale2001" /><ref name="GeraghtyEsmail2016">{{Cite journal
| last1 = Geraghty | first1 = Keith | authorlink1 = Keith Geraghty
| last2 = Esmail | first2 = Aneez | authorlink2 = Aneez Esmail
| title = Chronic fatigue syndrome: is the biopsychosocial model responsible for patient dissatisfaction and harm?
| journal = British Journal of General Practice | volume = 66 | issue =649 | page = 437-438
| date = 1 Aug 2016
| doi = 10.3399/bjgp16X686473
|url = https://doi.org/10.3399/bjgp16X686473
}}
</ref><ref name="obstruction" /> Similar experiences have been reported within disability assessments, and by clinicians at a specialist CFS/ME clinic in the UK.<ref name=":7" /><ref name=":9">{{Cite journal|last=Collings|first=Anthony D|author-link=Anthony Collings|last2=Newton|first2=David|author-link2=David Newton|author-link3=|author-link4=|author-link5=|date=Jun 18, 2014|title=Is Chronic Fatigue Syndrome a meme?|url=https://forums.phoenixrising.me/threads/bmj-rapid-response-is-chronic-fatigue-syndrome-a-meme-18-june-2014.30944/|dead-url=usurped|journal=[[BMJ]]|language=en|volume=|issue=|pages=|doi=|issn=0959-8138|pmid=|archive-url=|archive-date=Jun 18, 2014|quote=|via=|pmc=|last3=|first3=|last4=|first4=|last5=|first5=|last6=|first6=|last7=|first7=|last8=|first8=|access-date=|author-link6=}}</ref> In 2019, a [[UK Parliament Commons Chamber debate 24th January 2019|UK parliament debate]] highlighted that the members of the medical profession did not fully recognize ME, which increased the stigma and the marginalization of people with ME.<ref name="hansardjan19">{{Cite web|url=https://hansard.parliament.uk/Commons/2019-01-24/debates/FA1BBC27-37A7-4BFD-A2C0-A58B57F41D4D/AppropriateMETreatment|title=Appropriate ME Treatment {{!}} 24 January 2019 Volume 653|last=Hansard {{!}} UK Parliament|first=|authorlink=|last2=|first2=|authorlink2=|date=Jan 24, 2019|website=hansard.parliament.uk|archive-url=|archive-date=|dead-url=|access-date=2019-01-25}}</ref>

ME patients have been stereotyped in many ways, including being accused of having negative attitudes towards [[Mental health|mental illness]] and being [[Personality traits and patient attitudes in ME/CFS|"anti-psychiatry"]], however Wood & [[Simon Wessely|Wessely]] (1999) showed that attitudes towards mental illness are no different from those of other patient groups, for example [[rheumatoid arthritis]] patients.<ref>{{Cite journal|last=Wood|first=Barbara|author-link=Barbara Wood|last2=Wessely|first2=Simon|author-link2=Simon Wessely|author-link3=|author-link4=|author-link5=|date=Oct 1999|title=Personality and social attitudes in chronic fatigue syndrome|url=http://linkinghub.elsevier.com/retrieve/pii/S0022399999000252|journal=Journal of Psychosomatic Research|language=en|volume=47|issue=4|pages=385–397|doi=10.1016/S0022-3999(99)00025-2|quote=No differences were found between CFS and RA patients in measures of perfectionism, attitudes toward mental illness, defensiveness, social desirability, or sensitivity to punishment (a concept related to neuroticism), on either crude or adjusted analyses... There was no evidence from this study of major differences between the personalities of CFS patients and RA patients. The stereotype of CFS sufferers as perfectionists with negative attitudes toward psychiatry was not supported.|via=}}</ref>

===Researchers with ME/CFS: stigma from academic colleagues ===
Scientists who work on [[biomedical research]] or treat patients outside of the psychiatry and exercise focused [[biopsychosocial model]] (BPS) have been denied work in their country's public health care system, portrayed as quacks, anti-science, struggled to get research funding or lab time and been isolated and ostracized by their peers.<ref name=":3" /><ref name=":5">{{Cite journal|last=Maes|first=Michael|author-link=Michael Maes|last2=Mihaylova|first2=Ivana|author-link2=Ivana Mihaylova|last3=Bosmans|first3=Eugene|author-link3=Eugene Bosmans|author-link4=|author-link5=|date=August 2007|title=Not in the mind of neurasthenic lazybones but in the cell nucleus: patients with chronic fatigue syndrome have increased production of nuclear factor kappa beta|url=http://www.nel.edu/userfiles/articlesnew/NEL280407A15.pdf|journal=Neuro Endocrinology Letters|volume=28|issue=4|pages=456–462|issn=0172-780X|pmid=17693979|quote=For decades, CFS patients were (and still are) dismissed as lazybones or hypochondriacs. Since 1994, the baffling illness has received recognition by the introduction of diagnostic criteria [1]. Nevertheless, many medical doctors and insurance companies still assert that CFS merely is a mental condition. <br >Doctors who treat CFS patients as suffering from a biological disorder and scientists who deal with the psycho-neuro-immune pathophysiology of CFS are often considered quacks by some of their colleagues, insurance companies and anti-quack societies, which are sometimes officially supported by governments, e.g. the Dutch government, in order to eliminate the scientific view that CFS is an organic disorder. The latter obviously would mean that the national health care system is obliged to financially support those patients who now are considered hypochondriacs and thus are suspended from the national health care systems. In accordance, the mainstream, “evidence based” treatment for CFS is cognitive behavioural therapy, which means that patients with CFS are being treated as having a mental illness with “treatments” that do not treat any underlying pathophysiology. <br>There is, however, evidence that CFS is accompanied by severe immune disorders, such as activation of the inflammatory response system (IRS) and increased oxidative and nitrosative stress with a significant damage to membrane lipids and functional proteins [2–4].|via=}}</ref> Doctors, researchers and other health professionals who have called for controversial research or review articles to be retracted (withdrawn) on the grounds of not meeting adequate scientific standards have been labeled "activists" regardless of the scientific reasons they gave, the field they work in or their personal history.

Professors at medical schools report that they have been instructed by their department chairs to stop seeing ME/CFS patients, have been denied promotions due to their ME/CFS research, have received unfounded letters of reprimand, and have been subjected to ethics investigations for using their medical school email and other medical school resources to investigate ME/CFS.<ref name=":10">{{Cite web|url=http://immunedysfunction.org/images/Elephants%20in%20the%20Room%20As%20Delivered.pdf|title=Elephants in the room|last=Friedman|first=Kenneth|authorlink=Kenneth Friedman|last2=|first2=|authorlink2=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=March 4, 2019}}</ref> A charity offered to donate a scholarship to a medical school, to benefit medical students who study ME/CFS, but the medical school refused the donation because "ME-CFS patients set up an artificial distinction between psychiatric and organic illness, and the school does not wish its students exposed to patients who make such a distinction."<ref name=":10" />

== Discrimination ==
[[Charlotte Blease|Blease]] and [[Keith Geraghty|Geraghty]] (2018) found that "medical authorities" used "widespread negative stereotyping of patients" and acted to marginalize and exclude patient voices, which created "epistemic injustice."<ref name=":4" /> For instance, patients who challenged the views or actions of medical authorities were labeled "militant" and "activists", with several mainstream newspapers reporting unfounded accusations that they sent "death threats" to ME/CFS researchers<ref name=":4" />

===Effects of stigma ===
Stigma has resulted in patients being treated as
* lazy or work shy, resulting in denial of [[Access to benefits|disability benefits]] and rejection from society and family<ref name=":5" /><ref name=":7">{{Cite web|url=https://www.meassociation.org.uk/2011/02/countess-of-mars-forward-me-group-minutes-of-meeting-26-january-2011/|title=Countess of Mar’s ‘Forward ME’ Group – minutes of meeting, 26 January 2011|last=Forward-ME|first=|authorlink=Forward-ME|last2=|first2=|authorlink2=|date=Feb 2011|website=[[ME Association]]|language=en-US|archive-url=|archive-date=|dead-url=|access-date=2019-03-04}}</ref>
* hypochondriacs<ref name=":5" /><ref name="GeraghtyEsmail2016" />
* not ill, or only having trivial symptoms,<ref name="obstruction" /> resulting in denying basic medical treatment and tests,<ref name="GeraghtyEsmail2016" /> and denial of funding for medical research
* undeserving of medical care<ref name=":3" /><ref name=":5" />
* mentally ill, resulting in denial of medical care and disability aids, and limited / reduced disability or sickness payments<ref name=":8" />
* dangerous, threatening and mentally unstable<ref name=":4" />
* resistant to treatment, resulting in forced in-patient psychiatric care (including in children)
* children with ME/CFS have been put on child protection and "at risk" registers and separated from their parents, who are investigated for child abuse and [[Munchausen syndrome by proxy]]<ref name="colby2014">{{Cite web|url=https://www.tymestrust.org/pdfs/falseallegations.pdf|title=False Allegations of Child Abuse in Cases of Childhood Myalgic Encephalomyelitis (ME)|last=Colby|first=Jane|authorlink=Jane Colby|last2=|first2=|authorlink2=|date=2014|website=[[Tymes Trust]]|archive-url=|archive-date=|dead-url=|access-date=}}</ref><ref name="panorama">{{Cite web|url=http://news.bbc.co.uk/2/hi/events/panorama/506549.stm|title=Panorama {{!}} Sick and Tired|last=BBC news|first=|authorlink=Sick and Tired - BBC|last2=|first2=|authorlink2=|date=Nov 8, 1999|website=news.bbc.co.uk|archive-url=|archive-date=|dead-url=|access-date=2019-02-12}}</ref><ref name="colby2014" /><ref name="VanHoof2006">{{Cite journal|last=Van Hoof|first=E.|author-link=E Van Hoof|last2=De Becker|first2=P.|author-link2=Pascale De Becker|last3=De Meirleir|first3=K.|author-link3=Kenny De Meirleir|author-link4=|author-link5=|date=Jan 2006|title=Pediatric Chronic Fatigue Syndrome and Munchausen-By-Proxy: A Case Study|url=https://books.google.co.uk/books?id=MrcUN2k91IMC&oi=fnd&pg=PA45#v=onepage&q&f=false|journal=Journal of Chronic Fatigue Syndrome|language=en|volume=13|issue=2-3|pages=45–53|doi=10.1300/J092v13n02_02|issn=1057-3321|quote=|via=}}</ref>
* children too ill to attend school, or even too ill to eat have been diagnosed with "[[Pervasive School Refusal Syndrome]]" or [[Pervasive Refusal Syndrome]], with their health limitations interpreted as a "behavioral" issue<ref>{{Cite web|url=http://www.investinme.org/IIME-Newslet-1604-NS999.shtml|title=The Elephant in the Room - The General Medical Council - Dr Nigel Speight|last=Invest in ME Research|first=|authorlink=Invest in ME Research|last2=|first2=|authorlink2=|date=2006|website=www.investinme.org|archive-url=|archive-date=|dead-url=|access-date=2019-02-15|quote=Where there are some doctors who do not believe in ME as a diagnosis or do not accept that children with ME can be so seriously ill that they need tube feeding then flawed diagnoses are introduced such as Pervasive Refusal Syndrome. It is in these cases that Dr Speight’s experience and knowledge have provided enormous help to child patients and their families.}}</ref>

==Examples of stigma and discrimination of ME/CFS ==
*2011, The Sun, best selling [[UK]] newspaper - [http://www.investinme.org/Article-505%20PCC%20Complaint%20Aug%202011%20I03.shtml Invest in ME Research Complaint]
: By [[Rod Liddle]]: "ME, which used to be known as yuppie flu", "stigmatised as malingering mentals", "foaming paranoia" (which he claimed could be found on the [[ME Association]] website)

*2011, ''The Times'' newspaper - [https://www.meassociation.org.uk/2011/08/interview-with-professor-simon-wessely-the-times-6-august-2011/ An interview with Professor Simon Wessely] [http://www.investinme.org/Article-505%20PCC%20Complaint%20Aug%202011%20I03.shtml Invest in ME Research Complaint]
: By Stefanie Marsh: "Such was the vitriol and the constant ratcheting up of the threats emanating from the fringes that, ten years ago, Professor Wessely chose to give up his research."
:''Untrue: This was 7 months after the [[PACE trial]] was published, which [[Simon Wessely |Wessely]] helped design the [[PACE trial]] and was a PACE trial center manager for several years, and still researchs ME/CFS''
:Professor [[Simon Wessely|Wessely]] comments "―They‘re (ME activists) not as bad as the animal liberation people ... ―But they‘re just as fanatical. It‘s constant stalking, harassment, attempts at intimidation."

*2012, ''The Sun'' newspaper, [[UK]] [https://www.meassociation.org.uk/2012/01/that-nice-mr-liddle-in-todays-sun-viewspaper-26-january-2012/ ‘Pretend disabled’ really ARE sick]
: By [[Rod Liddle]] started with: "My New Year’s resolution for 2012 was to become disabled. Nothing too serious, maybe just a bit of bad luck or one of those newly invented illnesses which make you a bit peaky for decades – fibromyalgia, or M.E."
: [https://www.meassociation.org.uk/2012/02/the-sun-newspaper-and-their-columnist-rod-liddle-mea-complains-press-complaints-commission/ ME Association complaint], [https://www.meassociation.org.uk/2012/05/press-complaints-commission-uk-fibromyalgia-me-association-v-the-sun-2-may-2012/ Press Complaints Commission response]

*2014, [[BMJ|The BMJ]] journal rapid response [https://forums.phoenixrising.me/threads/bmj-rapid-response-is-chronic-fatigue-syndrome-a-meme-18-june-2014.30944/ Is Chronic Fatigue Syndrome a meme?]
: By Anthony Collings and David Newton, Essex CFS Service, UK.
: [https://www.meassociation.org.uk/2014/06/shock-anger-and-concern-from-people-with-mecfs-we-write-to-the-essex-cfs-service-20-june-2014/ ME Association complaint], [https://www.meassociation.org.uk/2014/06/essex-cfs-service-apologise-for-letter-to-the-bmj-naive-of-authors-not-to-consider-wider-implications-20-june-2014/ Essex CFS Service apologises]

*2015, [[MEAction| #MEAction]] - [https://www.meaction.net/2015/12/03/debunking-the-myth-of-the-militant-minority/ Debunking the myth of the militant minority]

*2018, Somerset Live (UK) - [https://www.somersetlive.co.uk/news/somerset-news/bridgwater-woman-speaks-dealing-me-1543864 Bridgwater woman speaks of dealing with M.E. after GP tells her 'It’s not as if you are disabled or anything']

* 2018, [[MEAction| #MEAction]] - [https://www.meaction.net/2018/09/18/afflicted-open-letter-solidarity-petition/ Open letter demands removal of Netflix's "AFFLICTED"]
:[https://docs.google.com/document/d/1DGtVMTkyzpVfXYar7oz99_xVjebkMeI6e-lYAWWAh4U/mobilebasic ME patients and other disabled people tweet their dismay at Netflix's Afflicted]
: Individuals who were lied to and misrepresented by Netflix’s [[Afflicted]] include Jake, Pilar, [[Jamison Hill|Jamison]], Bekah, Jill and Janine
:* 2018, Dr [[Keith Geraghty]] [https://www.twitter.com/keithgeraghty/status/968064492025405443 tweeted]:
:* "I have written a paper with a colleague at Harvard on whether or not Militancy has been used by researchers to downplay the legitimate concerns of ME/CFS sufferers; {we have FOI case] - awaiting final acceptance - we tackle this important point/issue (hope to see paper out soon)"

==Prevalence==

A study of 68 ME/CFS patients in the UK in 2001 found that more than half of patients reported that their doctor was either openly skeptical about their ME/CFS symptoms, or appeared disbelieving; similar experiences have been reported within disability assessments by clinicians at a specialist CFS/ME clinic in the UK.<ref name="Deale2001" /><ref name=":9" />

In 2019, a [[UK Parliament Commons Chamber debate 24th January 2019|UK parliament debate]] highlighted that the members of the medical profession did not fully recognize ME, which increased the stigma and the marginalization of people with ME.<ref name="hansardjan19" />

== Interviews and news articles ==
* 2019, [https://www.huffingtonpost.co.uk/entry/me-chronic-fatigue_uk_5ca38433e4b0c5dee18bbb33 ME affects four times more women than men Josie Richardson - Dismissing this Terrible Illness is Sexist] - Josie Richardson, Huffington Post

==Notable studies==
*1982, Suffering and the Social Construction of Illness: The Delegitimation of Illness Experience in Chronic Fatigue Syndrome<ref>{{Cite journal|last=Ware|first=Norma C.|author-link=Norma Ware|author-link2=|author-link3=|author-link4=|author-link5=|date=Dec 1992|title=Suffering and the Social Construction of Illness: The Delegitimation of Illness Experience in Chronic Fatigue Syndrome|url=https://anthrosource.onlinelibrary.wiley.com/doi/abs/10.1525/maq.1992.6.4.02a00030|journal=Medical Anthropology Quarterly|language=en|volume=6|issue=4|pages=347–361|doi=10.1525/maq.1992.6.4.02a00030|issn=0745-5194|quote=|via=}}</ref> [https://anthrosource.onlinelibrary.wiley.com/doi/abs/10.1525/maq.1992.6.4.02a00030 | (Abstract)]

*1993, All in her mind! Stereotypic views and the [[Psychologization|psychologisation]] of women's illness<ref>{{Cite journal|journal=Health Psychology Update|url=https://books.google.co.uk/books?hl=en&lr=&id=E1afUMVG0VEC&oi=fnd&pg=PA7|title=All in her mind! Stereotypic views and the psychologisation of women's illness|last=Goudsmit|first=Ellen M|last2=|first2=|date=1993|publisher=|year=|isbn=|editor-link=|volume=12|location=|pages=28-32|language=en|chapter=|quote=|author-link=Ellen Goudsmit|editor-last2=|editor-link2=}}</ref> [https://books.google.co.uk/books?hl=en&lr=&id=E1afUMVG0VEC&oi=fnd&pg=PA7 (Full text)]
*1999, Stigma and Chronic Fatigue Syndrome<ref>{{Cite journal|last=Green|first=Judith|author-link=Judith Green|last2=Romei|first2=Jennifer|author-link2=Jennifer Romei|last3=Natelson|first3=Benjamin H.|author-link3=Benjamin Natelson|date=Jan 1999|title=Stigma and Chronic Fatigue Syndrome|url=https://www.tandfonline.com/doi/abs/10.1300/J092v05n02_04|journal=Journal of Chronic Fatigue Syndrome|language=en|volume=5|issue=2|pages=63–75|doi=10.1300/j092v05n02_04|issn=1057-3321|quote=|via=}}</ref> [https://www.tandfonline.com/doi/abs/10.1300/J092v05n02_04 (Abstract)]
*2001, Attitudes Regarding Chronic Fatigue Syndrome: The Importance of a Name<ref>{{Cite journal|last=Jason|first=Leonard A.|author-link=Leonard Jason|last2=Taylor|first2=Renée R.|author-link2=Renee Taylor|last3=Stepanek|first3=Zuzana|author-link3=Zuzana Stepanek|last4=Plioplys|first4=Sigita|author-link4=Sigita Plioplys|author-link5=|date=2001-01-01|title=Attitudes Regarding Chronic Fatigue Syndrome: The Importance of a Name|url=https://doi.org/10.1177/135910530100600105|journal=Journal of Health Psychology|language=en|volume=6|issue=1|pages=61–71|doi=10.1177/135910530100600105|issn=1359-1053|quote=|via=}}</ref> [http://journals.sagepub.com/doi/abs/10.1177/135910530100600105?journalCode=hpqa (Abstract)]

*2001, Gender biases underlying the social construction of illness states: The case of chronic fatigue syndrome<ref>{{Cite journal|last=Richman|first=Judith A.|author-link=Judith Richman|last2=Jason|first2=Leonard A.|author-link2=Leonard Jason|author-link3=|author-link4=|author-link5=|date=May 2001|title=Gender Biases Underlying the Social Construction of Illness States: The Case of Chronic Fatigue Syndrome|url=http://journals.sagepub.com/doi/10.1177/0011392101049003003|journal=Current Sociology|language=en|volume=49|issue=3|pages=15–29|doi=10.1177/0011392101049003003|issn=0011-3921|quote=|via=}}</ref> [http://journals.sagepub.com/doi/abs/10.1177/0011392101049003003 (Abstract)]
*2001, Measuring Attributions About Chronic Fatigue Syndrome<ref>{{Cite journal|author-link1=Leonard Jason| first=Leonard A.|last=Jason|author-link2=Renee Taylor|first2=Renée R.|last2=Taylor|date=2001|doi=10.1300/J092v08n03_04|title=Measuring Attributions About Chronic Fatigue Syndrome|journal=Journal of Chronic Fatigue Syndrome|volume=8|issue=3–4|pages=31-40|url=http://dx.doi.org/10.1300/J092v08n03_04}}</ref> [http://dx.doi.org/10.1300/J092v08n03_04 (Abstract)]
*2001, Assessing attitudes toward new names for chronic fatigue syndrome<ref>{{Cite journal|last=Jason|first=L. A.|author-link=Leonard Jason|last2=Eisele|first2=H.|author-link2=H Eisele|last3=Taylor|first3=R. R.|author-link3=Renee Taylor|author-link4=|author-link5=|date=Dec 2001|title=Assessing attitudes toward new names for chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/11817200|journal=Evaluation & the Health Professions|volume=24|issue=4|pages=424–435|doi=10.1177/01632780122034993|issn=0163-2787|pmid=11817200|quote=|via=}}</ref> [https://www.ncbi.nlm.nih.gov/pubmed/11817200 (Abstract)]
*2001, Patients' perceptions of medical care in chronic fatigue syndrome<ref name="Deale2001">{{Cite journal|last=Deale|first=A.|author-link=Alicia Deale|last2=Wessely|first2=S.|author-link2=Simon Wessely|author-link3=|author-link4=|author-link5=|date=Jun 2001|title=Patients' perceptions of medical care in chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/m/pubmed/11352411/|journal=Social Science & Medicine (1982)|volume=52|issue=12|pages=1859–1864|issn=0277-9536|pmid=11352411|quote=|via=}}</ref> [https://www.ncbi.nlm.nih.gov/m/pubmed/11352411/ (Abstract)]
*2002, [https://www.ncbi.nlm.nih.gov/pubmed/11837367 Women's experiences of stigma in relation to chronic fatigue syndrome and fibromyalgia.]<ref name="asbring2002">{{Cite journal| issn = 1049-7323| volume = 12| issue = 2| pages = 148–160| last1 = Asbring| first1 = Pia| authorlink1 = Pia Asbring|last2 = Närvänen| authorlink2 = Anna-Liisa Närvänen|first2 = Anna-Liisa| title = Women's experiences of stigma in relation to chronic fatigue syndrome and fibromyalgia| journal = Qualitative Health Research| date = Feb 2002| pmid = 11837367}}</ref>
*2004, Stigma and chronic fatigue syndrome: Surveying a name change<ref>{{Cite journal|last=Jason|first=L. A.|author-link=Leonard Jason|last2=Holbert|first2 =C.|last3=Torres-Harding|author-link3=Susan Torres-Harding|first3=S|last4=Taylor|first4=R. R.|author-link4=Renee Taylor|date=2004|title=Stigma and chronic fatigue syndrome: Surveying a name change. Journal of Disability Policy Studies|volume =14|pages=222-228|url=https://www.researchgate.net/publication/236996166_Stigma_and_chronic_fatigue_syndrome_Surveying_a_name_change}}</ref> [https://www.researchgate.net/publication/236996166_Stigma_and_chronic_fatigue_syndrome_Surveying_a_name_change (Abstract, full text downloadable)]
* 2005, Can the social model explain all of the disability experience? Perspectives from people with chronic fatigue syndrome.<ref name="Taylor2005">https://www.ncbi.nlm.nih.gov/pubmed/16268016/</ref> [https://pdfs.semanticscholar.org/5e0f/362c499a24facdb02804c91eaffddcf01e8e.pdf (Full text)]
* 2006, Pediatric Chronic Fatigue Syndrome and Munchausen-By-Proxy: A Case Study<ref name="VanHoof2006" />[https://books.google.co.uk/books?id=MrcUN2k91IMC&oi=fnd&pg=PA45#v=onepage&q&f=false (Full text)]
*2007, The Effectiveness of Early Educational Intervention in Improving Future Physicians' Attitudes Regarding [[CFS]]/[[FM]]<ref>{{Cite journal|last=Lu|first=Tony V.|author-link=Tony Lu|last2=Torres-Harding|first2=Susan R.|author-link2=Susan Torres-Harding|last3=Jason|first3=Leonard A.|author-link3=Leonard Jason|author-link4=|author-link5=|date=Jan 2007|title=The Effectiveness of Early Educational Intervention in Improving Future Physicians' Attitudes Regarding CFS/FM|url=https://www.tandfonline.com/doi/abs/10.1300/J092v14n02_03|journal=Journal of Chronic Fatigue Syndrome|language=en|volume=14|issue=2|pages=25–30|doi=10.1300/j092v14n02_03|issn=1057-3321|quote=|via=}}</ref> [https://www.tandfonline.com/doi/abs/10.1300/J092v14n02_03 (Abstract)]
*2008, Obstructions for quality care experienced by patients with chronic fatigue syndrome (CFS)—A case study<ref name="obstruction">{{Cite journal|last=Gilje|first=Ann Marit|author-link=Ann Marit Gilje|last2=Söderlund|first2=Atle|author-link2=Atle Söderlund|last3=Malterud|first3=Kirsti|author-link3=Kirsti Malterud|author-link4=|author-link5=|date=Oct 2008|title=Obstructions for quality care experienced by patients with chronic fatigue syndrome (CFS)—A case study|url=https://linkinghub.elsevier.com/retrieve/pii/S0738399108001936|journal=[[Patient Education and Counseling]]|language=en|volume=73|issue=1|pages=36–41|doi=10.1016/j.pec.2008.04.001|quote=|via=}}</ref> [https://linkinghub.elsevier.com/retrieve/pii/S0738399108001936 (Abstract)]

*2016, [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4675701/ Caring for People with Severe Myalgic Encephalomyelitis: An Interpretative Phenomenological Analysis of Parents’ Experiences]<ref>{{Cite journal|last=Mihelicova|first=Martina|author-link=Martina Mihelicova|last2=Siegel|first2=Zachary|author-link2=Zachary Siegel|last3=Evans|first3=Meredyth|author-link3=Meredyth Evans|last4=Brown|first4=Abigail|author-link4=Abigail Brown|last5=Jason|first5=Leonard|author-link5=Leonard Jason|date=Dec 2016|title=Caring for People with Severe Myalgic Encephalomyelitis: An Interpretative Phenomenological Analysis of Parents’ Experiences|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4675701/|journal=Journal of health psychology|volume=21|issue=12|pages=2824–2837|doi=10.1177/1359105315587137|issn=1359-1053|pmc=4675701|pmid=26063209|quote=|via=}}</ref>
*2016, Educational Priorities for Healthcare Providers and Name Suggestions for Chronic Fatigue Syndrome: Including the Patient Voice<ref>{{Cite journal|last=Nicholson|first=Laura|author-link=Laura Nicholson|last2=Brown|first2=Abigail|author-link2=Abigail Brown|last3=Jason|first3=Leonard|author-link3=Leonard Jason|last4=Ohanian|first4=Diana|author-link4=Diana Ohanian|last5=O'Connor|first5=Kelly|author-link5=Kelly O'Connor|date=2016-02-18|title=Educational Priorities for Healthcare Providers and Name Suggestions for Chronic Fatigue Syndrome: Including the Patient Voice|url=https://www.researchgate.net/publication/295001642_Educational_Priorities_for_Healthcare_Providers_and_Name_Suggestions_for_Chronic_Fatigue_Syndrome_Including_the_Patient_Voice|journal=Clinical Research: Open Access ( ISSN 2469-6714 )|volume=2|issue=|pages=|doi=10.16966/2469-6714.112|quote=|via=}}</ref> [https://www.researchgate.net/publication/295001642_Educational_Priorities_for_Healthcare_Providers_and_Name_Suggestions_for_Chronic_Fatigue_Syndrome_Including_the_Patient_Voice (Full Text)]
* 2017, Research Volunteers’ Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis<ref>{{Cite journal|last=Nehrke|first=Pamela I|author-link=Pamela Nehrke|last2=Fox|first2=Pamela A|author-link2=Pamela Fox|last3=Jason|first3=Leonard A|author-link3=Leonard Jason|author-link4=|date=2017|title=Research Volunteers’ Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5898812/|journal=Neurology (E-Cronicon)|volume=7|issue=4|pages=172–178|pmc=5898812|pmid=29662969|quote=|via=}}</ref> [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5898812/ (Abstract)]
* 2017, Epistemic injustice in healthcare encounters: evidence from chronic fatigue syndrome<ref name=":4">{{Cite journal|last=Blease|first=Charlotte|author-link=Charlotte Blease|last2=Carel|first2=Havi|author-link2=Havi Carel|last3=Geraghty|first3=Keith|author-link3=Keith Geraghty|author-link4=|author-link5=|date=2017-08-01|title=Epistemic injustice in healthcare encounters: evidence from chronic fatigue syndrome|url=https://jme.bmj.com/content/43/8/549|journal=Journal of Medical Ethics|language=en|volume=43|issue=8|pages=549–557|doi=10.1136/medethics-2016-103691|issn=0306-6800|pmid=27920164|quote=|via=}}</ref> [https://jme.bmj.com/content/43/8/549| (Full text)]
* 2018, Are ME/CFS Patient Organizations "Militant"? : Patient Protest in a Medical Controversy.<ref>{{Cite journal|last=Blease|first=Charlotte|last2=Geraghty|first2=Keith J.|date=Sep 2018|title=Are ME/CFS Patient Organizations "Militant"? : Patient Protest in a Medical Controversy|url=http://docs.wixstatic.com/ugd/510dea_e4ef70833c2a4cb8926e01c1f42b97a1.pdf|journal=Journal of Bioethical Inquiry|volume=15|issue=3|pages=393–401|doi=10.1007/s11673-018-9866-5|issn=1176-7529|pmid=29971693|via=}}</ref> [http://docs.wixstatic.com/ugd/510dea_e4ef70833c2a4cb8926e01c1f42b97a1.pdf (Abstract)]
* 2018, Myalgic encephalomyelitis/chronic fatigue syndrome and the biopsychosocial model: a review of patient harm and distress in the medical encounter<ref name=":8">{{Cite journal|last=Geraghty|first=Keith J.|author-link=Keith Geraghty|last2=Blease|first2=Charlotte|author-link2=Charlotte Blease|author-link3=|author-link4=|author-link5=|date=2018-06-21|title=Myalgic encephalomyelitis/chronic fatigue syndrome and the biopsychosocial model: a review of patient harm and distress in the medical encounter|url=https://www.tandfonline.com/doi/full/10.1080/09638288.2018.1481149|journal=Disability and Rehabilitation|language=en|volume=|issue=|pages=1–10|doi=10.1080/09638288.2018.1481149|issn=0963-8288|quote=|via=}}</ref> [https://www.tandfonline.com/doi/full/10.1080/09638288.2018.1481149 (Abstract)]
*2018, Effects of unsupportive social interactions, stigma, and symptoms on patients with myalgic encephalomyelitis and chronic fatigue syndrome<ref name=":1">{{Cite journal|last=McManimen|first=Stephanie L.|author-link=Stephanie McManimen|last2=McClellan|first2=Damani|author-link2=Damani McClellan|last3=Stoothoff|first3=Jamie|author-link3=Jamie Stoothoff|last4=Jason|first4=Leonard A.|author-link4=Leonard Jason|author-link5=|date=2018-05-04|title=Effects of unsupportive social interactions, stigma, and symptoms on patients with myalgic encephalomyelitis and chronic fatigue syndrome|url=https://onlinelibrary.wiley.com/doi/abs/10.1002/jcop.21984|journal=Journal of Community Psychology|language=en|volume=46|issue=8|pages=959–971|doi=10.1002/jcop.21984|issn=0090-4392|quote=|via=}}</ref> [https://onlinelibrary.wiley.com/doi/abs/10.1002/jcop.21984 (Abstract)]
*2018, A content analysis of chronic fatigue syndrome and myalgic encephalomyelitis in the news from 1987 to 2013<ref name=":2">{{Cite journal|last=Siegel|first=Zachary A.|author-link=Zachary Siegel|last2=Brown|first2=Abigail|author-link2=Abigail Brown|last3=Devendorf|first3=Andrew|author-link3=Andrew Devendorf|last4=Collier|first4=Johanna|author-link4=Johanna Collier|last5=Jason|first5=Leonard A.|author-link5=Leonard Jason|date=Mar 2018|title=A content analysis of chronic fatigue syndrome and myalgic encephalomyelitis in the news from 1987 to 2013|url=https://www.ncbi.nlm.nih.gov/pubmed/28403636|journal=Chronic Illness|volume=14|issue=1|pages=3–12|doi=10.1177/1742395317703175|issn=1745-9206|pmid=28403636|quote=|via=}}</ref> [https://www.ncbi.nlm.nih.gov/pubmed/28403636 (Abstract)]
*2018, Stigma in Myalgic Encephalomyelitis and its association with functioning<ref name=":0">{{Cite journal|last=Baken|first=Don M.|author-link=Don Baken|last2=Harvey|first2=Shane T.|author-link2=Shane Harvey|last3=Bimler|first3=David L.|author-link3=David Bimler|last4=Ross|first4=Kirsty J.|author-link4=Kirsty Ross|author-link5=|date=2018-01-02|title=Stigma in Myalgic Encephalomyelitis and its association with functioning|url=https://www.tandfonline.com/doi/abs/10.1080/21641846.2018.1419553|journal=Fatigue: Biomedicine, Health & Behavior|language=en|volume=6|issue=1|pages=30–40|doi=10.1080/21641846.2018.1419553|issn=2164-1846|quote=|via=}}</ref> [https://www.tandfonline.com/doi/abs/10.1080/21641846.2018.1419553 (Abstract)]
*2019, Duvet woman versus action man: the gendered aetiology of Chronic Fatigue Syndrome according to English newspapers<ref name=":12" /> [https://doi.org/10.1080/14680777.2019.1595694 (Abstract)]
*2019, Legitimizing myalgic encephalomyelitis/chronic fatigue syndrome: indications of change over a decade<ref name="Friedberg2019">{{Cite journal|last=Friedberg|first=Fred|author-link=Fred Friedberg|last2=|first2=|author-link2=|last3=|first3=|author-link3=|last4=|first4=|author-link4=|last5=|first5=|author-link5=|last6=|first6=|author-link6=|last7=|first7=|last8=|first8=|date=2020-01-02|title=Legitimizing myalgic encephalomyelitis/chronic fatigue syndrome: indications of change over a decade|url=https://doi.org/10.1080/21641846.2020.1718292|journal=Fatigue: Biomedicine, Health & Behavior|volume=8|issue=1|pages=24–31|doi=10.1080/21641846.2020.1718292|issn=2164-1846|pmc=|pmid=|access-date=|quote=|via=}}</ref> - [https://www.tandfonline.com/doi/abs/10.1080/21641846.2020.1718292 (Abstract)]

==See also==

* [[Ethical issues]]
* [[Biopsychosocial model]]
*[[Munchausen syndrome by proxy]]
* [[Charlotte Blease]]
* [[Mary Dimmock]]
* [[Keith Geraghty]]
* [[Leonard Jason]]
* [[Individual quotes|Quotes about ME/CFS]]
* [[Unrest|''Unrest'']] (movie)

==Learn more==
* 2015, [http://www.wakeupcallbeweging.be/pdf/30yearsdisdainsummary.pdf THIRTY YEARS OF DISDAIN: How HHS and A Group of Psychiatrists Buried Myalgic Encephalomyelitis]<ref name=":3">{{Cite web|url=http://www.wakeupcallbeweging.be/pdf/30yearsdisdainsummary.pdf|title=THIRTY YEARS OF DISDAIN: How HHS and a group of psychiatrists Buried Myalgic Encephalomyelitis|last=Dimmock|first=Mary|authorlink=Mary Dimmock|last2=Lazell-Fairman|first2=Matthew|authorlink2=Matthew Lazell-Fairman|date=Dec 2015|website=|archive-url=|archive-date=|dead-url=|access-date=Nov 5, 2018}}</ref>
==References==
{{reflist}}
[[Category:Ethics]]

Stigma and discrimination

2020-10-24T11:57:13Z

Loopy:caption info

[[File:Rosa SEID.JPG|400px|thumb|Rosa age 25 in 1986 and mildly ill with [[ME/CFS]].|In 2015 the [[SEID]] criteria were released. Rosa read about [[Post-exertional malaise|PEM]] and how it is delayed and makes [[List of symptoms in ME CFS|ME/CFS symptoms]] like [[Chronic fatigue|CF]], [[Orthostatic intolerance|OI]], and [[Cognitive dysfunction|cognition]] worse. Her life since [[Pediatric myalgic encephalomyelitis/chronic fatigue syndrome|age 17]] fell into place as she never connected her worsening symptoms with increased [[Exertion#Exertion in ME.2FCFS|physical or mental activity]] 24-72 hours prior. She believes not understanding PEM made her condition worsen over the years and is now disabled meeting the [[Canadian Consensus Criteria|CCC]] with PEM "[[Canadian Consensus Criteria#Definition|option]]"]]
'''Stigma''' is "an attribute that links a person to an undesirable stereotype, leading other people to reduce the bearer from a whole and usual person to a tainted, discounted one."<ref>{{Cite book|title=Stigma: notes on the management of spoiled Identity|last=Goffman|first=E.|publisher=Simon and Schuster|year=1983|isbn=|editor-link=|location=New York|page=11|pages=|chapter=|quote=|editor-last2=|editor-link2=}}</ref> People with [[myalgic encephalomyelitis]] (ME) and [[chronic fatigue syndrome]] (CFS) often described feeling stigmatized and '''discriminated''' against.<ref name=":0" /><ref name=":1" /><ref name=":2" /><ref name=":3" />

{{Quote2|Sufferers of ME are often stigmatised and marginalised, as their conditions are not fully recognised by the Government or the medical profession. A number of my constituents suffer from ME. At least two have been bedridden for 30 years because of their condition, and their story is not uncommon.|Mohammad Yasin, MP|Appropriate ME Treatment debate (Jan 24, 2019)<ref name="hansardjan19"/>}}

{{Quote frame |...believing ME/CFS is a condition that can be cured by [[illness beliefs |attitude]] and [[Graded exercise therapy |effort]] is stigmatizing, no matter how carefully you try to frame it. That’s harmful, for individuals who blame themselves (or get blamed) for their suffering, and for the collective of people deeply affected...|author=[[Hilda Bastian]]|source=Consumer-Contested Evidence: Why the ME/CFS Exercise Dispute Matters So Much<ref name ="Bastian2016">{{Cite web|url=https://blogs.plos.org/absolutely-maybe/2019/02/08/consumer-contested-evidence-why-the-me-cfs-exercise-dispute-matters-so-much/|title=Consumer-Contested Evidence: Why the ME/CFS Exercise Dispute Matters So Much|last=Bastian|first=Hilda|authorlink=Hilda Bastian|last2=|first2=|authorlink2=|date=Feb 8, 2019|website=[[PlosOne]]|language=en-US|archive-url=|archive-date=|dead-url=|access-date=2019-03-03}}</ref>}}

=== The Yuppie flu label ===
ME was dismissed as "[[Yuppie Flu|yuppie flu]]" and even "shirker syndrome" in the 1980s and described as a reaction to the stresses of modern life.<ref>{{Cite web|url=http://sacfs.asn.au/download/New%20York%20Times%20article%20(17-07-07).pdf|title=Chronic Fatigue no longer seen as Yuppie Flu|last=Tuller|first=David|authorlink=David Tuller|last2=|first2=|authorlink2=|date=2007|website=New York Times|archive-url=|archive-date=|dead-url=|access-date=2018-12-30}}</ref> Under the label yuppie flu, [[Myalgic encephalomyelitis|ME]] was regarded as only affecting one group in society - young to middle-aged professionals.<ref>{{Cite journal|last=Dowsett|first=Elizabeth G.|author-link=Elizabeth Dowsett|author-link2=|author-link3=|author-link4=|author-link5=|date=Jan 1992|others=P D Welsby|title=Conversation piece. Interview by P. D. Welsby.|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2399326/|journal=Postgraduate Medical Journal|volume=68|issue=795|pages=63–65|issn=0032-5473|pmc=2399326|pmid=1561197|quote=|via=}}</ref>

=== Stigma from the media ===
A number media interviews and newspaper coverage have presented negative views of patients with ME, including representing some reporting legitimate claims through official chanqqnels as harassing, or intimidating researchers described as "vilification" and listed alongside unproven allegations of criminal acts such as sending "death threats".<ref name=":6">{{Cite web|url=http://downloads.bbc.co.uk/bbctrust/assets/files/pdf/appeals/esc_bulletins/2012/feb.pdf|title=“Torrent of abuse” hindering ME research {{!}} Today programme {{!}} BBC Radio 4|last=BBC News Online|first=|authorlink=BBC news|last2=|first2=|authorlink2=|date=July 29, 2011|website=|archive-url=|archive-date=|dead-url=|access-date=2019-03-02}}</ref> Murray et al. (2019) found a significant ''gender bias'' in their analysis of English newspaper articles featuring patients with ME/CFS, women were presented as more emotionally distressed with their physical symptoms minimized, and the impact on social and home functioning was emphasized, while men were portrayed as "action men" prior to their illness, with physical symptoms prominent and the impact on career and sports emphasized.<ref name=":12">{{Cite journal|last=Murray|first=Rebecca|author-link=Rebecca Murray|last2=Day|first2=Katy|author-link2=Katy Day|last3=Tobbell|first3=Jane|author-link3=Jane Tobbell|author-link4=|author-link5=|date=Apr 15, 2019|title=Duvet woman versus action man: the gendered aetiology of Chronic Fatigue Syndrome according to English newspapers|url=https://doi.org/10.1080/14680777.2019.1595694|journal=[[Feminist Media Studies]]|volume=|issue=|pages=1–16|doi=10.1080/14680777.2019.1595694|issn=1468-0777|quote=|via=}}</ref>

In other coverage, treatment success rates have been grossly exaggerated, with the controversial [[graded exercise therapy]] (GET) referred to as simply "[[exercise]]" in headlines rather than a specialist treatment.<ref name="BBCTodayFITNET">{{Cite web|url=https://downloads.bbc.co.uk/bbctrust/assets/files/pdf/appeals/esc_bulletins/2017/mar.pdf|title=Editorial Standards Findings Appeals to the Trust and other editorial issues considered by the Editorial Standards Committee: Decisions by the Head of Editorial Standards, Trust Unit February and March 2017|last=BBC Trust|first=|authorlink=BBC|last2=|first2=|authorlink2=|date=Mar 2017|website=|archive-url=|archive-date=|dead-url=|access-date=2019-03-02}}</ref> A [[BBC news|BBC]] report, believed to be heavily influenced by the biased [[Science Media Centre]] (SMC), "overstated" and made inaccurate claims that the [[Netherlands|Dutch]] [[FITNET trial]] could cure "two-thirds" of [[United Kingdom|[British]]<nowiki>] children with </nowiki>[[Chronic fatigue syndrome|CFS]] within 6 months, when the actual figure was under 40%, with those results heavily disputed due to including very broad diagnostic criteria, and the treatment only being available in 10% of the [[United Kingdom|UK]].<ref name="BBCTodayFITNET" />

A number of charities including [[Invest in ME Research]] and [[The ME Association]] have filed complaints or raised objections, in addition to individual patients.<ref name="IIMEpacebbc">{{Cite web|url=http://investinme.org/IIME-Newslet-1501-02.shtml|title=INVEST IN ME RESPONSE to BBC ARTICLE|last=Invest in ME Research|first=|authorlink=Invest in ME Research|last2=|first2=|authorlink2=|date=Jan 2015|website=[[Invest in ME Research]]|archive-url=|archive-date=|dead-url=|access-date=2019-03-02}}</ref><ref name=":6" /> The exaggerated recovery rates and headlines about "exercise" or a talking treatment have encouraged the public to stereotype patients as lazy, simply lacking the willingness to exercise, or as having [[:Category:Mental disorders|mental health]] problems.

===Stigma from the family, friends and the public ===
Patients with ME/CFS may be judged by friends as extremely lazy rather than ill, and become isolated from friends when they are too ill to spend time with others.<ref name="radio4-2007">{{Cite web|url=https://www.bbc.co.uk/radio4/science/casenotes_tr_20071106.shtml|title=Case notes: Programme number 10 - ME|last=BBC Radio 4|first=|authorlink=BBC radio 4|last2=|first2=|authorlink2=|date=2007|website=|type=Transcript|archive-url=https://web.archive.org/web/20071221221638/https://www.bbc.co.uk/radio4/science/casenotes_tr_20071106.shtml|archive-date=Dec 21, 2007|dead-url=yes|access-date=}}</ref><ref name=":11">{{Cite web|url=https://www.huffingtonpost.co.uk/entry/me-chronic-fatigue_uk_5ca38433e4b0c5dee18bbb33|title=ME Affects Four Times More Women Than Men – Dismissing This Terrifying Illness Is Sexist|last=Richardson|first=Josie|authorlink=Josie Richardson|last2=|first2=|authorlink2=|date=Apr 4, 2019|website=[[Huffington Post]]|language=en|archive-url=|archive-date=|dead-url=|access-date=2019-04-10}}</ref>

Work colleagues may accuse the person of being lazy, teachers may accuse children with ME of "enjoying themselves" when they are too ill to attend school.<ref name=":11" />

=== Stigma from health professionals ===
A number of [[Wessely school|highly influential health professionals]] have made highly stigmatized, dismissive and offensive comments about patients with [[ME/CFS]], which continues to this day. Many patients in the UK and elsewhere in continue to report that their doctor was either openly skeptical about their ones, or expressed disbelief.<ref name="Deale2001" /><ref name="GeraghtyEsmail2016">{{Cite journal
| last1 = Geraghty | first1 = Keith | authorlink1 = Keith Geraghty
| last2 = Esmail | first2 = Aneez | authorlink2 = Aneez Esmail
| title = Chronic fatigue syndrome: is the biopsychosocial model responsible for patient dissatisfaction and harm?
| journal = British Journal of General Practice | volume = 66 | issue =649 | page = 437-438
| date = 1 Aug 2016
| doi = 10.3399/bjgp16X686473
|url = https://doi.org/10.3399/bjgp16X686473
}}
</ref><ref name="obstruction" /> Similar experiences have been reported within disability assessments, and by clinicians at a specialist CFS/ME clinic in the UK.<ref name=":7" /><ref name=":9">{{Cite journal|last=Collings|first=Anthony D|author-link=Anthony Collings|last2=Newton|first2=David|author-link2=David Newton|author-link3=|author-link4=|author-link5=|date=Jun 18, 2014|title=Is Chronic Fatigue Syndrome a meme?|url=https://forums.phoenixrising.me/threads/bmj-rapid-response-is-chronic-fatigue-syndrome-a-meme-18-june-2014.30944/|dead-url=usurped|journal=[[BMJ]]|language=en|volume=|issue=|pages=|doi=|issn=0959-8138|pmid=|archive-url=|archive-date=Jun 18, 2014|quote=|via=|pmc=|last3=|first3=|last4=|first4=|last5=|first5=|last6=|first6=|last7=|first7=|last8=|first8=|access-date=|author-link6=}}</ref> In 2019, a [[UK Parliament Commons Chamber debate 24th January 2019|UK parliament debate]] highlighted that the members of the medical profession did not fully recognize ME, which increased the stigma and the marginalization of people with ME.<ref name="hansardjan19">{{Cite web|url=https://hansard.parliament.uk/Commons/2019-01-24/debates/FA1BBC27-37A7-4BFD-A2C0-A58B57F41D4D/AppropriateMETreatment|title=Appropriate ME Treatment {{!}} 24 January 2019 Volume 653|last=Hansard {{!}} UK Parliament|first=|authorlink=|last2=|first2=|authorlink2=|date=Jan 24, 2019|website=hansard.parliament.uk|archive-url=|archive-date=|dead-url=|access-date=2019-01-25}}</ref>

ME patients have been stereotyped in many ways, including being accused of having negative attitudes towards [[Mental health|mental illness]] and being [[Personality traits and patient attitudes in ME/CFS|"anti-psychiatry"]], however Wood & [[Simon Wessely|Wessely]] (1999) showed that attitudes towards mental illness are no different from those of other patient groups, for example [[rheumatoid arthritis]] patients.<ref>{{Cite journal|last=Wood|first=Barbara|author-link=Barbara Wood|last2=Wessely|first2=Simon|author-link2=Simon Wessely|author-link3=|author-link4=|author-link5=|date=Oct 1999|title=Personality and social attitudes in chronic fatigue syndrome|url=http://linkinghub.elsevier.com/retrieve/pii/S0022399999000252|journal=Journal of Psychosomatic Research|language=en|volume=47|issue=4|pages=385–397|doi=10.1016/S0022-3999(99)00025-2|quote=No differences were found between CFS and RA patients in measures of perfectionism, attitudes toward mental illness, defensiveness, social desirability, or sensitivity to punishment (a concept related to neuroticism), on either crude or adjusted analyses... There was no evidence from this study of major differences between the personalities of CFS patients and RA patients. The stereotype of CFS sufferers as perfectionists with negative attitudes toward psychiatry was not supported.|via=}}</ref>

===Researchers with ME/CFS: stigma from academic colleagues ===
Scientists who work on [[biomedical research]] or treat patients outside of the psychiatry and exercise focused [[biopsychosocial model]] (BPS) have been denied work in their country's public health care system, portrayed as quacks, anti-science, struggled to get research funding or lab time and been isolated and ostracized by their peers.<ref name=":3" /><ref name=":5">{{Cite journal|last=Maes|first=Michael|author-link=Michael Maes|last2=Mihaylova|first2=Ivana|author-link2=Ivana Mihaylova|last3=Bosmans|first3=Eugene|author-link3=Eugene Bosmans|author-link4=|author-link5=|date=August 2007|title=Not in the mind of neurasthenic lazybones but in the cell nucleus: patients with chronic fatigue syndrome have increased production of nuclear factor kappa beta|url=http://www.nel.edu/userfiles/articlesnew/NEL280407A15.pdf|journal=Neuro Endocrinology Letters|volume=28|issue=4|pages=456–462|issn=0172-780X|pmid=17693979|quote=For decades, CFS patients were (and still are) dismissed as lazybones or hypochondriacs. Since 1994, the baffling illness has received recognition by the introduction of diagnostic criteria [1]. Nevertheless, many medical doctors and insurance companies still assert that CFS merely is a mental condition. <br >Doctors who treat CFS patients as suffering from a biological disorder and scientists who deal with the psycho-neuro-immune pathophysiology of CFS are often considered quacks by some of their colleagues, insurance companies and anti-quack societies, which are sometimes officially supported by governments, e.g. the Dutch government, in order to eliminate the scientific view that CFS is an organic disorder. The latter obviously would mean that the national health care system is obliged to financially support those patients who now are considered hypochondriacs and thus are suspended from the national health care systems. In accordance, the mainstream, “evidence based” treatment for CFS is cognitive behavioural therapy, which means that patients with CFS are being treated as having a mental illness with “treatments” that do not treat any underlying pathophysiology. <br>There is, however, evidence that CFS is accompanied by severe immune disorders, such as activation of the inflammatory response system (IRS) and increased oxidative and nitrosative stress with a significant damage to membrane lipids and functional proteins [2–4].|via=}}</ref> Doctors, researchers and other health professionals who have called for controversial research or review articles to be retracted (withdrawn) on the grounds of not meeting adequate scientific standards have been labeled "activists" regardless of the scientific reasons they gave, the field they work in or their personal history.

Professors at medical schools report that they have been instructed by their department chairs to stop seeing ME/CFS patients, have been denied promotions due to their ME/CFS research, have received unfounded letters of reprimand, and have been subjected to ethics investigations for using their medical school email and other medical school resources to investigate ME/CFS.<ref name=":10">{{Cite web|url=http://immunedysfunction.org/images/Elephants%20in%20the%20Room%20As%20Delivered.pdf|title=Elephants in the room|last=Friedman|first=Kenneth|authorlink=Kenneth Friedman|last2=|first2=|authorlink2=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=March 4, 2019}}</ref> A charity offered to donate a scholarship to a medical school, to benefit medical students who study ME/CFS, but the medical school refused the donation because "ME-CFS patients set up an artificial distinction between psychiatric and organic illness, and the school does not wish its students exposed to patients who make such a distinction."<ref name=":10" />

== Discrimination ==
[[Charlotte Blease|Blease]] and [[Keith Geraghty|Geraghty]] (2018) found that "medical authorities" used "widespread negative stereotyping of patients" and acted to marginalize and exclude patient voices, which created "epistemic injustice."<ref name=":4" /> For instance, patients who challenged the views or actions of medical authorities were labeled "militant" and "activists", with several mainstream newspapers reporting unfounded accusations that they sent "death threats" to ME/CFS researchers<ref name=":4" />

===Effects of stigma ===
Stigma has resulted in patients being treated as
* lazy or work shy, resulting in denial of [[Access to benefits|disability benefits]] and rejection from society and family<ref name=":5" /><ref name=":7">{{Cite web|url=https://www.meassociation.org.uk/2011/02/countess-of-mars-forward-me-group-minutes-of-meeting-26-january-2011/|title=Countess of Mar’s ‘Forward ME’ Group – minutes of meeting, 26 January 2011|last=Forward-ME|first=|authorlink=Forward-ME|last2=|first2=|authorlink2=|date=Feb 2011|website=[[ME Association]]|language=en-US|archive-url=|archive-date=|dead-url=|access-date=2019-03-04}}</ref>
* hypochondriacs<ref name=":5" /><ref name="GeraghtyEsmail2016" />
* not ill, or only having trivial symptoms,<ref name="obstruction" /> resulting in denying basic medical treatment and tests,<ref name="GeraghtyEsmail2016" /> and denial of funding for medical research
* undeserving of medical care<ref name=":3" /><ref name=":5" />
* mentally ill, resulting in denial of medical care and disability aids, and limited / reduced disability or sickness payments<ref name=":8" />
* dangerous, threatening and mentally unstable<ref name=":4" />
* resistant to treatment, resulting in forced in-patient psychiatric care (including in children)
* children with ME/CFS have been put on child protection and "at risk" registers and separated from their parents, who are investigated for child abuse and [[Munchausen syndrome by proxy]]<ref name="colby2014">{{Cite web|url=https://www.tymestrust.org/pdfs/falseallegations.pdf|title=False Allegations of Child Abuse in Cases of Childhood Myalgic Encephalomyelitis (ME)|last=Colby|first=Jane|authorlink=Jane Colby|last2=|first2=|authorlink2=|date=2014|website=[[Tymes Trust]]|archive-url=|archive-date=|dead-url=|access-date=}}</ref><ref name="panorama">{{Cite web|url=http://news.bbc.co.uk/2/hi/events/panorama/506549.stm|title=Panorama {{!}} Sick and Tired|last=BBC news|first=|authorlink=Sick and Tired - BBC|last2=|first2=|authorlink2=|date=Nov 8, 1999|website=news.bbc.co.uk|archive-url=|archive-date=|dead-url=|access-date=2019-02-12}}</ref><ref name="colby2014" /><ref name="VanHoof2006">{{Cite journal|last=Van Hoof|first=E.|author-link=E Van Hoof|last2=De Becker|first2=P.|author-link2=Pascale De Becker|last3=De Meirleir|first3=K.|author-link3=Kenny De Meirleir|author-link4=|author-link5=|date=Jan 2006|title=Pediatric Chronic Fatigue Syndrome and Munchausen-By-Proxy: A Case Study|url=https://books.google.co.uk/books?id=MrcUN2k91IMC&oi=fnd&pg=PA45#v=onepage&q&f=false|journal=Journal of Chronic Fatigue Syndrome|language=en|volume=13|issue=2-3|pages=45–53|doi=10.1300/J092v13n02_02|issn=1057-3321|quote=|via=}}</ref>
* children too ill to attend school, or even too ill to eat have been diagnosed with "[[Pervasive School Refusal Syndrome]]" or [[Pervasive Refusal Syndrome]], with their health limitations interpreted as a "behavioral" issue<ref>{{Cite web|url=http://www.investinme.org/IIME-Newslet-1604-NS999.shtml|title=The Elephant in the Room - The General Medical Council - Dr Nigel Speight|last=Invest in ME Research|first=|authorlink=Invest in ME Research|last2=|first2=|authorlink2=|date=2006|website=www.investinme.org|archive-url=|archive-date=|dead-url=|access-date=2019-02-15|quote=Where there are some doctors who do not believe in ME as a diagnosis or do not accept that children with ME can be so seriously ill that they need tube feeding then flawed diagnoses are introduced such as Pervasive Refusal Syndrome. It is in these cases that Dr Speight’s experience and knowledge have provided enormous help to child patients and their families.}}</ref>

==Examples of stigma and discrimination of ME/CFS ==
*2011, The Sun, best selling [[UK]] newspaper - [http://www.investinme.org/Article-505%20PCC%20Complaint%20Aug%202011%20I03.shtml Invest in ME Research Complaint]
: By [[Rod Liddle]]: "ME, which used to be known as yuppie flu", "stigmatised as malingering mentals", "foaming paranoia" (which he claimed could be found on the [[ME Association]] website)

*2011, ''The Times'' newspaper - [https://www.meassociation.org.uk/2011/08/interview-with-professor-simon-wessely-the-times-6-august-2011/ An interview with Professor Simon Wessely] [http://www.investinme.org/Article-505%20PCC%20Complaint%20Aug%202011%20I03.shtml Invest in ME Research Complaint]
: By Stefanie Marsh: "Such was the vitriol and the constant ratcheting up of the threats emanating from the fringes that, ten years ago, Professor Wessely chose to give up his research."
:''Untrue: This was 7 months after the [[PACE trial]] was published, which [[Simon Wessely |Wessely]] helped design the [[PACE trial]] and was a PACE trial center manager for several years, and still researchs ME/CFS''
:Professor [[Simon Wessely|Wessely]] comments "―They‘re (ME activists) not as bad as the animal liberation people ... ―But they‘re just as fanatical. It‘s constant stalking, harassment, attempts at intimidation."

*2012, ''The Sun'' newspaper, [[UK]] [https://www.meassociation.org.uk/2012/01/that-nice-mr-liddle-in-todays-sun-viewspaper-26-january-2012/ ‘Pretend disabled’ really ARE sick]
: By [[Rod Liddle]] started with: "My New Year’s resolution for 2012 was to become disabled. Nothing too serious, maybe just a bit of bad luck or one of those newly invented illnesses which make you a bit peaky for decades – fibromyalgia, or M.E."
: [https://www.meassociation.org.uk/2012/02/the-sun-newspaper-and-their-columnist-rod-liddle-mea-complains-press-complaints-commission/ ME Association complaint], [https://www.meassociation.org.uk/2012/05/press-complaints-commission-uk-fibromyalgia-me-association-v-the-sun-2-may-2012/ Press Complaints Commission response]

*2014, [[BMJ|The BMJ]] journal rapid response [https://forums.phoenixrising.me/threads/bmj-rapid-response-is-chronic-fatigue-syndrome-a-meme-18-june-2014.30944/ Is Chronic Fatigue Syndrome a meme?]
: By Anthony Collings and David Newton, Essex CFS Service, UK.
: [https://www.meassociation.org.uk/2014/06/shock-anger-and-concern-from-people-with-mecfs-we-write-to-the-essex-cfs-service-20-june-2014/ ME Association complaint], [https://www.meassociation.org.uk/2014/06/essex-cfs-service-apologise-for-letter-to-the-bmj-naive-of-authors-not-to-consider-wider-implications-20-june-2014/ Essex CFS Service apologises]

*2015, [[MEAction| #MEAction]] - [https://www.meaction.net/2015/12/03/debunking-the-myth-of-the-militant-minority/ Debunking the myth of the militant minority]

*2018, Somerset Live (UK) - [https://www.somersetlive.co.uk/news/somerset-news/bridgwater-woman-speaks-dealing-me-1543864 Bridgwater woman speaks of dealing with M.E. after GP tells her 'It’s not as if you are disabled or anything']

* 2018, [[MEAction| #MEAction]] - [https://www.meaction.net/2018/09/18/afflicted-open-letter-solidarity-petition/ Open letter demands removal of Netflix's "AFFLICTED"]
:[https://docs.google.com/document/d/1DGtVMTkyzpVfXYar7oz99_xVjebkMeI6e-lYAWWAh4U/mobilebasic ME patients and other disabled people tweet their dismay at Netflix's Afflicted]
: Individuals who were lied to and misrepresented by Netflix’s [[Afflicted]] include Jake, Pilar, [[Jamison Hill|Jamison]], Bekah, Jill and Janine
:* 2018, Dr [[Keith Geraghty]] [https://www.twitter.com/keithgeraghty/status/968064492025405443 tweeted]:
:* "I have written a paper with a colleague at Harvard on whether or not Militancy has been used by researchers to downplay the legitimate concerns of ME/CFS sufferers; {we have FOI case] - awaiting final acceptance - we tackle this important point/issue (hope to see paper out soon)"

==Prevalence==

A study of 68 ME/CFS patients in the UK in 2001 found that more than half of patients reported that their doctor was either openly skeptical about their ME/CFS symptoms, or appeared disbelieving; similar experiences have been reported within disability assessments by clinicians at a specialist CFS/ME clinic in the UK.<ref name="Deale2001" /><ref name=":9" />

In 2019, a [[UK Parliament Commons Chamber debate 24th January 2019|UK parliament debate]] highlighted that the members of the medical profession did not fully recognize ME, which increased the stigma and the marginalization of people with ME.<ref name="hansardjan19" />

== Interviews and news articles ==
* 2019, [https://www.huffingtonpost.co.uk/entry/me-chronic-fatigue_uk_5ca38433e4b0c5dee18bbb33 ME affects four times more women than men Josie Richardson - Dismissing this Terrible Illness is Sexist] - Josie Richardson, Huffington Post

==Notable studies==
*1982, Suffering and the Social Construction of Illness: The Delegitimation of Illness Experience in Chronic Fatigue Syndrome<ref>{{Cite journal|last=Ware|first=Norma C.|author-link=Norma Ware|author-link2=|author-link3=|author-link4=|author-link5=|date=Dec 1992|title=Suffering and the Social Construction of Illness: The Delegitimation of Illness Experience in Chronic Fatigue Syndrome|url=https://anthrosource.onlinelibrary.wiley.com/doi/abs/10.1525/maq.1992.6.4.02a00030|journal=Medical Anthropology Quarterly|language=en|volume=6|issue=4|pages=347–361|doi=10.1525/maq.1992.6.4.02a00030|issn=0745-5194|quote=|via=}}</ref> [https://anthrosource.onlinelibrary.wiley.com/doi/abs/10.1525/maq.1992.6.4.02a00030 | (Abstract)]

*1993, All in her mind! Stereotypic views and the [[Psychologization|psychologisation]] of women's illness<ref>{{Cite journal|journal=Health Psychology Update|url=https://books.google.co.uk/books?hl=en&lr=&id=E1afUMVG0VEC&oi=fnd&pg=PA7|title=All in her mind! Stereotypic views and the psychologisation of women's illness|last=Goudsmit|first=Ellen M|last2=|first2=|date=1993|publisher=|year=|isbn=|editor-link=|volume=12|location=|pages=28-32|language=en|chapter=|quote=|author-link=Ellen Goudsmit|editor-last2=|editor-link2=}}</ref> [https://books.google.co.uk/books?hl=en&lr=&id=E1afUMVG0VEC&oi=fnd&pg=PA7 (Full text)]
*1999, Stigma and Chronic Fatigue Syndrome<ref>{{Cite journal|last=Green|first=Judith|author-link=Judith Green|last2=Romei|first2=Jennifer|author-link2=Jennifer Romei|last3=Natelson|first3=Benjamin H.|author-link3=Benjamin Natelson|date=Jan 1999|title=Stigma and Chronic Fatigue Syndrome|url=https://www.tandfonline.com/doi/abs/10.1300/J092v05n02_04|journal=Journal of Chronic Fatigue Syndrome|language=en|volume=5|issue=2|pages=63–75|doi=10.1300/j092v05n02_04|issn=1057-3321|quote=|via=}}</ref> [https://www.tandfonline.com/doi/abs/10.1300/J092v05n02_04 (Abstract)]
*2001, Attitudes Regarding Chronic Fatigue Syndrome: The Importance of a Name<ref>{{Cite journal|last=Jason|first=Leonard A.|author-link=Leonard Jason|last2=Taylor|first2=Renée R.|author-link2=Renee Taylor|last3=Stepanek|first3=Zuzana|author-link3=Zuzana Stepanek|last4=Plioplys|first4=Sigita|author-link4=Sigita Plioplys|author-link5=|date=2001-01-01|title=Attitudes Regarding Chronic Fatigue Syndrome: The Importance of a Name|url=https://doi.org/10.1177/135910530100600105|journal=Journal of Health Psychology|language=en|volume=6|issue=1|pages=61–71|doi=10.1177/135910530100600105|issn=1359-1053|quote=|via=}}</ref> [http://journals.sagepub.com/doi/abs/10.1177/135910530100600105?journalCode=hpqa (Abstract)]

*2001, Gender biases underlying the social construction of illness states: The case of chronic fatigue syndrome<ref>{{Cite journal|last=Richman|first=Judith A.|author-link=Judith Richman|last2=Jason|first2=Leonard A.|author-link2=Leonard Jason|author-link3=|author-link4=|author-link5=|date=May 2001|title=Gender Biases Underlying the Social Construction of Illness States: The Case of Chronic Fatigue Syndrome|url=http://journals.sagepub.com/doi/10.1177/0011392101049003003|journal=Current Sociology|language=en|volume=49|issue=3|pages=15–29|doi=10.1177/0011392101049003003|issn=0011-3921|quote=|via=}}</ref> [http://journals.sagepub.com/doi/abs/10.1177/0011392101049003003 (Abstract)]
*2001, Measuring Attributions About Chronic Fatigue Syndrome<ref>{{Cite journal|author-link1=Leonard Jason| first=Leonard A.|last=Jason|author-link2=Renee Taylor|first2=Renée R.|last2=Taylor|date=2001|doi=10.1300/J092v08n03_04|title=Measuring Attributions About Chronic Fatigue Syndrome|journal=Journal of Chronic Fatigue Syndrome|volume=8|issue=3–4|pages=31-40|url=http://dx.doi.org/10.1300/J092v08n03_04}}</ref> [http://dx.doi.org/10.1300/J092v08n03_04 (Abstract)]
*2001, Assessing attitudes toward new names for chronic fatigue syndrome<ref>{{Cite journal|last=Jason|first=L. A.|author-link=Leonard Jason|last2=Eisele|first2=H.|author-link2=H Eisele|last3=Taylor|first3=R. R.|author-link3=Renee Taylor|author-link4=|author-link5=|date=Dec 2001|title=Assessing attitudes toward new names for chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/11817200|journal=Evaluation & the Health Professions|volume=24|issue=4|pages=424–435|doi=10.1177/01632780122034993|issn=0163-2787|pmid=11817200|quote=|via=}}</ref> [https://www.ncbi.nlm.nih.gov/pubmed/11817200 (Abstract)]
*2001, Patients' perceptions of medical care in chronic fatigue syndrome<ref name="Deale2001">{{Cite journal|last=Deale|first=A.|author-link=Alicia Deale|last2=Wessely|first2=S.|author-link2=Simon Wessely|author-link3=|author-link4=|author-link5=|date=Jun 2001|title=Patients' perceptions of medical care in chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/m/pubmed/11352411/|journal=Social Science & Medicine (1982)|volume=52|issue=12|pages=1859–1864|issn=0277-9536|pmid=11352411|quote=|via=}}</ref> [https://www.ncbi.nlm.nih.gov/m/pubmed/11352411/ (Abstract)]
*2002, [https://www.ncbi.nlm.nih.gov/pubmed/11837367 Women's experiences of stigma in relation to chronic fatigue syndrome and fibromyalgia.]<ref name="asbring2002">{{Cite journal| issn = 1049-7323| volume = 12| issue = 2| pages = 148–160| last1 = Asbring| first1 = Pia| authorlink1 = Pia Asbring|last2 = Närvänen| authorlink2 = Anna-Liisa Närvänen|first2 = Anna-Liisa| title = Women's experiences of stigma in relation to chronic fatigue syndrome and fibromyalgia| journal = Qualitative Health Research| date = Feb 2002| pmid = 11837367}}</ref>
*2004, Stigma and chronic fatigue syndrome: Surveying a name change<ref>{{Cite journal|last=Jason|first=L. A.|author-link=Leonard Jason|last2=Holbert|first2 =C.|last3=Torres-Harding|author-link3=Susan Torres-Harding|first3=S|last4=Taylor|first4=R. R.|author-link4=Renee Taylor|date=2004|title=Stigma and chronic fatigue syndrome: Surveying a name change. Journal of Disability Policy Studies|volume =14|pages=222-228|url=https://www.researchgate.net/publication/236996166_Stigma_and_chronic_fatigue_syndrome_Surveying_a_name_change}}</ref> [https://www.researchgate.net/publication/236996166_Stigma_and_chronic_fatigue_syndrome_Surveying_a_name_change (Abstract, full text downloadable)]
* 2005, Can the social model explain all of the disability experience? Perspectives from people with chronic fatigue syndrome.<ref name="Taylor2005">https://www.ncbi.nlm.nih.gov/pubmed/16268016/</ref> [https://pdfs.semanticscholar.org/5e0f/362c499a24facdb02804c91eaffddcf01e8e.pdf (Full text)]
* 2006, Pediatric Chronic Fatigue Syndrome and Munchausen-By-Proxy: A Case Study<ref name="VanHoof2006" />[https://books.google.co.uk/books?id=MrcUN2k91IMC&oi=fnd&pg=PA45#v=onepage&q&f=false (Full text)]
*2007, The Effectiveness of Early Educational Intervention in Improving Future Physicians' Attitudes Regarding [[CFS]]/[[FM]]<ref>{{Cite journal|last=Lu|first=Tony V.|author-link=Tony Lu|last2=Torres-Harding|first2=Susan R.|author-link2=Susan Torres-Harding|last3=Jason|first3=Leonard A.|author-link3=Leonard Jason|author-link4=|author-link5=|date=Jan 2007|title=The Effectiveness of Early Educational Intervention in Improving Future Physicians' Attitudes Regarding CFS/FM|url=https://www.tandfonline.com/doi/abs/10.1300/J092v14n02_03|journal=Journal of Chronic Fatigue Syndrome|language=en|volume=14|issue=2|pages=25–30|doi=10.1300/j092v14n02_03|issn=1057-3321|quote=|via=}}</ref> [https://www.tandfonline.com/doi/abs/10.1300/J092v14n02_03 (Abstract)]
*2008, Obstructions for quality care experienced by patients with chronic fatigue syndrome (CFS)—A case study<ref name="obstruction">{{Cite journal|last=Gilje|first=Ann Marit|author-link=Ann Marit Gilje|last2=Söderlund|first2=Atle|author-link2=Atle Söderlund|last3=Malterud|first3=Kirsti|author-link3=Kirsti Malterud|author-link4=|author-link5=|date=Oct 2008|title=Obstructions for quality care experienced by patients with chronic fatigue syndrome (CFS)—A case study|url=https://linkinghub.elsevier.com/retrieve/pii/S0738399108001936|journal=[[Patient Education and Counseling]]|language=en|volume=73|issue=1|pages=36–41|doi=10.1016/j.pec.2008.04.001|quote=|via=}}</ref> [https://linkinghub.elsevier.com/retrieve/pii/S0738399108001936 (Abstract)]

*2016, [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4675701/ Caring for People with Severe Myalgic Encephalomyelitis: An Interpretative Phenomenological Analysis of Parents’ Experiences]<ref>{{Cite journal|last=Mihelicova|first=Martina|author-link=Martina Mihelicova|last2=Siegel|first2=Zachary|author-link2=Zachary Siegel|last3=Evans|first3=Meredyth|author-link3=Meredyth Evans|last4=Brown|first4=Abigail|author-link4=Abigail Brown|last5=Jason|first5=Leonard|author-link5=Leonard Jason|date=Dec 2016|title=Caring for People with Severe Myalgic Encephalomyelitis: An Interpretative Phenomenological Analysis of Parents’ Experiences|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4675701/|journal=Journal of health psychology|volume=21|issue=12|pages=2824–2837|doi=10.1177/1359105315587137|issn=1359-1053|pmc=4675701|pmid=26063209|quote=|via=}}</ref>
*2016, Educational Priorities for Healthcare Providers and Name Suggestions for Chronic Fatigue Syndrome: Including the Patient Voice<ref>{{Cite journal|last=Nicholson|first=Laura|author-link=Laura Nicholson|last2=Brown|first2=Abigail|author-link2=Abigail Brown|last3=Jason|first3=Leonard|author-link3=Leonard Jason|last4=Ohanian|first4=Diana|author-link4=Diana Ohanian|last5=O'Connor|first5=Kelly|author-link5=Kelly O'Connor|date=2016-02-18|title=Educational Priorities for Healthcare Providers and Name Suggestions for Chronic Fatigue Syndrome: Including the Patient Voice|url=https://www.researchgate.net/publication/295001642_Educational_Priorities_for_Healthcare_Providers_and_Name_Suggestions_for_Chronic_Fatigue_Syndrome_Including_the_Patient_Voice|journal=Clinical Research: Open Access ( ISSN 2469-6714 )|volume=2|issue=|pages=|doi=10.16966/2469-6714.112|quote=|via=}}</ref> [https://www.researchgate.net/publication/295001642_Educational_Priorities_for_Healthcare_Providers_and_Name_Suggestions_for_Chronic_Fatigue_Syndrome_Including_the_Patient_Voice (Full Text)]
* 2017, Research Volunteers’ Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis<ref>{{Cite journal|last=Nehrke|first=Pamela I|author-link=Pamela Nehrke|last2=Fox|first2=Pamela A|author-link2=Pamela Fox|last3=Jason|first3=Leonard A|author-link3=Leonard Jason|author-link4=|date=2017|title=Research Volunteers’ Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5898812/|journal=Neurology (E-Cronicon)|volume=7|issue=4|pages=172–178|pmc=5898812|pmid=29662969|quote=|via=}}</ref> [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5898812/ (Abstract)]
* 2017, Epistemic injustice in healthcare encounters: evidence from chronic fatigue syndrome<ref name=":4">{{Cite journal|last=Blease|first=Charlotte|author-link=Charlotte Blease|last2=Carel|first2=Havi|author-link2=Havi Carel|last3=Geraghty|first3=Keith|author-link3=Keith Geraghty|author-link4=|author-link5=|date=2017-08-01|title=Epistemic injustice in healthcare encounters: evidence from chronic fatigue syndrome|url=https://jme.bmj.com/content/43/8/549|journal=Journal of Medical Ethics|language=en|volume=43|issue=8|pages=549–557|doi=10.1136/medethics-2016-103691|issn=0306-6800|pmid=27920164|quote=|via=}}</ref> [https://jme.bmj.com/content/43/8/549| (Full text)]
* 2018, Are ME/CFS Patient Organizations "Militant"? : Patient Protest in a Medical Controversy.<ref>{{Cite journal|last=Blease|first=Charlotte|last2=Geraghty|first2=Keith J.|date=Sep 2018|title=Are ME/CFS Patient Organizations "Militant"? : Patient Protest in a Medical Controversy|url=http://docs.wixstatic.com/ugd/510dea_e4ef70833c2a4cb8926e01c1f42b97a1.pdf|journal=Journal of Bioethical Inquiry|volume=15|issue=3|pages=393–401|doi=10.1007/s11673-018-9866-5|issn=1176-7529|pmid=29971693|via=}}</ref> [http://docs.wixstatic.com/ugd/510dea_e4ef70833c2a4cb8926e01c1f42b97a1.pdf (Abstract)]
* 2018, Myalgic encephalomyelitis/chronic fatigue syndrome and the biopsychosocial model: a review of patient harm and distress in the medical encounter<ref name=":8">{{Cite journal|last=Geraghty|first=Keith J.|author-link=Keith Geraghty|last2=Blease|first2=Charlotte|author-link2=Charlotte Blease|author-link3=|author-link4=|author-link5=|date=2018-06-21|title=Myalgic encephalomyelitis/chronic fatigue syndrome and the biopsychosocial model: a review of patient harm and distress in the medical encounter|url=https://www.tandfonline.com/doi/full/10.1080/09638288.2018.1481149|journal=Disability and Rehabilitation|language=en|volume=|issue=|pages=1–10|doi=10.1080/09638288.2018.1481149|issn=0963-8288|quote=|via=}}</ref> [https://www.tandfonline.com/doi/full/10.1080/09638288.2018.1481149 (Abstract)]
*2018, Effects of unsupportive social interactions, stigma, and symptoms on patients with myalgic encephalomyelitis and chronic fatigue syndrome<ref name=":1">{{Cite journal|last=McManimen|first=Stephanie L.|author-link=Stephanie McManimen|last2=McClellan|first2=Damani|author-link2=Damani McClellan|last3=Stoothoff|first3=Jamie|author-link3=Jamie Stoothoff|last4=Jason|first4=Leonard A.|author-link4=Leonard Jason|author-link5=|date=2018-05-04|title=Effects of unsupportive social interactions, stigma, and symptoms on patients with myalgic encephalomyelitis and chronic fatigue syndrome|url=https://onlinelibrary.wiley.com/doi/abs/10.1002/jcop.21984|journal=Journal of Community Psychology|language=en|volume=46|issue=8|pages=959–971|doi=10.1002/jcop.21984|issn=0090-4392|quote=|via=}}</ref> [https://onlinelibrary.wiley.com/doi/abs/10.1002/jcop.21984 (Abstract)]
*2018, A content analysis of chronic fatigue syndrome and myalgic encephalomyelitis in the news from 1987 to 2013<ref name=":2">{{Cite journal|last=Siegel|first=Zachary A.|author-link=Zachary Siegel|last2=Brown|first2=Abigail|author-link2=Abigail Brown|last3=Devendorf|first3=Andrew|author-link3=Andrew Devendorf|last4=Collier|first4=Johanna|author-link4=Johanna Collier|last5=Jason|first5=Leonard A.|author-link5=Leonard Jason|date=Mar 2018|title=A content analysis of chronic fatigue syndrome and myalgic encephalomyelitis in the news from 1987 to 2013|url=https://www.ncbi.nlm.nih.gov/pubmed/28403636|journal=Chronic Illness|volume=14|issue=1|pages=3–12|doi=10.1177/1742395317703175|issn=1745-9206|pmid=28403636|quote=|via=}}</ref> [https://www.ncbi.nlm.nih.gov/pubmed/28403636 (Abstract)]
*2018, Stigma in Myalgic Encephalomyelitis and its association with functioning<ref name=":0">{{Cite journal|last=Baken|first=Don M.|author-link=Don Baken|last2=Harvey|first2=Shane T.|author-link2=Shane Harvey|last3=Bimler|first3=David L.|author-link3=David Bimler|last4=Ross|first4=Kirsty J.|author-link4=Kirsty Ross|author-link5=|date=2018-01-02|title=Stigma in Myalgic Encephalomyelitis and its association with functioning|url=https://www.tandfonline.com/doi/abs/10.1080/21641846.2018.1419553|journal=Fatigue: Biomedicine, Health & Behavior|language=en|volume=6|issue=1|pages=30–40|doi=10.1080/21641846.2018.1419553|issn=2164-1846|quote=|via=}}</ref> [https://www.tandfonline.com/doi/abs/10.1080/21641846.2018.1419553 (Abstract)]
*2019, Duvet woman versus action man: the gendered aetiology of Chronic Fatigue Syndrome according to English newspapers<ref name=":12" /> [https://doi.org/10.1080/14680777.2019.1595694 (Abstract)]
*2019, Legitimizing myalgic encephalomyelitis/chronic fatigue syndrome: indications of change over a decade<ref name="Friedberg2019">{{Cite journal|last=Friedberg|first=Fred|author-link=Fred Friedberg|last2=|first2=|author-link2=|last3=|first3=|author-link3=|last4=|first4=|author-link4=|last5=|first5=|author-link5=|last6=|first6=|author-link6=|last7=|first7=|last8=|first8=|date=2020-01-02|title=Legitimizing myalgic encephalomyelitis/chronic fatigue syndrome: indications of change over a decade|url=https://doi.org/10.1080/21641846.2020.1718292|journal=Fatigue: Biomedicine, Health & Behavior|volume=8|issue=1|pages=24–31|doi=10.1080/21641846.2020.1718292|issn=2164-1846|pmc=|pmid=|access-date=|quote=|via=}}</ref> - [https://www.tandfonline.com/doi/abs/10.1080/21641846.2020.1718292 (Abstract)]

==See also==

* [[Ethical issues]]
* [[Biopsychosocial model]]
*[[Munchausen syndrome by proxy]]
* [[Charlotte Blease]]
* [[Mary Dimmock]]
* [[Keith Geraghty]]
* [[Leonard Jason]]
* [[Individual quotes|Quotes about ME/CFS]]
* [[Unrest|''Unrest'']] (movie)

==Learn more==
* 2015, [http://www.wakeupcallbeweging.be/pdf/30yearsdisdainsummary.pdf THIRTY YEARS OF DISDAIN: How HHS and A Group of Psychiatrists Buried Myalgic Encephalomyelitis]<ref name=":3">{{Cite web|url=http://www.wakeupcallbeweging.be/pdf/30yearsdisdainsummary.pdf|title=THIRTY YEARS OF DISDAIN: How HHS and a group of psychiatrists Buried Myalgic Encephalomyelitis|last=Dimmock|first=Mary|authorlink=Mary Dimmock|last2=Lazell-Fairman|first2=Matthew|authorlink2=Matthew Lazell-Fairman|date=Dec 2015|website=|archive-url=|archive-date=|dead-url=|access-date=Nov 5, 2018}}</ref>
==References==
{{reflist}}
[[Category:Ethics]]

Post-COVID-19 illness

2020-07-21T13:01:22Z

Loopy:/* Post-viral syndrome */ other doctors on symptoms

[[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 [[Coronavirus disease 19|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> One small study from Wuhan, China, found that survivors of [[Coronavirus disease 19|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>

===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 is uncertainty about whether this is a relapse due to the virus remaining at low levels in the body and bring reactivated, or if this is a reinfection.{{citation needed}}

==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=PMC3071317|pmid=21435231}}</ref>

==Severe COVID-19 survivors==

===ICU survivors===
[[File:Post-COVID-19 ventilators.png|alt=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)|left|frameless]]
{{Clear|both}}
[[File:Post intensive care syndrome.png|thumb|Post Intensive Care Syndrome symptoms. Source: [https://medicaljournals.se/jrm/content/html/10.2340/16501977-2677 J Rehabil Med 2020; 52: jrm00044]. License: CC-BY NC.]]
<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>{{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|last=H J|first=Stam|authorlink=|last2=G|first2=Stucki|authorlink2=|date=2020-04-15|website=Journal of rehabilitation medicine|language=en|doi=10.2340/16501977-2677|pmid=32286675|archive-url=|archive-date=|dead-url=|access-date=2020-04-23|last3=J|first3=Bickenbach|volume=52|issue=4}}</ref>

===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|last2=|first2=|authorlink2=|date=2020-02-11|website=Centers for Disease Control and Prevention|language=en-us|archive-url=|archive-date=|dead-url=|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.{{citation needed}}

===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|last2=|first2=|authorlink2=|date=2017-10-17|website=nhs.uk|language=en|archive-url=|archive-date=|dead-url=|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===
Invasive ventilation using a mechanical ventilator was needed by 47-71% of patients admitted to Intensive Care Units.<ref name="JH-ABX-540747" />

===COVID-19 complications===
These include:
*Anecdotal reports of DVT and PE 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:
**secondary infections including [[bacteria]]l and [[fungal infection]]s
**thromboembolism
**gastrointestinal bleeding
**critical illness polyneuropathy/myopathy.<ref name="JH-ABX-540747" /><ref name="CDC-clinicalguide" />

==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.|author-link=Keiji Fukuda|last2=Straus|first2=S. E.|author-link2=Stephen Straus|last3=Hickie|first3=I.|author-link3=Ian Hickie|last4=Sharpe|first4=M. C.|author-link4=Michael Sharpe|last5=Dobbins|first5=J. G.|author-link5=James Dobbins|last6=Komaroff|first6=A.|author-link6=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
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| 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
| url = http://www.investinme.org/Documents/PDFdocuments/CanadianDefinitionME-CFS.pdf
}}</ref><ref name="fukuda1994" />

== Potential brain damage ==
Scientists warn of a potential wave of coronavirus-related brain damage as new evidence suggests [[Coronavirus disease 19|COVID-19]] can lead to severe [[Nervous system|neurological]] complications, including [[brain inflammation]], [[psychosis]] and [[delirium]].<ref name=":1">{{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><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=":1" /></blockquote>

=== Notable studies ===
* Jul 8, 2020, The emerging spectrum of COVID-19 neurology: clinical, radiological and laboratory findings<ref name=":0">{{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|language=en|doi=10.1093/brain/awaa240}}</ref>
<blockquote>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.</blockquote><blockquote>The research adds to recent studies which also found the disease can damage the brain.<ref name=":0" /></blockquote>

==Post-viral syndrome==
'''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]], [[Brain fog|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|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 [[Coronavirus disease 19|COVID-19]] patients may have [[Myalgic encephalomyelitis|ME]], also known as [[chronic fatigue syndrome]], or [[ME/CFS]].<ref>{{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=":2">{{Cite web|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=CNN|first=By <a href="/profiles/joshua-berlinger">Joshua Berlinger</a>, <a href="/profiles/brett-mckeehan">Brett McKeehan</a>, <a href="/profiles/ivana-kottasova">Ivana Kottasová</a>, Ed Upright, <a href="/profiles/meg-wagner">Meg Wagner</a> and Melissa Macaya|date=2020-07-09|website=CNN|language=en|access-date=2020-07-21}}</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=":2" /> At the [https://www.youtube.com/watch?v=UMmT48IC0us&feature=emb_logo International AIDS conference], he 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>{{Cite web|url=https://www.healthline.com/health-news/fauci-warns-about-post-viral-syndrome-after-covid-19|title=Fauci Warns About ‘Post-Viral’ Syndrome After COVID-19|date=2020-07-16|website=Healthline|language=en|access-date=2020-07-21}}</ref>

An internist at Texas Health Presbyterian Hospital, Dr. Donna Casey, said “We can now see documented abnormalities in your [[Nervous system|nervous]], [[Immune system|immune]], and [[metabolic]] systems. So we’re seeing abnormalities in all three that create [[myalgic encephalomyelitis]].”<ref name=":3">{{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 (ME/CFS) {{!}} CDC|date=2019-11-19|website=www.cdc.gov|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=|last2=|first2=|authorlink2=|date=|website=National Academy of Medicine (Formerly the Institute of Medicine)|archive-url=|archive-date=|dead-url=|access-date=}}</ref> for COVID, but she does see ongoing improvement in her hospitalized patients.<ref name=":3" /> 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=":3" />

==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]]
[[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=www.who.int|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=www.cdc.gov|author-link=Centers for Disease Control|date=|access-date=Apr 17, 2020|first=|last2=|first2=|authorlink2=|archive-url=|archive-date=|dead-url=}}</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)}}

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|Chronic fatigue syndrome}}

==Treatment==
No treatment studies have yet been published, despite this and the uncertainty over long term physical and psychological health consequences of coronavirus disease 19 (COVID-19), some self-help advice has already been published.<ref name="openletter20042020" />

A group of over 20 [[Myalgic encephalomyelitis|ME]] and [[chronic fatigue syndrome]] specialists and patient groups have recommended [[fatigue]] following COVID-19 should be treated/managed using:
*activity [[pacing]]
*nutrition and
*[[sleep hygiene]], stating that should help reduce the risk of developing ME/CFS after COVID-19.<ref name="Vink2019">{{Cite journal|last=Vink|last2=Vink-Niese|date=2019-09-20|title=Work Rehabilitation and Medical Retirement for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Patients. A Review and Appraisal of Diagnostic Strategies|url=https://www.mdpi.com/2075-4418/9/4/124|journal=Diagnostics|language=en|volume=9|issue=4|pages=124|doi=10.3390/diagnostics9040124|issn=2075-4418|first=Mark|first2=Alexandra|pmc=|pmid=|author-link=Mark Vink|author-link2=Alexandra Vink-Niese|access-date=|via=}}</ref><ref name="openletter20042020" />

===Pacing===
Less controversially, the self-help leaflet mentions [[pacing]], a symptom-management approach also without evidence for COVID-19 survivors, but which is used by many people with chronic fatigue, chronic pain, and/or persistent illness that limits their everyday activities.<ref name="TullerOx16apr2020" /> ME patient associations surveys have found pacing helped most, but not all, patients.<ref name="forwardme-survey" /><ref name="IIMER-NICE" />
{{See also|Pacing}}

===CBT and GET not recommended for fatigue===
The Oxford Health NHS Foundation Trust published a ''Coping with Coronavirus: Fatigue'' leaflet referring to [[chronic fatigue syndrome]], a neurological disease, as a possible ''[[mental health]]'' consequence of COVID-19, and confusing fatigue after COVID-19 illness with [[chronic fatigue syndrome]]. The leaflet recommenddations included the highly controversial use of [[cognitive behavioral therapy]] (CBT) and graded exercise therapy (GET) to address the physical symptoms of chronic fatigue syndrome. The leaflet was withdrawn after public health expert [[David Tuller]] asked for the evidence based used by it, details of its authorship, and strongly criticised the advice given in it. An [[Opposition to Oxford Health NHS Foundation Trust: "Coping with Coronavirus: Fatigue"|open letter opposing the leaflet]] was signed by a large number of medical professionals and UK patient groups at around the same time.<ref name="openletter20042020" />

CBT for fatigue is a psychological therapy focused on treating a presumed [[illness beliefs|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]], [[MEAction]], 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=actionforme.org.uk}}</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=www.investinme.org|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|last2=|first2=|authorlink2=|date=2017-10-24|website=nhs.uk|language=en|archive-url=|archive-date=|dead-url=|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|last2=|first2=|authorlink2=|date=2018-07-18|website=nhs.uk|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-04-29}}</ref>

{{See also|Cognitive behavioral therapy}}{{See also|Graded exercise therapy}}

==Recovery advice==
* [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] - ME Association ''(May 2020)''
* [https://www.physiosforme.com/covid-19 Post Covid-19 Rehabilitation] - Physios for ME, Workwell Foundation, and ME Association ''(May 2020)''

==Notable studies==
No studies have yet been completed on the impact of COVID-19 on the long term health of survivors, or on treatment approaches.

==News articles and blogs==
* 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 1, 2020, [https://www.wsj.com/articles/three-months-in-these-patients-are-still-ravaged-by-covids-fallout-11593612004 Three Months In, These Patients Are Still Ravaged by Covid’s Fallout] - Wall Street Journal
* May 18, 2020, [https://blogs.bmj.com/bmj/2020/05/19/paul-garner-covid-19-and-fatigue-a-game-of-snakes-and-ladders/ Paul Garner: Covid-19 and fatigue—a game of snakes and ladders] - The BMJ
* 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://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.ws}}</ref>
*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.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|last=Lowenstein|first=Fiona|date=2020-04-13|publisher=New York Times|title=We Need to Talk About What Coronavirus Recoveries Look Like}}</ref> - Fiona Lowenstein, 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]]
*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==
*[[Coronavirus disease 19]] (COVID-19)
*[[Myalgic encephalomyelitis]]
*[[Chronic fatigue syndrome]] - the neurological disease
*[[Postviral fatigue syndrome]]
*[[Chronic fatigue]] - a symptom of many illnesses
*[[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]]
*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=|doi=|oclc=|quote=|archive-url=|archive-date=|location=}}</ref> (book)

==Learn more==
* 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=meassociation.org}}</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=|dead-url=|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
* 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 {{!}} 30 April 2020|date=Apr 30, 2020|last=Charles Shepherd|author-link=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

==References==
{{Reflist}}

[[Category:Diagnoses]]

David Tuller

2020-07-21T12:22:29Z

Loopy:/* Other print media */ STAT article

[[File:David tuller.jpg|right]]
'''David M. Tuller''', DrPh, or '''Dave Tuller''', is a Senior Fellow in Public Health in Journalism at the Center of Global Public Health, School of Public Health, University of California, Berkeley, California and regularly writes about research on [[myalgic encephalomyelitis]] and [[chronic fatigue syndrome]] and other frequently misunderstood illness.<ref>{{Cite web|url=http://www.microbe.tv/twiv/twivs-tuller4/|title=TWiV Special: Tear it up with David Tuller {{!}} This Week in Virology|language=en-US|access-date=2019-08-14}}</ref> Previously to his current appointment at Berkeley in July 2017, he was of academic coordinator of the University of California, Berkeley's joint masters program in public health and journalism. He's worked as a reporter and editor for ten years at the ''San Francisco Chronicle'', served as health editor at ''Salon.com'' and frequently writes about health for ''The New York Times''.<ref>{{Cite web|url=https://journalism.berkeley.edu/person/david_tuller/|title=David Tuller|website=UC Berkeley Graduate School of Journalism|language=en-US|access-date=2019-08-14}}</ref>

He's an experienced public health activist with a background as an [[ACT UP]] activist which included an arrest at the Wall Street demonstration in 1987.<ref>{{Cite web|title=Jay Blotcher's ACT UP & Friends Reunion in San Francisco|url=http://mpetrelis.blogspot.com/2013/05/jay-blotchers-act-up-friends-reunion-in.html|access-date=2019-04-20|language=en|last=Petrelis|date=May 21, 2013|website=Petrelis Files|first=Michael|authorlink=|last2=|first2=|authorlink2=|archive-url=|archive-date=|dead-url=|quote=[O]ur friend David Tuller. Back in 1987 at ACT UP's first demonstration on Wall Street, he was among the arrestees...the Wall Street 17}}</ref>

==PACE trial ==
David Tuller covered the [[PACE trial]] results for ''The New York Times'' in February 2011.<ref>{{Cite news|url=https://www.nytimes.com/2011/02/18/health/research/18fatigue.html|title=Psychotherapy Eases Chronic Fatigue Syndrome, Study Says|last=Tuller|first=David|date=2011-02-17|work=The New York Times|access-date=2019-08-14|language=en-US|issn=0362-4331}}</ref> However he became concerned about the trial and wrote a further article regarding case definitions which resulted in an immediate response from the PACE trial authors which resulted in him investigating the trial and its authors further after contact with others in the patient community.<ref>{{Cite news|url=https://www.nytimes.com/2011/03/08/health/research/08fatigue.html|title=Troubles of Chronic Fatigue Syndrome Start With Defining It|last=Tuller|first=David|date=2011-03-04|work=The New York Times|access-date=2019-08-14|language=en-US|issn=0362-4331}} </ref><ref>http://www.nytimes.com/2011/03/15/health/15letters-STUDYINGAFAT_LETTERS.html </ref>

Tuller is sympathetic toward the cause of the [[ME/CFS|myalgic encephalomyelitis/chronic fatigue syndrome]] (ME/CFS) patient community. In an article in 2015 he wrote:

<blockquote>"In the course of my reporting, I’d realized that the disease was both devastating and widely misunderstood. People were really, really sick—some were homebound for months and years at a stretch. Yet their condition had been saddled with one of the most condescending names ever given a major illness."<ref>{{Cite web|url=https://alumni.berkeley.edu/california-magazine/just-in/2015-11-30/reporter-excoriates-chronic-fatigue-syndrome-study-i-stopped|title=Reporter Excoriates Chronic Fatigue Syndrome Study: I Stopped at 14,000 Words-Enough Was Enough|date=2015-11-18|website=Cal Alumni Association|access-date=2019-08-14}}</ref></blockquote>

In June 2017 after writing dozens of articles and organizing open letters on the PACE trial, David Tuller sought crowdfunding help from the patient community to continue his work on investigating the PACE trial. MEAction had an exclusive interview about his crowdfunding effort.<ref>[http://www.meaction.net/2017/06/08/interview-with-tuller-on-pace-work/?mc_cid=fd937eaa3d&mc_eid=83ddbd3a71 Tuller on PACE Investigation Plans: Not Beholden to anyone].</ref> He raised it on Crowdrise [https://www.crowdrise.com/virology-blogs-trial-by-error-more-reporting-on-pace-mecfs-and-related-issues1/fundraiser/davidtuller?utm_source=dash-gtwo-cr&utm_platform=twt&utm_device=desktop Virology Blog's Trial By Error: Reporting on PACE, ME/CFS and Related Issues (2017)] and succeeded and actually exceeded his goal within four weeks. The funds raised went to the Center for Scientific Integrity who transferred them to the School of Public Health at University of California, Berkeley, which in turn created a position for Tuller to continue his investigative work.<ref>{{Cite web|url=https://www.crowdrise.com/virology-blogs-trial-by-error-more-reporting-on-pace-mecfs-and-related-issues1/fundraiser/davidtuller|title=Click here to support Virology Blog's Trial By Error: Reporting on PACE, ME/CFS and Related Issues by David Tuller|website=CrowdRise|language=en|access-date=2019-08-14}}</ref><ref>{{Cite web|url=https://www.facebook.com/thisweekinvirology/posts/1422844667771846|title=This Week in Virology|website=www.facebook.com|language=en|access-date=2019-08-14}}</ref>

In 2018, Tuller is renewing his crowdfunding campaign in order to continue his work on writing and speaking to raise awareness about ME/CFS and the error-ridden PACE trial.

Tuller began 2019 by covering the [[UK Parliament Commons Chamber debate 24th January 2019|UK Parliament Appropriate ME Treatment debate]], criticizing both the UK government response from Under-secretary [[Steve Brine]], and the [[ME/CFS]] training course offered by the [[Royal College of General Practitioners]] which Steve Brine had praised during the debate.<ref name="stevebrine">{{Cite web|url=http://www.virology.ws/2019/01/28/trial-by-error-steve-brines-troubling-claim-in-parliamentary-debate-on-me/|title=Trial By Error: Steve Brine’s Troubling Claim in Parliamentary Debate on ME|last=Tuller|first=David|authorlink=David Tuller|last2=|first2=|authorlink2=|date=Jan 28, 2018|website=[[Virology blog]]|archive-url=|archive-date=|dead-url=|access-date=2019-01-28}}</ref>

==Education==

*2005, Masters in Public Health from University of California, Berkeley<ref>{{Cite web|url=https://journalism.berkeley.edu/person/david_tuller/|title=David Tuller|website=UC Berkeley Graduate School of Journalism|language=en-US|access-date=2019-08-14}}</ref>
*Doctor of Public Health

==Awards==

*2016, [[IACFS/ME]] Special Service Award - for outstanding personal effort and contribution to the CFS/ME community<ref>{{Cite web|url=https://www.iacfsme.org/iacfs-me-awardees|title=IACFS/ME Awardees|website=
IACFS/ME|access-date=2020-04-23}}</ref>
*2016, [[Tymes Trust]] Award for Scientific Journalism<ref>{{Cite web|url=https://www.facebook.com/tymestrust/photos/a.1484669648484839/1823344051284062/?type=3|title=Tymes Trust|website=www.facebook.com|language=en|access-date=2019-08-14}}</ref>

==Talks and interviews==

*Feb 6, 2011 - Virology blog podcast: [http://www.twiv.tv/2011/02/06/twiv-119-science-and-journalism-with-david-tuller/ TWiV 119: Science and journalism with David Tuller]. Dr. Tuller appeared as a guest on [[Vincent Racaniello]]'s podcast.
*Feb 27, 2016 - [https://www.youtube.com/watch?v=UN1bYhkDHA4&feature=youtu.be Discussed the flaws of the Pace trial] with [[Frank Twisk]] while in Amsterdam at The [[Forgotten Plague]] Conference.
*Feb 28, 2016 - [https://www.youtube.com/watch?v=1fS6Gzc52VI Speech on PACE Trial with Q&As] in Amsterdam.
*Jul 10, 2016 - Virology blog Podcast: [http://www.microbe.tv/twiv/twiv-397/ TWiV 397: Trial by Error] Dr. Tuller speaks at length and in detail about the [[PACE trial]] (calling the PACE Trial preposterous and a pack of nonsense, and a piece of crap) and [[FINE trial]], ''[[The Lancet]]'', ''[[British Medical Journal]]'' (BMJ) and ''[[PLOS ONE]]'', patients being ill yet deconstructing the PACE Trial, how [[ME/CFS]] is a disease being treated inappropriately with [[Exercise]], [[GET]] and [[CBT]], touches on the [[Institute of Medicine report]] and [[SEID]], [[Valerie Eliot Smith]] and [[Karina Hansen]], and more.<ref>{{Cite web|url=http://www.microbe.tv/twiv/twiv-397/|title=TWiV 397: Trial by Error {{!}} This Week in Virology|language=en-US|access-date=2019-08-14}}</ref>
*Aug 21, 2016 - Virology blog Podcast: [http://www.microbe.tv/twiv/twiv-403/ TWiV 403: It’s not easy being vaccine] Discussion with David Tuller regarding PACE trial at 00.17.38- 00.23.57.
*Oct 29, 2016 - Undark Podcast [http://undark.org/2016/10/31/undark-podcast-chronic-fatigue/ #8: Worse Than the Disease] Dr. Tuller discusses [[Graded Exercise Therapy]] (GET) "a therapy commonly prescribed for chronic fatigue syndrome — one for which supporting research is now unraveling."
*Feb 20, 2017 - [[Chronic Fatigue: Missing Millions (Carte Blanche DSTV)]]
*30th May 2017 - Hope 4 ME & Fibro Northern Ireland Seeking Solutions conference took place in the Long Gallery, Stormont, Northern Ireland government headquarters. David Tuller presented an overview of the PACE Trial to medical professionals, health commissioners and MLAs (members of the legislative assembly)
*May 31, 2017 - [[Virology blog]] Podcast: [http://www.microbe.tv/twiv/twivs-tuller3/ TWiV Special: Trial by Error, Continued] David Tuller returns to discuss the continuing saga of the UK’s [[PACE trial]] for [[chronic fatigue syndrome]], including the accusation that he is engaging in libelous blogging.
*May 2017 - [https://www.youtube.com/watch?v=xbikuCqoD98 Interview with David Tuller PhD, Dublin, May 2017]
*June 1, 2017, Pre-Conference Dinner Speaker at the 12th [[Invest in ME International ME Conference]] on "#TearItUp" on his analysis of the [[Pace trial]]<ref>{{Cite web|url=http://investinme.org/cindex.shtml|title=Invest in ME Research - International ME Conferences and Colloquiums Home Page|website=investinme.org|access-date=2019-08-14}}</ref>
:*[https://www.youtube.com/watch?v=6zWnVB_2lUU&feature=youtu.be Video of pre-conference dinner presentation]
*Oct 14, 2017, [http://www.microbe.tv/twiv/twivs-tuller4/ TWiV Special: Tear it up with David Tuller], interviewed by [[Vincent Racaniello]]
*Dec 26, 2017, [http://anilvanderzee.com/david-tuller-and-the-space-cake-eaters/ David Tuller and the (s)PACE cake eaters] interviewed by Anil van der Zee
*Mar 2018 - [https://www.facebook.com/EmergeAustraliaInc/videos/10156242916534111/?fref=mentions&pnref=story Talk] with [[Emerge Australia]]
*Apr 15, 2018 - [http://radioadelaide.org.au/2018/04/15/me-cfs-debunking-medical-myths/ ME/CFS – Debunking Medical Myths], A Conversation between Sue Gilbey, Dr David Tuller, Penelope McMillan & Tania Emms, highlighting the challenges of living with ME/CFS on Radio Adelaide
*Apr 16, 2018 - [https://www.6pr.com.au/podcast/u-s-journalist-raising-awareness-for-chronic-fatigue/ U.S. Journalist raising awareness for Chronic Fatigue] interviewed on ''Perth Tonight with Chris Ilsley''
*Nov 15, 2018, [https://www.youtube.com/watch?v=21oP6WRZy2A ME/CFS Alert Episode 102] - Interviewed by [[Llewellyn King]]
*Jan 22, 2020 - [https://www.virology.ws/2020/01/22/trial-by-error-my-talk-last-october-at-oxford-video/ Trial By Error: My Talk Last October in Oxford (Video)]

==Writings about ME/CFS==

'''[[Trial By Error]] on Virology Blog''' (Older posts can be found on [[Trial By Error]])

=== 2020 ===
* Jan 7, 2020 - [https://www.virology.ws/2020/01/07/trial-by-error-some-more-thoughts-on-functional-neurological-disorder/ Trial By Error: Some More Thoughts on Functional Neurological Disorder]
* Jan 8, 2020 - [https://www.virology.ws/2020/01/08/trial-by-error-the-danish-me-associations-open-letter/ Trial By Error: The Danish ME Association’s Open Letter]
* Jan 8, 2020 - [https://www.virology.ws/2020/01/08/trial-by-error-nih-funding-needs-life-support-says-jennie-spotila/ Trial By Error: NIH Funding “Needs Life Support,” Says Jennie Spotila]
* Jan 13, 2020 - [https://www.virology.ws/2020/01/13/trial-by-error-the-uks-proposed-genetics-study/ Trial By Error: The UK’s Proposed Genetics Study]
* Jan 13, 2020 - [https://www.virology.ws/2020/01/13/trial-by-error-the-2018-pace-reanalysis-and-the-smcs-expert-appraisals/ Trial By Error: The 2018 PACE Reanalysis and the SMC’s Expert Appraisals]
* Jan 15, 2020 - [https://www.virology.ws/2020/01/15/trial-by-error-cbt-provides-no-benefits-to-advanced-cancer-patients-study-finds/ Trial By Error: CBT Provides No Benefit for Advanced Cancer Patients, Study Finds]
* Jan 22, 2020 - [https://www.virology.ws/2020/01/22/trial-by-error-my-talk-last-october-at-oxford-video/ Trial By Error: My Talk Last October in Oxford (Video)]
* Jan 24, 2020 - [https://www.virology.ws/2020/01/24/trial-by-error-cbt-and-irritable-bowel-syndrome/ Trial By Error: CBT and Irritable Bowel Syndrome]
* Jan 27, 2020 - [https://www.virology.ws/2020/01/27/trial-by-error-my-foi-request-to-kings-college-london-my-letter-to-mahana-therapeutics/ Trial By Error: My FOI Request to King’s College London; My Letter to Mahana Therapeutics]
* Jan 27, 2020 - [https://www.virology.ws/2020/01/27/trial-by-error-a-commercial-deal-for-kings-college-londons-ibs-cbt-digital-program/ Trial By Error: A Commercial Deal for King’s College London’s IBS-CBT Digital Program]
* Jan 28, 2020 - [https://www.virology.ws/2020/01/28/trial-by-error-more-on-the-mahana-therapeutics-deal/ Trial By Error: More on the Mahana Therapeutics Deal]
* Feb 3, 2020 - [https://www.virology.ws/2020/02/03/trial-by-error-my-letter-to-professor-moss-morris/ Trial By Error: My Letter to Professor Moss-Morris]
* Feb 5, 2020 - [https://www.virology.ws/2020/02/05/trial-by-error-my-letter-to-one-of-mahanas-gastroenterology-advisors/ Trial By Error: My Letter to One of Mahana’s Gastroenterology Advisors]
* Feb 10, 2020 - [https://www.virology.ws/2020/02/10/trial-by-error-my-follow-up-letter-to-professor-rona-moss-morris/ Trial By Error: My Follow-Up Letter to Professor Rona Moss-Morris]
* Feb 11, 2020 - [https://www.virology.ws/2020/02/11/trial-by-error-my-letter-to-two-more-mahana-gi-advisors/ Trial By Error: My Letter to Two More Mahana GI Advisors]
* Feb 11, 2020 - [https://www.virology.ws/2020/02/11/trial-by-error-my-letter-to-mahanas-ceo-and-co-founder/ Trial By Error: My Letter to Mahana’s CEO and Co-Founder]
* Feb 17, 2020 - [https://www.virology.ws/2020/02/17/trial-by-error-my-follow-up-letter-to-mahana-therapeutics-ceo/ Trial By Error: My Follow-up Letter to Mahana Therapeutic’s CEO]
* Feb 19, 2020 - [https://www.virology.ws/2020/02/19/trial-by-error-an-australian-radio-interview-with-melbournes-dr-mark-guthridge/ Trial By Error: An Australian Radio Interview with Melbourne’s Mark Guthridge]
* Feb 24, 2020 - [https://www.virology.ws/2020/02/24/trial-by-error-another-letter-about-mahana-berkeleywellness-on-ibs-study/ Trial By Error: Another Letter About Mahana; BerkeleyWellness on IBS Study]
* Feb 25, 2020 - [https://www.virology.ws/2020/02/25/trial-by-error-simon-mcgrath-on-leonard-jasons-study-of-us-pediatric-prevalence/ Trial By Error: Simon McGrath on Leonard Jason’s Study of US Pediatric Prevalence]
* March 2, 2020 - [https://www.virology.ws/2020/03/02/trial-by-error-new-biopsychosocial-study-of-fatigue-in-hiv-patients/ Trial By Error: New Biopsychosocial Study of Fatigue in HIV Patients]
* March 16, 2020 - [https://www.virology.ws/2020/03/16/trial-by-error-my-virtual-appearance-in-sheffield/ Trial By Error: My Virtual Appearance in Sheffield]
* March 18, 2020 - [https://www.virology.ws/2020/03/18/trial-by-error-what-now/ Trial By Error: What Now?]
* March 26, 2020 - [https://www.virology.ws/2020/03/26/trial-by-error-some-coronavirus-advice-from-me-associations-dr-charles-shepherd/ Trial By Error: Some Coronavirus Advice from ME Association’s Charles Shepherd]
* April 2, 2020 - [https://www.virology.ws/2020/04/02/trial-by-error-a-long-time-patient-reflects-on-a-stay-at-home-world/ Trial By Error: A Long-Time Patient Reflects on a Stay-at-Home World]
* April 3, 2020 - [https://www.virology.ws/2020/04/03/trial-by-error-thoughts-on-self-isolation-from-anil-van-der-zee/ Trial By Error: Thoughts on Self-Isolation from Anil van der Zee]
* April 7, 2020 - [https://www.virology.ws/2020/04/07/trial-by-error-a-non-covid-post-about-kcls-rejection-of-my-foi-request/ Trial By Error: A Non-COVID Post about KCL’s Rejection of My FOI Request]
* April 8, 2020 - [https://www.virology.ws/2020/04/08/trial-by-error-a-post-about-lupus-and-mus-not-covid/ Trial By Error: A Post About Lupus and MUS, Not COVID]
* April 9, 2020 - [https://www.virology.ws/2020/04/09/trial-by-error-my-visits-with-alem-matthees-reprise/ Trial By Error: My Visits with Alem Matthees (Reprise)]
* April 13, 2020 - [https://www.virology.ws/2020/04/13/trial-by-error-berkeley-crowdfunding-month-coronavirus-edition/ Trial By Error: Berkeley Crowdfunding Month, Coronavirus Edition]
* April 15, 2020 - [https://www.virology.ws/2020/04/15/trial-by-error-revisiting-mahana-and-irritable-bowel-syndrome/ Trial By Error: Revisiting Mahana and Irritable Bowel Syndrome…]
* April 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]
* April 18, 2020 - [https://www.virology.ws/2020/04/18/trial-by-error-my-foi-letter-about-oxfords-post-covid-19-fatigue-pamphlet/ Trial By Error: My FOI Letter about Oxford’s Post-COVID-19 Fatigue Pamphlet]
* April 18, 2020 - [https://www.virology.ws/2020/04/18/trial-by-error-a-follow-up-to-the-follow-up-letter-to-mahana/ Trial By Error: A Follow-Up to the Follow-Up Letter to Mahana]
* April 20, 2020 - [https://www.virology.ws/2020/04/20/trial-by-error-oxford-health-blinks-removes-pamphlet-on-post-covid-illness/ Trial By Error: Oxford Health Blinks, Removes Pamphlet on Post-COVID Illness]
* April 20, 2020 - [https://www.virology.ws/2020/04/20/trial-by-error-my-follow-up-freedom-of-information-request-to-oxford-health/ Trial By Error: My Follow-Up Freedom-of-Information Request to Oxford Health]
* April 25, 2020 - [https://www.virology.ws/2020/04/25/trial-by-error-more-on-the-mahana-mess/ Trial By Error: More on the Mahana Mess…]
* April 28, 2020 - [https://www.virology.ws/2020/04/28/trial-by-error-another-nudge-to-mahanas-gasteroenterology-advisers/ Trial By Error: Another Nudge to Mahana’s Gasteroenterology Advisers]
* April 30, 2020 - [https://www.virology.ws/2020/04/30/trial-by-error-a-letter-to-mahana-therapeutics-nhs-adviser/ Trial By Error: A Letter to Mahana’s NHS-Linked Business Adviser]
* May 2, 2020 - [https://www.virology.ws/2020/05/02/trial-by-error-oxford-healths-response-to-my-freedom-of-information-request/ Trial By Error: Oxford Health’s Response to My Freedom of Information Request]
* May 2, 2020 - [https://www.virology.ws/2020/05/02/trial-by-error-norways-proposed-lightning-process-trial/ Trial By Error: Norway’s Proposed Lightning Process Trial]
* May 5, 2020 - [https://www.virology.ws/2020/05/05/trial-by-error-my-letter-to-ibs-studys-corresponding-author/ Trial By Error: My Letter to IBS Study’s Corresponding Author]
* May 6, 2020 - [https://www.virology.ws/2020/05/06/trial-by-error-merck-manual-still-disseminates-get-cbt-advice/ Trial By Error: Merck Manual Still Disseminates GET/CBT Advice]
* May 8, 2020 - [https://www.virology.ws/2020/05/08/trial-by-error-valerie-eliot-smith-on-covid-19-me-and-legal-repercussions/ Trial By Error: Valerie Eliot Smith on COVID-19, ME and Legal Repercussions]
* May 12, 2020 - [https://www.virology.ws/2020/05/12/trial-by-error-today-is-may-12th-and-everyones-missing/ Trial By Error: Today is May 12th and Everyone’s Missing]
* May 16, 2020 - [https://www.virology.ws/2020/05/16/trial-by-error-more-on-that-norwegian-cbt-music-therapy-study/ Trial By Error: More on that Norwegian CBT/Music Therapy Study]
* May 20, 2020 - [https://www.virology.ws/2020/05/18/trial-by-error-more-strangeness-with-that-norwegian-cbt-music-therapy-study/ Trial By Error: More Strangeness with that Norwegian CBT/Music Therapy Study]
* May 20, 2020 - [https://www.virology.ws/2020/05/20/trial-by-error-norways-double-whammy-of-fuzzy-science/ Trial By Error: Norway’s Double Whammy of Fuzzy Science]
* May 22, 2020 - [https://www.virology.ws/2020/05/22/trial-by-error-my-letter-to-senior-author-of-norways-cbt-music-therapy-study/ Trial By Error: My Letter to Senior Author of Norway’s CBT-Music Therapy Study]
* May 28, 2020 - [https://www.virology.ws/2020/05/28/trial-by-error-tacks-take-on-bmjs-cbt-music-therapy-feasibility-study/ Trial by Error: Tack’s Take on BMJ’s CBT-Music Therapy “Feasibility Study”]
* May 28, 2020 - [https://www.virology.ws/2020/05/28/trial-by-error-my-letter-to-peer-reviewer-of-bmjs-cbt-music-therapy-paper/ Trial By Error: My Letter to Peer Reviewer of BMJ’s CBT-Music Therapy Paper]
* May 30, 2020 - [https://www.virology.ws/2020/05/30/trial-by-error-two-letters-to-dagbladet-about-its-me-coverage/ Trial By Error: Two Letters to Dagbladet About Its ME Coverage]
* May 31, 2020 - [https://www.virology.ws/2020/05/31/trial-by-error-letter-to-bmj-paediatrics-open-about-that-cbt-music-therapy-study/ Trial By Error: Letter to BMJ Paediatrics Open About that CBT-Music Therapy Study]
* June 2, 2020 - [https://www.virology.ws/2020/06/02/trial-by-error-a-couple-of-blog-posts-worth-reading/ Trial By Error: A Couple of Blog Posts Worth Reading]
* June 3, 2020 - [https://www.virology.ws/2020/06/03/trial-by-error-a-response-from-dagbladet/ Trial By Error: A Response from Dagbladet]
* June 9, 2020 - [https://www.virology.ws/2020/06/09/trial-by-error-coupla-more-posts-worth-reading/ Trial By Error: Coupla More Posts Worth Reading]
* June 11, 2020 - [https://www.virology.ws/2020/06/11/trial-by-error-a-kings-college-london-press-release-hides-the-bad-news/ Trial By Error: A King’s College London Press Release Hides the Bad News]
* June 15, 2020 - [https://www.virology.ws/2020/06/15/trial-by-error-another-letter-to-kcl-another-letter-to-bmj/ Trial By Error: A Letter to KCL, Another Letter to BMJ]
* June 17, 2020 - [https://www.virology.ws/2020/06/17/trial-by-error-trio-of-trials-shows-limits-of-cbt-for-medically-unexplained-symptoms/ Trial By Error: Trio of Trials Shows Limits of CBT for Medically Unexplained Symptoms]
* June 18, 2020 - [https://www.virology.ws/2020/06/18/trial-by-error-bmj-responds-to-appeals-about-norways-cbt-music-therapy-study/ Trial By Error: BMJ Responds to Appeals About Norway’s CBT-Music Therapy Study]
* June 23, 2020 - [https://www.virology.ws/2020/06/23/trial-by-error-more-questions-about-codes-trial-of-cbt-for-seizures/ Trial By Error: More Questions About CODES Trial of CBT for Seizures]
* June 25, 2020 - [https://www.virology.ws/2020/06/25/trial-by-error-uk-funds-genetics-project-my-letter-to-codes-investigators/ Trial By Error: UK Funds Genetics Project; My Letter to CODES Investigators]
* June 26, 2020 - [https://www.virology.ws/2020/06/26/trial-by-error-codes-trial-commentary-promotes-eminence-based-medicine/ Trial By Error: CODES Trial Commentary Promotes ‘Eminence-Based Medicine’]
* June 27, 2020 - [https://www.virology.ws/2020/06/27/trial-by-error-my-letter-to-author-of-codes-commentary/ Trial By Error: My Letter to Author of CODES Commentary]
* June 30, 2020 - [https://www.virology.ws/2020/06/30/trial-by-error-a-few-interesting-studies/ Trial By Error: A Few Interesting Studies]
* July 2, 2020 - [https://www.virology.ws/2020/07/02/trial-by-error-now-theres-cbt-for-health-anxiety-in-cfs/ Trial By Error: Now There’s CBT for ‘Health Anxiety’ in CFS]
* July 3, 2020 - [https://www.virology.ws/2020/07/03/trial-by-error-nudge-for-bmj-about-music-therapy-letter-to-health-anxiety-expert/ Trial By Error: Nudge for BMJ About Music Therapy; Letter to “Health Anxiety” Expert]
(Older blog entries can be found on the [[Trial By Error]] page.)

==New York Times==
*Jul 17, 2007 - [http://www.nytimes.com/2007/07/17/science/17fatigue.html Chronic Fatigue No Longer Seen as 'Yuppie Flu']
*May 30, 2008 - [http://www.nytimes.com/ref/health/healthguide/esn-chronicfatigue-questions.html What to Ask About Chronic Fatigue Syndrome]
*May 30, 2008 - [http://www.nytimes.com/ref/health/healthguide/esn-chronicfatigue-expert.html Learning Firsthand About Chronic Fatigue Syndrome]
*Aug 24, 2010 - [http://query.nytimes.com/gst/fullpage.html?res=9C00E4DB1439F937A1575BC0A9669D8B63 Study Links Chronic Fatigue to Virus Class]
*Jan 3, 2011 - [http://www.nytimes.com/2011/01/04/health/04fatigue.html Exhausted by Illness, and Doubts]
*Feb 17, 2011 - [http://www.nytimes.com/2011/02/18/health/research/18fatigue.html Psychotherapy Eases Chronic Fatigue Syndrome, Study Finds]
*Mar 4, 2011 - [http://www.nytimes.com/2011/03/08/health/research/08fatigue.html Defining an Illness Is Fodder for Debate]
*Jun 1, 2011 - [http://www.nytimes.com/2011/06/01/health/research/01fatigue.html?_r=1 2 Studies Examine Syndrome of Fatigue]
*Sep 22, 2011 - [http://www.nytimes.com/2011/09/23/health/research/23fatigue.html Viral Theory Is Set Back in Chronic Fatigue Syndrome Study]
*Dec 22, 2011 - [http://www.nytimes.com/2011/12/23/health/research/science-journal-retracts-chronic-fatigue-syndrome-paper.html?ref=research Fatigue Syndrome Study Is Retracted by Journal]
*Dec 26, 2011 - [http://www.nytimes.com/2011/12/27/health/research/scholars-retract-another-study-linking-xmrv-to-chronic-fatigue-syndrome.html Scholars Retract Another Study Linking Virus to Fatigue Syndrome]
*Feb 6, 2012 - [http://www.nytimes.com/2012/02/07/health/fallout-from-fatigue-syndrome-retraction-is-far-and-wide.html?pagewanted=1&_r=1 Fallout From Fatigue Syndrome Retraction Is Wide]
*Sep 18, 2012 - [http://well.blogs.nytimes.com/2012/09/18/chronic-fatigue-syndrome-back-to-square-1/ Chronic Fatigue Syndrome Back to Square 1]
*Nov 24, 2014 - [[Brains of People With Chronic Fatigue Syndrome Offer Clues About Disorder - New York Times: Well (2014)]]
*Feb 10, 2015 - [http://well.blogs.nytimes.com/2015/02/10/chronic-fatigue-syndrome-gets-a-new-name/ Chronic Fatigue Syndrome Gets a New Name]
*Mar 18, 2017 - [https://www.nytimes.com/2017/03/18/opinion/sunday/getting-it-wrong-on-chronic-fatigue-syndrome.html?smid=tw-share&_r=0 Getting It Wrong on Chronic Fatigue Syndrome] (with [[Julie Rehmeyer]]) and Letters of response' [https://mobile.nytimes.com/2017/03/27/opinion/understanding-and-treating-chronic-fatigue.html?em_pos=small&emc=edit_ty_20170327&nl=opinion-today&nl_art=14&nlid=77538787&ref=headline&te=1&referer= Letters - The New York Times]

==Other print media==

*Jan 27, 2014 - [http://www.buzzfeed.com/davidtuller/chronic-fatigue-syndrome#.tnegBjJ82 How 'Chronic Fatigue Syndrome' Obscures A Serious Illness] ''Buzzfeed''
*Nov 18, 2015 - [http://alumni.berkeley.edu/california-magazine/just-in/2015-11-18/reporter-excoriates-chronic-fatigue-syndrome-study-i-stopped Reporter Excoriates Chronic Fatigue Syndrome Study: "I Stopped at 14,000 Words-Enough Was Enough"] ''California Magazine''
*Oct 27, 2016 - [http://undark.org/article/chronic-fatigue-graded-exercise-pace/ Worse Than the Disease] ''Undark''
*Apr 27, 2017 - [http://journals.sagepub.com/doi/full/10.1177/1359105317703788 Once again, the PACE authors respond to concerns with empty answers] ''Journal of Health Psychology''
*Jul 26, 2017 - [https://undark.org/2017/07/26/cdc-chronic-fatigue-graded-exercise/ CDC Removes Reference to Disputed ME/CFS Therapies From Website] ''Undark''
* Sep 25, 2017 - [https://www.statnews.com/2017/09/25/chronic-fatigue-syndrome-cdc/ Why did it take the CDC so long to reverse course on debunked treatments for chronic fatigue syndrome?] ''StatNews'' by David Tuller and [[Julie Rehmeyer]]
*2018 - Rethinking the treatment of chronic fatigue syndrome—A reanalysis and evaluation of findings from a recent major trial of graded exercise and CBT<ref name="Wilshire, 2018">{{Citation
|last1= Wilshire | first1 = C | authorlink1 = Carolyn Wilshire
|last2= Kindlon | first2 = T | authorlink2 = Tom Kindlon
|last3= Courtney | first3 = R | authorlink3 = Robert Courtney
|last4= Matthees | first4 = A | authorlink4 = Alem Matthees
|last5= Tuller | first5 = D | authorlink5 = David Tuller
|last6= Geraghty | first6 = K | authorlink6 = Keith Geraghty
|last7= Levin | first7 = B | authorlink7 = Bruce Levin
|title= Rethinking the treatment of chronic fatigue syndrome—A reanalysis and evaluation of findings from a recent major trial of graded exercise and CBT
|journal= ResearchGate | volume =| issue = | page =
|date= 2018|doi=10.1186/s40359-018-0218-3 |url=https://bmcpsychology.biomedcentral.com/articles/10.1186/s40359-018-0218-3}}</ref> [https://bmcpsychology.biomedcentral.com/articles/10.1186/s40359-018-0218-3 (Full Text)]
*2019 - The 'Cognitive Behavioural Model' of Chronic Fatigue Syndrome: Critique of a Flawed Model<ref>{{Cite journal|last=Geraghty|first=Keith|author-link=Keith Geraghty|last2=Jason|first2=Leonard|author-link2=Leonard Jason|last3=Sunnquist|first3=Madison|author-link3=Madison Sunnquist|last4=Blease|first4=Charlotte|author-link4=Charlotte Blease|last5=Tuller|first5=David|author-link5=David Tuller|last6=Adeniji|first6=Charles|author-link6=|date=Feb 2019|title=The 'Cognitive Behavioural Model' of Chronic Fatigue Syndrome: Critique of a Flawed Model. Journal of Health Psychology.|url=https://www.researchgate.net/publication/330901648_The_'Cognitive_Behavioural_Model'_of_Chronic_Fatigue_Syndrome_Critique_of_a_Flawed_Model|journal=Journal of Health Psychology|volume=|issue=|pages=|quote=|via=}}</ref> [https://www.researchgate.net/publication/330901648_The_'Cognitive_Behavioural_Model'_of_Chronic_Fatigue_Syndrome_Critique_of_a_Flawed_Model (Abstract)]
*July 21, 2020 - [https://www.statnews.com/2020/07/21/chronic-fatigue-syndrome-keys-understanding-post-covid-syndrome/ Chronic fatigue syndrome may hold keys to understanding post-Covid syndrome] ''StatNews'' by David Tuller and [[Steven Lubet]]

==Online presence==

*[http://www.twitter.com/davidtuller1 Twitter]
*[https://www.researchgate.net/profile/David_Tuller ResearchGate]

== See also ==
* [[Intimidation of PACE critics]]

* [[Trial By Error|Trial By Error blog]]

==Learn more==

*[http://www.berkeleywellness.com/author/davidtullerdrph Berkeley Wellness - David Tuller]

==References==
{{reflist}}

[[Category:Journalists]]
[[Category:Advocates or allies]]
[[Category:Psychological paradigm critics]]
[[Category:PACE trial critics]]
[[Category:American advocates or allies]]

Post-COVID-19 illness

2020-07-21T12:16:34Z

Loopy:/* Fatigue after COVID-19 */ moved information under another heading

[[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 [[Coronavirus disease 19|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> One small study from Wuhan, China, found that survivors of [[Coronavirus disease 19|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>

===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 is uncertainty about whether this is a relapse due to the virus remaining at low levels in the body and bring reactivated, or if this is a reinfection.{{citation needed}}

==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=PMC3071317|pmid=21435231}}</ref>

==Severe COVID-19 survivors==

===ICU survivors===
[[File:Post-COVID-19 ventilators.png|alt=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)|left|frameless]]
{{Clear|both}}
[[File:Post intensive care syndrome.png|thumb|Post Intensive Care Syndrome symptoms. Source: [https://medicaljournals.se/jrm/content/html/10.2340/16501977-2677 J Rehabil Med 2020; 52: jrm00044]. License: CC-BY NC.]]
<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>{{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|last=H J|first=Stam|authorlink=|last2=G|first2=Stucki|authorlink2=|date=2020-04-15|website=Journal of rehabilitation medicine|language=en|doi=10.2340/16501977-2677|pmid=32286675|archive-url=|archive-date=|dead-url=|access-date=2020-04-23|last3=J|first3=Bickenbach|volume=52|issue=4}}</ref>

===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|last2=|first2=|authorlink2=|date=2020-02-11|website=Centers for Disease Control and Prevention|language=en-us|archive-url=|archive-date=|dead-url=|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.{{citation needed}}

===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|last2=|first2=|authorlink2=|date=2017-10-17|website=nhs.uk|language=en|archive-url=|archive-date=|dead-url=|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===
Invasive ventilation using a mechanical ventilator was needed by 47-71% of patients admitted to Intensive Care Units.<ref name="JH-ABX-540747" />

===COVID-19 complications===
These include:
*Anecdotal reports of DVT and PE 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:
**secondary infections including [[bacteria]]l and [[fungal infection]]s
**thromboembolism
**gastrointestinal bleeding
**critical illness polyneuropathy/myopathy.<ref name="JH-ABX-540747" /><ref name="CDC-clinicalguide" />

==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.|author-link=Keiji Fukuda|last2=Straus|first2=S. E.|author-link2=Stephen Straus|last3=Hickie|first3=I.|author-link3=Ian Hickie|last4=Sharpe|first4=M. C.|author-link4=Michael Sharpe|last5=Dobbins|first5=J. G.|author-link5=James Dobbins|last6=Komaroff|first6=A.|author-link6=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
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| last7 = Staines | first7 = D | authorlink7 = Donald Staines
| last8 = Powles | first8 = ACP | authorlink8 = A C Peter Powles
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| last10 = Vallings | first10= R | authorlink10= Rosamund Vallings
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| 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
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| 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
| url = http://www.investinme.org/Documents/PDFdocuments/CanadianDefinitionME-CFS.pdf
}}</ref><ref name="fukuda1994" />

== Potential brain damage ==
Scientists warn of a potential wave of coronavirus-related brain damage as new evidence suggests [[Coronavirus disease 19|COVID-19]] can lead to severe [[Nervous system|neurological]] complications, including [[brain inflammation]], [[psychosis]] and [[delirium]].<ref name=":1">{{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><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=":1" /></blockquote>

=== Notable studies ===
* Jul 8, 2020, The emerging spectrum of COVID-19 neurology: clinical, radiological and laboratory findings<ref name=":0">{{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|language=en|doi=10.1093/brain/awaa240}}</ref>
<blockquote>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.</blockquote><blockquote>The research adds to recent studies which also found the disease can damage the brain.<ref name=":0" /></blockquote>

==Post-viral syndrome==
'''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]], [[Brain fog|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|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 [[Coronavirus disease 19|COVID-19]] patients may have [[Myalgic encephalomyelitis|ME]], also known as [[chronic fatigue syndrome]], or [[ME/CFS]].<ref>{{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=":2">{{Cite web|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=CNN|first=By <a href="/profiles/joshua-berlinger">Joshua Berlinger</a>, <a href="/profiles/brett-mckeehan">Brett McKeehan</a>, <a href="/profiles/ivana-kottasova">Ivana Kottasová</a>, Ed Upright, <a href="/profiles/meg-wagner">Meg Wagner</a> and Melissa Macaya|date=2020-07-09|website=CNN|language=en|access-date=2020-07-21}}</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=":2" />

==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]]
[[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=www.who.int|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=www.cdc.gov|author-link=Centers for Disease Control|date=|access-date=Apr 17, 2020|first=|last2=|first2=|authorlink2=|archive-url=|archive-date=|dead-url=}}</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)}}

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|Chronic fatigue syndrome}}

==Treatment==
No treatment studies have yet been published, despite this and the uncertainty over long term physical and psychological health consequences of coronavirus disease 19 (COVID-19), some self-help advice has already been published.<ref name="openletter20042020" />

A group of over 20 [[Myalgic encephalomyelitis|ME]] and [[chronic fatigue syndrome]] specialists and patient groups have recommended [[fatigue]] following COVID-19 should be treated/managed using:
*activity [[pacing]]
*nutrition and
*[[sleep hygiene]], stating that should help reduce the risk of developing ME/CFS after COVID-19.<ref name="Vink2019">{{Cite journal|last=Vink|last2=Vink-Niese|date=2019-09-20|title=Work Rehabilitation and Medical Retirement for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Patients. A Review and Appraisal of Diagnostic Strategies|url=https://www.mdpi.com/2075-4418/9/4/124|journal=Diagnostics|language=en|volume=9|issue=4|pages=124|doi=10.3390/diagnostics9040124|issn=2075-4418|first=Mark|first2=Alexandra|pmc=|pmid=|author-link=Mark Vink|author-link2=Alexandra Vink-Niese|access-date=|via=}}</ref><ref name="openletter20042020" />

===Pacing===
Less controversially, the self-help leaflet mentions [[pacing]], a symptom-management approach also without evidence for COVID-19 survivors, but which is used by many people with chronic fatigue, chronic pain, and/or persistent illness that limits their everyday activities.<ref name="TullerOx16apr2020" /> ME patient associations surveys have found pacing helped most, but not all, patients.<ref name="forwardme-survey" /><ref name="IIMER-NICE" />
{{See also|Pacing}}

===CBT and GET not recommended for fatigue===
The Oxford Health NHS Foundation Trust published a ''Coping with Coronavirus: Fatigue'' leaflet referring to [[chronic fatigue syndrome]], a neurological disease, as a possible ''[[mental health]]'' consequence of COVID-19, and confusing fatigue after COVID-19 illness with [[chronic fatigue syndrome]]. The leaflet recommenddations included the highly controversial use of [[cognitive behavioral therapy]] (CBT) and graded exercise therapy (GET) to address the physical symptoms of chronic fatigue syndrome. The leaflet was withdrawn after public health expert [[David Tuller]] asked for the evidence based used by it, details of its authorship, and strongly criticised the advice given in it. An [[Opposition to Oxford Health NHS Foundation Trust: "Coping with Coronavirus: Fatigue"|open letter opposing the leaflet]] was signed by a large number of medical professionals and UK patient groups at around the same time.<ref name="openletter20042020" />

CBT for fatigue is a psychological therapy focused on treating a presumed [[illness beliefs|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]], [[MEAction]], 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=actionforme.org.uk}}</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=www.investinme.org|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|last2=|first2=|authorlink2=|date=2017-10-24|website=nhs.uk|language=en|archive-url=|archive-date=|dead-url=|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|last2=|first2=|authorlink2=|date=2018-07-18|website=nhs.uk|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-04-29}}</ref>

{{See also|Cognitive behavioral therapy}}{{See also|Graded exercise therapy}}

==Recovery advice==
* [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] - ME Association ''(May 2020)''
* [https://www.physiosforme.com/covid-19 Post Covid-19 Rehabilitation] - Physios for ME, Workwell Foundation, and ME Association ''(May 2020)''

==Notable studies==
No studies have yet been completed on the impact of COVID-19 on the long term health of survivors, or on treatment approaches.

==News articles and blogs==
* 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 1, 2020, [https://www.wsj.com/articles/three-months-in-these-patients-are-still-ravaged-by-covids-fallout-11593612004 Three Months In, These Patients Are Still Ravaged by Covid’s Fallout] - Wall Street Journal
* May 18, 2020, [https://blogs.bmj.com/bmj/2020/05/19/paul-garner-covid-19-and-fatigue-a-game-of-snakes-and-ladders/ Paul Garner: Covid-19 and fatigue—a game of snakes and ladders] - The BMJ
* 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://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.ws}}</ref>
*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.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|last=Lowenstein|first=Fiona|date=2020-04-13|publisher=New York Times|title=We Need to Talk About What Coronavirus Recoveries Look Like}}</ref> - Fiona Lowenstein, 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]]
*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==
*[[Coronavirus disease 19]] (COVID-19)
*[[Myalgic encephalomyelitis]]
*[[Chronic fatigue syndrome]] - the neurological disease
*[[Postviral fatigue syndrome]]
*[[Chronic fatigue]] - a symptom of many illnesses
*[[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]]
*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=|doi=|oclc=|quote=|archive-url=|archive-date=|location=}}</ref> (book)

==Learn more==
* 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=meassociation.org}}</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=|dead-url=|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
* 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 {{!}} 30 April 2020|date=Apr 30, 2020|last=Charles Shepherd|author-link=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

==References==
{{Reflist}}

[[Category:Diagnoses]]

Post-COVID-19 illness

2020-07-21T12:13:46Z

Loopy:/* Fatigue after COVID-19 */ Dr. Fauci quote in STAT and CNN articles

[[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 [[Coronavirus disease 19|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> One small study from Wuhan, China, found that survivors of [[Coronavirus disease 19|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>

===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 is uncertainty about whether this is a relapse due to the virus remaining at low levels in the body and bring reactivated, or if this is a reinfection.{{citation needed}}

==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=PMC3071317|pmid=21435231}}</ref>

==Severe COVID-19 survivors==

===ICU survivors===
[[File:Post-COVID-19 ventilators.png|alt=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)|left|frameless]]
{{Clear|both}}
[[File:Post intensive care syndrome.png|thumb|Post Intensive Care Syndrome symptoms. Source: [https://medicaljournals.se/jrm/content/html/10.2340/16501977-2677 J Rehabil Med 2020; 52: jrm00044]. License: CC-BY NC.]]
<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>{{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|last=H J|first=Stam|authorlink=|last2=G|first2=Stucki|authorlink2=|date=2020-04-15|website=Journal of rehabilitation medicine|language=en|doi=10.2340/16501977-2677|pmid=32286675|archive-url=|archive-date=|dead-url=|access-date=2020-04-23|last3=J|first3=Bickenbach|volume=52|issue=4}}</ref>

===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|last2=|first2=|authorlink2=|date=2020-02-11|website=Centers for Disease Control and Prevention|language=en-us|archive-url=|archive-date=|dead-url=|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.{{citation needed}}

===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|last2=|first2=|authorlink2=|date=2017-10-17|website=nhs.uk|language=en|archive-url=|archive-date=|dead-url=|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===
Invasive ventilation using a mechanical ventilator was needed by 47-71% of patients admitted to Intensive Care Units.<ref name="JH-ABX-540747" />

===COVID-19 complications===
These include:
*Anecdotal reports of DVT and PE 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:
**secondary infections including [[bacteria]]l and [[fungal infection]]s
**thromboembolism
**gastrointestinal bleeding
**critical illness polyneuropathy/myopathy.<ref name="JH-ABX-540747" /><ref name="CDC-clinicalguide" />

==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.|author-link=Keiji Fukuda|last2=Straus|first2=S. E.|author-link2=Stephen Straus|last3=Hickie|first3=I.|author-link3=Ian Hickie|last4=Sharpe|first4=M. C.|author-link4=Michael Sharpe|last5=Dobbins|first5=J. G.|author-link5=James Dobbins|last6=Komaroff|first6=A.|author-link6=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
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| last16 = Gerken | first16= A | authorlink16= Anne Gerken
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| 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
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}}</ref><ref name="fukuda1994" />

Dr. [[Anthony Fauci]], the [[United States]] top [[infectious disease]] expert, acknowledged that many unrecovered [[Coronavirus disease 19|COVID-19]] patients may have [[Myalgic encephalomyelitis|ME]], also known as [[chronic fatigue syndrome]], or [[ME/CFS]].<ref>{{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=":2">{{Cite web|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=CNN|first=By <a href="/profiles/joshua-berlinger">Joshua Berlinger</a>, <a href="/profiles/brett-mckeehan">Brett McKeehan</a>, <a href="/profiles/ivana-kottasova">Ivana Kottasová</a>, Ed Upright, <a href="/profiles/meg-wagner">Meg Wagner</a> and Melissa Macaya|date=2020-07-09|website=CNN|language=en|access-date=2020-07-21}}</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=":2" />

== Potential brain damage ==
Scientists warn of a potential wave of coronavirus-related brain damage as new evidence suggests [[Coronavirus disease 19|COVID-19]] can lead to severe [[Nervous system|neurological]] complications, including [[brain inflammation]], [[psychosis]] and [[delirium]].<ref name=":1">{{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><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=":1" /></blockquote>

=== Notable studies ===
* Jul 8, 2020, The emerging spectrum of COVID-19 neurology: clinical, radiological and laboratory findings<ref name=":0">{{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|language=en|doi=10.1093/brain/awaa240}}</ref>
<blockquote>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.</blockquote><blockquote>The research adds to recent studies which also found the disease can damage the brain.<ref name=":0" /></blockquote>

==Post-viral syndrome==
'''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]], [[Brain fog|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|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" />

==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]]
[[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=www.who.int|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=www.cdc.gov|author-link=Centers for Disease Control|date=|access-date=Apr 17, 2020|first=|last2=|first2=|authorlink2=|archive-url=|archive-date=|dead-url=}}</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)}}

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|Chronic fatigue syndrome}}

==Treatment==
No treatment studies have yet been published, despite this and the uncertainty over long term physical and psychological health consequences of coronavirus disease 19 (COVID-19), some self-help advice has already been published.<ref name="openletter20042020" />

A group of over 20 [[Myalgic encephalomyelitis|ME]] and [[chronic fatigue syndrome]] specialists and patient groups have recommended [[fatigue]] following COVID-19 should be treated/managed using:
*activity [[pacing]]
*nutrition and
*[[sleep hygiene]], stating that should help reduce the risk of developing ME/CFS after COVID-19.<ref name="Vink2019">{{Cite journal|last=Vink|last2=Vink-Niese|date=2019-09-20|title=Work Rehabilitation and Medical Retirement for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Patients. A Review and Appraisal of Diagnostic Strategies|url=https://www.mdpi.com/2075-4418/9/4/124|journal=Diagnostics|language=en|volume=9|issue=4|pages=124|doi=10.3390/diagnostics9040124|issn=2075-4418|first=Mark|first2=Alexandra|pmc=|pmid=|author-link=Mark Vink|author-link2=Alexandra Vink-Niese|access-date=|via=}}</ref><ref name="openletter20042020" />

===Pacing===
Less controversially, the self-help leaflet mentions [[pacing]], a symptom-management approach also without evidence for COVID-19 survivors, but which is used by many people with chronic fatigue, chronic pain, and/or persistent illness that limits their everyday activities.<ref name="TullerOx16apr2020" /> ME patient associations surveys have found pacing helped most, but not all, patients.<ref name="forwardme-survey" /><ref name="IIMER-NICE" />
{{See also|Pacing}}

===CBT and GET not recommended for fatigue===
The Oxford Health NHS Foundation Trust published a ''Coping with Coronavirus: Fatigue'' leaflet referring to [[chronic fatigue syndrome]], a neurological disease, as a possible ''[[mental health]]'' consequence of COVID-19, and confusing fatigue after COVID-19 illness with [[chronic fatigue syndrome]]. The leaflet recommenddations included the highly controversial use of [[cognitive behavioral therapy]] (CBT) and graded exercise therapy (GET) to address the physical symptoms of chronic fatigue syndrome. The leaflet was withdrawn after public health expert [[David Tuller]] asked for the evidence based used by it, details of its authorship, and strongly criticised the advice given in it. An [[Opposition to Oxford Health NHS Foundation Trust: "Coping with Coronavirus: Fatigue"|open letter opposing the leaflet]] was signed by a large number of medical professionals and UK patient groups at around the same time.<ref name="openletter20042020" />

CBT for fatigue is a psychological therapy focused on treating a presumed [[illness beliefs|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]], [[MEAction]], 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=actionforme.org.uk}}</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=www.investinme.org|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|last2=|first2=|authorlink2=|date=2017-10-24|website=nhs.uk|language=en|archive-url=|archive-date=|dead-url=|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|last2=|first2=|authorlink2=|date=2018-07-18|website=nhs.uk|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-04-29}}</ref>

{{See also|Cognitive behavioral therapy}}{{See also|Graded exercise therapy}}

==Recovery advice==
* [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] - ME Association ''(May 2020)''
* [https://www.physiosforme.com/covid-19 Post Covid-19 Rehabilitation] - Physios for ME, Workwell Foundation, and ME Association ''(May 2020)''

==Notable studies==
No studies have yet been completed on the impact of COVID-19 on the long term health of survivors, or on treatment approaches.

==News articles and blogs==
* 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 1, 2020, [https://www.wsj.com/articles/three-months-in-these-patients-are-still-ravaged-by-covids-fallout-11593612004 Three Months In, These Patients Are Still Ravaged by Covid’s Fallout] - Wall Street Journal
* May 18, 2020, [https://blogs.bmj.com/bmj/2020/05/19/paul-garner-covid-19-and-fatigue-a-game-of-snakes-and-ladders/ Paul Garner: Covid-19 and fatigue—a game of snakes and ladders] - The BMJ
* 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://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.ws}}</ref>
*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.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|last=Lowenstein|first=Fiona|date=2020-04-13|publisher=New York Times|title=We Need to Talk About What Coronavirus Recoveries Look Like}}</ref> - Fiona Lowenstein, 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]]
*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==
*[[Coronavirus disease 19]] (COVID-19)
*[[Myalgic encephalomyelitis]]
*[[Chronic fatigue syndrome]] - the neurological disease
*[[Postviral fatigue syndrome]]
*[[Chronic fatigue]] - a symptom of many illnesses
*[[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]]
*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=|doi=|oclc=|quote=|archive-url=|archive-date=|location=}}</ref> (book)

==Learn more==
* 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=meassociation.org}}</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=|dead-url=|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
* 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 {{!}} 30 April 2020|date=Apr 30, 2020|last=Charles Shepherd|author-link=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

==References==
{{Reflist}}

[[Category:Diagnoses]]

Post-COVID-19 illness

2020-07-08T14:46:18Z

Loopy:/* Post-Covid-19 brain dysfunction */ new heading "Notable studies"

[[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 [[Coronavirus disease 19|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> One small study from Wuhan, China, found that survivors of [[Coronavirus disease 19|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>

===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 is uncertainty about whether this is a relapse due to the virus remaining at low levels in the body and bring reactivated, or if this is a reinfection.{{citation needed}}

==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=PMC3071317|pmid=21435231}}</ref>

==Severe COVID-19 survivors==

===ICU survivors===
[[File:Post-COVID-19 ventilators.png|alt=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)|left|frameless]]
{{Clear|both}}
[[File:Post intensive care syndrome.png|thumb|Post Intensive Care Syndrome symptoms. Source: [https://medicaljournals.se/jrm/content/html/10.2340/16501977-2677 J Rehabil Med 2020; 52: jrm00044]. License: CC-BY NC.]]
<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>{{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|last=H J|first=Stam|authorlink=|last2=G|first2=Stucki|authorlink2=|date=2020-04-15|website=Journal of rehabilitation medicine|language=en|doi=10.2340/16501977-2677|pmid=32286675|archive-url=|archive-date=|dead-url=|access-date=2020-04-23|last3=J|first3=Bickenbach|volume=52|issue=4}}</ref>

===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|last2=|first2=|authorlink2=|date=2020-02-11|website=Centers for Disease Control and Prevention|language=en-us|archive-url=|archive-date=|dead-url=|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.{{citation needed}}

===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|last2=|first2=|authorlink2=|date=2017-10-17|website=nhs.uk|language=en|archive-url=|archive-date=|dead-url=|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===
Invasive ventilation using a mechanical ventilator was needed by 47-71% of patients admitted to Intensive Care Units.<ref name="JH-ABX-540747" />

===COVID-19 complications===
These include:
*Anecdotal reports of DVT and PE 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:
**secondary infections including [[bacteria]]l and [[fungal infection]]s
**thromboembolism
**gastrointestinal bleeding
**critical illness polyneuropathy/myopathy.<ref name="JH-ABX-540747" /><ref name="CDC-clinicalguide" />

==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.|author-link=Keiji Fukuda|last2=Straus|first2=S. E.|author-link2=Stephen Straus|last3=Hickie|first3=I.|author-link3=Ian Hickie|last4=Sharpe|first4=M. C.|author-link4=Michael Sharpe|last5=Dobbins|first5=J. G.|author-link5=James Dobbins|last6=Komaroff|first6=A.|author-link6=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
| url = http://www.investinme.org/Documents/PDFdocuments/CanadianDefinitionME-CFS.pdf
}}</ref><ref name="fukuda1994" />

== Potential brain damage ==
Scientists warn of a potential wave of coronavirus-related brain damage as new evidence suggests [[Coronavirus disease 19|COVID-19]] can lead to severe [[Nervous system|neurological]] complications, including [[brain inflammation]], [[psychosis]] and [[delirium]].<ref name=":1">{{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><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=":1" /></blockquote>

=== Notable studies ===
* Jul 8, 2020, The emerging spectrum of COVID-19 neurology: clinical, radiological and laboratory findings<ref name=":0">{{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|language=en|doi=10.1093/brain/awaa240}}</ref>
<blockquote>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.</blockquote><blockquote>The research adds to recent studies which also found the disease can damage the brain.<ref name=":0" /></blockquote>

==Post-viral syndrome==
'''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]], [[Brain fog|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|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" />

==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]]
[[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=www.who.int|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=www.cdc.gov|author-link=Centers for Disease Control|date=|access-date=Apr 17, 2020|first=|last2=|first2=|authorlink2=|archive-url=|archive-date=|dead-url=}}</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)}}

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|Chronic fatigue syndrome}}

==Treatment==
No treatment studies have yet been published, despite this and the uncertainty over long term physical and psychological health consequences of coronavirus disease 19 (COVID-19), some self-help advice has already been published.<ref name="openletter20042020" />

A group of over 20 [[Myalgic encephalomyelitis|ME]] and [[chronic fatigue syndrome]] specialists and patient groups have recommended [[fatigue]] following COVID-19 should be treated/managed using:
*activity [[pacing]]
*nutrition and
*[[sleep hygiene]], stating that should help reduce the risk of developing ME/CFS after COVID-19.<ref name="Vink2019">{{Cite journal|last=Vink|last2=Vink-Niese|date=2019-09-20|title=Work Rehabilitation and Medical Retirement for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Patients. A Review and Appraisal of Diagnostic Strategies|url=https://www.mdpi.com/2075-4418/9/4/124|journal=Diagnostics|language=en|volume=9|issue=4|pages=124|doi=10.3390/diagnostics9040124|issn=2075-4418|first=Mark|first2=Alexandra|pmc=|pmid=|author-link=Mark Vink|author-link2=Alexandra Vink-Niese|access-date=|via=}}</ref><ref name="openletter20042020" />

===Pacing===
Less controversially, the self-help leaflet mentions [[pacing]], a symptom-management approach also without evidence for COVID-19 survivors, but which is used by many people with chronic fatigue, chronic pain, and/or persistent illness that limits their everyday activities.<ref name="TullerOx16apr2020" /> ME patient associations surveys have found pacing helped most, but not all, patients.<ref name="forwardme-survey" /><ref name="IIMER-NICE" />
{{See also|Pacing}}

===CBT and GET not recommended for fatigue===
The Oxford Health NHS Foundation Trust published a ''Coping with Coronavirus: Fatigue'' leaflet referring to [[chronic fatigue syndrome]], a neurological disease, as a possible ''[[mental health]]'' consequence of COVID-19, and confusing fatigue after COVID-19 illness with [[chronic fatigue syndrome]]. The leaflet recommenddations included the highly controversial use of [[cognitive behavioral therapy]] (CBT) and graded exercise therapy (GET) to address the physical symptoms of chronic fatigue syndrome. The leaflet was withdrawn after public health expert [[David Tuller]] asked for the evidence based used by it, details of its authorship, and strongly criticised the advice given in it. An [[Opposition to Oxford Health NHS Foundation Trust: "Coping with Coronavirus: Fatigue"|open letter opposing the leaflet]] was signed by a large number of medical professionals and UK patient groups at around the same time.<ref name="openletter20042020" />

CBT for fatigue is a psychological therapy focused on treating a presumed [[illness beliefs|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]], [[MEAction]], 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=actionforme.org.uk}}</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=www.investinme.org|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|last2=|first2=|authorlink2=|date=2017-10-24|website=nhs.uk|language=en|archive-url=|archive-date=|dead-url=|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|last2=|first2=|authorlink2=|date=2018-07-18|website=nhs.uk|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-04-29}}</ref>

{{See also|Cognitive behavioral therapy}}{{See also|Graded exercise therapy}}

==Recovery advice==
* [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] - ME Association ''(May 2020)''
* [https://www.physiosforme.com/covid-19 Post Covid-19 Rehabilitation] - Physios for ME, Workwell Foundation, and ME Association ''(May 2020)''

==Notable studies==
No studies have yet been completed on the impact of COVID-19 on the long term health of survivors, or on treatment approaches.

==News articles and blogs==
* Jul 1, 2020, [https://www.wsj.com/articles/three-months-in-these-patients-are-still-ravaged-by-covids-fallout-11593612004 Three Months In, These Patients Are Still Ravaged by Covid’s Fallout] - Wall Street Journal
* May 18, 2020, [https://blogs.bmj.com/bmj/2020/05/19/paul-garner-covid-19-and-fatigue-a-game-of-snakes-and-ladders/ Paul Garner: Covid-19 and fatigue—a game of snakes and ladders] - The BMJ
* 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://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.ws}}</ref>
*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.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|last=Lowenstein|first=Fiona|date=2020-04-13|publisher=New York Times|title=We Need to Talk About What Coronavirus Recoveries Look Like}}</ref> - Fiona Lowenstein, 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]]
*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==
*[[Coronavirus disease 19]] (COVID-19)
*[[Myalgic encephalomyelitis]]
*[[Chronic fatigue syndrome]] - the neurological disease
*[[Postviral fatigue syndrome]]
*[[Chronic fatigue]] - a symptom of many illnesses
*[[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]]
*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=|doi=|oclc=|quote=|archive-url=|archive-date=|location=}}</ref> (book)

==Learn more==
* 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=meassociation.org}}</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=|dead-url=|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
* 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 {{!}} 30 April 2020|date=Apr 30, 2020|last=Charles Shepherd|author-link=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

==References==
{{Reflist}}

[[Category:Diagnoses]]

Post-COVID-19 illness

2020-07-08T14:42:48Z

Loopy:/* Potential brain damage */ heading

[[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 [[Coronavirus disease 19|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> One small study from Wuhan, China, found that survivors of [[Coronavirus disease 19|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>

===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 is uncertainty about whether this is a relapse due to the virus remaining at low levels in the body and bring reactivated, or if this is a reinfection.{{citation needed}}

==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=PMC3071317|pmid=21435231}}</ref>

==Severe COVID-19 survivors==

===ICU survivors===
[[File:Post-COVID-19 ventilators.png|alt=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)|left|frameless]]
{{Clear|both}}
[[File:Post intensive care syndrome.png|thumb|Post Intensive Care Syndrome symptoms. Source: [https://medicaljournals.se/jrm/content/html/10.2340/16501977-2677 J Rehabil Med 2020; 52: jrm00044]. License: CC-BY NC.]]
<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>{{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|last=H J|first=Stam|authorlink=|last2=G|first2=Stucki|authorlink2=|date=2020-04-15|website=Journal of rehabilitation medicine|language=en|doi=10.2340/16501977-2677|pmid=32286675|archive-url=|archive-date=|dead-url=|access-date=2020-04-23|last3=J|first3=Bickenbach|volume=52|issue=4}}</ref>

===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|last2=|first2=|authorlink2=|date=2020-02-11|website=Centers for Disease Control and Prevention|language=en-us|archive-url=|archive-date=|dead-url=|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.{{citation needed}}

===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|last2=|first2=|authorlink2=|date=2017-10-17|website=nhs.uk|language=en|archive-url=|archive-date=|dead-url=|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===
Invasive ventilation using a mechanical ventilator was needed by 47-71% of patients admitted to Intensive Care Units.<ref name="JH-ABX-540747" />

===COVID-19 complications===
These include:
*Anecdotal reports of DVT and PE 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:
**secondary infections including [[bacteria]]l and [[fungal infection]]s
**thromboembolism
**gastrointestinal bleeding
**critical illness polyneuropathy/myopathy.<ref name="JH-ABX-540747" /><ref name="CDC-clinicalguide" />

==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.|author-link=Keiji Fukuda|last2=Straus|first2=S. E.|author-link2=Stephen Straus|last3=Hickie|first3=I.|author-link3=Ian Hickie|last4=Sharpe|first4=M. C.|author-link4=Michael Sharpe|last5=Dobbins|first5=J. G.|author-link5=James Dobbins|last6=Komaroff|first6=A.|author-link6=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
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| 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
| url = http://www.investinme.org/Documents/PDFdocuments/CanadianDefinitionME-CFS.pdf
}}</ref><ref name="fukuda1994" />

== Potential brain damage ==
Scientists warn of a potential wave of coronavirus-related brain damage as new evidence suggests [[Coronavirus disease 19|COVID-19]] can lead to severe [[Nervous system|neurological]] complications, including [[brain inflammation]], [[psychosis]] and [[delirium]].<ref name=":1">{{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><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=":1" /></blockquote>

=== Post-Covid-19 brain dysfunction ===
* Jul 8, 2020, The emerging spectrum of COVID-19 neurology: clinical, radiological and laboratory findings<ref name=":0">{{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|language=en|doi=10.1093/brain/awaa240}}</ref>
<blockquote>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.</blockquote><blockquote>The research adds to recent studies which also found the disease can damage the brain.<ref name=":0" /></blockquote>

==Post-viral syndrome==
'''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]], [[Brain fog|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|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" />

==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]]
[[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=www.who.int|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=www.cdc.gov|author-link=Centers for Disease Control|date=|access-date=Apr 17, 2020|first=|last2=|first2=|authorlink2=|archive-url=|archive-date=|dead-url=}}</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)}}

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|Chronic fatigue syndrome}}

==Treatment==
No treatment studies have yet been published, despite this and the uncertainty over long term physical and psychological health consequences of coronavirus disease 19 (COVID-19), some self-help advice has already been published.<ref name="openletter20042020" />

A group of over 20 [[Myalgic encephalomyelitis|ME]] and [[chronic fatigue syndrome]] specialists and patient groups have recommended [[fatigue]] following COVID-19 should be treated/managed using:
*activity [[pacing]]
*nutrition and
*[[sleep hygiene]], stating that should help reduce the risk of developing ME/CFS after COVID-19.<ref name="Vink2019">{{Cite journal|last=Vink|last2=Vink-Niese|date=2019-09-20|title=Work Rehabilitation and Medical Retirement for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Patients. A Review and Appraisal of Diagnostic Strategies|url=https://www.mdpi.com/2075-4418/9/4/124|journal=Diagnostics|language=en|volume=9|issue=4|pages=124|doi=10.3390/diagnostics9040124|issn=2075-4418|first=Mark|first2=Alexandra|pmc=|pmid=|author-link=Mark Vink|author-link2=Alexandra Vink-Niese|access-date=|via=}}</ref><ref name="openletter20042020" />

===Pacing===
Less controversially, the self-help leaflet mentions [[pacing]], a symptom-management approach also without evidence for COVID-19 survivors, but which is used by many people with chronic fatigue, chronic pain, and/or persistent illness that limits their everyday activities.<ref name="TullerOx16apr2020" /> ME patient associations surveys have found pacing helped most, but not all, patients.<ref name="forwardme-survey" /><ref name="IIMER-NICE" />
{{See also|Pacing}}

===CBT and GET not recommended for fatigue===
The Oxford Health NHS Foundation Trust published a ''Coping with Coronavirus: Fatigue'' leaflet referring to [[chronic fatigue syndrome]], a neurological disease, as a possible ''[[mental health]]'' consequence of COVID-19, and confusing fatigue after COVID-19 illness with [[chronic fatigue syndrome]]. The leaflet recommenddations included the highly controversial use of [[cognitive behavioral therapy]] (CBT) and graded exercise therapy (GET) to address the physical symptoms of chronic fatigue syndrome. The leaflet was withdrawn after public health expert [[David Tuller]] asked for the evidence based used by it, details of its authorship, and strongly criticised the advice given in it. An [[Opposition to Oxford Health NHS Foundation Trust: "Coping with Coronavirus: Fatigue"|open letter opposing the leaflet]] was signed by a large number of medical professionals and UK patient groups at around the same time.<ref name="openletter20042020" />

CBT for fatigue is a psychological therapy focused on treating a presumed [[illness beliefs|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]], [[MEAction]], 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=actionforme.org.uk}}</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=www.investinme.org|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|last2=|first2=|authorlink2=|date=2017-10-24|website=nhs.uk|language=en|archive-url=|archive-date=|dead-url=|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|last2=|first2=|authorlink2=|date=2018-07-18|website=nhs.uk|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-04-29}}</ref>

{{See also|Cognitive behavioral therapy}}{{See also|Graded exercise therapy}}

==Recovery advice==
* [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] - ME Association ''(May 2020)''
* [https://www.physiosforme.com/covid-19 Post Covid-19 Rehabilitation] - Physios for ME, Workwell Foundation, and ME Association ''(May 2020)''

==Notable studies==
No studies have yet been completed on the impact of COVID-19 on the long term health of survivors, or on treatment approaches.

==News articles and blogs==
* Jul 1, 2020, [https://www.wsj.com/articles/three-months-in-these-patients-are-still-ravaged-by-covids-fallout-11593612004 Three Months In, These Patients Are Still Ravaged by Covid’s Fallout] - Wall Street Journal
* May 18, 2020, [https://blogs.bmj.com/bmj/2020/05/19/paul-garner-covid-19-and-fatigue-a-game-of-snakes-and-ladders/ Paul Garner: Covid-19 and fatigue—a game of snakes and ladders] - The BMJ
* 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://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.ws}}</ref>
*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.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|last=Lowenstein|first=Fiona|date=2020-04-13|publisher=New York Times|title=We Need to Talk About What Coronavirus Recoveries Look Like}}</ref> - Fiona Lowenstein, 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]]
*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==
*[[Coronavirus disease 19]] (COVID-19)
*[[Myalgic encephalomyelitis]]
*[[Chronic fatigue syndrome]] - the neurological disease
*[[Postviral fatigue syndrome]]
*[[Chronic fatigue]] - a symptom of many illnesses
*[[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]]
*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=|doi=|oclc=|quote=|archive-url=|archive-date=|location=}}</ref> (book)

==Learn more==
* 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=meassociation.org}}</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=|dead-url=|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
* 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 {{!}} 30 April 2020|date=Apr 30, 2020|last=Charles Shepherd|author-link=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

==References==
{{Reflist}}

[[Category:Diagnoses]]

Post-COVID-19 illness

2020-07-08T14:38:34Z

Loopy:/* Potential brain damage */ quote from article post-covid-19 brain damage

[[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 [[Coronavirus disease 19|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> One small study from Wuhan, China, found that survivors of [[Coronavirus disease 19|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>

===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 is uncertainty about whether this is a relapse due to the virus remaining at low levels in the body and bring reactivated, or if this is a reinfection.{{citation needed}}

==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=PMC3071317|pmid=21435231}}</ref>

==Severe COVID-19 survivors==

===ICU survivors===
[[File:Post-COVID-19 ventilators.png|alt=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)|left|frameless]]
{{Clear|both}}
[[File:Post intensive care syndrome.png|thumb|Post Intensive Care Syndrome symptoms. Source: [https://medicaljournals.se/jrm/content/html/10.2340/16501977-2677 J Rehabil Med 2020; 52: jrm00044]. License: CC-BY NC.]]
<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>{{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|last=H J|first=Stam|authorlink=|last2=G|first2=Stucki|authorlink2=|date=2020-04-15|website=Journal of rehabilitation medicine|language=en|doi=10.2340/16501977-2677|pmid=32286675|archive-url=|archive-date=|dead-url=|access-date=2020-04-23|last3=J|first3=Bickenbach|volume=52|issue=4}}</ref>

===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|last2=|first2=|authorlink2=|date=2020-02-11|website=Centers for Disease Control and Prevention|language=en-us|archive-url=|archive-date=|dead-url=|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.{{citation needed}}

===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|last2=|first2=|authorlink2=|date=2017-10-17|website=nhs.uk|language=en|archive-url=|archive-date=|dead-url=|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===
Invasive ventilation using a mechanical ventilator was needed by 47-71% of patients admitted to Intensive Care Units.<ref name="JH-ABX-540747" />

===COVID-19 complications===
These include:
*Anecdotal reports of DVT and PE 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:
**secondary infections including [[bacteria]]l and [[fungal infection]]s
**thromboembolism
**gastrointestinal bleeding
**critical illness polyneuropathy/myopathy.<ref name="JH-ABX-540747" /><ref name="CDC-clinicalguide" />

==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.|author-link=Keiji Fukuda|last2=Straus|first2=S. E.|author-link2=Stephen Straus|last3=Hickie|first3=I.|author-link3=Ian Hickie|last4=Sharpe|first4=M. C.|author-link4=Michael Sharpe|last5=Dobbins|first5=J. G.|author-link5=James Dobbins|last6=Komaroff|first6=A.|author-link6=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
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| last3 = De Meirleir | first3 = KL | authorlink3 = Kenny de Meirleir
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| title = Myalgic encephalomyelitis: Adult & Paediatric: International Consensus Primer for Medical Practitioners
| date = 2012
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| 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
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| title = Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols
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}}</ref><ref name="fukuda1994" />

== Potential brain damage ==
Scientists warn of a potential wave of coronavirus-related brain damage as new evidence suggests [[Coronavirus disease 19|COVID-19]] can lead to severe [[Nervous system|neurological]] complications, including [[brain inflammation]], [[psychosis]] and [[delirium]].<ref name=":1">{{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><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=":1" /></blockquote>
* Jul 8, 2020, The emerging spectrum of COVID-19 neurology: clinical, radiological and laboratory findings<ref name=":0">{{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|language=en|doi=10.1093/brain/awaa240}}</ref>
<blockquote>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.</blockquote><blockquote>The research adds to recent studies which also found the disease can damage the brain.<ref name=":0" /></blockquote>

==Post-viral syndrome==
'''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]], [[Brain fog|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|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" />

==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]]
[[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=www.who.int|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=www.cdc.gov|author-link=Centers for Disease Control|date=|access-date=Apr 17, 2020|first=|last2=|first2=|authorlink2=|archive-url=|archive-date=|dead-url=}}</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)}}

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|Chronic fatigue syndrome}}

==Treatment==
No treatment studies have yet been published, despite this and the uncertainty over long term physical and psychological health consequences of coronavirus disease 19 (COVID-19), some self-help advice has already been published.<ref name="openletter20042020" />

A group of over 20 [[Myalgic encephalomyelitis|ME]] and [[chronic fatigue syndrome]] specialists and patient groups have recommended [[fatigue]] following COVID-19 should be treated/managed using:
*activity [[pacing]]
*nutrition and
*[[sleep hygiene]], stating that should help reduce the risk of developing ME/CFS after COVID-19.<ref name="Vink2019">{{Cite journal|last=Vink|last2=Vink-Niese|date=2019-09-20|title=Work Rehabilitation and Medical Retirement for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Patients. A Review and Appraisal of Diagnostic Strategies|url=https://www.mdpi.com/2075-4418/9/4/124|journal=Diagnostics|language=en|volume=9|issue=4|pages=124|doi=10.3390/diagnostics9040124|issn=2075-4418|first=Mark|first2=Alexandra|pmc=|pmid=|author-link=Mark Vink|author-link2=Alexandra Vink-Niese|access-date=|via=}}</ref><ref name="openletter20042020" />

===Pacing===
Less controversially, the self-help leaflet mentions [[pacing]], a symptom-management approach also without evidence for COVID-19 survivors, but which is used by many people with chronic fatigue, chronic pain, and/or persistent illness that limits their everyday activities.<ref name="TullerOx16apr2020" /> ME patient associations surveys have found pacing helped most, but not all, patients.<ref name="forwardme-survey" /><ref name="IIMER-NICE" />
{{See also|Pacing}}

===CBT and GET not recommended for fatigue===
The Oxford Health NHS Foundation Trust published a ''Coping with Coronavirus: Fatigue'' leaflet referring to [[chronic fatigue syndrome]], a neurological disease, as a possible ''[[mental health]]'' consequence of COVID-19, and confusing fatigue after COVID-19 illness with [[chronic fatigue syndrome]]. The leaflet recommenddations included the highly controversial use of [[cognitive behavioral therapy]] (CBT) and graded exercise therapy (GET) to address the physical symptoms of chronic fatigue syndrome. The leaflet was withdrawn after public health expert [[David Tuller]] asked for the evidence based used by it, details of its authorship, and strongly criticised the advice given in it. An [[Opposition to Oxford Health NHS Foundation Trust: "Coping with Coronavirus: Fatigue"|open letter opposing the leaflet]] was signed by a large number of medical professionals and UK patient groups at around the same time.<ref name="openletter20042020" />

CBT for fatigue is a psychological therapy focused on treating a presumed [[illness beliefs|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]], [[MEAction]], 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=actionforme.org.uk}}</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=www.investinme.org|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|last2=|first2=|authorlink2=|date=2017-10-24|website=nhs.uk|language=en|archive-url=|archive-date=|dead-url=|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|last2=|first2=|authorlink2=|date=2018-07-18|website=nhs.uk|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-04-29}}</ref>

{{See also|Cognitive behavioral therapy}}{{See also|Graded exercise therapy}}

==Recovery advice==
* [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] - ME Association ''(May 2020)''
* [https://www.physiosforme.com/covid-19 Post Covid-19 Rehabilitation] - Physios for ME, Workwell Foundation, and ME Association ''(May 2020)''

==Notable studies==
No studies have yet been completed on the impact of COVID-19 on the long term health of survivors, or on treatment approaches.

==News articles and blogs==
* Jul 1, 2020, [https://www.wsj.com/articles/three-months-in-these-patients-are-still-ravaged-by-covids-fallout-11593612004 Three Months In, These Patients Are Still Ravaged by Covid’s Fallout] - Wall Street Journal
* May 18, 2020, [https://blogs.bmj.com/bmj/2020/05/19/paul-garner-covid-19-and-fatigue-a-game-of-snakes-and-ladders/ Paul Garner: Covid-19 and fatigue—a game of snakes and ladders] - The BMJ
* 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://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.ws}}</ref>
*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.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|last=Lowenstein|first=Fiona|date=2020-04-13|publisher=New York Times|title=We Need to Talk About What Coronavirus Recoveries Look Like}}</ref> - Fiona Lowenstein, 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]]
*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==
*[[Coronavirus disease 19]] (COVID-19)
*[[Myalgic encephalomyelitis]]
*[[Chronic fatigue syndrome]] - the neurological disease
*[[Postviral fatigue syndrome]]
*[[Chronic fatigue]] - a symptom of many illnesses
*[[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]]
*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=|doi=|oclc=|quote=|archive-url=|archive-date=|location=}}</ref> (book)

==Learn more==
* 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=meassociation.org}}</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=|dead-url=|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
* 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 {{!}} 30 April 2020|date=Apr 30, 2020|last=Charles Shepherd|author-link=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

==References==
{{Reflist}}

[[Category:Diagnoses]]

Post-COVID-19 illness

2020-07-08T14:35:55Z

Loopy:Study and news article on post-covid-19 brain damage

User talk:Notjusttired

2020-04-17T12:14:07Z

Loopy:/* Edit Issues? -- ~~~~ */ new section

== New theory of CFS ==

Hi. I have a new theory of CFS. I'm not sure this is the best forum, but I'd love it if you'd take a look.

https://cfstheory.blogspot.com/2019/11/new-theory-of-cfs.html

Thanks! -Tom

==subpages==
[[User_talk:Notjusttired/cleanup]]

==Leave me a message ==

Could you explain what you are doing to the [[fatty acid]] and the [[antibody]] pages? You are removing important links that are there to remind us that we need to create these pages. Red links help us to figure out which important pages need to be created, such as the [[fatty acid]] and the [[antibody]] pages. By removing important red links, we lose track of which pages need to be created. All your changes will need to be reverted when the pages are created. If you are looking to simplify things, then we can get rid of the categories, rather than the main pages for the categories. In this case, we would combine all pages in the category into the main page for the category, so that we have one page, rather than a whole category. Please explain.
<br>[[User:Pyrrhus|Pyrrhus]] ([[User talk:Pyrrhus|talk]]) 00:29, October 11, 2019 (EDT)
:I already discussed this with [[User:Kmdenmark]] as I think you've already seen [[Talk:Single_nucleotide_polymorphism here]] - others you tagged earlier did not respond. Those pages won't have enough content to be worthwhile do terms are now added to the glossary. They have been stub pages for many years rather than wanted pages - I have looked for content and there is simply too little to justify a page. Fatty acids is a category that does not need a summary article in my view, plus there are articles for very long chain fatty acids, short chain fatty acids, etc. Please think carefully about making mass reverts without checking. [[User:Pyrrhus]] ~[[User:Notjusttired|Njt]] ([[User talk:Notjusttired|talk]]) 09:26, October 11, 2019 (EDT)

Messages I've seen:

{{collapse top}}
Hi Njt! I just wanted to briefly clarify what I said on Kmdenmark's talk page. I'll use bullet points because I find it easier to organize my thoughts:
* There are three different language settings in MediaWiki:
** The wiki's default language setting (specified in LocalSettings.php)
** The page's content language setting (reflected by the language code suffix such as "/de")
** The reader's preferred language setting (specified in preferences, for now)

* The visible screen in MediaWiki is divided into user interface and content.
** The user interface should always match the reader's preferred language setting.
** The content should always match the page's content language setting.

*Now, template messages mostly count as user interface, not as content, so templates mostly follow the reader's preferred language, not the page's content language. This is why templates use <nowiki>{{int:}} or {{int:lang}}</nowiki>, since these parser functions follow the reader's preferred language, not the page's content language.
*However, when you're editing content inside a regular page, your content should follow the page's content language. In this case, you should use <nowiki>{{PAGELANGUAGE}}, not {{int:}}</nowiki>. Of course, since each language gets their own page via a suffix like "/de", you probably won't need to use either.

*Example: [[Template:Cleanup]] displays a message about the page at the top of the page. This is best considered part of the user interface, not part of the page itself. Therefore, this template will follow the reader's preferred language and use <nowiki>{{int:}}, not {{PAGELANGUAGE}}</nowiki>.
*Example: [[Glossary/de]] is a content page. Therefore anything added to this page should follow the page's content language, not the reader's preferred language. To put it another way, the content of a page ending in "/de" should be in German, no matter what the reader's preferred language is.
*More complicated example: [[Template:Citation needed]] displays a message embedded inside the content of a page. Does this make it part of the user interface or part of the page content itself? If we consider it part of the user interface, then it should use <nowiki>{{int:lang}}</nowiki>. However, if we consider it part of the page content then it should use <nowiki>{{PAGELANGUAGE}} instead of {{int:lang}}</nowiki>. This is kind of a grey area, but the more I think about it, it should probably be considered part of the content, not part of the user interface. Therefore, we should consider switching it from <nowiki>{{int:lang}} to {{PAGELANGUAGE}}</nowiki>.

*NOTE: <nowiki>{{PAGELANGUAGE}}</nowiki> does not yet work, as it needs a developer change in order to make sure that it returns the same language as the "/de" suffix.

Hope this is clear!
<br>[[User:Pyrrhus|Pyrrhus]] ([[User talk:Pyrrhus|talk]]) 00:04, September 7, 2019 (EDT)
:Thanks for the great explanation. Does PAGELANGUAGE use system messages? I guess having a main page in different languages would probably be too much to maintain? Although if it was possible to create them using system messages it might be simple since the page doesn't change often. Do you know if the word Portal is translated in the user interface? I think it might not be. A more recent developer tasks list would be appreciated on Slack since I am not sure if we have requested certain things or not. [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 09:23, September 7, 2019 (EDT)
::PAGELANGUAGE is just a global system variable that returns the page content language of the current page. I don’t think having the main page in different languages will be such a big deal, it’s short and it doesn’t change much. Plus, you don’t need admin privileges to create [[Welcome to MEpedia/de]], like you would need in order to create a system message. But more importantly, if someone chooses to view the German version of the main page using the interlanguage links in the sidebar, then they should expect to see the page in German, not in whatever their reader preferred language setting might be at the time, which is why system messages are to be avoided in a content page. This will all probably become much clearer when the developer changes are made and we can test things out for ourselves. I’ll send you a link on Slack to the “DRAFT Developer Suggestions” as it currently stands. Hope this helps.
::[[User:Pyrrhus|Pyrrhus]] ([[User talk:Pyrrhus|talk]]) 20:41, September 7, 2019 (EDT)
:::Great! My thinking with system messages was to use without '''int:''', eg <nowiki >MediaWiki:mymessage/{{PAGELANGUAGE}}</nowiki > [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 15:51, September 8, 2019 (EDT)
{{collapse bottom}}

==Category banners: Medical hypotheses and Potential treatments ==
{{collapse top}}
'''Compatibility with all skins'''

Both the pivot and Timeless (dark) skins rely on classes being used - without that no banner appears on the Pivot skin and the colors are messed up on Timeless skin (it adds a dark shadow to text to improve contrast: it's also a "low vision" skin). Current banners are created by [[MediaWiki:Common.js]] Javascript using the following classes and css (note: banner position can be moved below heading if "append" is used instead of "prepend").
<pre>
//$(".mw-body-content").css ("background-color","#f8d6c2");
//$(".toc").css ("background-color","#f8d6c2");
$(".firstHeading").prepend ('<div style = "margin:auto;padding:20px;width:100%;text-align:center;background-color:#00ee54;">This is a <a href = "/wiki/Category:Potential_treatments">Potential treatments</a> page</div>');

// pivot fix
$("h1.title"...
</pre>
So any h1 headings should apply <code><nowiki>class="title"</nowiki></code> and text not using the "h1" style should include <code><nowiki>class="firstHeading"</nowiki></code>.
We should probably move these colors to [[MediaWiki:Common.css]], perhaps creating a class for each banner style with the relevant background and font colors.

Suggested new formatting: using low vision sky blue to slightly improve contrast, fixing text color rather than changing depending on if the link has been visited or not, and a text shadow to improve visibly.

Add to [[MediaWiki:Common.css]]
<pre>
.title {
background-color: #56b4e9;
color: white;
margin:auto;
padding:20px;
width:100%;
text-align: center;
font-size: 1.8em;
text-shadow: 1px 1px black;
}
.title a.link:active, .title a.link:hover,
.title a.link:visited, .title a.link,
.title a {
color: white !important;
font-weight: bold;
}
</pre>
Change code on [[MediaWiki:Top-notice-Biopsychosocial model]] to:
<pre>
<div class="title" style="background: #56b4e9">This is a [[:Category:Medical_hypotheses|Medical hypothesis]] page.</div>
</pre>
~[[User:Notjusttired|Njt]] ([[User talk:Notjusttired|talk]]) 16:55, October 25, 2019 (EDT)[[User:Notjusttired|Njt]] ([[User talk:Notjusttired|talk]]) 16:40, October 25, 2019 (EDT)[[User:Notjusttired|Njt]] ([[User talk:Notjusttired|talk]]) 16:08, October 25, 2019 (EDT)

Code now above. I think I over-complicated explanation - won't add new features, just better color contrast and text shadow which works on all skins (light and dark). Once confirmed working small updates needed to [[MediaWiki:Common.js]] for both Potential treatments and Medical hypothesis banners. Pretty much looks like this (but with a link):

<div style="margin:auto; padding:20px; width:100%; text-align:center; background-color:#56b4e9!important; font-size: 1.8em!important; color: #fff!important; text-shadow: 1px 1px black;">This is a <span style="font-weight:bold">Medical hypothesis</span> page.</div>

::[[User:Pyrrhus]] ~[[User:Notjusttired|Njt]] ([[User talk:Notjusttired|talk]]) 16:55, October 25, 2019 (EDT)

:This sounds like a new feature request. You can start a new section for this request at [[MediaWiki talk:Common.js]]. This talk page will be deleted once I am done testing the new banner.
:[[User:Pyrrhus|Pyrrhus]] ([[User talk:Pyrrhus|talk]]) 16:31, October 25, 2019 (EDT)

::I think I understand now. One question: Is "title" a new CSS class or an existing class? If it's a new class, maybe we should choose a more unique name such as "custom-header" or something that won't conflict with other classes? [[User:Notjusttired]]
::[[User:Pyrrhus|Pyrrhus]] ([[User talk:Pyrrhus|talk]]) 18:25, October 25, 2019 (EDT)
{{collapse bottom}}

==Bulk Import==
{{Done}} {{Thanks}} [[User:Kmdenmark]]
{{collapse top}}
<pre >
<mediawiki xmlns="http://www.mediawiki.org/xml/export-0.10/" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="http://www.mediawiki.org/xml/export-0.10/ http://www.mediawiki.org/xml/export-0.10.xsd" version="0.10" xml:lang="en">
<siteinfo>
<sitename>MEpedia</sitename>
<dbname>me_pedia_org_3</dbname>
<base>https://www.me-pedia.org/wiki/Welcome_to_MEpedia</base>
<generator>MediaWiki 1.30.0</generator>
<case>first-letter</case>
<namespaces>
<namespace key="-2" case="first-letter">Media</namespace>
<namespace key="-1" case="first-letter">Special</namespace>
<namespace key="0" case="first-letter" />
<namespace key="1" case="first-letter">Talk</namespace>
<namespace key="2" case="first-letter">User</namespace>
<namespace key="3" case="first-letter">User talk</namespace>
<namespace key="4" case="first-letter">MEpedia</namespace>
<namespace key="5" case="first-letter">MEpedia talk</namespace>
<namespace key="6" case="first-letter">File</namespace>
<namespace key="7" case="first-letter">File talk</namespace>
<namespace key="8" case="first-letter">MediaWiki</namespace>
<namespace key="9" case="first-letter">MediaWiki talk</namespace>
<namespace key="10" case="first-letter">Template</namespace>
<namespace key="11" case="first-letter">Template talk</namespace>
<namespace key="12" case="first-letter">Help</namespace>
<namespace key="13" case="first-letter">Help talk</namespace>
<namespace key="14" case="first-letter">Category</namespace>
<namespace key="15" case="first-letter">Category talk</namespace>
<namespace key="828" case="first-letter">Module</namespace>
<namespace key="829" case="first-letter">Module talk</namespace>
<namespace key="2300" case="first-letter">Gadget</namespace>
<namespace key="2301" case="first-letter">Gadget talk</namespace>
<namespace key="2302" case="case-sensitive">Gadget definition</namespace>
<namespace key="2303" case="case-sensitive">Gadget definition talk</namespace>
<namespace key="3006" case="first-letter">Portal</namespace>
<namespace key="3007" case="first-letter">Portal talk</namespace>
</namespaces>
</siteinfo>
<page>
<title>MediaWiki:Pagetriage-tags-cleanup-desc</title>
<ns>8</ns>
<revision>
<model>wikitext</model>
<format>text/x-wiki</format>
<text xml:space="preserve">This article needs cleanup to meet [[MEpedia:Guidelines|MEpedia's guidelines]].</text>
</revision>
</page>
<page>
<title>MediaWiki:Pagetriage-tags-cleanup-desc/de</title>
<ns>8</ns>
<revision>
<model>wikitext</model>
<format>text/x-wiki</format>
<text xml:space="preserve">Dieser Artikel muss möglicherweise Überarbeitet werden, um die [[MEpedia:Guidelines|Richtlinien von MEpedia]] zu erfüllen.</text>
</revision>
</page>
</mediawiki></pre>
{{collapse bottom}}

==Translations to do ==
Pyrrhus may change footer text or links eg [[MediaWiki:Wikimedia-developers]] and it's URL

{{collapse top}}
Cleanup Reason given is
[[User:Pyrrhus]] can you also do these 3 imports. [[User:Notjusttired|Njt]] ([[User talk:Notjusttired|talk]]) 06:54, September 28, 2019 (EDT)
:{{done}} 181 pages imported. Please check to make sure that all pages were correctly imported.
:[[User:Pyrrhus|Pyrrhus]] ([[User talk:Pyrrhus|talk]]) 19:00, September 30, 2019 (EDT)

::Great, thanks. There's just the German one that I must have got the wrong message in. I've tagged you in the talk page with the right translation. ~[[User:Notjusttired|Njt]] ([[User talk:Notjusttired|talk]])|
:::Cleanup-reason-is all done so code deleted ~[[User:Notjusttired|Njt]] ([[User talk:Notjusttired|talk]]) 20:31, October 6, 2019 (EDT)
{{collapse bottom}}

===No-reason custom message (done)===
Basically an export of Lqt_noreason messages, but with the message name changed. Ready to import [[User:Pyrrhus]]. ~[[User:Notjusttired|Njt]] ([[User talk:Notjusttired|talk]]) 23:45, October 6, 2019 (EDT)
::All done.{{collapse top}}
<pre>

<mediawiki xmlns="http://www.mediawiki.org/xml/export-0.10/" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="http://www.mediawiki.org/xml/export-0.10/ http://www.mediawiki.org/xml/export-0.10.xsd" version="0.10" xml:lang="en">
<siteinfo>
<sitename>translatewiki.net</sitename>
<dbname>translatewiki_net</dbname>
<base>https://translatewiki.net/</base>
<generator>MediaWiki 1.34.0-alpha</generator>
<case>first-letter</case>
<namespaces>
<namespace key="0" case="first-letter" />
<namespace key="14" case="first-letter">Category</namespace>
<namespace key="15" case="first-letter">Category talk</namespace>
<namespace key="208" case="first-letter">Concept</namespace>
<namespace key="209" case="first-letter">Concept talk</namespace>
<namespace key="6" case="first-letter">File</namespace>
<namespace key="7" case="first-letter">File talk</namespace>
<namespace key="106" case="first-letter">Form</namespace>
<namespace key="107" case="first-letter">Form talk</namespace>
<namespace key="2300" case="first-letter">Gadget</namespace>
<namespace key="2302" case="case-sensitive">Gadget definition</namespace>
<namespace key="2303" case="case-sensitive">Gadget definition talk</namespace>
<namespace key="2301" case="first-letter">Gadget talk</namespace>
<namespace key="12" case="first-letter">Help</namespace>
<namespace key="13" case="first-letter">Help talk</namespace>
<namespace key="-2" case="first-letter">Media</namespace>
<namespace key="100" case="first-letter">Portal</namespace>
<namespace key="101" case="first-letter">Portal talk</namespace>
<namespace key="4" case="first-letter">Project</namespace>
<namespace key="5" case="first-letter">Project talk</namespace>
<namespace key="202" case="first-letter">Property</namespace>
<namespace key="203" case="first-letter">Property talk</namespace>
<namespace key="214" case="first-letter">Rule</namespace>
<namespace key="215" case="first-letter">Rule talk</namespace>
<namespace key="212" case="first-letter">smw/schema</namespace>
<namespace key="213" case="first-letter">smw/schema talk</namespace>
<namespace key="-1" case="first-letter">Special</namespace>
<namespace key="92" case="first-letter">Summary</namespace>
<namespace key="93" case="first-letter">Summary talk</namespace>
<namespace key="1" case="first-letter">Talk</namespace>
<namespace key="10" case="first-letter">Template</namespace>
<namespace key="11" case="first-letter">Template talk</namespace>
<namespace key="90" case="first-letter">Thread</namespace>
<namespace key="91" case="first-letter">Thread talk</namespace>
<namespace key="1102" case="first-letter">Translating</namespace>
<namespace key="1103" case="first-letter">Translating talk</namespace>
<namespace key="2" case="first-letter">User</namespace>
<namespace key="3" case="first-letter">User talk</namespace>
<namespace key="1276" case="case-sensitive">Ajapaik</namespace>
<namespace key="1277" case="case-sensitive">Ajapaik talk</namespace>
<namespace key="1256" case="first-letter">Blockly</namespace>
<namespace key="1257" case="first-letter">Blockly talk</namespace>
<namespace key="1214" case="first-letter">Commonist</namespace>
<namespace key="1215" case="first-letter">Commonist talk</namespace>
<namespace key="1272" case="case-sensitive">Dissemin</namespace>
<namespace key="1273" case="case-sensitive">Dissemin talk</namespace>
<namespace key="1264" case="case-sensitive">EntryScape</namespace>
<namespace key="1265" case="case-sensitive">EntryScape talk</namespace>
<namespace key="1242" case="first-letter">EOL</namespace>
<namespace key="1243" case="first-letter">EOL talk</namespace>
<namespace key="1250" case="first-letter">EtherpadLite</namespace>
<namespace key="1251" case="first-letter">EtherpadLite talk</namespace>
<namespace key="1236" case="first-letter">Europeana</namespace>
<namespace key="1237" case="first-letter">Europeana talk</namespace>
<namespace key="1202" case="first-letter">FreeCol</namespace>
<namespace key="1203" case="first-letter">FreeCol talk</namespace>
<namespace key="1218" case="first-letter">FUDforum</namespace>
<namespace key="1219" case="first-letter">FUDforum talk</namespace>
<namespace key="1254" case="first-letter">FUEL</namespace>
<namespace key="1255" case="first-letter">FUEL talk</namespace>
<namespace key="1266" case="case-sensitive">Hivejs</namespace>
<namespace key="1267" case="case-sensitive">Hivejs talk</namespace>
<namespace key="1248" case="first-letter">Huggle</namespace>
<namespace key="1249" case="first-letter">Huggle talk</namespace>
<namespace key="1228" case="first-letter">iHRIS</namespace>
<namespace key="1229" case="first-letter">iHRIS talk</namespace>
<namespace key="1262" case="first-letter">iNaturalist</namespace>
<namespace key="1263" case="first-letter">iNaturalist talk</namespace>
<namespace key="1240" case="first-letter">Intuition</namespace>
<namespace key="1241" case="first-letter">Intuition talk</namespace>
<namespace key="1244" case="first-letter">Kiwix</namespace>
<namespace key="1245" case="first-letter">Kiwix talk</namespace>
<namespace key="1268" case="case-sensitive">lib.reviews</namespace>
<namespace key="1269" case="case-sensitive">lib.reviews talk</namespace>
<namespace key="1278" case="case-sensitive">LibreMesh</namespace>
<namespace key="1279" case="case-sensitive">LibreMesh talk</namespace>
<namespace key="1210" case="first-letter">Mantis</namespace>
<namespace key="1211" case="first-letter">Mantis talk</namespace>
<namespace key="1258" case="first-letter">MathJax</namespace>
<namespace key="1259" case="first-letter">MathJax talk</namespace>
<namespace key="1280" case="case-sensitive">MAZI</namespace>
<namespace key="1281" case="case-sensitive">MAZI talk</namespace>
<namespace key="8" case="first-letter">MediaWiki</namespace>
<namespace key="9" case="first-letter">MediaWiki talk</namespace>
<namespace key="1230" case="first-letter">Mifos</namespace>
<namespace key="1231" case="first-letter">Mifos talk</namespace>
<namespace key="1246" case="first-letter">Mozilla</namespace>
<namespace key="1247" case="first-letter">Mozilla talk</namespace>
<namespace key="1212" case="first-letter">Mwlib</namespace>
<namespace key="1213" case="first-letter">Mwlib talk</namespace>
<namespace key="1260" case="first-letter">NFCRingControl</namespace>
<namespace key="1261" case="first-letter">NFCRingControl talk</namespace>
<namespace key="1204" case="first-letter">Nocc</namespace>
<namespace key="1205" case="first-letter">Nocc talk</namespace>
<namespace key="1220" case="first-letter">Okawix</namespace>
<namespace key="1221" case="first-letter">Okawix talk</namespace>
<namespace key="1234" case="first-letter">OpenImages</namespace>
<namespace key="1235" case="first-letter">OpenImages talk</namespace>
<namespace key="1216" case="first-letter">OpenLayers</namespace>
<namespace key="1217" case="first-letter">OpenLayers talk</namespace>
<namespace key="1270" case="case-sensitive">Oppia</namespace>
<namespace key="1271" case="case-sensitive">Oppia talk</namespace>
<namespace key="1222" case="first-letter">Osm</namespace>
<namespace key="1223" case="first-letter">Osm talk</namespace>
<namespace key="1274" case="case-sensitive">Phabricator</namespace>
<namespace key="1275" case="case-sensitive">Phabricator talk</namespace>
<namespace key="1238" case="first-letter">Pywikibot</namespace>
<namespace key="1239" case="first-letter">Pywikibot talk</namespace>
<namespace key="1226" case="first-letter">Shapado</namespace>
<namespace key="1227" case="first-letter">Shapado talk</namespace>
<namespace key="1208" case="first-letter">StatusNet</namespace>
<namespace key="1209" case="first-letter">StatusNet talk</namespace>
<namespace key="1198" case="first-letter">Translations</namespace>
<namespace key="1199" case="first-letter">Translations talk</namespace>
<namespace key="1252" case="first-letter">Vicuna</namespace>
<namespace key="1253" case="first-letter">Vicuna talk</namespace>
<namespace key="1200" case="first-letter">Voctrain</namespace>
<namespace key="1201" case="first-letter">Voctrain talk</namespace>
<namespace key="1232" case="first-letter">Wikia</namespace>
<namespace key="1233" case="first-letter">Wikia talk</namespace>
<namespace key="1282" case="case-sensitive">Wikidocumentaries</namespace>
<namespace key="1283" case="case-sensitive">Wikidocumentaries talk</namespace>
<namespace key="1206" case="first-letter">Wikimedia</namespace>
<namespace key="1207" case="first-letter">Wikimedia talk</namespace>
<namespace key="1224" case="first-letter">WikiReader</namespace>
<namespace key="1225" case="first-letter">WikiReader talk</namespace>
</namespaces>
</siteinfo>
<page>
<title>MediaWiki:No-reason/ar</title>
<ns>8</ns>
<id>114330</id>
<revision>
<id>161369</id>
<timestamp>2007-11-23T07:44:38Z</timestamp>
<contributor>
<username>Meno25</username>
<id>315</id>
</contributor>
<model>wikitext</model>
<format>text/x-wiki</format>
<text xml:space="preserve" bytes="21">لا سبب معطى.</text>
<sha1>trbxdtbjsbqc6n7do97xtdlikuiljet</sha1>
</revision>
</page>
<page>
<title>MediaWiki:No-reason/da</title>
<ns>8</ns>
<id>2057108</id>
<revision>
<id>2951594</id>
<timestamp>2011-04-25T05:34:11Z</timestamp>
<contributor>
<username>Peter Alberti</username>
<id>3782</id>
</contributor>
<model>wikitext</model>
<format>text/x-wiki</format>
<text xml:space="preserve" bytes="26">Ingen begrundelse angivet.</text>
<sha1>ic5gwik8pqulwwq8x9ubgdkkqt7e68k</sha1>
</revision>
</page>
<page>
<title>MediaWiki:No-reason/fi</title>
<ns>8</ns>
<id>909955</id>
<revision>
<id>1289062</id>
<timestamp>2009-07-02T10:52:16Z</timestamp>
<contributor>
<username>Cimon Avaro</username>
<id>283</id>
</contributor>
<comment>suomeksi</comment>
<model>wikitext</model>
<format>text/x-wiki</format>
<text xml:space="preserve" bytes="19">Ei annettua syytä.</text>
<sha1>0rcsgy11ym0psz051cyj70nan4gwyl7</sha1>
</revision>
</page>
<page>
<title>MediaWiki:No-reason/it</title>
<ns>8</ns>
<id>1033853</id>
<revision>
<id>1460274</id>
<timestamp>2009-08-29T17:10:40Z</timestamp>
<contributor>
<username>Marco 27</username>
<id>2110</id>
</contributor>
<comment>Translate</comment>
<model>wikitext</model>
<format>text/x-wiki</format>
<text xml:space="preserve" bytes="29">Nessuna motivazione indicata.</text>
<sha1>b0nip64qeghwffvyr0463rpzvupwdns</sha1>
</revision>
</page>
<page>
<title>MediaWiki:No-reason/ja</title>
<ns>8</ns>
<id>191005</id>
<revision>
<id>261562</id>
<timestamp>2008-02-17T16:20:46Z</timestamp>
<contributor>
<username>JtFuruhata</username>
<id>791</id>
</contributor>
<comment>translate</comment>
<model>wikitext</model>
<format>text/x-wiki</format>
<text xml:space="preserve" bytes="39">理由は付記されていません。</text>
<sha1>1d2qt9uhieh8c9hoptqqfth6x1waa8f</sha1>
</revision>
</page>
<page>
<title>MediaWiki:No-reason/pl</title>
<ns>8</ns>
<id>215941</id>
<revision>
<id>1491831</id>
<parentid>294155</parentid>
<timestamp>2009-09-15T16:34:01Z</timestamp>
<contributor>
<username>Leinad</username>
<id>921</id>
</contributor>
<model>wikitext</model>
<format>text/x-wiki</format>
<text xml:space="preserve" bytes="18">Nie podano powodu.</text>
<sha1>m5y060qmskof0mqy0j2e61ewfdrtr5i</sha1>
</revision>
</page>
<page>
<title>MediaWiki:No-reason/pt</title>
<ns>8</ns>
<id>178383</id>
<revision>
<id>1727893</id>
<parentid>243351</parentid>
<timestamp>2009-12-05T02:00:11Z</timestamp>
<contributor>
<username>Hamilton Abreu</username>
<id>2715</id>
</contributor>
<model>wikitext</model>
<format>text/x-wiki</format>
<text xml:space="preserve" bytes="36">Não foi especificado nenhum motivo.</text>
<sha1>avtjeyv5wb49krj6tbgx32c1bhdhnhn</sha1>
</revision>
</page>
<page>
<title>MediaWiki:No-reason/ru</title>
<ns>8</ns>
<id>132336</id>
<revision>
<id>1446038</id>
<parentid>183803</parentid>
<timestamp>2009-08-22T07:30:26Z</timestamp>
<contributor>
<username>Kv75</username>
<id>2463</id>
</contributor>
<comment>correction</comment>
<model>wikitext</model>
<format>text/x-wiki</format>
<text xml:space="preserve" bytes="35">Не указана причина.</text>
<sha1>j6tvgosjjberi6m3gqq61eqa0kncte0</sha1>
</revision>
</page>
<page>
<title>MediaWiki:No-reason/sv</title>
<ns>8</ns>
<id>191517</id>
<revision>
<id>262234</id>
<timestamp>2008-02-18T08:13:15Z</timestamp>
<contributor>
<username>M.M.S.</username>
<id>802</id>
</contributor>
<model>wikitext</model>
<format>text/x-wiki</format>
<text xml:space="preserve" bytes="22">Ingen anledning given.</text>
<sha1>cycjvls08gyso44n0t7c0p3os4p3oo6</sha1>
</revision>
</page>
<page>
<title>MediaWiki:No-reason/vi</title>
<ns>8</ns>
<id>254886</id>
<revision>
<id>350621</id>
<timestamp>2008-04-11T03:42:28Z</timestamp>
<contributor>
<username>Vinhtantran</username>
<id>709</id>
</contributor>
<model>wikitext</model>
<format>text/x-wiki</format>
<text xml:space="preserve" bytes="23">Không đưa ra lý do.</text>
<sha1>242zviqquhnat6dle2aurg8pbgs6kin</sha1>
</revision>
</page>
<page>
<title>MediaWiki:No-reason/zh-hans</title>
<ns>8</ns>
<id>512160</id>
<revision>
<id>1445831</id>
<parentid>698700</parentid>
<timestamp>2009-08-22T07:06:14Z</timestamp>
<contributor>
<username>FuzzyBot</username>
<id>646</id>
</contributor>
<comment>Updating translation from external source</comment>
<model>wikitext</model>
<format>text/x-wiki</format>
<text xml:space="preserve" bytes="18">未给出原因。</text>
<sha1>mo3jtv9i5zrlb79gd6tbqc0zu2nh5sa</sha1>
</revision>
</page>
<page>
<title>MediaWiki:No-reason/zh-hant</title>
<ns>8</ns>
<id>125571</id>
<revision>
<id>5561381</id>
<parentid>175199</parentid>
<timestamp>2014-05-26T17:35:19Z</timestamp>
<contributor>
<username>Cwlin0416</username>
<id>4987</id>
</contributor>
<model>wikitext</model>
<format>text/x-wiki</format>
<text xml:space="preserve" bytes="18">未說明原因。</text>
<sha1>fgjh29koetf7sxb79nfbcjfya4p84a0</sha1>
</revision>
</page>
</mediawiki>

</pre>
{{collapse bottom}}

==Stub==

{{System message translations|Pagetriage-tags-stub-label}}
(not ready)

custom messages
*[[MediaWiki:Pagetriage-tags-stub-label/ast]] Entamu
*[[MediaWiki:Pagetriage-tags-stub-label/bg]] Мъниче
*[[MediaWiki:Pagetriage-tags-stub-label/cs]] Pahýl
*[[MediaWiki:Pagetriage-tags-stub-label/el]] Λήμμα προς επέκταση
*[[MediaWiki:Pagetriage-tags-stub-label/hr]] Mrva
*[[MediaWiki:Pagetriage-tags-stub-label/ml]] അപൂർണ്ണം
*[[MediaWiki:Pagetriage-tags-stub-label/mni]] ꯑꯇꯦꯟꯕ
*[[MediaWiki:Pagetriage-tags-stub-label/my]] ဆောင်းပါးတို
*[[MediaWiki:Pagetriage-tags-stub-label/nb]] Stubbe
*[[MediaWiki:Pagetriage-tags-stub-label/no]] Stubbe
*[[MediaWiki:Pagetriage-tags-stub-label/pt]] Esboço
* (change value) [[MediaWiki:Pagetriage-tags-stub-label/pt-br]] Provisória
*[[MediaWiki:Pagetriage-tags-stub-label/qqq]] Translation of the word Stub.
*[[MediaWiki:Pagetriage-tags-stub-label/ro]] Ciot
*[[MediaWiki:Pagetriage-tags-stub-label/sr-ec]] Клица
*[[MediaWiki:Pagetriage-tags-stub-label/uk]] Заготовка

==[[MediaWiki:Moodbar-action-reason-required]] ==
{{collapse top}}
[[User:Kmdenmark]] can you please create these? ~[[User:Notjusttired|Njt]] ([[User talk:Notjusttired|talk]]) 20:27, October 11, 2019 (EDT)
:{{done}} [[User:Kmdenmark|Kmdenmark]] ([[User talk:Kmdenmark|talk]]) 14:52, October 15, 2019 (EDT)

*[[mediawiki:Moodbar-action-reason-required/es]]<pre>
Proporciona una razón.</pre>
*[[MediaWiki:pagetriage-tags-cleanupreorganise-desc/es]]<pre>
Esta página necesita una reorganización para cumplir con las recomendaciones de diseño.</pre>

*[[MediaWiki:pagetriage-tags-cleanupreorganise-desc/fr]]<pre>
Le contenu de cette page a besoin d’être réorganisé pour respecter les recommandations.</pre>

*[[MediaWiki:pagetriage-tags-cleanupreorganise-desc/nl]]<pre>
Deze pagina heeft extra referenties of bronnen nodig voor controleerbaarheid.</pre>
:Great, {{Thank}} ~[[User:Notjusttired|Njt]] ([[User talk:Notjusttired|talk]]) 16:57, October 15, 2019 (EDT)
{{collapse bottom}}
===Navigation translations ===
Done
*[[MediaWiki_talk:Pagetriage-tags-cleanup-desc]] for template:Cleanup
*[[mediawiki:Gettingstarted-lightbulb-heading]] Pages to improve
*[[MediaWiki:Qbbrowse]] Browse
*[[MediaWiki:Externalguidance-specialpage-contribute-title]] Ways to contribute

==Translations: Licenses ==
{{collapse top}}
If anyone of you could help with the translations below I would really appreciate it. It's to help Non-English speakers upload files. [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 06:45, August 16, 2019 (EDT)
[[User:Hannosch]] [[User:sigridjones]] [[User:Sisyphus]] [[User:Guido den Broeder]] [[User:DaviSpain]]

If you want to add languages you speak to your user page you can find user boxes on [[Template:Userbox]] Thank you [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 06:45, August 16, 2019 (EDT)

===License system message test===
* Unknown_copyright|{{int:copyright-i-dont-know}}
* CC-by-sa-3.0|{{int:copyright-own-sa-simple}}
* CC-by-nd-4.0|{{int:copyright-own-nd-simple}}
* CC-zero|{{int:copyright-own-pd-simple}}

* {{int:wm-license-cc-conditions-attribution-header}}{{colon}}
** PD|{{int:copyright-pd}}
** PD-USGov|{{int:Copyright-pd-usgov}}
** GFDL|GFDL{{colon}} GNU Free Documentation License
** LGPL|LGPL{{colon}} GNU Lesser General Public License
** FAL|{{int:wm-license-fal}} (artlibre.org)
** CC-zero|Creative Commons Zero - {{int:copyright-pd}}

* CC Share-Alike:
** CC-by-sa-4.0|Creative Commons ShareAlike 4.0
** CC-by-sa-3.0|Creative Commons ShareAlike 3.0
** CC-by-sa-2.5|Creative Commons ShareAlike 2.5
** CC-by-sa-2.0|Creative Commons ShareAlike 2.0

* CC Attribution only:
** CC-by-4.0|Creative Commons Attribution 4.0
** CC-by-3.0|Creative Commons Attribution 3.0
** CC-by-2.5|Creative Commons Attribution 2.5
** CC-by-2.0|Creative Commons Attribution 2.0

* CC other:
** CC-by-nc-4.0|CC NonCommercial 4.0
** CC-by-nc-3.0|CC NonCommercial 3.0
** CC-by-nc-2.5|CC NonCommercial 2.5
** CC-by-nc-2.0|CC NonCommercial 2.0
** CC-by-nc-nd-4.0|CC NonCommercial No-Derivs 4.0
** CC-by-nd-4.0|CC No-Derivs 4.0

* {{int:Other}}{{Colon}}
** Fair_Use_License|{{int:Copyright-fair-usage}}{{Colon}} {{int:Copyright-explain-exception}}
** Other_license|{{int:Other}}{{Colon}} {{int:Copyright-leave-explanation}}

==English ==
* Unknown copyright
**I don't know exactly
* I created this and anyone can copy it but don't alter it, and credit me as the author
* I created this and anyone can alter or copy it, but credit me as the author
*I created this and I don’t care what anyone does to it, no one has to credit me as the author

* Free licenses:
** Public domain
** Public domain US Government
** Free Art License

* Other:
** Fair Use: Please explain the copyright exception (e.g. scholarship/research)
** Other: Please leave detailed explanation

#[[Template:Used with permission]]
#[[Template:Fair Use License]]
#[[Template:Unknown copyright]]
#[[Template:Copyright violation]]

==Français==
*GFDL: Licence de documentation libre GNU
*LGPL : licence publique générale limitée GNU
* Attribution - Pas d'Utilisation Commerciale - Pas de Modification 4.0 International (CC BY-NC-ND 4.0)

* Unknown copyright
**I don't know exactly
* I created this and anyone can copy it but don't alter it, and credit me as the author
* I created this and anyone can alter or copy it, but credit me as the author
*I created this and I don’t care what anyone does to it, no one has to credit me as the author

* Free licenses:
** Public domain
** Public domain US Government
** Free Art License

* Other:
** Fair Use: Please explain the copyright exception (e.g. scholarship/research)
** Other: Please leave detailed explanation

#[[Template:Used with permission/fr]]
#[[Template:Fair Use License/fr]]
#[[Template:Unknown copyright/fr]]
#[[Template:Copyright violation/fr]]

==Deutsch==
Done

*Nicht kommerziell - Keine Bearbeitungen 4.0 International (CC BY-NC-ND 4.0)
*Nicht kommerziell 4.0 International (CC BY-NC 4.0)
*Keine Bearbeitungen 4.0 International (CC BY-ND 4.0)
*Namensnennung - Attribution
*GFDL - GNU-Lizenz für freie Dokumentation
* wm-license-gfdl-1.3-only plus wm-license-gfdl-1.2-and-later - GFDL text
* wm-license-gpl-text - GFDL explanation
* wm-license-gfdl-wiki-link - GFDL link

{{collapse top}}
* Unbekanntes Copyright
**Ich weiß es nicht sicher
* Ich habe dies erstellt und es darf von jedem genutzt werden, aber bitte verändere es nicht und nenne mich als Autor
* Ich habe dies erstellt und jeder darf es verändern und kopieren, aber bitte nenne mich als Autor
* Ich habe dies erstellt und es ist mir egal, wie es genutzt wird, niemand braucht mich als Autor zu nennen

* Freie Lizenzen:
** Öffentliche Domain
** Öffentliche Domain US-Regierung
** Lizenz für freie Kunst

* Weitere:
** Fairer Gebrauch: Bitte erläutere die Ausnahmen vom Copyright (z.B. Stipendium/Forschung)
** Andere: Bitte detailliert erläutern

#[[Template:Gebrauch mit Erlaubnis]]/de
#[[Template:Lizenz zum fairen Gebrauch]]/de
#[[Template:Unbekanntes Copyright]]/de
#[[Template:Verstoß gegen das Copyright]]/de
{{collapse bottom}}

==Español ==
* Unknown copyright
**I don't know exactly
* I created this and anyone can copy it but don't alter it, and credit me as the author
* I created this and anyone can alter or copy it, but credit me as the author
*I created this and I don’t care what anyone does to it, no one has to credit me as the author

* Free licenses:
** Public domain
** Public domain US Government
** Free Art License

* Other:
** Fair Use: Please explain the copyright exception (e.g. scholarship/research)
** Other: Please leave detailed explanation

#[[Template:Used with permission/es]]
#[[Template:Fair Use License/es]]
#[[Template:Unknown copyright/es]]
#[[Template:Copyright violation/es]]
==Nederland ==
* Unknown copyright
**I don't know exactly
* I created this and anyone can copy it but don't alter it, and credit me as the author
* I created this and anyone can alter or copy it, but credit me as the author
*I created this and I don’t care what anyone does to it, no one has to credit me as the author

* Free licenses:
** Public domain
** Public domain US Government
** Free Art License

* Other:
** Fair Use: Please explain the copyright exception (e.g. scholarship/research)
** Other: Please leave detailed explanation

#[[Template:Used with permission/nl]]
#[[Template:Fair Use License/nl]]
#[[Template:Unknown copyright/nl]]
#[[Template:Copyright violation/nl]]

==Other==
* Unknown copyright
**I don't know exactly
* I created this and anyone can copy it but don't alter it, and credit me as the author
* I created this and anyone can alter or copy it, but credit me as the author
*I created this and I don’t care what anyone does to it, no one has to credit me as the author

* Free licenses:
** Public domain
** Public domain US Government
** Free Art License

* Other:
** Fair Use: Please explain the copyright exception (e.g. scholarship/research)
** Other: Please leave detailed explanation

#[[Template:Used with permission]]
#[[Template:Fair Use License]]
#[[Template:Unknown copyright]]
#[[Template:Copyright violation]]

I've tried to translate it into Dutch an French but it isn't that easy. These Copyright terms are quite specific and ifrequently used in ordinary language. So perhaps you could let other Dutch/French speakers check if it sounds ok. - Sisyphus
:Thanks for your help [[User:Sisyphus]], I will do that with the copyright specific ones. [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 17:50, August 17, 2019 (EDT)

* English
* Dutch
* French

* Unknown copyright
* Auteursrecht ongekend
* Copyright inconnu

* I don't know exactly
* Ik weet het niet precies
* Je ne sais pas exactement

* I created this and anyone can copy it but don't alter it, and credit me as the author
* Ik heb dit gemaakt en iedereen mag het kopiëren, maar wijzig het niet en vermeldt me als auteur
* J'ai créé ceci et tout le monde peut le copier mais ne le modifie pas, et créditez-moi comme auteur

* I created this and anyone can alter or copy it, but credit me as the author
* Ik heb dit gemaakt en iedereen mag het kopiëren en wijzigen, maar vermeldt me als auteur
* J'ai créé ceci et tout le monde peut le copier ou le modifier mais créditez-moi comme auteur

* I created this and I don’t care what anyone does to it, no one has to credit me as the author
* Ik heb dit gemaakt en iedereen mag het gebruiken naar goeddunken; je hoeft me niet als auteur te vermelden
* J'ai créé ceci et tout le monde peut l’utiliser comme il veut ; one ne doit pas me créditer comme auteur.

* Free licences
* Vrije licentie
* Licence libre

* Public domain
* Publiek domein
* Domaine public

* Public domain US Government
* Publiek domein, overheid van de Verenigde Staten van Amerika
* Domaine public, gouvernement des États-Unis

* Free Art License
* Vrijekunstlicentie
* Licence Art Libre

* Fair Use: Please explain the copyright exception (e.g. scholarship/research)
* Faire Use: verduidelijk alstublieft de uitzonderingen op auteursrecht (bijv. voor studiebeurzen/ onderzoek)
* Faire Use: explique les exceptions au droit d’auteur (p. ex. bourse/recherche scientifique)

* Please leave detailed explanation
* Geef alstublieft een gedetailleerde verklaring
* Laissez des explications détaillées

* Template: Used with permission
* Sjabloon: gebruikt met toestemming
* Modèle: utilisé avec permission

* Template:Fair Use License
* Sjabloon: Fair Use licentie
* Modèle: Licence Faire Use

* Template: Unknown copyright
* Sjabloon: ongekend auteursrecht
* Modèle: Copyright inconnu

* Template: Copyright violation
* Sjabloon: Inbreuk tegen het auteursrecht
* Modèle: Atteinte au droit d'auteur

{{collapse bottom}}

{{collapse bottom}}
==Archived messages ==

{{collapse top}}
===Tweet ===
Hey Njt! I noticed a weird error message regarding the Tweet/doc page at [[:category:Pages_with_incorrect_formatting_templates_use]]. I really don’t know what to make of it, maybe it makes more sense to you... Cheers!
<br>[[User:Pyrrhus|Pyrrhus]] ([[User talk:Pyrrhus|talk]]) 20:07, July 6, 2019 (EDT)
:Do you mean the date script error? I think the Math extension might be needed for that template (which isn't in use yet). It fails because the Extract template it uses doesn't work. [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 15:13, July 7, 2019 (EDT)
:Now fixed [[User:Pyrrhus]] [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 06:29, August 6, 2019 (EDT)

===Re: Leave me a message -- [[User:Sigridjones|sigrid.jones]] ([[User talk:Sigridjones|talk]]) 04:20, August 6, 2019 (EDT)===

Thank you! I just added some user boxes. Happy to be here. Best regards, Sigrid --sigrid.jones (talk) 04:05, August 6, 2019 (EDT)

===Deleting pages problem ===
Hi [[User:Notjusttired|notjusttired]]! I started deleting some of the pages you cited for deletion, however, without them the references no longer populate, so I restored several. Please advise. Thanks, [[User:Kmdenmark|Kmdenmark]] ([[User talk:Kmdenmark|talk]]) 16:44, June 26, 2019 (EDT)
:Hi [[User:Kmdenmark|Kmdenmark]]! I see that the "Articles for deletion" category is broken, and it is showing a number of template pages that were never marked for deletion. I will look into the problem later on today or tomorrow and then I will get back to you. In the meantime, please restore the following templates that still need to be restored: [[Template:Chem2]], [[Template:Chem2/doc]], [[Template:Citation needed/doc]], [[Template:Composition bar]], [[Template:Composition bar/doc]], [[Template:Coord/doc]]. Thanks!
:[[User:Pyrrhus|Pyrrhus]] ([[User talk:Pyrrhus|talk]]) 17:16, June 26, 2019 (EDT)
::[[User:Pyrrhus|Pyrrhus]] Thanks! Take your time with it. I'll restore the ones deleted and will ignore the list until further notice. [[User:Kmdenmark|Kmdenmark]] ([[User talk:Kmdenmark|talk]]) 17:40, June 26, 2019 (EDT)
:::Yikes! [[User:Kmdenmark]] All the ones I marked for deletion today start with "Template:Template:" so those should be fine to delete, and all should have a similarly named page with "Template:" just mentioned once. I can't imagine what happened here. [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 18:05, June 26, 2019 (EDT)
::::Please hold off on deleting anything. There maybe some weird unanticipated link between the templates we want deleted and those we don’t want deleted...
::::[[User:Pyrrhus|Pyrrhus]] ([[User talk:Pyrrhus|talk]]) 18:26, June 26, 2019 (EDT)
:::::[[User:Pyrrhus|Pyrrhus]] and [[User:Notjusttired|notjusttired]], I'll hold off from deleting anything for now. I'm assuming that keeping the pages for now will not interfere with other operations. [[User:Kmdenmark|Kmdenmark]] ([[User talk:Kmdenmark|talk]]) 11:51, June 27, 2019 (EDT)
::::::[[User:Pyrrhus]] [[User:Kmdenmark]] I believe it's fixed now. I accidentally marked 2 templates that are needed for deletion, and they must be transclusions, so they added the deletion category to every template that used them. Can you please add protection to these 2 pages to prevent this happening again - the pages are [[Template:Template_other]] and [[Template:Template_error_report]]. The pages I had intended for deletion all had "Template:" in the name not just "Template", and all should be blank except for the deletion category. Perhaps you can both check if [[:Category:Articles for deletion]] looks right now. I'm really sorry for the problems caused by my mistake. [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 14:16, June 27, 2019 (EDT)
:::::::looks good to me, thanks njt!
:::::::[[User:Pyrrhus|Pyrrhus]] ([[User talk:Pyrrhus|talk]]) 14:48, June 27, 2019 (EDT)

===Pivot===
Hi Njt! Hope you’re enjoying your weekend. In case you missed it, the Pivot skin comes with some configuration variables. For more info, see https://pivot.wikiproject.net/wiki/Pivot_features
<br>Here is some example code you may be interested in:
<pre>
$wgPivotFeatures = [
'navbarIcon' => true,
'addThisPUBID' => 'ra-5cdfe8dacb9028fa'
];
$wgAddThisSidebar = true;
$wgAddThispubid = 'ra-5cdfe8dacb9028fa';
</pre>
(Code obviously comes after <nowiki>wfLoadSkin( 'pivot' );</nowiki>.) Hope this helps.
<br>[[User:Pyrrhus|Pyrrhus]] ([[User talk:Pyrrhus|talk]]) 17:40, May 25, 2019 (EDT)
::I've seen that, thanks. The publisher ID I requested and should sort the sidebar issue. Oddly the side bar setting does not work as you'd expect given the name! The logo setting might be withwhile but only applies to the smallest mobiles and puts the logo in the centre of the top bar! I've swapped the font and style of the title bar for the moment, and got it displayed #MEpedia. See code on [[MediaWiki_talk:Pivot.css]] for .p-logo-text. When the weekend is over In going to put in a request to add the MEAction fonts for ALL skins, which will mean we can use the logo text style anywhere. [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 17:51, May 25, 2019 (EDT)

Hi! Just checking if you need me to make any other changes. Hope all is well [[User:Kmdenmark|Kmdenmark]] ([[User talk:Kmdenmark|talk]]) 17:31, 16 May 2019 (EDT)
:Thank you for the offer of help. I'm making a lot of changes to the 2 new skins so that would be great. Can you do the new code for Timeless, like you did for the Pivot one? It's on here [[MediaWiki_talk:Timeless.css]] and needs to overwrite [[MediaWiki:Timeless.css]] totally, which will be easier than deleting the sections causing layout issues. Thanks again [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 15:41, 17 May 2019 (EDT)

===Archived ===
"Hi Njt! I noticed the following suggestion of yours in the Dev queue of [[MEpedia:Suggested_tasks]]:
<br>"Create custom Special page for tracking pages using NeedsImage template requested by User:Notjusttired"
<br>I was under the impression that this page accomplishes this: [[:Category:Articles_that_need_an_image_or_photo]]
<br>Am I wrong or missing something? Thanks.
<br>[[User:Pyrrhus|Pyrrhus]] ([[User talk:Pyrrhus|talk]]) 19:22, 28 March 2019 (EDT)
::Have done that now. I originally hoped to add or as a Tracking category in special pages so it's easy to find, but there's no simple way to do this. Would rather focus on other dev tasks.
::Have you got any thoughts on different skins? I added some to the Dev queue including a dark one. [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 17:18, 30 March 2019 (EDT)
:::BTW, I recently created a page to collate all those weird special pages together: [[MEpedia:Pages in need]]
:::The idea is that there would be a link in the lefthand sidebar to this "Pages in need" page so that contributors would have quick access to all these weird special pages. I'm pretty clueless on skins, so no opinion here, but I'll try to take a look. Thanks for all your help, Njt!
:::[[User:Pyrrhus|Pyrrhus]] ([[User talk:Pyrrhus|talk]]) 18:47, 30 March 2019 (EDT)
:::okay, I’ve finally taken a look at skins. It looks like you are recommending TimelessDarkCSS as a light-sensitive option and Pivot as the Mobile option. Is this correct?
:::Also, i note that your user page mentions “collapsible lists”. Do you know of any way to do that? That would be ideal for the Contents page...
:::[[User:Pyrrhus|Pyrrhus]] ([[User talk:Pyrrhus|talk]]) 18:59, 10 April 2019 (EDT)

::::Hi Pyrrhus. Yes to the Timeless-DarkCSS for those with photophobia or preferring a dark background.
::::The '''Pivot''' skin is brilliant for mobile devices and tablets but actually looks excellent on a Desktop (in my view) - Timeless without the dark CSS is a serif font I seem to remember and also looks good on mobiles, tablets and desktops. The norm is to default to Vector for wikis but Vector is really hard work on small screens because you can't hide the side menu - either you zoom and scroll a lot or need the most amazing vision.
::::Assuming these get installed and work as well as expected it should be nice to have a button to flip to the dark skin for those '''not logged in '''. I haven't seen the code to do this yet though. [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 16:44, 11 April 2019 (EDT)
:::::okay, here’s what it looks like we should do:
:::::#Install Timeless-DarkCSS and Pivot skins
:::::#Put two links in the lefthand/top sidebar: “Light-sensitive interface” and “Mobile-friendly interface”. These links will bring up instructions for how to switch skins in the user’s Preferences. When we find the code for a not-logged-in-user button, we’ll replace the links with buttons.
:::::#If the Pivot interface turns out to be as good as you say, we should talk about making Pivot the default interface for all devices.
:::::Does that look right?
:::::[[User:Pyrrhus|Pyrrhus]] ([[User talk:Pyrrhus|talk]]) 17:25, 11 April 2019 (EDT)

::::::Yes, that's right, although I think calling it "dark view" or "dark version" would be better. Dark timeless is simply a skin called Timeless with extra CSS, Timeless has almost the same features as Pivot so it might be a case of seeing whether Timeless in white is more popular than Pivot - I prefer Pivot myself. There's 2 different ways to automatically switch skins for mobile users [https://www.mediawiki.org/w/index.php?title=Simple_mobile_skin_auto_change/en&mobileaction=toggle_view_desktop Method 1] and [https://www.mediawiki.org/wiki/Extension:MobileFrontend Mobile Frontend method] which would allow desktop users to stay on Vector automatically. If you want to checkout hope they look on different screen sizes then [https://quirktools.com/screenfly/ Screenfly] is pretty good [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 18:50, 11 April 2019 (EDT)
"

==Renaming?==

I renamed this page to use the US spelling, as per the Manual of Style. [[User:kmdenmark]]
But should the category be renamed to '''British Organizations'''?
This would be easier to browse from [[:Category:Organizations]] because the country make would be first and the name is shorter. The same issue is there for Universities.
This would also fit with the Standard MEpedia country categories eg [[:Category:British research initiatives]].
I've created a temporary [[MEpedia Page Outlines]] for both Universities and Organizations but would welcome input / Ch changes from others. [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 18:14, 20 February 2019 (EST)

::The changes are fine with me. I have no attachment to either way. I think "Organizations based in the United Kingdom" is a bit long and awkward but it's the category title that Wikipedia uses. ([https://en.wikipedia.org/w/index.php?search=Category%3AOrganizations+based+in+the+United+Kingdom&title=Special%3ASearch&profile=advanced&fulltext=1&advancedSearch-current=%7B%22namespaces%22%3A%5B0%5D%7D&ns0=1 Wikipedia page for "Organizations based in the United Kingdom"]) [[User:Kmdenmark|Kmdenmark]] ([[User talk:Kmdenmark|talk]]) 19:03, 21 February 2019 (EST)
{{collapse bottom}}

{{collapse bottom}}
==Categories for UK politicians==
{{Read more|
Hi. Can you avoid removing politicians from the categories for political parties? This is crucial information for advocacy and not held elsewhere. Labour/Co-op members are considered members of both parties so need to be in more than one category. Keeping them as categories allows someone to look for UK adbocates, then use the subcategories to find just politicians for political parties or fod which committee they are on - one committee is investigating the PACE trial Parties cover both MPs and the unelected House of Lords.

::Thank you for explaining the need for categories for politicians. I see your point and will not delete them anymore. [[User:Kmdenmark|Kmdenmark]] ([[User talk:Kmdenmark|talk]]) 14:29, 11 February 2019 (EST)

::::Thanks [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 19:01, 11 February 2019 (EST)

Also please don't mark redirects for deletion - they are there to help from the correctly spelled page - searching the incorrect name means MEpedia then find the correct page name too. notjusttired (talk) 13:06, 7 February 2019 (EST)

::Re: misspellings - I don't think misspellings should be honored with redirects. It is impossible to conceive of every misspelling that someone could use. I think the misspellings clutter the drop down menu in our search engine and make articles harder to find rather than easier. I support using redirects for alternative spellings, but not misspellings. If you can give me an example of one of the redirects you want to stay, it would help me understand your reasoning. I, also, eliminated some redirects where pages were not medically the same and to keep them as such would be inaccurate. A better way to link similar but different pages would be with links in the 'See also' section. (I don't know if you were the author of those redirects, but I wanted to explain why I eliminated those redirects, also.) My best, [[User:Kmdenmark|Kmdenmark]] ([[User talk:Kmdenmark|talk]]) 14:29, 11 February 2019 (EST)

::::It depends on the reason for the mispelling and how common it is. Eg if you delete the redirect for [[Intestinal permiability]] and type of into a search the correct page name won't come up - there's no results. Delete redirects for different spacing in page names and that search phrase may not work any more (eg The M.E. Society vs The ME Society). There's also a few unexpected UK vs US spellings (diarrhoea), and a few researchers with names that are commonly mispelled or have very similar spellings, which sometimes means their research is under several different names (AT Anbu vs Theo Anbu). When it comes to linking redirects have a link icon next to the page name, so it's easy to pick the right one - although perhaps there is a hidden property that can be used.

::I'm fine with trying it your way. Let's watch how the redirects work and see if we get other feedback from users.
:::A couple specific points: Sometimes the search engine is extra slow or temporary not working; that may explain why the correct spelling for [[Intestinal permeability]] didn't come up when you originally searched. I tested it and it came up every time I searched this morning.
:::Re: British spelling. I wholeheartedly agree that redirects for British spellings should have redirects. The main title is to be in American spelling as per MEpedia manual of style. My best, [[User:Kmdenmark|Kmdenmark]] ([[User talk:Kmdenmark|talk]]) 12:01, 12 February 2019 (EST)

:::::::: Thanks [[User:Kmdenmark]] - I've noticed performance problems but that has been loading pages rather than on searches. Maybe there's something else going on.

::::With making redirects for deletion, they need any pages using them to be updated first. The Contents page (which I can't edit) has a non-standard [[List of Quotes]] link, so deleting to use the correct capitalization breaks the link on the Contents page.
}}

==Messages I've seen ==
{{Read more|RE: Csn the Mike Beadsworth page be the main one, with Michael Beadsworth the redirect? Professionally he uses the name Mike far more.
Njt
[[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 13:58, 23 January 2019 (EST)

Sure, sounds good. [[User:Kmdenmark|Kmdenmark]] ([[User talk:Kmdenmark|talk]]) 17:19, 23 January 2019 (EST)

----
Just FYI: On the Pathogen page, you have left the following typo: "_Chia_201dorferi_paper.png"

I can't fix the typo since I'm not sure what it was meant to say...

Best, Pyrrhus

[[User:Pyrrhus|Pyrrhus]] ([[User talk:Pyrrhus|talk]]) 20:36, 10 February 2019 (EST)

Thank you [[User:Pyrrhus|Pyrrhus]] - I'm not sure what image it was supposed to be so I added an alternative and fixed the problem. [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 09:07, 11 February 2019 (EST)
}}
{{collapse bottom}}

== Priorities ==
* Image copyrights to organize
* Check copyrights on ICC and other files
* Better symptom photos e.g. malaise, levels of fatigue and disability, symptoms
* Infographics template - XMP CC info, large size, site name only in corner (font as wiki?)
* Infographic & poster creation

== Brain fog tasks ==
* [[Articles that need an image or photo]]
* [[:Category:Articles with unsourced statements]]
* [[Add source and copyright to existing images]]

== Tips ==
* [[Science Guidelines]]
* [[Using the source_code editor]]
* [[Power user/editor tips]]

==Welcome to MEpedia!==
* [[How_to_contribute|How to contribute]]
* If you need ideas of improvements to make to MEpedia, See [[MEpedia_suggestions|suggestions]]
* [[Contents|MEpedia Contents]]

* To create new page, use one an outline: [MEpedia_article_outlines]

To see your contributions history, click Contributions in the top-right corner. To see recent contributions by others, click Recent Changes on the left. Not ready to edit pages, but want to suggest a change? On the page, just click Discussion, and write your suggestion there for others to see.|realName=Anonymous|name=Notjusttired}}

== Random code==
{{bar box
|title=Chronic Fatigue Syndrome: Common Symptoms
|titlebar=#DDD
|left1='''Symptom'''
|right2=%
|width=400px
|bars=
{{bar pixel|Fatigue: persistent or relapsing|#0CBCBC|100}}
{{bar pixel|Symptoms last over 6 months|#0CBCBC|100}}
{{bar pixel|Significant reduction in activities|#0CBCBC|100}}
{{bar pixel|Post-exertional malaise|#0CBCBC|96}}
{{bar pixel|Memory & concentration probs|#0CBCBC|98}}
{{bar pixel|Unrefreshing sleep|#0CBCBC|99}}
{{bar pixel|Headaches - new or different|#0CBCBC|100}}
{{bar pixel|Muscle pain (myalgia)|#0CBCBC|96}}
{{bar pixel|Sore throat|#0CBCBC|81}}
{{bar pixel|Joint pain (arthalgia)|#0CBCBC|86}}
{{bar pixel|Lymph node pain|#0CBCBC|81}}
|caption=Source: Jason et al.
}}‎

{{Bar chart
| title = <div style="font-size:1.4em; margin-bottom: 0.4em;">Common Symptoms in Chronic Fatigue Syndrome</div>
| bar_width = 15
| width = 30
| width_units = em
| label_type = Symptom
| label1 = Fatigue - persist or relapsing*
| label2 = Significant reduction in activities*
| label3 = Symptoms last over 6 months*
| label4 = Post-exertional malaise
| label5 = Memory & concentration probs
| label6 = Unrefreshing sleep
| label7 = Headaches - new or different
| label8 = Muscle pain (myalgia)
| label9 = Sore throat
| color = #0CBCBC
| data_type = Mild to Severe<br> Symptom %
| data_max = 101
| data1 = 100
| data2 = 100
| data3 = 100
| data4 = 96
| data5 = 98
| data6 = 99
| data7 = 90
| data8 = 96
| data9 = 81
| col2_data_type = Moderate to Severe<br> Symptom %
| col2_data_max = 101
| col2_data1 = 95
| col2_data2 = 100
| col2_data3 = 100
| col2_data4 = 86
| col2_data5 = 80
| col2_data6 = 92
| col2_data7 = 50
| col2_data8 = 73
| col2_data9 = 31
|caption= '''Source: Jason et al.'''
}}

===Messages ===
Notjustired: [[Severe and very severe ME]] Chronological order goes from earliest to latest. Citations are not placed under the study and instead, they are cited. If details like pages are necessary, they can be entered into the citation. --[[User:MEcfsFMS|MEcfsFMS]] ([[User talk:MEcfsFMS|talk]]) 09:51, 20 October 2018 (EDT)

Hi. Is that somewhere in the editorial standards? I don't remember reading it. I think it's important to add doi to citations of they aren't already in there. I will look at adding author links to the citations too. I created a talk page for the Severe ME image to discuss ideas.
[[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 10:15, 20 October 2018 (EDT)

:I put doi in and the PMID? But PMC causes an error and I don't think they have figured out why yet. Authors links don't get created and I thought they were in the "Reference" area.--[[User:MEcfsFMS|MEcfsFMS]] ([[User talk:MEcfsFMS|talk]]) 10:39, 20 October 2018 (EDT)

:I see, if the citation automatically creates the citation, authors internal links are created. If they have to be manually input then it does not seem to create them.

:That makes sense. I thought people had been spending ages manually adding them or copying and pasting the code for the most common ones. I normally automatically generate a citation, if it doesn't work I use another link or the doi, then replace the finished link with a full text link if necessary. Links from investinme and researchgate normally don't generate automatically so I use a PubMed link and overwrite the link only after the citation is generated.
Could you update the [[Manual of style]] with anything else that isn't in there?
I'll go back sort the citations I changed. [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 10:53, 20 October 2018 (EDT)

== MOS - Dates ==

Hi Notjusttired:

Somewhere at some point early on, I remember the date format was to be US, Jun 10, 2016, and not 10 Jun 2016. I can't remember where or when I read this but a few of us started changing dates in UK format and going forward we used US format. I think Jen had posted about it but I'm not sure. Also, we were to change any UK spellings to the US spelling unless it was a quote.--[[User:MEcfsFMS|MEcfsFMS]] ([[User talk:MEcfsFMS|talk]]) 14:26, 31 October 2018 (EDT)

ty for letting me know, can you fix what I wrote on [[MOS]] - does the same apply to date in citations? Sometimes they cause an error so I presume I put them in as Jun, 28 2018 now?

:Yes, that is how I write in the citations, but move the comma so it is Jun 28, 2018 or Jun 2018. I will change MOS.--[[User:MEcfsFMS|MEcfsFMS]] ([[User talk:MEcfsFMS|talk]]) 14:43, 31 October 2018 (EDT)
- Will do, do you know about fixing the citation template error at all? Dates generated in the form 2018-06 always give an error when you generate a citation from a link - I presume it's possible to fix this? [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 14:49, 31 October 2018 (EDT)

== Fibromyaliga Page ==

Please be careful where information is added on the [[Fibromyalgia]] page. The blood test information you added should go on the [[Fibromyalgia notable studies]] page as it is not an accepted blood test yet. I moved the EpicGenetics blood test under the subheading "Blood tests" under "United States" and put the study you had added on the ''Fibromyalgia'' discussion page. You can post this research on the ''Fibromyalgia notable studies'' page.

I created and edited most of these pages starting with the username DxCFS. I lost my PW when FF crashed and could not get it back using the PW retrieval as there is something wrong with MEpedia carrying out this task. I have had many usernames because I am really bad with remembering my usernames and usually just use a VPN now.--[[Special:Contributions/77.111.245.10|77.111.245.10]] 12:07, 25 March 2019 (EDT)

:Also, the ''Fibromyalgia'' page became too long to use the "Edit" tab and the "Edit source" tab is not an option due to citations and that is why I broke ''Notable studies'' off. There is an area at the bottom of the ''Fibromyalgia'' page to post news articles about research as people usually want to read about research by media and bloggers and not the hard research.--[[Special:Contributions/77.111.245.10|77.111.245.10]] 12:13, 25 March 2019 (EDT)

:Thanks for the input - I've never edited that page before. I will update the redirects for blood test info - when I searched before adding it the Fibro Notable studies page wasn't near the top of the results (I don't recall seeing it at all). [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 16:49, 25 March 2019 (EDT)

== Simon Wessely Page ==
{{collapse top}}
Wessely Page - Hi Notjusttired. I'm currently editing the page on Simon Wessely by inserting many references. Please leave the page for a moment otherwise we crosspost and I loose all the changes which is many hours of work. Kind regards, Sisyphus.
:I've just seen your notice. I will leave alone. I am going to put some improved citations on the talk page and leave it at that. [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 08:08, July 16, 2019 (EDT)

Thanks. It's ok now. The references have been inserted (It took a while). Could you delete the warning "This article may require cleanup to meet MEpedia's quality standards"? If not, could you explain which sections or claims you disagree with (for example in the discussion section of the page). Kind regards, Sisyphus.
::I will take a look. Did you see the citations I suggested on the talk page, including the Camelford ones? [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 10:45, July 16, 2019 (EDT)

I used some of them. I only briefly mention Camelford as an example where Wessely controversially pointed towards psychosocial factors in a case that isn't clear. More information about this could be posted on a seperate MEpedia page. I unfortunately do not know the details of this case, so I'll leave it to you and others. - Sisypus.
:[[User:Sisyphus]] Can you explain why so many sections have been removed or pretty much reverted? It was only recently changed about 3 weeks ago. It now reads as if everything Wessely claims via journalists or is in his research is a fact - even though at times he contradicts his previous statements so making it hard to know what he thinks. Eg the fact that Wessely claims CFS is part of MUS is his opinion, not a generally accept fact and that needs to be clear. In fact, one of the controversies around Wessely is him repeatedly making the claim that it can be classed as a psychological condition in the ICD-10 manual - despite confirmation from the World Health Organization that it is explicitly excluded and only classified as neurological. Including the death threats. The carefully phrased sections I added about those contesting his many claims are gone. He is known for saying one thing to one audience and something totally different to another. The links to the 3 pages of quotes complied from him are gone. I haven't seen a reason in the history or a mention of the removals or changes to the headings. Even his retirement claim is not a fact - he carried on publishing CFS research for years after "retiring". Eg police freedom of information act requests contradict that. As far as Wessely's claims of victimization go, we should be reporting "In a 2017 interview, Wessely stated that" but not in a way that suggests that it is factual. Wessely refused to appear before the UK's Gibson Enquiry which was pressing him for answers on his views. [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 11:59, July 17, 2019 (EDT)

I tried to rewrite the page in full text and provide more context to his work and the controversies. I’m sorry if have deleted things without providing a reason why.
Regarding the ICD, I personally think he was trying to say that patients with the symptoms of CFS can be diagnosed as having CFS (G93.3) or neurasthenia/fatigue syndrome (F48.8) and don’t see this as a big issue. If you disagree, perhaps we can make a section on this under controversies. Regarding the quotes: I am not a fan of quotes without context, certainly if it is used to criticize someone or cast someone in a certain light. That’s certainly the case of the links you mention. If you want them restored perhaps we could use them as example of criticism of Wessely rather than as an resource of quotes from him? Regarding the death threats I’m ok with restoring the info for example regarding the freedom of information request. I didn’t think this was vital because the information doesn’t permit us to make conclusions about what happened. And regarding the Gibson Enquiry if Wessely did actually get serious death threats, than I could understand why he prefers not to be questioned about the details on this. So I don't think this means much. If you insist on including more info about this, perhaps there is enough to make a separate page on this (there’s also some relevant info about this from Valerie Eliot Smith’s blog). Kind regards, Sispyhus.
::I'm happy to have the quotes back under a heading "Quotes critical of Wessely" or similar. The classification of ME/CFS is a huge issue because it is part of his claims that it is not a disease / has no disease process and that it is psychological or mostly psychological which justifies the CBT and even GET. He refuses to acknowledge any science he does not like such as mitochondria or immune days. It's quite likely he quit research rather than having his work proved wrong. Same with Michael Sharpe, also from the PACE trial. Peter White of the PACE trial allegedly retired early from clinical practice to avoid GMC complaints that could have removed his license to practice (he was under investigation). Wessely also helped design the PACE trial - a crucial fact now missing from the top of his page. Wessely and his policies largely in control of UK treatment and has been for over a decade. Regular political questions on him and his [[Wessely school]]. Thanks to his attempts to re-classify the illness all UK ME/CFS treatment comes from a mental health health budget, he controls the media via the Science Media Centre, and gives numerous interviews making nasty persons attacks on patients. Wessely and Deale provided the key randomized controlled trial in the 1990s still used as "evidence" for CBT. The Gibson Enquiry was a scientific one, many years before he stated his death threat claims - which some have suggested are simply a way to detect from PACE trial criticism, since that's when they appeared. Absolutely nothing to fear from that except scientific scrutiny. Several Freedom of Information Act requests have shown that PACE trial critics are not harassing let alone threatening anyone. Although they tried to use this argument to prevent the release of the data. <br >
I feel that the page re-write portrays Wessely incorrectly as mostly not controversial, and portrays his science as student accepted, and endorses his views given in newspaper interviews as accurate and unbiased. He will make claims like Gulf War Illness doesn't exist, then later claim to have originally discovered it! He's also a social security advisor and does not believe patients should be entitled to disability benefits.As regards the quotes - they come from several charities and are certainly not taken out of context. It's very hard to see how many of the statements could be out of context given how rude and nasty they often are about patients, who he calls "disgusting" and "not wanting to get better".<br>
What do you think about adding back in the references that were removed, and then working together to tackle a section at once? I think it important to be very careful not to claim Wessely has reported the truth about himself since this is often untrue or contradicted (either by himself or by independent sources). [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 13:35, July 17, 2019 (EDT)

I have thought about your comments but I think we have to be neutral and objective on this. I don’t think the texts of Margaret Williams and Malcolm Hooper should be used as a basis for the MEpedia page for exactly this reason. The page already contains much criticism of Wessely. It says in the introduction that his work is controversial and has been repeatedly criticized and it already contains numerous controversial quotes of him (including the “not wanting to get better” one).
Regarding the quotes out of context: I do think this is a big problem. The one about ME merely being a belief for example has been circulating within the ME community as it were to mean that ME patients are malingering, which isn’t what Wessely was saying. These kinds of misunderstandings are very unfortunate and distract from the real issues with his work.
I also think the MEpedia page should not only be directed towards patients but also to outsiders such as journalists or researchers who want objective information about Wessely. So a link to a list of controversial quotes with comments mocking what he said seems inappropriate. There are plenty of blogs and articles that criticize his work or scrutinize every word he said during his career, looking for inconsistencies or poorly nuanced statements. I don’t think the MEpedia page should be another of these and instead should offer an overview of his work and career like we do with other pages on researchers. If you see further problems with the page, I don’t mind discussing it further. But I think the current version is well balanced. - Sisyphus.
:I think the issue we are disagreeing on here is mostly neutrality. While parts of the previous page were not put across in a way that was fully neutrally totally excluding critical sources has in fact done the opposite. We can look at phrasing at the amount of text given to criticism but removing it is entirely inappropriate. I have an issue with passing off Wessely's views as facts when they are not - such as claiming CFS is part of MUS. We should not be doing that on any researcher's page. There is no doubt that Wessely is controversial - in fact he has given a number of interviews knowing that they would be controversial. "Controversial" is not a negative judgement - the Enterovirus theory is also controversial. ME itself and much of the research is controversial. The fact is his research is controversial too - after all the CDC, NHS and others followed it and the CDC and others then dumped it, plus there was the Stop GET petition too. The Institute of Medicine report disputes it. On neurality, we also can't claim Wessely invented CBT for CFS when he actually was one of 3 - Trudie Chalder has separately claimed to be the inventer. I am going to make some edits today, keeping in mind what you have said, to add in more neutral phrasing on his research "Wessely stated", in "Sir Wessely's view" etc. And add back in some references critical. While Margaret Williams and Malcolm Hooper are very critical, that does not mean they should be totally left off the page - that's not neutrality - but neither should they be emphasized. Patient groups critical of Wessely should certainly be referenced, along with Freedom of Information Act requests since they are neutral and accurate. This might mean overall that less text is critical of Wessely than before, but that there are a large number of sources supporting certain points. Part of the guidelines we are writing for is to allow others to find out more information, so we do need to either reference or link to quotes or Hooper's Mental health movement, but also any articles praising him and summarizing his contribution. If Quotes aren't used as a heading then they could go in Learn more for example. Clearly given the significant time taken to collect all these, they do have significance and may bring people to do the page who are looking for "Weasel words" - in which case they would then see an article more balanced than just those quotes. Perhaps you would like to look for those, or have some in mind. Re: Malingering: Wessely has said exactly that, in fact using the phrase "malinger's charter". Part of the basis of his scientific arguments is that around the "secondary gain" - his work and especially interviews repeatedly make this claim. That doesn't necessarily mean that particular quote needs including, but it is representative of his views. [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 07:12, July 18, 2019 (EDT)

With all the respect notjusttired but I disagree with some of your changes and would prefer the original to be reinstated. I don’t want to use an argument of authority here, but my text does include 135 references, mostly scientific publications. I have worked many months on this and I know what I’m talking about.
For example regarding the Gulf War syndrome: there’s not really a contradiction: his 1999 epidemiological study demonstrated that there was an adverse effect of going to the Gulf war that goes beyond deployed to war or being a soldier at that time period. So his study was one of the most important ones in demonstrating that the health of soldiers who went to the Gulf War was affected by something. But he doesn’t want to say there is a Gulf War Syndrome because there was no evidence for a unique constellation of signs or symptoms – the Gulf war veterans reported more of all the 50 symptoms assessed in the study. That’s his view and it’s unambiguously presented in his publications. It’s only by relying on fragmented quotes or misrepresentations by Hooper and Williams that things get obscure and that’s what I’m trying to avoid on the page.
Malingering is another example. There is no evidence that Wessely thinks CFS patients are malingering. In fact he has repeatedly warned against this idea, saying “there is little evidence to suggest that the fatigue results from impaired motivation, and the use of terms such as ‘malingering’ or ‘hysteria’ is to be deplored.” (Source: https://studylib.net/doc/7895242/chronic-fatigue-syndrome). He made similar arguments about Gulf War Syndrme (see minute 50 of this lecture: https://vimeo.com/52995882).
I can also attest that Wessely developed CBT for CFS: he was to first to publish about this in 1988 and to first to publish a trial on this in 1991. Chalder worked for him at the time so when she says she first developed CBT, she probably meant she was part of the team that did and that team was lead by Wessely. I highly doubt that she would contest that. She has no problem with crediting him, even about the scale that now bears her name: “I think its more Simons research than mine that we developed a fatigue scale, which is now called The Chalder fatigue scale.” (source: https://www.s4me.info/threads/13-march-2019-chalder-%E2%80%98medically-unexplained-symptoms%E2%80%99-my-clinical-and-research-journey-over-30-years.5576/page-3#post-152193)
I have reread the page and don’t understand what you mean by presenting Wesselys' view that CFS is part of MUS as a fact. I constantly use the phrase “they argued…” Williams and Hooper are allready on the page, they are references as examples of criticism of Wessely’s work. And I don’t quite understand why you made a separate heading for the PACE trial: Wessely wasn’t an author of the PACE trial. It seems weird to focus on this. He has published approximately 600 papers, several books and numerous newspaper articles – most which don’t get a mention because of a lack of space.
I’ve waited on editing the Wessely page until I’ve read most of his work and got an overview. By working this way I hoped to achieve a balance in attention each items receives without making the page too long. So please be mindful of that if you change things. Kind regards - Sisyphus.

"CBT is is based on a psychological and fatigue-based approach, with an expectation that exercise would normally be part of the treatment." is also not correct. In contrast to the CBT developed by Bleijenberg and Vercoulen, the CBT model developed at Kings' College does not necessarily include exercise. Instead it is focussed on graded actvity which can be increases in social activities, reading etc. Furthermore it is strange to describe it as a fatigue-based approach as it was inspired by the treatment of chronic pain. Wessely and other CBT-authors acknowledge this repeatedly.
::Do you mind if I move this conversion to the Talk page for Wessely? We are getting into what feels like a stalemate, I think input and suggestions from others would help. There shouldn't be a question on authority here, I would like to achieve a consensus and that should be possible. One of the very difficult issues with Wessely is that he contradicts himself, and these are worth pointing out. He will claim one thing in one place and another to a different audience - "malinger's charter" is a direct quote from him which he later contradicted (just as an example). So we should be careful in claiming his view or one thing or another when he himself has contradicted it elsewhere. The new section I will respond on in a moment, with a paste from the research to clarify.
::I recognize you have worked hard on this, but I think to make huge changes at all once causes issues for other editors. I also have worked extensively in this page, in Nov/Dec, and in March and then in June, plus on related topics recently - eg CBM model, and CBT. I too would prefer a revert to before you made the changes (!) but I think a looking towards a consensus would be a better approach. [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 09:20, July 18, 2019 (EDT)

Yes perhaps it's best to move the conversion to the talk page for Wessely. Perhaps we can just copy paste what we wrote here so that others can follow our conversation?
I also agree in working towards a consensus. But changes need to be carefully argued with good references (not just something someone else has claimed on a blog or tweet). I haven't seen any evidence that Wessely often contradicts himself, excepts perhaps for his statements on not seeing Ean P. Of course if one dissects everything a researcher has said or published in the last 30 years, you'll always find something. But haven't noticed clear contradictions. I'm not aware however where the 'malinger's charter' quote comes from - was this during a lecture?
One option would be to add more detailed criticism and information about Wessely on a seperate page - for example 'Wessely school' and to add a prominent link on the Simon Wessely page to this one for further details on the criticism of his work, including what Hooper and Williams have written.
I apologize if I deleted information you saw as important. I tried to incorporate most in the text I've wrote. I appreciate the hard work you put into MEpedia.
{{collapse bottom}}

== Tagging -- [[User:Brettz9|Brettz9]] ([[User talk:Brettz9|talk]]) 16:06, July 23, 2019 (EDT) ==

Hi there... I'm really too drained and preoccupied to do much these days with the wiki, so if you wouldn't mind only tagging me in cases where I had added the content myself, I'd appreciate it. Thanks! [[User:Brettz9|Brettz9]] ([[User talk:Brettz9|talk]]) 16:06, July 23, 2019 (EDT)
:Sure [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 16:41, July 23, 2019 (EDT)

== Slow down ==

Please slow down with your edits on Dutch topics. You're making lots of mistakes. As I suffer from ME, I can't possibly keep up. [[User:Guido den Broeder|Guido den Broeder]] ([[User talk:Guido den Broeder|talk]]) 21:24, September 12, 2019 (EDT)
:I can slow down editing, although I have no yet seen evidence that I had said anything not supported by references [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 13:18, September 13, 2019 (EDT)
I am now asking you to stay away from the Dutch pages that I'm editing. If you don't do that voluntarily, I will ask for you to be topic-banned. [[User:Guido den Broeder|Guido den Broeder]] ([[User talk:Guido den Broeder|talk]]) 17:25, September 14, 2019 (EDT)
::Explain your reason please. There are several editors reversing your edits, you are not following editorial or science guidelines, and even reversing some manual of style changes at the same time (eg date format). And you have a clear conflict of interest with this topic because you are founder one Dutch charity and wrote here - on MEpedia - that you previously lead a revolt against changes in another. So I find this request of yours quite unexpected. [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 20:03, September 14, 2019 (EDT)
:::This is not Wikipedia. Conflict of interest is not even defined here. If we were to apply the Wikipedia policy I would have a conflict of interest with every topic on this wiki, and so would all knowledgable editors, and the wiki would remain empty. So instead we just do the best we can, because it's important and there are only a few of us. All that you contribute on these pages is a lot of mistakes. That costs too much of my time and energy, so it needs to stop. There is plenty of technical work to do, so why don't you do that and leave the content to others. [[User:Guido den Broeder|Guido den Broeder]] ([[User talk:Guido den Broeder|talk]]) 20:27, September 14, 2019 (EDT)
:::With regard to dates: when I'm creating an article, I avoid using citation templates, because those clutter up the source text so badly that my ME brain can't cope very well. So the date format is irrelevant and I use the same format that I apply everywhere else, again saving time and energy. Content is important, minor differences in style are not. [[User:Guido den Broeder|Guido den Broeder]] ([[User talk:Guido den Broeder|talk]]) 20:51, September 14, 2019 (EDT)
::::So basically, you don't have a reason other than "mistakes". Please see the [[MEpedia:Manual of style]] including the talk page for it on dates. Everything here is US format, with short month names. It is up to you whether you use the Visual editor or not, but it would create ask the citations for you very quickly. Alternatively, just paste in the link as you do now, without the <nowiki >[ ]</nowiki >square brackets , then when you next use the Visual editor click it, and you will get a "Convert" option which will do so the citation for you. The citation template is not optional - but we are always keen to find ways to reduce the concentration needed to edit or read. I am somewhat surprised that you have not edited your own charity page now (I was on the website earlier but can't find some of the standard info we normally add). Brain fog I can never get used to. [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 21:31, September 14, 2019 (EDT)

== Signature in section headers ==

Section headers should not auto-generate a signature in them. Not only does that makes things messy, it affects Google searches. Can you please change that back to default? [[User:Guido den Broeder|Guido den Broeder]] ([[User talk:Guido den Broeder|talk]]) 16:34, September 15, 2019 (EDT)
:This is an automatic feature on MEpedia for editors using the toolbar button. There is no option not to include the name and signature. If you want this to change you need find out how it works and request the change, although it may have been added because inexperienced editors were forgetting to sign their posts. MEpedia talk pages are not indexed. [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 17:45, September 15, 2019 (EDT)
::Not so much inexperienced editors, but you do forget to sign your posts. Apparently, despite offering technical help, you don't have access to the backside of this wiki. That's OK, I will ask elsewhere. Could you explain what your offer of technical assistance means instead? [[User:Guido den Broeder|Guido den Broeder]] ([[User talk:Guido den Broeder|talk]]) 17:55, September 15, 2019 (EDT)

== Manual of style ==

The [[Manual of style]] was in part created by editors that are no longer around, with random edits by you in between. I intend to change it to make it easier for ME patients to contribute, before inviting other ME patients to join this project. For now, just remember that the MoS is not mandatory, especially not on pages that are still work in progress. They are guidance, not policy. Allowing users to contribute in a style that they feel comfortable with has priority. [[User:Guido den Broeder|Guido den Broeder]] ([[User talk:Guido den Broeder|talk]]) 17:36, September 15, 2019 (EDT)
:That is a ridiculous statement. I hope that you did not mean to suggest that the ill health of editors should be used to disregard their views and contributions entirely. It would appear that you have total disdain for the current MOS, editorial guidelines and science guidelines, and the fact that we have over 2,000 pages following these. Repeated uncivil behavior toward several users is also apparent. As I understand from your message here and your repeated failure to follow what has been agreed, you appear to have chosen not to engage with the process and feel that you will just change them as how you choose and without discussion. This is a collaborate project rather than a website you can simply hijack. [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 17:57, September 15, 2019 (EDT)

==Guido den Broeder ==
I refuse to accept further messages from you on my talk page.
You are repeatedly harassing me and edit warring, and at times insulting me. This is not civil behavior.

In future, if you have something to say to me use the relevant article talk page instead. [[User:Guido den Broeder]] [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 17:57, September 15, 2019 (EDT)

== Dorsal root ganglion or Dorsal root ganglia -- [[User:Loopy|Loopy]] ([[User talk:Loopy|talk]]) 08:51, November 18, 2019 (EST) ==

Hi, Notjusttired.

I wanted to ask if you felt that the Dorsal root ganglia page should really be Dorsal root ganglion. I see it both ways but usually Dorsal root ganglion. Wikipedia has a page that uses "ganglion". https://en.wikipedia.org/wiki/Dorsal_root_ganglion

--[[User:Loopy|Loopy]] ([[User talk:Loopy|talk]]) 08:51, November 18, 2019 (EST)
::I'm not really sure to be honest. If you want to rename it, leave the old redirect in place in case anyone searches for the old name. The wiki reference (ref 1) should be replaced with an encyclopedia or similar to meet the Science guidelines. ~[[User:Notjusttired|Njt]] ([[User talk:Notjusttired|talk]]) 13:19, November 18, 2019 (EST)

== Edit Issues? -- [[User:Loopy|Loopy]] ([[User talk:Loopy|talk]]) 05:14, April 17, 2020 (PDT) ==

I am having problems with editing. Only "Edit source" will let me edit, and even this option does not seem to be working well. And suddenly my FF browser will not let me edit here due to it not being an HTTPS site? Are you having problems? Trying to use the "Edit" tab, but keep getting the error "Error loading data from server: apierror-visualeditor-docserver-http-error: (curl error: 7) Couldn't connect to server. Would you like to retry?"

Coronavirus disease 19

2020-04-17T12:10:07Z

Loopy:/* See also */ x

'''Coronavirus disease 19''', commonly known as '''COVID-19''', is the infectious respiratory illness caused by the novel (new) [[Severe acute respiratory syndrome coronavirus 2]] (SARS-CoV-2), previously known as ''2019-nCoV''.<ref name="WHO-QA">{{Cite web|url=https://www.who.int/news-room/q-a-detail/q-a-coronaviruses|title=Q&A on coronaviruses (COVID-19)|last=World Health Organization|first=|authorlink=World Health Organization|last2=|first2=|authorlink2=|date=|website=www.who.int|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-16}}</ref><ref name="CDC-coronoviruses">{{Cite web|url=https://www.cdc.gov/coronavirus/types.html|title=Human Coronavirus Types|last=Centers for Disease Control and Prevention|first=|authorlink=Centers for Disease Control and Prevention|last2=|first2=|authorlink2=|date=2020-02-27|website=www.cdc.gov|language=en-us|archive-url=|archive-date=|dead-url=|access-date=2020-03-16}}</ref><ref>{{Cite journal|last=Li|first=Guangdi|author-link=|last2=Clercq|first2=Erik De|author-link2=|last3=|first3=|author-link3=|last4=|first4=|author-link4=|last5=|first5=|author-link5=|last6=|first6=|author-link6=|last7=|first7=|last8=|first8=|date=Mar 2020|title=Therapeutic options for the 2019 novel coronavirus (2019-nCoV)|url=https://www.nature.com/articles/d41573-020-00016-0|journal=Nature Reviews Drug Discovery|language=en|volume=19|issue=3|pages=149–150|doi=10.1038/d41573-020-00016-0|pmc=|pmid=|access-date=|quote=|via=}}</ref><ref>{{Cite web|url=https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/naming-the-coronavirus-disease-(covid-2019)-and-the-virus-that-causes-it|title=Naming the coronavirus disease (COVID-19) and the virus that causes it|website=www.who.int|language=en|access-date=2020-03-28}}</ref>
[[File:Covid-19-lung-lesions.jpg|thumb|left|alt=Computer-aided identification of lesions on the lungs of COVID-19 patients.|'''COVID-19 can cause lesions on lungs, and pneumonia.'''<br>Author: [https://www.sciencedirect.com/science/article/pii/S2095177920302264 Shen et al. 2020. Journal of Pharmaceutical Analysis]. Copyright: CC-BY-NC-ND-4.0]]{{clear}}
COVID-19 was first identified in Wuhan, China, in December 2019,<ref name="WHO-QA" /> and can infect babies, children, and adults of any age.<ref>{{Cite journal|last=Wei|first=Min|last2=Yuan|first2=Jingping|last3=Liu|first3=Yu|last4=Fu|first4=Tao|last5=Yu|first5=Xue|last6=Zhang|first6=Zhi-Jiang|date=2020-02-14|title=Novel Coronavirus Infection in Hospitalized Infants Under 1 Year of Age in China|url=https://jamanetwork.com/journals/jama/fullarticle/2761659|journal=JAMA|language=en|doi=10.1001/jama.2020.2131}}</ref> It spread globally, resulting in the 2019-2020 coronavirus pandemic.<ref>{{Cite journal|last=Hui|first=David S.|last2=Azhar|first2=Esam I.|last3=Madani|first3=Tariq A.|last4=Ntoumi|first4=Francine|last5=Kock|first5=Richard|last6=Dar|first6=Osman|last7=Ippolito|first7=Giuseppe|last8=Mchugh|first8=Timothy D.|last9=Memish|first9=Ziad A.|date=2020-02-01|title=The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health — The latest 2019 novel coronavirus outbreak in Wuhan, China|url=https://www.ijidonline.com/article/S1201-9712(20)30011-4/abstract|journal=International Journal of Infectious Diseases|language=English|volume=91|pages=264–266|doi=10.1016/j.ijid.2020.01.009|issn=1201-9712|pmid=31953166}}</ref><ref>{{Cite web|url=https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020|title=WHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020|website=www.who.int|language=en|access-date=2020-03-28}}</ref>

== Symptoms ==
Symptoms are usually mild and begin gradually, although around 1 in 6 people with COVID-19 need medical help.<ref name="WHO-QA" /> Some people become infected but don't develop any symptoms and don't feel unwell.<ref name=":0">{{Cite web||last=World Health Organization|first=|authorlink=World Health Organization|url=https://www.who.int/news-room/q-a-detail/q-a-coronaviruses|title=Q&A on coronaviruses (COVID-19)|website=www.who.int|language=en|access-date=2020-03-24}}</ref> These symptoms may appear 1-14 days after exposure; most commonly around five days.<ref name=":0" /><ref name=":1">{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html|title=Coronavirus Disease 2019 (COVID-19) – Symptoms|last=CDC|date=2020-03-20||author-link=Centers for Disease Control|website=Centers for Disease Control and Prevention|language=en-us|access-date=2020-03-24}}</ref>

=== Common Symptoms ===
* [[fever]]
* [[Fatigue|tiredness]]
* continuous cough, coughing episodes or a dry [[cough|cough,]]<ref>{{Cite web|url=https://www.nhs.uk/conditions/coronavirus-covid-19/symptoms-and-what-to-do/|title=Symptoms and what to do - Coronavirus (COVID-19)|last=National Health Service|first=|authorlink=National Health Service|last2=|first2=|authorlink2=|date=2020-03-24|website=nhs.uk|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-26}}</ref><ref name=":0" /> or [[Dyspnea|shortness of breath]]<ref name=":1" />
Most patients only have one or two of the common symptoms.<ref name=":0" /><ref name=":3">{{Cite journal|last=Mizumoto|first=Kenji|last2=Kagaya|first2=Katsushi|last3=Zarebski|first3=Alexander|last4=Chowell|first4=Gerardo|date=2020-03-12|title=Estimating the asymptomatic proportion of coronavirus disease 2019 (COVID-19) cases on board the Diamond Princess cruise ship, Yokohama, Japan, 2020|url=https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.10.2000180|journal=Eurosurveillance|language=en|volume=25|issue=10|pages=2000180|doi=10.2807/1560-7917.ES.2020.25.10.2000180|issn=1560-7917|pmc=PMC7078829|pmid=32183930}}</ref><ref name="Lan2020" />

=== Other Symptoms ===
* aches and [[Pain|pains]]
* nasal congestion
* runny nose
* [[sore throat]]
* [[diarrhea]]<ref name=":0" />

=== Emergency Warning Signs* ===
* trouble breathing
* [[Chest pain|persistent pain or pressure in the chest]]
* new [[confusion]] or inability to arouse (unresponsive)
* bluish lips or face<ref name=":1" />
<nowiki>*</nowiki>This list is not all inclusive. Consult your medical provider for any other symptoms that are severe or concerning.<ref name=":1" />

Additionally, there are reports that patients have lost or have a reduced [[changes in sense of smell|sense of smell]], or [[Changes in taste|lost or distorted of taste]], but are otherwise [[#asymptomaticcarriers|asymptomatic]].<ref name=":2">{{Cite news|url=https://www.nytimes.com/2020/03/22/health/coronavirus-symptoms-smell-taste.html|title=Lost Sense of Smell May Be Peculiar Clue to Coronavirus Infection|last=Rabin|first=Roni Caryn|date=2020-03-22|work=The New York Times|access-date=2020-03-24|language=en-US|issn=0362-4331}}</ref><blockquote>The American Academy of Otolaryngology on Sunday posted information on its website<ref>{{Cite web|url=https://www.entnet.org/content/coronavirus-disease-2019-resources|title=Coronavirus Disease 2019: Resources|last=American Academy of Otolaryngology|date=2020-03-15|website=American Academy of Otolaryngology-Head and Neck Surgery|language=en|access-date=2020-03-24}}</ref> saying that mounting anecdotal evidence indicates that lost or reduced [[changes in sense of smell|sense of smell]] and loss of [[changes in taste|sense of taste]] are significant symptoms associated with Covid-19, and that they have been seen in patients who ultimately tested positive with no other symptoms.<ref name=":2" /></blockquote><blockquote>The symptoms, in the absence of allergies or sinusitis, should alert doctors to screen patients for the virus and “warrant serious consideration for self isolation and testing of these individuals,” the academy said.<ref name=":2" /></blockquote>

===Neurological symptoms===
Mao et al. (2020) reported that 36% of a group of 214 COVID-19 patients admitted to hospitals in Wuhan, China, had "neurologic manifestations" of the disease.<ref name="Mao2020">https://jamanetwork.com/journals/jamaneurology/fullarticle/2764549</ref>

Neurological symptoms were:
* [[central nervous system]] symptoms:
**[[dizziness]]
**[[headache]]
**impaired consciousness
**acute cerebrovascular disease
**[[ataxia]]
**[[seizure]]
* peripheral nervous symptoms:
**altered or loss of [[changes in taste|sense of taste]]
**altered or loss of [[changes in sense of smell|sense of smell]]
**[[visual dysfunction|impaired vision]]
**[[neuralgia|nerve pain]]
**skeletal muscular injury manifestations
*impaired or change in consciousness:
**[[somnolence]]
**stupor
**coma
**[[confusion]]
**delirium

==<span id="asymptomaticcarriers">Asymptomatic carriers</span>==
[[File:Covid-19-virus.png|thumb|upright=0.4|'''The SARS-CoV-2 virus causes COVID-19.'''<br>Author: CDC]]
A number of studies have found that some people who test positive for COVID-19 do not have any symptoms of illness or a raised temperature, and have normal blood test results, but are able to infect others, some of whom developed severe COVID-19 [[pneumonia]] as a result of COVID-19.<ref name="Bai2020">{{Cite journal|last=Bai|first=Yan|last2=Yao|first2=Lingsheng|last3=Wei|first3=Tao|last4=Tian|first4=Fei|last5=Jin|first5=Dong-Yan|last6=Chen|first6=Lijuan|last7=Wang|first7=Meiyun|date=2020-02-21|title=Presumed Asymptomatic Carrier Transmission of COVID-19|url=https://jamanetwork.com/journals/jama/fullarticle/2762028|journal=JAMA|language=en|doi=10.1001/jama.2020.2565}}</ref><ref name="Chan2019">{{Cite journal|last=Chan|first=Jasper Fuk-Woo|last2=Yuan|first2=Shuofeng|last3=Kok|first3=Kin-Hang|last4=To|first4=Kelvin Kai-Wang|last5=Chu|first5=Hin|last6=Yang|first6=Jin|last7=Xing|first7=Fanfan|last8=Liu|first8=Jieling|last9=Yip|first9=Cyril Chik-Yan|date=2020-02-15|title=A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster|url=https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30154-9/abstract|journal=The Lancet|language=English|volume=395|issue=10223|pages=514–523|doi=10.1016/S0140-6736(20)30154-9|issn=0140-6736|pmid=31986261}}</ref><ref name="delRio2020">{{Cite journal|last=del Rio|first=Carlos|author-link=|last2=Malani|first2=Preeti N.|author-link2=|last3=|first3=|author-link3=|last4=|first4=|author-link4=|last5=|first5=|author-link5=|last6=|first6=|author-link6=|last7=|first7=|last8=|first8=|date=2020-02-28|title=COVID-19—New Insights on a Rapidly Changing Epidemic|url=https://jamanetwork.com/journals/jama/fullarticle/2762510|journal=JAMA|language=en|volume=|issue=|pages=|doi=10.1001/jama.2020.3072|pmc=|pmid=|access-date=|quote=|via=}}</ref> Some asymptomatic carriers have abnormal chest CT scans, and some do not. False negative tests have also been reported.<ref name="Bai2020" /><ref name="Chan2019" />

Estimates of the number of asymptomatic carriers vary wildly. Mizumoto et al. (2020) estimated that asymptomatic carriers accounted for 17.9% of the COVID-19 positive people on the ''Diamond Princess'' cruise ship, which was quarantined for 14 day after a previous passenger developed the illness.<ref name=":3" />

==<span id="recovered">Recovered patients testing positive</span>==
Lan et al (2020) identified a group of 4 recovered patients who continued to test positive for COVID-19 after recovery; suggesting that they may still be infectious.<ref name="Lan2020">{{Cite journal|last=Lan|first=Lan|last2=Xu|first2=Dan|last3=Ye|first3=Guangming|last4=Xia|first4=Chen|last5=Wang|first5=Shaokang|last6=Li|first6=Yirong|last7=Xu|first7=Haibo|date=2020-02-27|title=Positive RT-PCR Test Results in Patients Recovered From COVID-19|url=https://jamanetwork.com/journals/jama/fullarticle/2762452|journal=JAMA|language=en|doi=10.1001/jama.2020.2783}}</ref> It is not known whether patients who have recovered may be reinfected later, or whether those who later needed treatment actually relapsed, or if recovered patients who later test positive do so because of issues with the diagnostic test's accuracy.<ref>{{Cite web|url=https://www.snopes.com/fact-check/covid-19-reinfection/|title=Can People Who Recover from COVID-19 Become Reinfected?|website=Snopes.com|language=en-US|access-date=2020-03-26}}</ref> Another study found group of 5 recovered patients were found to have reactivated COVID-19.<ref>{{Cite journal|last=Ye|first=Guangming|last2=Pan|first2=Zhenyu|last3=Pan|first3=Yunbao|last4=Deng|first4=Qiaoling|last5=Chen|first5=Liangjun|last6=Li|first6=Jin|last7=Li|first7=Yirong|last8=Wang|first8=Xinghuan|date=2020-03-11|title=Clinical characteristics of severe acute respiratory syndrome coronavirus 2 reactivation|url=https://www.journalofinfection.com/article/S0163-4453(20)30114-6/abstract|journal=Journal of Infection|language=English|volume=0|issue=0|doi=10.1016/j.jinf.2020.03.001|issn=0163-4453|pmid=32171867}}</ref>

==ME/CFS==

{{Video|id=pkGXiJ1jM14|service=youtube|dimensions=550|description=COVID-19 and ME/CFS - Dr Nancy Klimas, Mar 13, 2020|alignment=left|urlargs=}}

{{clear}}

====<span id="catchingcovid19">Risk of COVID-19 in patients with ME/CFS</span>====
There is a lack of evidence about ME/CFS patients developing COVID-19 illness; but a number of medical advisors have given their expert opinions on this. Immunologist and [[Myalgic encephalomyelitis|ME]] researcher Dr [[Nancy Klimas]] has said she believes people with ME/CFS are at a little higher risk of developing COVID-19 after exposure to the virus;<ref name="Klimas20200313">{{Cite web|url=https://www.youtube.com/watch?v=pkGXiJ1jM14|title=COVID-19 and ME/CFS - Dr Nancy Klimas, Mar 13, 2020|last=Klimas|first=Nancy|date=2020-03-13|work=|access-date=Mar 24, 2020|archive-url=|archive-date=|dead-url=|quote=|author-link=Nancy Klimas}}</ref> Dr [[Nigel Speight]], Dr [[William Weir]] and Dr [[Charles Shepherd]] have said they do not think there is an increased risk.<ref name="SpeightWeirMar20" /><ref name="SpeightMar20" /><ref name="MEA16Mar20" /> Dr [[Lucinda Bateman]] has said this is unknown.<ref name="Bateman20200323QA">{{Cite web |title=COVID-19 and ME/CFS/FM Frequently Asked Questions|last=Bateman|first=Lucinda|author-link=Lucinda Bateman|website=Bateman-Horne Center|date=2020-03-23|url=http://www.batemanhornecenter.org/wp-content/uploads/2020/03/COVID-19-FAQ-Public.pdf}}</ref>Klimas, Speight, Weir, Shepherd and Bateman have all advised ME/CFS patients to take additional precautions, and highlighted that there is a risk of ME/CFS becoming significantly worse after viral infections or after COVID-19.<ref name="Klimas20200313" /><ref name="SpeightWeirMar20" /><ref name="SpeightMar20" /><ref name="MEA16Mar20" /><ref name="Bateman20200323QA" />

ME/CFS includes [[:Category:Immune signs and symptoms|immune symptoms]] including a [[sore throat]], [[swollen lymph nodes]], and [[flu-like symptoms]], but patients are generally '''''not''''' considered to be severely immunocompromised, and immunosuppressant medications are unlikely to be used by most ME/CFS patients. <ref name="Klimas20200313" /> <ref name="canadianconsensus">{{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
| url = http://www.investinme.org/Documents/PDFdocuments/CanadianDefinitionME-CFS.pdf
}}</ref><ref name="ICP2011primer">{{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> This means most ME/CFS patients would '''''not''''' be considered to be at very high risk of COVID-19 illness.<ref name="Klimas20200313" />

The unproven [[autoimmune hypothesis]] states that a subtype of ME involves autoimmunity, which is an overactive immune system rather than a weakened immune response.<ref name="OMF2018research">{{Cite web|url=https://www.omf.ngo/2018/02/28/omf-funded-research-t-cells-molecular-immunology/|title=OMF-funded research: T cells and molecular immunology|last=Open Medicine Foundation|first=|authorlink=Open Medicine Foundation|last2=|first2=|authorlink2=|date=Feb 28, 2018|website=Open Medicine Foundation|language=en-US|archive-url=|archive-date=|dead-url=|access-date=2019-07-11}}</ref> Evidence for this theory is limited.

===Drug related risks===
The following drugs may be used for some ME/CFS symptoms and are a possible concern
* '''<span id="ibuprofen">[[Ibuprofen]]</span>''' - Ibuprofen drugs (Nurofen, Bruprofen, Advil, Midol, Motrin, Motrin) are anti-inflammatories commonly used for cold/flu symptoms and for ME/CFS. There have been some reports that ibuprofen taken for COVID-19 may prolong the illness and increase it's severity. Several countries including the UK and France now recommend that people with suspected or confirmed COVID-19 avoid ibuprofen and '''use paracetamol / acetaminophen''' (e.g., Tylenol) instead, although the evidence for this is relatively limited.<ref name="MEA16Mar20" /><ref name="Day20200317">{{Cite journal|last=Day|first=Michael|date=2020-03-17|title=Covid-19: ibuprofen should not be used for managing symptoms, say doctors and scientists|url=https://www.bmj.com/content/368/bmj.m1086|journal=BMJ|language=en|volume=368|doi=10.1136/bmj.m1086|issn=1756-1833|pmid=32184201}}</ref><ref>{{Cite web|url=https://www.nhs.uk/conditions/coronavirus-covid-19/self-isolation-advice/|title=Stay at home advice - Coronavirus (COVID-19)|last=National Health Service|first=|authorlink=National Health Service|last2=|first2=|authorlink2=|date=2020-02-28|website=nhs.uk|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref> There is no suggestion that ibuprofen affects the risk of catching COVID-19.
* '''[[Rituximab]]''' - The MS Society has stated that taking rituximab, which has been used in clinical trials for ME/CFS, may affect the risk of catching COVID-19.<ref name="Covid-19-MS">{{Cite web|url=https://www.mssociety.org.uk/about-ms/treatments-and-therapies/disease-modifying-therapies/covid-19-coronavirus-and-ms|title=COVID-19 coronavirus and MS|last=MS Society|first=|authorlink=|last2=|first2=|authorlink2=|date=|website=www.mssociety.org.uk|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref><ref>{{Cite web|url=https://renal.org/wp-content/uploads/2020/03/BAPN-COVID-19-patient-info-for-HD.PD_.Immunosuppression-17March20.pdf|title=Coronavirus (SARS-CoV-2) and its associated illness (COVID-19) {{!}} Information and Guidance for Children on Haemodialysis, Peritoneal Dialysis and Immune suppression (including Renal Transplants)|last=Renal Association|first=|authorlink=|last2=|first2=|authorlink2=|date=2020-03-17|website=renal.org|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref>
* '''[[Ampligen]]''' - Ampligen or ''rintatolimod'' is sometimes used by ME/CFS patients, it is an [[antiviral]] immunostimulant rather than immunosuppressing drug, and is being tested for the treatment of COVID-19 illness in Japan.<ref>{{Cite web|url=https://adisinsight.springer.com/drugs/800001203|title=Rintatolimod - AIM ImmunoTech - AdisInsight|website=adisinsight.springer.com|access-date=2020-03-23}}</ref> There is no information about whether it may help prevent COVID-19 in ME/CFS patients.
*'''[[Fludrocortisone]]''', a [[corticosteroid]] (steroid) - brand names include Florinef. This may be used by patients with [[POTS]], which is common in ME/CFS patients.<ref name="Fludrocortisone-Drugbank">https://www.drugbank.ca/drugs/DB00687</ref >
* Other '''[[corticosteroid]]s''' (steroids) if they could suppress the immune system.<ref name="UKgov-vulnerable">{{Cite web|url=https://www.gov.uk/government/publications/covid-19-guidance-on-social-distancing-and-for-vulnerable-people/guidance-on-social-distancing-for-everyone-in-the-uk-and-protecting-older-people-and-vulnerable-adults|website=gov.uk|access-date=2020-04-06|title=COVID-19 guidance on social distancing and for vulnerable people|last=Public Health England}}</ref>
* Any other '''immunosuppressant drugs or therapies''', including chemotherapy treatments and certain targeted cancer treatments<ref name="UKgov-vulnerable" /><ref name="UKgov-extremelyvulnerable">{{Cite web|title=Guidance on shielding and protecting extremely vulnerable people from COVID-19|url=https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19|website=gov.uk|access-date=2020-04-06|last=Public Health England}}</ref >
{{Quote box|I have now reached the conclusion that people with pre-existing health conditions that make them more vulnerable to lung complications (which may or may not be the case with ME/CFS – at this stage we just don’t know), or have a condition like ME/CFS where an infection such as this will almost certainly cause a relapse, or significant exacerbation of symptoms, need to be doing far more to protect themselves, and to socially distance themselves from other people, than official NHS guidance indicates.

In particular, for those who are not housebound, this applies to social mobility and what you can do (and cannot do) if you decide to leave your home.<ref name="MEA16Mar20"/>|author=[[Charles Shepherd]], ME Association|date=Mar 16, 2020|title=Advice from the UK's ME Association}}

====<span id="deathrisk">Risk of death or serious complications in ME/CFS patients</span>====
{{Quote box|Although ME is a "chronic condition" my gut feeling is that they are not actually at greater risk of dying from the virus itself than healthy people. The conditions which put people at extra risk would be things like severe asthma or COPD, or immunosuppressed people eg those on chemotherapy for cancer.

The biggest worry therefore for ME sufferers is that catching the virus will make their ME much worse, and of course people in the 25% group do not have much leeway.

It might even be that worsening of their already severe ME could be a bigger threat to life than the virus itself.<ref name="SpeightMar20" />|author=[[Nigel Speight]]|date=Mar 2020|title=25% ME Group for Severe ME}}

====<span id="triggerforME">Risk of developing ME/CFS after COVID-19</span>====
ME/CFS has been linked to many different viruses, but it is not known what the likelihood is of developing ME/CFS after COVID-19 illness.
{{See also|Postviral fatigue syndrome}}

===<span id="medicaladvisors">ME/CFS charity medical advisors' COVID-19 statements</span>===
*Mar 30, 2020, ME Association, [https://www.meassociation.org.uk/2020/03/me-association-full-guidance-coronavirus-and-me-cfs-by-dr-charles-shepherd-30-march-2020/ ME Association full guidance: Coronavirus and ME/CFS by Dr Charles Shepherd]<ref name="MEA30Mar20">{{Cite web|url=https://www.meassociation.org.uk/2020/03/me-association-full-guidance-coronavirus-and-me-cfs-by-dr-charles-shepherd-30-march-2020/|title=ME Association full guidance: Coronavirus and ME/CFS by Dr Charles Shepherd {{!}} 30 March 2020|last=Shepherd|first=Charles|authorlink=Charles Shepherd|last2=|first2=|authorlink2=|date=2020-04-06|website=ME Association|language=en-GB|archive-url=|archive-date=|dead-url=|access-date=2020-03-30}}</ref>
*Mar 23 2020, Bateman Horne Center, [http://www.batemanhornecenter.org/covid19 COVID-19 resources]
*Mar 17, 2020, ME Association, [https://www.meassociation.org.uk/2020/03/coronavirus-covid-19-latest-government-advice-and-what-it-means-for-people-with-me-cfs-17-march-2020/ Coronavirus Covid-19: Latest Government advice and what it means for people with ME/CFS]<ref name="MEA17Mar20">{{Cite web|url=https://www.meassociation.org.uk/2020/03/coronavirus-covid-19-latest-government-advice-and-what-it-means-for-people-with-me-cfs-17-march-2020/|title=Coronavirus Covid-19: Latest Government advice and what it means for people with ME/CFS {{!}} 17 March 2020|last=Shepherd|first=Charles|authorlink=Charles Shepherd|last2=|first2=|authorlink2=|date=2020-03-17|website=ME Association|language=en-GB|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref>
*Mar 16, 2020, ME Association, [https://www.meassociation.org.uk/2020/03/me-association-guidance-coronavirus-covid-19-and-me-cfs-by-dr-charles-shepherd-16-march-2020/ ME Association Guidance: Coronavirus and ME/CFS by Dr Charles Shepherd]<ref name="MEA16Mar20">{{Cite web|url=https://www.meassociation.org.uk/2020/03/me-association-guidance-coronavirus-covid-19-and-me-cfs-by-dr-charles-shepherd-16-march-2020/|title=ME Association Guidance: Coronavirus and ME/CFS by Dr Charles Shepherd {{!}} 16 March 2020|last=Shepherd|first=Charles|authorlink=Charles Shepherd|last2=|first2=|authorlink2=|date=2020-03-16|website=ME Association|language=en-GB|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref>
*Mar 2020, 25% ME Group, [https://25megroup.org/download/1796/?v=3236 re Coronavirus and members of the 25% ME Group, Severe ME charity | Message from Dr Willy Weir and Dr Nigel Speight, Medical Advisor to 25% ME Group | Update to the advice given on 29 February 2020],<ref name="SpeightWeirMar20">{{Cite web|url=https://25megroup.org/download/1796/?v=3236|author-link=Nigel Speight|last=Speight|first=Nigel||last2=Weir|first2=William|author-link2=William Weir|title=re Coronavirus and members of the 25% ME Group, Severe ME charity {{!}} Message from Dr Willy Weir and Dr Nigel Speight, Medical Advisor to 25% ME Group {{!}} Update to the advice given on 29 February 2020 |date=Mar 2020|website=25megroup.org}}</ref>
*Mar 2020, 25% ME Group, [https://25megroup.org/download/1796/?v=3226 re Coronavirus and members of the 25% ME Group, Severe ME charity Types | Message from Dr Nigel Speight, Medical Advisor to 25% ME Group]<ref name="SpeightMar20">{{Cite web|url=https://25megroup.org/download/1796/?v=3226|author-link=Nigel Speight|last=Speight|first=Nigel|title=re Coronavirus and members of the 25% ME Group, Severe ME charity Types {{!}} Message from Dr Nigel Speight, Medical Advisor to 25% ME Group|date=Mar 2020|website=25megroup.org|others=[[William Weir]]}}</ref>

===Research on ME/CFS and COVID-19===
COVID-19 is a new illness and research on the effects on ME/CFS patients has not been published yet. Patient surveys in progress include:
*[https://www.zorgvolg.nl/mecvscor.php Corona ME/CFS study] - [[ME/CVS-Stichting Nederland]] - in Dutch
:A Dutch patient organization survey to assess if the risk of contracting COVID-19 is higher for those with ME/CFS, and if symptoms are more severe in ME/CFS patients.<ref name="EMEA-q12020">http://europeanmealliance.org/news-Q12020-001.shtml?</ref><ref name="MECVS-survey-23Mar2020">https://mecvs.nl/nieuws/persbericht-covid-19-onder-me-cvs-patienten/</ref > The [[European ME Alliance]] is suggesting that non-Dutch speakers use an online translation tool to complete it.<ref name="EMEA-q12020"/>

==Prevention==
[[File:CDC-Coronavirus-badge-300.png|thumb|upright=1|left|Image author: CDC|alt=image of Coronavirus Disease 2019 (COVID-19)|link=https://www.cdc.gov/coronavirus/2019-ncov/index.html]]
<br style="clear:both;line-height:0">
The SARS-CoV-2 coronavirus is an ''enveloped virus'', which means it is easier to kill outside the body than ''non-enveloped'' viruses like [[Coxsackievirus]], or [[Poliovirus]].<ref>{{Cite web|url=https://www.epa.gov/pesticides/coronavirus-cases-trigger-epa-rapid-response|title=Coronavirus Cases Trigger EPA Rapid Response|last=US Environmental Protection Agency|first=|authorlink=|last2=|first2=|authorlink2=|date=2020-01-29|website=US EPA|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref><ref>{{Cite journal|last=Firquet|first=Swan|author-link=|last2=Beaujard|first2=Sophie|author-link2=|last3=Lobert|first3=Pierre-Emmanuel|author-link3=|last4=Sané|first4=Famara|author-link4=|last5=Caloone|first5=Delphine|author-link5=|last6=Izard|first6=Daniel|author-link6=|last7=Hober|first7=Didier|last8=|first8=|date=June 2015|title=Survival of Enveloped and Non-Enveloped Viruses on Inanimate Surfaces|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4462923/|journal=Microbes and Environments|volume=30|issue=2|pages=140–144|doi=10.1264/jsme2.ME14145|issn=1342-6311|pmc=4462923|pmid=25843687|access-date=|quote=|via=}}</ref>
*[https://www.cdc.gov/coronavirus/2019-ncov/prepare/get-your-household-ready-for-COVID-19.html Get your Household Ready for COVID-19] - CDC
*[https://www.americanchemistry.com/Novel-Coronavirus-Fighting-Products-List.pdf Novel Coronavirus (COVID-19)-Fighting Products] - Center for Biocide Chemistries
*[https://www.health.gov.au/sites/default/files/documents/2020/03/coronavirus-covid-19-information-on-social-distancing.pdf Social distancing - Department of Health, Australia]

==== CDC advice ====
* Know How it Spreads
* Clean your hands often
* Avoid close contact
* Stay home if you're sick (may have the virus)
* Cover coughs and sneezes
* Wear a face mask if you are sick (may have the virus)
* Clean and disinfect
<i><div role="note" class="hatnote navigation-not-searchable">{{MediaWiki:Seealso/{{{lang|{{PAGELANGUAGE}}}}}}}{{colon}}
[https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html Coronavirus disease 19 Prevention - CDC]</div></i>

===<span id="high-touch">High touch surfaces: disinfect daily</span>===
[[File:High-touch surfaces-CDC-covid-19.png|alt=High-touch surfaces: disinfect daily. Tables, doorknobs, light switches, countertops, handles, desks, phones keyboards, remote controls, toilets, faucets, sinks, hard-backed chairs. Source: Coronavirus disease 19 Prevention - CDC, March 2020. Public domain image.|thumb|upright=0.7]]<br style="line-height:0" />
The CDC currently recommends people '''clean''' AND '''disinfect''' frequently touched surfaces daily:
<div style="column-count:2;-moz-column-count:2;-webkit-column-count:2">
*tables
*doorknobs
*light switches
*countertops
*handles
*desks
*phones
*keyboards
*remote controls
*toilets
*faucets
*sinks
*hard-backed chairs<ref name="CDC-prevention" /><ref name="CDC-suspectedcases">{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/prepare/cleaning-disinfection.html|title=Coronavirus Disease 2019 (COVID-19) - Environmental Cleaning and Disinfection Recommendations|last=CDC|first=|authorlink=Centers for Disease Control and Prevention|last2=|first2=|authorlink2=|date=2020-02-11|website=Centers for Disease Control and Prevention|language=en-us|archive-url=|archive-date=|dead-url=|access-date=2020-03-18}}</ref>
</div><br style="clear:both; line-height:0" />
:'''To clean use:'''
*Detergent or soap and water prior to disinfection. <ref name="CDC-prevention" />

:'''To disinfect use:'''
*[https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2 '''Disinfectants used against SARS-CoV-2'''] (list)
*'''Most common EPA-registered household disinfectants''' will work, or
* '''Diluted household bleach''' (mix: 5 tablespoons bleach per gallon of water, OR 4 teaspoons bleach per quart of water), or
*'''Alcohol solutions''' with at least 70% alcohol
:Follow manufacturer’s instructions for application and ''proper ventilation''. Check the product is not past its expiration date. ''(Updated Mar 18, 2020)''<ref name="CDC-prevention">{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html|title=Coronavirus Disease 2019 (COVID-19) – Prevention & Treatment|last=CDC|first=|authorlink=Centers for Disease Control and Prevention|last2=|first2=|authorlink2=|date=2020-03-16|website=Centers for Disease Control and Prevention|language=en-us|archive-url=|archive-date=|dead-url=|access-date=2020-03-17}}</ref>

:'''Check for updates:'''
* [https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html Coronavirus disease 19 Prevention - CDC]

'''Suspected or confirmed COVID-19 cases:'''<br />If possible the '''sick person''' should also clean:
<div style="column-count:2;-moz-column-count:2;-webkit-column-count:2">
*soiled items and surfaces (as needed)
*if a separate bathroom is not available, the bathroom should be cleaned and disinfected after each use by an ill person
*provide personal cleaning and disinfectant supplies in ill person's room (unless unsafe, e.g. they are a young child) - include tissues, paper towels, cleaners and EPA-registered disinfectants<ref name="CDC-prevention" /><ref name="CDC-suspectedcases" /></div>

===Coronavirus transmission from surfaces===
The new coronavirus can survive on different surfaces for hours or days:
*small, airborne virus particles (aerosols) - 3 hours
*copper - 4 hours
*cardboard - 24 hours
*stainless steel - 2 to 3 days
*plastic - 2 to 3 days<ref name="stablesurfacesPRMar20">{{Cite web|url=https://www.nih.gov/news-events/news-releases/new-coronavirus-stable-hours-surfaces|title=New coronavirus stable for hours on surfaces|last=National Institutes of Health|first=|authorlink=National Institutes of Health|last2=|first2=|authorlink2=|date=2020-03-17|website=National Institutes of Health (NIH)|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-25}}</ref><ref name="Tellier2006">{{Cite journal|last=Tellier|first=Raymond|author-link=|last2=|first2=|author-link2=|last3=|first3=|author-link3=|last4=|first4=|author-link4=|last5=|first5=|author-link5=|last6=|first6=|author-link6=|last7=|first7=|last8=|first8=|date=Nov 2006|title=Review of Aerosol Transmission of Influenza A Virus|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3372341/|journal=Emerging Infectious Diseases|volume=12|issue=11|pages=1657–1662|doi=10.3201/eid1211.060426|issn=1080-6040|pmc=3372341|pmid=17283614|access-date=|quote=|via=}}</ref>

This means direct contact with an infected person is not needed to contact the illness.<ref name="stablesurfacesPRMar20" /> Surgical [[#facemasks|face masks]] have not been effective against aerosols in previous influenza outbreaks like swine flu, but N95 respirators have been effective.<ref name="Tellier2006" />

==<span id="someoneissick">Disinfecting your home if someone is sick</span>==

The following is an abbreviated bullet-point list from the [[Centers for Disease Control and Prevention]] (CDC) article [https://www.cdc.gov/coronavirus/2019-ncov/prepare/disinfecting-your-home.html "Everyday Steps and Extra Steps When Someone Is Sick"]<ref>{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/disinfecting-your-home.html|title=Coronavirus Disease 2019 (COVID-19)|last=CDC|date=2020-02-11|website=Centers for Disease Control and Prevention|language=en-us|access-date=2020-04-01}}</ref>

'''Suspected or confirmed COVID-19 cases:'''<br />
*'''Clean''' AND '''disinfect''' all [[#High-touch|high-touch]] areas daily.

If possible the '''sick person''' should also clean:
<div style="column-count:2;-moz-column-count:2;-webkit-column-count:2">
*soiled items and surfaces (as needed)
*if a separate bathroom is not available, the bathroom should be cleaned and disinfected after each use by an ill person
*provide personal cleaning and disinfectant supplies in ill person's room (unless unsafe, e.g. they are a young child) - include tissues, paper towels, cleaners and EPA-registered disinfectants<ref name="CDC-prevention" /><ref name="CDC-suspectedcases" /><ref name="CDCDisinfectYourHome">https://www.cdc.gov/coronavirus/2019-ncov/prepare/disinfecting-your-home.html</ref></div>

<div role="note" class="hatnote navigation-searchable" style="padding:0">Take additional steps covering '''soft surfaces, food, laundry, and trash''' as described{{colon}}
*[https://www.cdc.gov/coronavirus/2019-ncov/prepare/disinfecting-your-home.html Disinfecting your home if someone is sick - CDC]

==<span id="sari">COVID-19 pneumonia</span>==
'''Severe Acute Respiratory Infection''' (SARI) is a type of pneumonia caused by COVID-19 which develops in severely ill COVID-19 patients.<ref name="vitCtrial">{{Cite web|url=https://clinicaltrials.gov/ct2/show/NCT04264533|title=Vitamin C Infusion for the Treatment of Severe 2019-nCoV Infected Pneumonia - Full Text View - ClinicalTrials.gov|website=clinicaltrials.gov|language=en|access-date=2020-03-22}}</ref> A clinical trial is in progress to determine if intravenous [[vitamin C]] is an effective treatment for SARI.<ref name="vitCtrial" />

==<span id="ards">Acute Respiratory Distress Syndrome</span>==
ARDS is another complication of severe COVID-19, and may develop after 5-8 data of illness, along with pneumonitis and shortness of breath.<ref name="Jiang2020">{{Cite journal|url=http://techscience.com/cmc/v63n1/38464|title=Towards an Artificial Intelligence Framework for Data-Driven Prediction of Coronavirus Clinical Severity|last=Jiang|first=X|authorlink=|last2=Coffee|first2=M|authorlink2=|date=2020|website=|pages=537-551|archive-url=|archive-date=|dead-url=|access-date=2020-04-01|last3=Bari|first3=A|last4=Wang|first4=J|last5=Jiang|first5=X|last6=Huang|first6=J|last7=Shi|first7=J|last8=Dai|first8=J|last9=Cai|first9=J|last10= et al.|volume=63|issue=1|journal=CMC-Computers, Materials & Continua}}</ref> 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|last2=|first2=|authorlink2=|date=2017-10-17|website=nhs.uk|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-04-01}}</ref>

==Myth, Hoaxes, Scams and Fake News==
Many myths, hoaxes and fake news have been spreading, particularly on social media, some of which claim to be from doctors or health professionals.<ref name="WHOmyths">{{Cite web|url=https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters|title=Coronavirus 2019 {{!}} Myth busters|last=World Health Organization|first=|authorlink=World Health Organization|last2=|first2=|authorlink2=|date=|website=www.who.int|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-17}}</ref><ref name="BuzzfeedHoax3Mar20">{{Cite web|url=https://www.buzzfeednews.com/article/janelytvynenko/coronavirus-disinformation-spread|title=Here Are Some Of The Coronavirus Hoaxes That Spread In The First Few Weeks|website=BuzzFeed News|language=en|access-date=2020-03-17}}</ref> Scam include seeking fake cures or ineffective protective equipment like masks, scammers pretending to be from the World Health Organization asking for donations, or a stranger asking for money on behalf of a relative's medical bills.<ref name="FTC-scams">{{Cite web|url=https://www.consumer.ftc.gov/features/coronavirus-scams-what-ftc-doing|title=Coronavirus Scams: What the FTC is doing|last=FTC|first=|authorlink=|last2=|first2=|authorlink2=|date=2020-03-06|website=Consumer Information|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-17}}</ref><ref name="WHO-cybersecurity">{{Cite web|url=https://www.who.int/about/communications/cyber-security|title=Communications {{!}} Cybersecurity|last=World Health Organization|first=|authorlink=World Health Organization|last2=|first2=|authorlink2=|date=|website=www.who.int|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-17}}</ref>

*[https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters Coronavirus disease (COVID-19) advice for the public: Myth busters] - World Health Organization
*Mar 3, 2020 - [https://www.buzzfeednews.com/article/janelytvynenko/coronavirus-disinformation-spread Here Are Some Of The Coronavirus Hoaxes That Spread In The First Few Weeks] - Buzzfeed News
*Mar 2020 - [https://www.buzzfeednews.com/article/janelytvynenko/heres-a-running-list-of-the-latest-disinformation Here's A Running List Of The Latest Hoaxes Spreading About The Coronavirus] - Buzzfeed News
*[https://www.who.int/about/communications/cyber-security Cybersecurity - World Health Organization]
*[https://www.consumer.ftc.gov/features/coronavirus-scams-what-ftc-doing Coronavirus scams - What the FTC os doing]

==Posters for those self-isolating to avoid infection==
*[https://chronicallyawesome.org.uk/posters-for-those-who-are-self-isolating-as-a-preventative-measure/? Unofficial posters] stating where people should leave deliveries - Chronically Awesome

==Mental health ==
Anxiety around COVID-19 illness may cause anxiety or affect mental health.
*[https://www.nami.org/getattachment/About-NAMI/NAMI-News/2020/NAMI-Updates-on-the-Coronavirus/COVID-19-Updated-Guide-1.pdf?lang=en-US COVID-19 Guide - National Association of Mental Illness]
*[https://www.who.int/docs/default-source/coronaviruse/coping-with-stress.pdf?sfvrsn=9845bc3a_2 Coping with stress during the nCov-2019 outbreak (poster)] - World Health Organization

==News articles and blogs==
* Feb 29, 2020 - [https://www.nytimes.com/2020/02/29/health/coronavirus-reinfection.html They Recovered From the Coronavirus. Were They Infected Again?] - NY Times
*Mar 1, 2020, [http://www.investinme.org//IIMER-Newslet-20-0301covid.shtml COVID-19 and ME] - [[Invest in ME Research]] Newsletter
*Mar 14, 2020, [https://www.cnn.com/2020/03/14/health/coronavirus-covid-19-flu-comparison-frieden-analysis/index.html Former CDC director: Covid-19 is different from flu and we must respond differently, Dr. Tom Frieden] - CNN
*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 8, 2020, [https://www.independent.co.uk/news/world/europe/coronavirus-greece-cases-deaths-flatten-curve-update-a9455436.html Coronavirus: How Greece managed to flatten the curve] - The Independent

==Learn more==
'''Government Health Organizations'''
*[https://www.who.int/emergencies/diseases/novel-coronavirus-2019 Coronavirus disease 19 (COVID-19) - World Health Organization]
*[https://www.cdc.gov/coronavirus/2019-ncov/index.html Coronavirus disease 19 (COVID-19) - CDC]
*[https://www.nhs.uk/conditions/coronavirus-covid-19/ Coronavirus (COVID-19) - NHS]
*[https://www.who.int/gpsc/5may/Guide_to_Local_Production.pdf Guide to Local Production: WHO-recommended Handrub Formulations] - only for when soap and water is not available
*[https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public Protect yourself: Coronavirus disease 19 (COVID-19) - World Health Organization]
*[https://www.who.int/news-room/q-a-detail/q-a-coronaviruses Q&A on coronaviruses (COVID-19) - World Health Organization]
'''ME/CFS Organizations'''
*[http://batemanhornecenter.org/wp-content/uploads/2020/03/Medical-Care-Considerations-Letter-Final.pdf Useful medical information when treating COVID-19 in patients with underlying myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and severe fibromyalgia (FM)] - Dr Lucinda Bateman, Bateman Horne Center
*[https://www.meaction.net/covid-19/ COVID-19 Resources for People with ME - #MEAction]
*[https://www.meassociation.org.uk/2020/03/me-association-guidance-coronavirus-covid-19-update-09-march-2020/ ME Association Guidance: Coronavirus (COVID-19) Update | 09 March 2020] - The ME Association
'''Johns Hopkins University Global Cases Map'''
* [https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6 Desktop]
* [https://www.arcgis.com/apps/opsdashboard/index.html#/85320e2ea5424dfaaa75ae62e5c06e61 Mobile]

==See also ==
*[[Postviral fatigue syndrome]] (PVFS)
*[[Myalgic encephalomyelitis]]
*[[Severe acute respiratory syndrome coronavirus 2]] (SARS-CoV-2)
*[[Severe Acute Respiratory Syndrome]]
*[[:Category:Disinfectants|Disinfectants Category]]

==References ==
{{Reflist}}

[[Category:Infectious diseases]]
[[Category:Triggers and risk factors]]
[[Category:Virology]]

Coronavirus disease 19

2020-04-17T12:07:01Z

Loopy:x

'''Coronavirus disease 19''', commonly known as '''COVID-19''', is the infectious respiratory illness caused by the novel (new) [[Severe acute respiratory syndrome coronavirus 2]] (SARS-CoV-2), previously known as ''2019-nCoV''.<ref name="WHO-QA">{{Cite web|url=https://www.who.int/news-room/q-a-detail/q-a-coronaviruses|title=Q&A on coronaviruses (COVID-19)|last=World Health Organization|first=|authorlink=World Health Organization|last2=|first2=|authorlink2=|date=|website=www.who.int|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-16}}</ref><ref name="CDC-coronoviruses">{{Cite web|url=https://www.cdc.gov/coronavirus/types.html|title=Human Coronavirus Types|last=Centers for Disease Control and Prevention|first=|authorlink=Centers for Disease Control and Prevention|last2=|first2=|authorlink2=|date=2020-02-27|website=www.cdc.gov|language=en-us|archive-url=|archive-date=|dead-url=|access-date=2020-03-16}}</ref><ref>{{Cite journal|last=Li|first=Guangdi|author-link=|last2=Clercq|first2=Erik De|author-link2=|last3=|first3=|author-link3=|last4=|first4=|author-link4=|last5=|first5=|author-link5=|last6=|first6=|author-link6=|last7=|first7=|last8=|first8=|date=Mar 2020|title=Therapeutic options for the 2019 novel coronavirus (2019-nCoV)|url=https://www.nature.com/articles/d41573-020-00016-0|journal=Nature Reviews Drug Discovery|language=en|volume=19|issue=3|pages=149–150|doi=10.1038/d41573-020-00016-0|pmc=|pmid=|access-date=|quote=|via=}}</ref><ref>{{Cite web|url=https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/naming-the-coronavirus-disease-(covid-2019)-and-the-virus-that-causes-it|title=Naming the coronavirus disease (COVID-19) and the virus that causes it|website=www.who.int|language=en|access-date=2020-03-28}}</ref>
[[File:Covid-19-lung-lesions.jpg|thumb|left|alt=Computer-aided identification of lesions on the lungs of COVID-19 patients.|'''COVID-19 can cause lesions on lungs, and pneumonia.'''<br>Author: [https://www.sciencedirect.com/science/article/pii/S2095177920302264 Shen et al. 2020. Journal of Pharmaceutical Analysis]. Copyright: CC-BY-NC-ND-4.0]]{{clear}}
COVID-19 was first identified in Wuhan, China, in December 2019,<ref name="WHO-QA" /> and can infect babies, children, and adults of any age.<ref>{{Cite journal|last=Wei|first=Min|last2=Yuan|first2=Jingping|last3=Liu|first3=Yu|last4=Fu|first4=Tao|last5=Yu|first5=Xue|last6=Zhang|first6=Zhi-Jiang|date=2020-02-14|title=Novel Coronavirus Infection in Hospitalized Infants Under 1 Year of Age in China|url=https://jamanetwork.com/journals/jama/fullarticle/2761659|journal=JAMA|language=en|doi=10.1001/jama.2020.2131}}</ref> It spread globally, resulting in the 2019-2020 coronavirus pandemic.<ref>{{Cite journal|last=Hui|first=David S.|last2=Azhar|first2=Esam I.|last3=Madani|first3=Tariq A.|last4=Ntoumi|first4=Francine|last5=Kock|first5=Richard|last6=Dar|first6=Osman|last7=Ippolito|first7=Giuseppe|last8=Mchugh|first8=Timothy D.|last9=Memish|first9=Ziad A.|date=2020-02-01|title=The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health — The latest 2019 novel coronavirus outbreak in Wuhan, China|url=https://www.ijidonline.com/article/S1201-9712(20)30011-4/abstract|journal=International Journal of Infectious Diseases|language=English|volume=91|pages=264–266|doi=10.1016/j.ijid.2020.01.009|issn=1201-9712|pmid=31953166}}</ref><ref>{{Cite web|url=https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020|title=WHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020|website=www.who.int|language=en|access-date=2020-03-28}}</ref>

== Symptoms ==
Symptoms are usually mild and begin gradually, although around 1 in 6 people with COVID-19 need medical help.<ref name="WHO-QA" /> Some people become infected but don't develop any symptoms and don't feel unwell.<ref name=":0">{{Cite web||last=World Health Organization|first=|authorlink=World Health Organization|url=https://www.who.int/news-room/q-a-detail/q-a-coronaviruses|title=Q&A on coronaviruses (COVID-19)|website=www.who.int|language=en|access-date=2020-03-24}}</ref> These symptoms may appear 1-14 days after exposure; most commonly around five days.<ref name=":0" /><ref name=":1">{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html|title=Coronavirus Disease 2019 (COVID-19) – Symptoms|last=CDC|date=2020-03-20||author-link=Centers for Disease Control|website=Centers for Disease Control and Prevention|language=en-us|access-date=2020-03-24}}</ref>

=== Common Symptoms ===
* [[fever]]
* [[Fatigue|tiredness]]
* continuous cough, coughing episodes or a dry [[cough|cough,]]<ref>{{Cite web|url=https://www.nhs.uk/conditions/coronavirus-covid-19/symptoms-and-what-to-do/|title=Symptoms and what to do - Coronavirus (COVID-19)|last=National Health Service|first=|authorlink=National Health Service|last2=|first2=|authorlink2=|date=2020-03-24|website=nhs.uk|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-26}}</ref><ref name=":0" /> or [[Dyspnea|shortness of breath]]<ref name=":1" />
Most patients only have one or two of the common symptoms.<ref name=":0" /><ref name=":3">{{Cite journal|last=Mizumoto|first=Kenji|last2=Kagaya|first2=Katsushi|last3=Zarebski|first3=Alexander|last4=Chowell|first4=Gerardo|date=2020-03-12|title=Estimating the asymptomatic proportion of coronavirus disease 2019 (COVID-19) cases on board the Diamond Princess cruise ship, Yokohama, Japan, 2020|url=https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.10.2000180|journal=Eurosurveillance|language=en|volume=25|issue=10|pages=2000180|doi=10.2807/1560-7917.ES.2020.25.10.2000180|issn=1560-7917|pmc=PMC7078829|pmid=32183930}}</ref><ref name="Lan2020" />

=== Other Symptoms ===
* aches and [[Pain|pains]]
* nasal congestion
* runny nose
* [[sore throat]]
* [[diarrhea]]<ref name=":0" />

=== Emergency Warning Signs* ===
* trouble breathing
* [[Chest pain|persistent pain or pressure in the chest]]
* new [[confusion]] or inability to arouse (unresponsive)
* bluish lips or face<ref name=":1" />
<nowiki>*</nowiki>This list is not all inclusive. Consult your medical provider for any other symptoms that are severe or concerning.<ref name=":1" />

Additionally, there are reports that patients have lost or have a reduced [[changes in sense of smell|sense of smell]], or [[Changes in taste|lost or distorted of taste]], but are otherwise [[#asymptomaticcarriers|asymptomatic]].<ref name=":2">{{Cite news|url=https://www.nytimes.com/2020/03/22/health/coronavirus-symptoms-smell-taste.html|title=Lost Sense of Smell May Be Peculiar Clue to Coronavirus Infection|last=Rabin|first=Roni Caryn|date=2020-03-22|work=The New York Times|access-date=2020-03-24|language=en-US|issn=0362-4331}}</ref><blockquote>The American Academy of Otolaryngology on Sunday posted information on its website<ref>{{Cite web|url=https://www.entnet.org/content/coronavirus-disease-2019-resources|title=Coronavirus Disease 2019: Resources|last=American Academy of Otolaryngology|date=2020-03-15|website=American Academy of Otolaryngology-Head and Neck Surgery|language=en|access-date=2020-03-24}}</ref> saying that mounting anecdotal evidence indicates that lost or reduced [[changes in sense of smell|sense of smell]] and loss of [[changes in taste|sense of taste]] are significant symptoms associated with Covid-19, and that they have been seen in patients who ultimately tested positive with no other symptoms.<ref name=":2" /></blockquote><blockquote>The symptoms, in the absence of allergies or sinusitis, should alert doctors to screen patients for the virus and “warrant serious consideration for self isolation and testing of these individuals,” the academy said.<ref name=":2" /></blockquote>

===Neurological symptoms===
Mao et al. (2020) reported that 36% of a group of 214 COVID-19 patients admitted to hospitals in Wuhan, China, had "neurologic manifestations" of the disease.<ref name="Mao2020">https://jamanetwork.com/journals/jamaneurology/fullarticle/2764549</ref>

Neurological symptoms were:
* [[central nervous system]] symptoms:
**[[dizziness]]
**[[headache]]
**impaired consciousness
**acute cerebrovascular disease
**[[ataxia]]
**[[seizure]]
* peripheral nervous symptoms:
**altered or loss of [[changes in taste|sense of taste]]
**altered or loss of [[changes in sense of smell|sense of smell]]
**[[visual dysfunction|impaired vision]]
**[[neuralgia|nerve pain]]
**skeletal muscular injury manifestations
*impaired or change in consciousness:
**[[somnolence]]
**stupor
**coma
**[[confusion]]
**delirium

==<span id="asymptomaticcarriers">Asymptomatic carriers</span>==
[[File:Covid-19-virus.png|thumb|upright=0.4|'''The SARS-CoV-2 virus causes COVID-19.'''<br>Author: CDC]]
A number of studies have found that some people who test positive for COVID-19 do not have any symptoms of illness or a raised temperature, and have normal blood test results, but are able to infect others, some of whom developed severe COVID-19 [[pneumonia]] as a result of COVID-19.<ref name="Bai2020">{{Cite journal|last=Bai|first=Yan|last2=Yao|first2=Lingsheng|last3=Wei|first3=Tao|last4=Tian|first4=Fei|last5=Jin|first5=Dong-Yan|last6=Chen|first6=Lijuan|last7=Wang|first7=Meiyun|date=2020-02-21|title=Presumed Asymptomatic Carrier Transmission of COVID-19|url=https://jamanetwork.com/journals/jama/fullarticle/2762028|journal=JAMA|language=en|doi=10.1001/jama.2020.2565}}</ref><ref name="Chan2019">{{Cite journal|last=Chan|first=Jasper Fuk-Woo|last2=Yuan|first2=Shuofeng|last3=Kok|first3=Kin-Hang|last4=To|first4=Kelvin Kai-Wang|last5=Chu|first5=Hin|last6=Yang|first6=Jin|last7=Xing|first7=Fanfan|last8=Liu|first8=Jieling|last9=Yip|first9=Cyril Chik-Yan|date=2020-02-15|title=A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster|url=https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30154-9/abstract|journal=The Lancet|language=English|volume=395|issue=10223|pages=514–523|doi=10.1016/S0140-6736(20)30154-9|issn=0140-6736|pmid=31986261}}</ref><ref name="delRio2020">{{Cite journal|last=del Rio|first=Carlos|author-link=|last2=Malani|first2=Preeti N.|author-link2=|last3=|first3=|author-link3=|last4=|first4=|author-link4=|last5=|first5=|author-link5=|last6=|first6=|author-link6=|last7=|first7=|last8=|first8=|date=2020-02-28|title=COVID-19—New Insights on a Rapidly Changing Epidemic|url=https://jamanetwork.com/journals/jama/fullarticle/2762510|journal=JAMA|language=en|volume=|issue=|pages=|doi=10.1001/jama.2020.3072|pmc=|pmid=|access-date=|quote=|via=}}</ref> Some asymptomatic carriers have abnormal chest CT scans, and some do not. False negative tests have also been reported.<ref name="Bai2020" /><ref name="Chan2019" />

Estimates of the number of asymptomatic carriers vary wildly. Mizumoto et al. (2020) estimated that asymptomatic carriers accounted for 17.9% of the COVID-19 positive people on the ''Diamond Princess'' cruise ship, which was quarantined for 14 day after a previous passenger developed the illness.<ref name=":3" />

==<span id="recovered">Recovered patients testing positive</span>==
Lan et al (2020) identified a group of 4 recovered patients who continued to test positive for COVID-19 after recovery; suggesting that they may still be infectious.<ref name="Lan2020">{{Cite journal|last=Lan|first=Lan|last2=Xu|first2=Dan|last3=Ye|first3=Guangming|last4=Xia|first4=Chen|last5=Wang|first5=Shaokang|last6=Li|first6=Yirong|last7=Xu|first7=Haibo|date=2020-02-27|title=Positive RT-PCR Test Results in Patients Recovered From COVID-19|url=https://jamanetwork.com/journals/jama/fullarticle/2762452|journal=JAMA|language=en|doi=10.1001/jama.2020.2783}}</ref> It is not known whether patients who have recovered may be reinfected later, or whether those who later needed treatment actually relapsed, or if recovered patients who later test positive do so because of issues with the diagnostic test's accuracy.<ref>{{Cite web|url=https://www.snopes.com/fact-check/covid-19-reinfection/|title=Can People Who Recover from COVID-19 Become Reinfected?|website=Snopes.com|language=en-US|access-date=2020-03-26}}</ref> Another study found group of 5 recovered patients were found to have reactivated COVID-19.<ref>{{Cite journal|last=Ye|first=Guangming|last2=Pan|first2=Zhenyu|last3=Pan|first3=Yunbao|last4=Deng|first4=Qiaoling|last5=Chen|first5=Liangjun|last6=Li|first6=Jin|last7=Li|first7=Yirong|last8=Wang|first8=Xinghuan|date=2020-03-11|title=Clinical characteristics of severe acute respiratory syndrome coronavirus 2 reactivation|url=https://www.journalofinfection.com/article/S0163-4453(20)30114-6/abstract|journal=Journal of Infection|language=English|volume=0|issue=0|doi=10.1016/j.jinf.2020.03.001|issn=0163-4453|pmid=32171867}}</ref>

==ME/CFS==

{{Video|id=pkGXiJ1jM14|service=youtube|dimensions=550|description=COVID-19 and ME/CFS - Dr Nancy Klimas, Mar 13, 2020|alignment=left|urlargs=}}

{{clear}}

====<span id="catchingcovid19">Risk of COVID-19 in patients with ME/CFS</span>====
There is a lack of evidence about ME/CFS patients developing COVID-19 illness; but a number of medical advisors have given their expert opinions on this. Immunologist and [[Myalgic encephalomyelitis|ME]] researcher Dr [[Nancy Klimas]] has said she believes people with ME/CFS are at a little higher risk of developing COVID-19 after exposure to the virus;<ref name="Klimas20200313">{{Cite web|url=https://www.youtube.com/watch?v=pkGXiJ1jM14|title=COVID-19 and ME/CFS - Dr Nancy Klimas, Mar 13, 2020|last=Klimas|first=Nancy|date=2020-03-13|work=|access-date=Mar 24, 2020|archive-url=|archive-date=|dead-url=|quote=|author-link=Nancy Klimas}}</ref> Dr [[Nigel Speight]], Dr [[William Weir]] and Dr [[Charles Shepherd]] have said they do not think there is an increased risk.<ref name="SpeightWeirMar20" /><ref name="SpeightMar20" /><ref name="MEA16Mar20" /> Dr [[Lucinda Bateman]] has said this is unknown.<ref name="Bateman20200323QA">{{Cite web |title=COVID-19 and ME/CFS/FM Frequently Asked Questions|last=Bateman|first=Lucinda|author-link=Lucinda Bateman|website=Bateman-Horne Center|date=2020-03-23|url=http://www.batemanhornecenter.org/wp-content/uploads/2020/03/COVID-19-FAQ-Public.pdf}}</ref>Klimas, Speight, Weir, Shepherd and Bateman have all advised ME/CFS patients to take additional precautions, and highlighted that there is a risk of ME/CFS becoming significantly worse after viral infections or after COVID-19.<ref name="Klimas20200313" /><ref name="SpeightWeirMar20" /><ref name="SpeightMar20" /><ref name="MEA16Mar20" /><ref name="Bateman20200323QA" />

ME/CFS includes [[:Category:Immune signs and symptoms|immune symptoms]] including a [[sore throat]], [[swollen lymph nodes]], and [[flu-like symptoms]], but patients are generally '''''not''''' considered to be severely immunocompromised, and immunosuppressant medications are unlikely to be used by most ME/CFS patients. <ref name="Klimas20200313" /> <ref name="canadianconsensus">{{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
| url = http://www.investinme.org/Documents/PDFdocuments/CanadianDefinitionME-CFS.pdf
}}</ref><ref name="ICP2011primer">{{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> This means most ME/CFS patients would '''''not''''' be considered to be at very high risk of COVID-19 illness.<ref name="Klimas20200313" />

The unproven [[autoimmune hypothesis]] states that a subtype of ME involves autoimmunity, which is an overactive immune system rather than a weakened immune response.<ref name="OMF2018research">{{Cite web|url=https://www.omf.ngo/2018/02/28/omf-funded-research-t-cells-molecular-immunology/|title=OMF-funded research: T cells and molecular immunology|last=Open Medicine Foundation|first=|authorlink=Open Medicine Foundation|last2=|first2=|authorlink2=|date=Feb 28, 2018|website=Open Medicine Foundation|language=en-US|archive-url=|archive-date=|dead-url=|access-date=2019-07-11}}</ref> Evidence for this theory is limited.

===Drug related risks===
The following drugs may be used for some ME/CFS symptoms and are a possible concern
* '''<span id="ibuprofen">[[Ibuprofen]]</span>''' - Ibuprofen drugs (Nurofen, Bruprofen, Advil, Midol, Motrin, Motrin) are anti-inflammatories commonly used for cold/flu symptoms and for ME/CFS. There have been some reports that ibuprofen taken for COVID-19 may prolong the illness and increase it's severity. Several countries including the UK and France now recommend that people with suspected or confirmed COVID-19 avoid ibuprofen and '''use paracetamol / acetaminophen''' (e.g., Tylenol) instead, although the evidence for this is relatively limited.<ref name="MEA16Mar20" /><ref name="Day20200317">{{Cite journal|last=Day|first=Michael|date=2020-03-17|title=Covid-19: ibuprofen should not be used for managing symptoms, say doctors and scientists|url=https://www.bmj.com/content/368/bmj.m1086|journal=BMJ|language=en|volume=368|doi=10.1136/bmj.m1086|issn=1756-1833|pmid=32184201}}</ref><ref>{{Cite web|url=https://www.nhs.uk/conditions/coronavirus-covid-19/self-isolation-advice/|title=Stay at home advice - Coronavirus (COVID-19)|last=National Health Service|first=|authorlink=National Health Service|last2=|first2=|authorlink2=|date=2020-02-28|website=nhs.uk|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref> There is no suggestion that ibuprofen affects the risk of catching COVID-19.
* '''[[Rituximab]]''' - The MS Society has stated that taking rituximab, which has been used in clinical trials for ME/CFS, may affect the risk of catching COVID-19.<ref name="Covid-19-MS">{{Cite web|url=https://www.mssociety.org.uk/about-ms/treatments-and-therapies/disease-modifying-therapies/covid-19-coronavirus-and-ms|title=COVID-19 coronavirus and MS|last=MS Society|first=|authorlink=|last2=|first2=|authorlink2=|date=|website=www.mssociety.org.uk|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref><ref>{{Cite web|url=https://renal.org/wp-content/uploads/2020/03/BAPN-COVID-19-patient-info-for-HD.PD_.Immunosuppression-17March20.pdf|title=Coronavirus (SARS-CoV-2) and its associated illness (COVID-19) {{!}} Information and Guidance for Children on Haemodialysis, Peritoneal Dialysis and Immune suppression (including Renal Transplants)|last=Renal Association|first=|authorlink=|last2=|first2=|authorlink2=|date=2020-03-17|website=renal.org|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref>
* '''[[Ampligen]]''' - Ampligen or ''rintatolimod'' is sometimes used by ME/CFS patients, it is an [[antiviral]] immunostimulant rather than immunosuppressing drug, and is being tested for the treatment of COVID-19 illness in Japan.<ref>{{Cite web|url=https://adisinsight.springer.com/drugs/800001203|title=Rintatolimod - AIM ImmunoTech - AdisInsight|website=adisinsight.springer.com|access-date=2020-03-23}}</ref> There is no information about whether it may help prevent COVID-19 in ME/CFS patients.
*'''[[Fludrocortisone]]''', a [[corticosteroid]] (steroid) - brand names include Florinef. This may be used by patients with [[POTS]], which is common in ME/CFS patients.<ref name="Fludrocortisone-Drugbank">https://www.drugbank.ca/drugs/DB00687</ref >
* Other '''[[corticosteroid]]s''' (steroids) if they could suppress the immune system.<ref name="UKgov-vulnerable">{{Cite web|url=https://www.gov.uk/government/publications/covid-19-guidance-on-social-distancing-and-for-vulnerable-people/guidance-on-social-distancing-for-everyone-in-the-uk-and-protecting-older-people-and-vulnerable-adults|website=gov.uk|access-date=2020-04-06|title=COVID-19 guidance on social distancing and for vulnerable people|last=Public Health England}}</ref>
* Any other '''immunosuppressant drugs or therapies''', including chemotherapy treatments and certain targeted cancer treatments<ref name="UKgov-vulnerable" /><ref name="UKgov-extremelyvulnerable">{{Cite web|title=Guidance on shielding and protecting extremely vulnerable people from COVID-19|url=https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19|website=gov.uk|access-date=2020-04-06|last=Public Health England}}</ref >
{{Quote box|I have now reached the conclusion that people with pre-existing health conditions that make them more vulnerable to lung complications (which may or may not be the case with ME/CFS – at this stage we just don’t know), or have a condition like ME/CFS where an infection such as this will almost certainly cause a relapse, or significant exacerbation of symptoms, need to be doing far more to protect themselves, and to socially distance themselves from other people, than official NHS guidance indicates.

In particular, for those who are not housebound, this applies to social mobility and what you can do (and cannot do) if you decide to leave your home.<ref name="MEA16Mar20"/>|author=[[Charles Shepherd]], ME Association|date=Mar 16, 2020|title=Advice from the UK's ME Association}}

====<span id="deathrisk">Risk of death or serious complications in ME/CFS patients</span>====
{{Quote box|Although ME is a "chronic condition" my gut feeling is that they are not actually at greater risk of dying from the virus itself than healthy people. The conditions which put people at extra risk would be things like severe asthma or COPD, or immunosuppressed people eg those on chemotherapy for cancer.

The biggest worry therefore for ME sufferers is that catching the virus will make their ME much worse, and of course people in the 25% group do not have much leeway.

It might even be that worsening of their already severe ME could be a bigger threat to life than the virus itself.<ref name="SpeightMar20" />|author=[[Nigel Speight]]|date=Mar 2020|title=25% ME Group for Severe ME}}

====<span id="triggerforME">Risk of developing ME/CFS after COVID-19</span>====
ME/CFS has been linked to many different viruses, but it is not known what the likelihood is of developing ME/CFS after COVID-19 illness.
{{See also|Postviral fatigue syndrome}}

===<span id="medicaladvisors">ME/CFS charity medical advisors' COVID-19 statements</span>===
*Mar 30, 2020, ME Association, [https://www.meassociation.org.uk/2020/03/me-association-full-guidance-coronavirus-and-me-cfs-by-dr-charles-shepherd-30-march-2020/ ME Association full guidance: Coronavirus and ME/CFS by Dr Charles Shepherd]<ref name="MEA30Mar20">{{Cite web|url=https://www.meassociation.org.uk/2020/03/me-association-full-guidance-coronavirus-and-me-cfs-by-dr-charles-shepherd-30-march-2020/|title=ME Association full guidance: Coronavirus and ME/CFS by Dr Charles Shepherd {{!}} 30 March 2020|last=Shepherd|first=Charles|authorlink=Charles Shepherd|last2=|first2=|authorlink2=|date=2020-04-06|website=ME Association|language=en-GB|archive-url=|archive-date=|dead-url=|access-date=2020-03-30}}</ref>
*Mar 23 2020, Bateman Horne Center, [http://www.batemanhornecenter.org/covid19 COVID-19 resources]
*Mar 17, 2020, ME Association, [https://www.meassociation.org.uk/2020/03/coronavirus-covid-19-latest-government-advice-and-what-it-means-for-people-with-me-cfs-17-march-2020/ Coronavirus Covid-19: Latest Government advice and what it means for people with ME/CFS]<ref name="MEA17Mar20">{{Cite web|url=https://www.meassociation.org.uk/2020/03/coronavirus-covid-19-latest-government-advice-and-what-it-means-for-people-with-me-cfs-17-march-2020/|title=Coronavirus Covid-19: Latest Government advice and what it means for people with ME/CFS {{!}} 17 March 2020|last=Shepherd|first=Charles|authorlink=Charles Shepherd|last2=|first2=|authorlink2=|date=2020-03-17|website=ME Association|language=en-GB|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref>
*Mar 16, 2020, ME Association, [https://www.meassociation.org.uk/2020/03/me-association-guidance-coronavirus-covid-19-and-me-cfs-by-dr-charles-shepherd-16-march-2020/ ME Association Guidance: Coronavirus and ME/CFS by Dr Charles Shepherd]<ref name="MEA16Mar20">{{Cite web|url=https://www.meassociation.org.uk/2020/03/me-association-guidance-coronavirus-covid-19-and-me-cfs-by-dr-charles-shepherd-16-march-2020/|title=ME Association Guidance: Coronavirus and ME/CFS by Dr Charles Shepherd {{!}} 16 March 2020|last=Shepherd|first=Charles|authorlink=Charles Shepherd|last2=|first2=|authorlink2=|date=2020-03-16|website=ME Association|language=en-GB|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref>
*Mar 2020, 25% ME Group, [https://25megroup.org/download/1796/?v=3236 re Coronavirus and members of the 25% ME Group, Severe ME charity | Message from Dr Willy Weir and Dr Nigel Speight, Medical Advisor to 25% ME Group | Update to the advice given on 29 February 2020],<ref name="SpeightWeirMar20">{{Cite web|url=https://25megroup.org/download/1796/?v=3236|author-link=Nigel Speight|last=Speight|first=Nigel||last2=Weir|first2=William|author-link2=William Weir|title=re Coronavirus and members of the 25% ME Group, Severe ME charity {{!}} Message from Dr Willy Weir and Dr Nigel Speight, Medical Advisor to 25% ME Group {{!}} Update to the advice given on 29 February 2020 |date=Mar 2020|website=25megroup.org}}</ref>
*Mar 2020, 25% ME Group, [https://25megroup.org/download/1796/?v=3226 re Coronavirus and members of the 25% ME Group, Severe ME charity Types | Message from Dr Nigel Speight, Medical Advisor to 25% ME Group]<ref name="SpeightMar20">{{Cite web|url=https://25megroup.org/download/1796/?v=3226|author-link=Nigel Speight|last=Speight|first=Nigel|title=re Coronavirus and members of the 25% ME Group, Severe ME charity Types {{!}} Message from Dr Nigel Speight, Medical Advisor to 25% ME Group|date=Mar 2020|website=25megroup.org|others=[[William Weir]]}}</ref>

===Research on ME/CFS and COVID-19===
COVID-19 is a new illness and research on the effects on ME/CFS patients has not been published yet. Patient surveys in progress include:
*[https://www.zorgvolg.nl/mecvscor.php Corona ME/CFS study] - [[ME/CVS-Stichting Nederland]] - in Dutch
:A Dutch patient organization survey to assess if the risk of contracting COVID-19 is higher for those with ME/CFS, and if symptoms are more severe in ME/CFS patients.<ref name="EMEA-q12020">http://europeanmealliance.org/news-Q12020-001.shtml?</ref><ref name="MECVS-survey-23Mar2020">https://mecvs.nl/nieuws/persbericht-covid-19-onder-me-cvs-patienten/</ref > The [[European ME Alliance]] is suggesting that non-Dutch speakers use an online translation tool to complete it.<ref name="EMEA-q12020"/>

==Prevention==
[[File:CDC-Coronavirus-badge-300.png|thumb|upright=1|left|Image author: CDC|alt=image of Coronavirus Disease 2019 (COVID-19)|link=https://www.cdc.gov/coronavirus/2019-ncov/index.html]]
<br style="clear:both;line-height:0">
The SARS-CoV-2 coronavirus is an ''enveloped virus'', which means it is easier to kill outside the body than ''non-enveloped'' viruses like [[Coxsackievirus]], or [[Poliovirus]].<ref>{{Cite web|url=https://www.epa.gov/pesticides/coronavirus-cases-trigger-epa-rapid-response|title=Coronavirus Cases Trigger EPA Rapid Response|last=US Environmental Protection Agency|first=|authorlink=|last2=|first2=|authorlink2=|date=2020-01-29|website=US EPA|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref><ref>{{Cite journal|last=Firquet|first=Swan|author-link=|last2=Beaujard|first2=Sophie|author-link2=|last3=Lobert|first3=Pierre-Emmanuel|author-link3=|last4=Sané|first4=Famara|author-link4=|last5=Caloone|first5=Delphine|author-link5=|last6=Izard|first6=Daniel|author-link6=|last7=Hober|first7=Didier|last8=|first8=|date=June 2015|title=Survival of Enveloped and Non-Enveloped Viruses on Inanimate Surfaces|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4462923/|journal=Microbes and Environments|volume=30|issue=2|pages=140–144|doi=10.1264/jsme2.ME14145|issn=1342-6311|pmc=4462923|pmid=25843687|access-date=|quote=|via=}}</ref>
*[https://www.cdc.gov/coronavirus/2019-ncov/prepare/get-your-household-ready-for-COVID-19.html Get your Household Ready for COVID-19] - CDC
*[https://www.americanchemistry.com/Novel-Coronavirus-Fighting-Products-List.pdf Novel Coronavirus (COVID-19)-Fighting Products] - Center for Biocide Chemistries
*[https://www.health.gov.au/sites/default/files/documents/2020/03/coronavirus-covid-19-information-on-social-distancing.pdf Social distancing - Department of Health, Australia]

==== CDC advice ====
* Know How it Spreads
* Clean your hands often
* Avoid close contact
* Stay home if you're sick (may have the virus)
* Cover coughs and sneezes
* Wear a face mask if you are sick (may have the virus)
* Clean and disinfect
<i><div role="note" class="hatnote navigation-not-searchable">{{MediaWiki:Seealso/{{{lang|{{PAGELANGUAGE}}}}}}}{{colon}}
[https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html Coronavirus disease 19 Prevention - CDC]</div></i>

===<span id="high-touch">High touch surfaces: disinfect daily</span>===
[[File:High-touch surfaces-CDC-covid-19.png|alt=High-touch surfaces: disinfect daily. Tables, doorknobs, light switches, countertops, handles, desks, phones keyboards, remote controls, toilets, faucets, sinks, hard-backed chairs. Source: Coronavirus disease 19 Prevention - CDC, March 2020. Public domain image.|thumb|upright=0.7]]<br style="line-height:0" />
The CDC currently recommends people '''clean''' AND '''disinfect''' frequently touched surfaces daily:
<div style="column-count:2;-moz-column-count:2;-webkit-column-count:2">
*tables
*doorknobs
*light switches
*countertops
*handles
*desks
*phones
*keyboards
*remote controls
*toilets
*faucets
*sinks
*hard-backed chairs<ref name="CDC-prevention" /><ref name="CDC-suspectedcases">{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/prepare/cleaning-disinfection.html|title=Coronavirus Disease 2019 (COVID-19) - Environmental Cleaning and Disinfection Recommendations|last=CDC|first=|authorlink=Centers for Disease Control and Prevention|last2=|first2=|authorlink2=|date=2020-02-11|website=Centers for Disease Control and Prevention|language=en-us|archive-url=|archive-date=|dead-url=|access-date=2020-03-18}}</ref>
</div><br style="clear:both; line-height:0" />
:'''To clean use:'''
*Detergent or soap and water prior to disinfection. <ref name="CDC-prevention" />

:'''To disinfect use:'''
*[https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2 '''Disinfectants used against SARS-CoV-2'''] (list)
*'''Most common EPA-registered household disinfectants''' will work, or
* '''Diluted household bleach''' (mix: 5 tablespoons bleach per gallon of water, OR 4 teaspoons bleach per quart of water), or
*'''Alcohol solutions''' with at least 70% alcohol
:Follow manufacturer’s instructions for application and ''proper ventilation''. Check the product is not past its expiration date. ''(Updated Mar 18, 2020)''<ref name="CDC-prevention">{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html|title=Coronavirus Disease 2019 (COVID-19) – Prevention & Treatment|last=CDC|first=|authorlink=Centers for Disease Control and Prevention|last2=|first2=|authorlink2=|date=2020-03-16|website=Centers for Disease Control and Prevention|language=en-us|archive-url=|archive-date=|dead-url=|access-date=2020-03-17}}</ref>

:'''Check for updates:'''
* [https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html Coronavirus disease 19 Prevention - CDC]

'''Suspected or confirmed COVID-19 cases:'''<br />If possible the '''sick person''' should also clean:
<div style="column-count:2;-moz-column-count:2;-webkit-column-count:2">
*soiled items and surfaces (as needed)
*if a separate bathroom is not available, the bathroom should be cleaned and disinfected after each use by an ill person
*provide personal cleaning and disinfectant supplies in ill person's room (unless unsafe, e.g. they are a young child) - include tissues, paper towels, cleaners and EPA-registered disinfectants<ref name="CDC-prevention" /><ref name="CDC-suspectedcases" /></div>

===Coronavirus transmission from surfaces===
The new coronavirus can survive on different surfaces for hours or days:
*small, airborne virus particles (aerosols) - 3 hours
*copper - 4 hours
*cardboard - 24 hours
*stainless steel - 2 to 3 days
*plastic - 2 to 3 days<ref name="stablesurfacesPRMar20">{{Cite web|url=https://www.nih.gov/news-events/news-releases/new-coronavirus-stable-hours-surfaces|title=New coronavirus stable for hours on surfaces|last=National Institutes of Health|first=|authorlink=National Institutes of Health|last2=|first2=|authorlink2=|date=2020-03-17|website=National Institutes of Health (NIH)|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-25}}</ref><ref name="Tellier2006">{{Cite journal|last=Tellier|first=Raymond|author-link=|last2=|first2=|author-link2=|last3=|first3=|author-link3=|last4=|first4=|author-link4=|last5=|first5=|author-link5=|last6=|first6=|author-link6=|last7=|first7=|last8=|first8=|date=Nov 2006|title=Review of Aerosol Transmission of Influenza A Virus|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3372341/|journal=Emerging Infectious Diseases|volume=12|issue=11|pages=1657–1662|doi=10.3201/eid1211.060426|issn=1080-6040|pmc=3372341|pmid=17283614|access-date=|quote=|via=}}</ref>

This means direct contact with an infected person is not needed to contact the illness.<ref name="stablesurfacesPRMar20" /> Surgical [[#facemasks|face masks]] have not been effective against aerosols in previous influenza outbreaks like swine flu, but N95 respirators have been effective.<ref name="Tellier2006" />

==<span id="someoneissick">Disinfecting your home if someone is sick</span>==

The following is an abbreviated bullet-point list from the [[Centers for Disease Control and Prevention]] (CDC) article [https://www.cdc.gov/coronavirus/2019-ncov/prepare/disinfecting-your-home.html "Everyday Steps and Extra Steps When Someone Is Sick"]<ref>{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/disinfecting-your-home.html|title=Coronavirus Disease 2019 (COVID-19)|last=CDC|date=2020-02-11|website=Centers for Disease Control and Prevention|language=en-us|access-date=2020-04-01}}</ref>

'''Suspected or confirmed COVID-19 cases:'''<br />
*'''Clean''' AND '''disinfect''' all [[#High-touch|high-touch]] areas daily.

If possible the '''sick person''' should also clean:
<div style="column-count:2;-moz-column-count:2;-webkit-column-count:2">
*soiled items and surfaces (as needed)
*if a separate bathroom is not available, the bathroom should be cleaned and disinfected after each use by an ill person
*provide personal cleaning and disinfectant supplies in ill person's room (unless unsafe, e.g. they are a young child) - include tissues, paper towels, cleaners and EPA-registered disinfectants<ref name="CDC-prevention" /><ref name="CDC-suspectedcases" /><ref name="CDCDisinfectYourHome">https://www.cdc.gov/coronavirus/2019-ncov/prepare/disinfecting-your-home.html</ref></div>

<div role="note" class="hatnote navigation-searchable" style="padding:0">Take additional steps covering '''soft surfaces, food, laundry, and trash''' as described{{colon}}
*[https://www.cdc.gov/coronavirus/2019-ncov/prepare/disinfecting-your-home.html Disinfecting your home if someone is sick - CDC]

==<span id="sari">COVID-19 pneumonia</span>==
'''Severe Acute Respiratory Infection''' (SARI) is a type of pneumonia caused by COVID-19 which develops in severely ill COVID-19 patients.<ref name="vitCtrial">{{Cite web|url=https://clinicaltrials.gov/ct2/show/NCT04264533|title=Vitamin C Infusion for the Treatment of Severe 2019-nCoV Infected Pneumonia - Full Text View - ClinicalTrials.gov|website=clinicaltrials.gov|language=en|access-date=2020-03-22}}</ref> A clinical trial is in progress to determine if intravenous [[vitamin C]] is an effective treatment for SARI.<ref name="vitCtrial" />

==<span id="ards">Acute Respiratory Distress Syndrome</span>==
ARDS is another complication of severe COVID-19, and may develop after 5-8 data of illness, along with pneumonitis and shortness of breath.<ref name="Jiang2020">{{Cite journal|url=http://techscience.com/cmc/v63n1/38464|title=Towards an Artificial Intelligence Framework for Data-Driven Prediction of Coronavirus Clinical Severity|last=Jiang|first=X|authorlink=|last2=Coffee|first2=M|authorlink2=|date=2020|website=|pages=537-551|archive-url=|archive-date=|dead-url=|access-date=2020-04-01|last3=Bari|first3=A|last4=Wang|first4=J|last5=Jiang|first5=X|last6=Huang|first6=J|last7=Shi|first7=J|last8=Dai|first8=J|last9=Cai|first9=J|last10= et al.|volume=63|issue=1|journal=CMC-Computers, Materials & Continua}}</ref> 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|last2=|first2=|authorlink2=|date=2017-10-17|website=nhs.uk|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-04-01}}</ref>

==Myth, Hoaxes, Scams and Fake News==
Many myths, hoaxes and fake news have been spreading, particularly on social media, some of which claim to be from doctors or health professionals.<ref name="WHOmyths">{{Cite web|url=https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters|title=Coronavirus 2019 {{!}} Myth busters|last=World Health Organization|first=|authorlink=World Health Organization|last2=|first2=|authorlink2=|date=|website=www.who.int|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-17}}</ref><ref name="BuzzfeedHoax3Mar20">{{Cite web|url=https://www.buzzfeednews.com/article/janelytvynenko/coronavirus-disinformation-spread|title=Here Are Some Of The Coronavirus Hoaxes That Spread In The First Few Weeks|website=BuzzFeed News|language=en|access-date=2020-03-17}}</ref> Scam include seeking fake cures or ineffective protective equipment like masks, scammers pretending to be from the World Health Organization asking for donations, or a stranger asking for money on behalf of a relative's medical bills.<ref name="FTC-scams">{{Cite web|url=https://www.consumer.ftc.gov/features/coronavirus-scams-what-ftc-doing|title=Coronavirus Scams: What the FTC is doing|last=FTC|first=|authorlink=|last2=|first2=|authorlink2=|date=2020-03-06|website=Consumer Information|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-17}}</ref><ref name="WHO-cybersecurity">{{Cite web|url=https://www.who.int/about/communications/cyber-security|title=Communications {{!}} Cybersecurity|last=World Health Organization|first=|authorlink=World Health Organization|last2=|first2=|authorlink2=|date=|website=www.who.int|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-17}}</ref>

*[https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters Coronavirus disease (COVID-19) advice for the public: Myth busters] - World Health Organization
*Mar 3, 2020 - [https://www.buzzfeednews.com/article/janelytvynenko/coronavirus-disinformation-spread Here Are Some Of The Coronavirus Hoaxes That Spread In The First Few Weeks] - Buzzfeed News
*Mar 2020 - [https://www.buzzfeednews.com/article/janelytvynenko/heres-a-running-list-of-the-latest-disinformation Here's A Running List Of The Latest Hoaxes Spreading About The Coronavirus] - Buzzfeed News
*[https://www.who.int/about/communications/cyber-security Cybersecurity - World Health Organization]
*[https://www.consumer.ftc.gov/features/coronavirus-scams-what-ftc-doing Coronavirus scams - What the FTC os doing]

==Posters for those self-isolating to avoid infection==
*[https://chronicallyawesome.org.uk/posters-for-those-who-are-self-isolating-as-a-preventative-measure/? Unofficial posters] stating where people should leave deliveries - Chronically Awesome

==Mental health ==
Anxiety around COVID-19 illness may cause anxiety or affect mental health.
*[https://www.nami.org/getattachment/About-NAMI/NAMI-News/2020/NAMI-Updates-on-the-Coronavirus/COVID-19-Updated-Guide-1.pdf?lang=en-US COVID-19 Guide - National Association of Mental Illness]
*[https://www.who.int/docs/default-source/coronaviruse/coping-with-stress.pdf?sfvrsn=9845bc3a_2 Coping with stress during the nCov-2019 outbreak (poster)] - World Health Organization

==News articles and blogs==
* Feb 29, 2020 - [https://www.nytimes.com/2020/02/29/health/coronavirus-reinfection.html They Recovered From the Coronavirus. Were They Infected Again?] - NY Times
*Mar 1, 2020, [http://www.investinme.org//IIMER-Newslet-20-0301covid.shtml COVID-19 and ME] - [[Invest in ME Research]] Newsletter
*Mar 14, 2020, [https://www.cnn.com/2020/03/14/health/coronavirus-covid-19-flu-comparison-frieden-analysis/index.html Former CDC director: Covid-19 is different from flu and we must respond differently, Dr. Tom Frieden] - CNN
*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 8, 2020, [https://www.independent.co.uk/news/world/europe/coronavirus-greece-cases-deaths-flatten-curve-update-a9455436.html Coronavirus: How Greece managed to flatten the curve] - The Independent

==Learn more==
'''Government Health Organizations'''
*[https://www.who.int/emergencies/diseases/novel-coronavirus-2019 Coronavirus disease 19 (COVID-19) - World Health Organization]
*[https://www.cdc.gov/coronavirus/2019-ncov/index.html Coronavirus disease 19 (COVID-19) - CDC]
*[https://www.nhs.uk/conditions/coronavirus-covid-19/ Coronavirus (COVID-19) - NHS]
*[https://www.who.int/gpsc/5may/Guide_to_Local_Production.pdf Guide to Local Production: WHO-recommended Handrub Formulations] - only for when soap and water is not available
*[https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public Protect yourself: Coronavirus disease 19 (COVID-19) - World Health Organization]
*[https://www.who.int/news-room/q-a-detail/q-a-coronaviruses Q&A on coronaviruses (COVID-19) - World Health Organization]
'''ME/CFS Organizations'''
*[http://batemanhornecenter.org/wp-content/uploads/2020/03/Medical-Care-Considerations-Letter-Final.pdf Useful medical information when treating COVID-19 in patients with underlying myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and severe fibromyalgia (FM)] - Dr Lucinda Bateman, Bateman Horne Center
*[https://www.meaction.net/covid-19/ COVID-19 Resources for People with ME - #MEAction]
*[https://www.meassociation.org.uk/2020/03/me-association-guidance-coronavirus-covid-19-update-09-march-2020/ ME Association Guidance: Coronavirus (COVID-19) Update | 09 March 2020] - The ME Association
'''Johns Hopkins University Global Cases Map'''
* [https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6 Desktop]
* [https://www.arcgis.com/apps/opsdashboard/index.html#/85320e2ea5424dfaaa75ae62e5c06e61 Mobile]

==See also ==
*[[Postviral fatigue syndrome]] (PVFS)
*[[Myalgic encephalomyelitis]]
*[[Severe acute respiratory syndrome coronavirus 2]] (SARS-CoV-2)
*[[Severe Acute Respiratory Syndrome]]
*[[Category:Disinfectants|Disinfectants Category]]

==References ==
{{Reflist}}

[[Category:Infectious diseases]]
[[Category:Triggers and risk factors]]
[[Category:Virology]]

Coronavirus disease 19

2020-04-17T12:04:47Z

Loopy:x

'''Coronavirus disease 19''', commonly known as '''COVID-19''', is the infectious respiratory illness caused by the novel (new) [[Severe acute respiratory syndrome coronavirus 2]] (SARS-CoV-2), previously known as ''2019-nCoV''.<ref name="WHO-QA">{{Cite web|url=https://www.who.int/news-room/q-a-detail/q-a-coronaviruses|title=Q&A on coronaviruses (COVID-19)|last=World Health Organization|first=|authorlink=World Health Organization|last2=|first2=|authorlink2=|date=|website=www.who.int|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-16}}</ref><ref name="CDC-coronoviruses">{{Cite web|url=https://www.cdc.gov/coronavirus/types.html|title=Human Coronavirus Types|last=Centers for Disease Control and Prevention|first=|authorlink=Centers for Disease Control and Prevention|last2=|first2=|authorlink2=|date=2020-02-27|website=www.cdc.gov|language=en-us|archive-url=|archive-date=|dead-url=|access-date=2020-03-16}}</ref><ref>{{Cite journal|last=Li|first=Guangdi|author-link=|last2=Clercq|first2=Erik De|author-link2=|last3=|first3=|author-link3=|last4=|first4=|author-link4=|last5=|first5=|author-link5=|last6=|first6=|author-link6=|last7=|first7=|last8=|first8=|date=Mar 2020|title=Therapeutic options for the 2019 novel coronavirus (2019-nCoV)|url=https://www.nature.com/articles/d41573-020-00016-0|journal=Nature Reviews Drug Discovery|language=en|volume=19|issue=3|pages=149–150|doi=10.1038/d41573-020-00016-0|pmc=|pmid=|access-date=|quote=|via=}}</ref><ref>{{Cite web|url=https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/naming-the-coronavirus-disease-(covid-2019)-and-the-virus-that-causes-it|title=Naming the coronavirus disease (COVID-19) and the virus that causes it|website=www.who.int|language=en|access-date=2020-03-28}}</ref>
[[File:Covid-19-lung-lesions.jpg|thumb|left|alt=Computer-aided identification of lesions on the lungs of COVID-19 patients.|'''COVID-19 can cause lesions on lungs, and pneumonia.'''<br>Author: [https://www.sciencedirect.com/science/article/pii/S2095177920302264 Shen et al. 2020. Journal of Pharmaceutical Analysis]. Copyright: CC-BY-NC-ND-4.0]]{{clear}}
COVID-19 was first identified in Wuhan, China, in December 2019,<ref name="WHO-QA" /> and can infect babies, children, and adults of any age.<ref>{{Cite journal|last=Wei|first=Min|last2=Yuan|first2=Jingping|last3=Liu|first3=Yu|last4=Fu|first4=Tao|last5=Yu|first5=Xue|last6=Zhang|first6=Zhi-Jiang|date=2020-02-14|title=Novel Coronavirus Infection in Hospitalized Infants Under 1 Year of Age in China|url=https://jamanetwork.com/journals/jama/fullarticle/2761659|journal=JAMA|language=en|doi=10.1001/jama.2020.2131}}</ref> It spread globally, resulting in the 2019-2020 coronavirus pandemic.<ref>{{Cite journal|last=Hui|first=David S.|last2=Azhar|first2=Esam I.|last3=Madani|first3=Tariq A.|last4=Ntoumi|first4=Francine|last5=Kock|first5=Richard|last6=Dar|first6=Osman|last7=Ippolito|first7=Giuseppe|last8=Mchugh|first8=Timothy D.|last9=Memish|first9=Ziad A.|date=2020-02-01|title=The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health — The latest 2019 novel coronavirus outbreak in Wuhan, China|url=https://www.ijidonline.com/article/S1201-9712(20)30011-4/abstract|journal=International Journal of Infectious Diseases|language=English|volume=91|pages=264–266|doi=10.1016/j.ijid.2020.01.009|issn=1201-9712|pmid=31953166}}</ref><ref>{{Cite web|url=https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020|title=WHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020|website=www.who.int|language=en|access-date=2020-03-28}}</ref>

== Symptoms ==
Symptoms are usually mild and begin gradually, although around 1 in 6 people with COVID-19 need medical help.<ref name="WHO-QA" /> Some people become infected but don't develop any symptoms and don't feel unwell.<ref name=":0">{{Cite web||last=World Health Organization|first=|authorlink=World Health Organization|url=https://www.who.int/news-room/q-a-detail/q-a-coronaviruses|title=Q&A on coronaviruses (COVID-19)|website=www.who.int|language=en|access-date=2020-03-24}}</ref> These symptoms may appear 1-14 days after exposure; most commonly around five days.<ref name=":0" /><ref name=":1">{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html|title=Coronavirus Disease 2019 (COVID-19) – Symptoms|last=CDC|date=2020-03-20||author-link=Centers for Disease Control|website=Centers for Disease Control and Prevention|language=en-us|access-date=2020-03-24}}</ref>

=== Common Symptoms ===
* [[fever]]
* [[Fatigue|tiredness]]
* continuous cough, coughing episodes or a dry [[cough|cough,]]<ref>{{Cite web|url=https://www.nhs.uk/conditions/coronavirus-covid-19/symptoms-and-what-to-do/|title=Symptoms and what to do - Coronavirus (COVID-19)|last=National Health Service|first=|authorlink=National Health Service|last2=|first2=|authorlink2=|date=2020-03-24|website=nhs.uk|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-26}}</ref><ref name=":0" /> or [[Dyspnea|shortness of breath]]<ref name=":1" />
Most patients only have one or two of the common symptoms.<ref name=":0" /><ref name=":3">{{Cite journal|last=Mizumoto|first=Kenji|last2=Kagaya|first2=Katsushi|last3=Zarebski|first3=Alexander|last4=Chowell|first4=Gerardo|date=2020-03-12|title=Estimating the asymptomatic proportion of coronavirus disease 2019 (COVID-19) cases on board the Diamond Princess cruise ship, Yokohama, Japan, 2020|url=https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.10.2000180|journal=Eurosurveillance|language=en|volume=25|issue=10|pages=2000180|doi=10.2807/1560-7917.ES.2020.25.10.2000180|issn=1560-7917|pmc=PMC7078829|pmid=32183930}}</ref><ref name="Lan2020" />

=== Other Symptoms ===
* aches and [[Pain|pains]]
* nasal congestion
* runny nose
* [[sore throat]]
* [[diarrhea]]<ref name=":0" />

=== Emergency Warning Signs* ===
* trouble breathing
* [[Chest pain|persistent pain or pressure in the chest]]
* new [[confusion]] or inability to arouse (unresponsive)
* bluish lips or face<ref name=":1" />
<nowiki>*</nowiki>This list is not all inclusive. Consult your medical provider for any other symptoms that are severe or concerning.<ref name=":1" />

Additionally, there are reports that patients have lost or have a reduced [[changes in sense of smell|sense of smell]], or [[Changes in taste|lost or distorted of taste]], but are otherwise [[#asymptomaticcarriers|asymptomatic]].<ref name=":2">{{Cite news|url=https://www.nytimes.com/2020/03/22/health/coronavirus-symptoms-smell-taste.html|title=Lost Sense of Smell May Be Peculiar Clue to Coronavirus Infection|last=Rabin|first=Roni Caryn|date=2020-03-22|work=The New York Times|access-date=2020-03-24|language=en-US|issn=0362-4331}}</ref><blockquote>The American Academy of Otolaryngology on Sunday posted information on its website<ref>{{Cite web|url=https://www.entnet.org/content/coronavirus-disease-2019-resources|title=Coronavirus Disease 2019: Resources|last=American Academy of Otolaryngology|date=2020-03-15|website=American Academy of Otolaryngology-Head and Neck Surgery|language=en|access-date=2020-03-24}}</ref> saying that mounting anecdotal evidence indicates that lost or reduced [[changes in sense of smell|sense of smell]] and loss of [[changes in taste|sense of taste]] are significant symptoms associated with Covid-19, and that they have been seen in patients who ultimately tested positive with no other symptoms.<ref name=":2" /></blockquote><blockquote>The symptoms, in the absence of allergies or sinusitis, should alert doctors to screen patients for the virus and “warrant serious consideration for self isolation and testing of these individuals,” the academy said.<ref name=":2" /></blockquote>

===Neurological symptoms===
Mao et al. (2020) reported that 36% of a group of 214 COVID-19 patients admitted to hospitals in Wuhan, China, had "neurologic manifestations" of the disease.<ref name="Mao2020">https://jamanetwork.com/journals/jamaneurology/fullarticle/2764549</ref>

Neurological symptoms were:
* [[central nervous system]] symptoms:
**[[dizziness]]
**[[headache]]
**impaired consciousness
**acute cerebrovascular disease
**[[ataxia]]
**[[seizure]]
* peripheral nervous symptoms:
**altered or loss of [[changes in taste|sense of taste]]
**altered or loss of [[changes in sense of smell|sense of smell]]
**[[visual dysfunction|impaired vision]]
**[[neuralgia|nerve pain]]
**skeletal muscular injury manifestations
*impaired or change in consciousness:
**[[somnolence]]
**stupor
**coma
**[[confusion]]
**delirium

==<span id="asymptomaticcarriers">Asymptomatic carriers</span>==
[[File:Covid-19-virus.png|thumb|upright=0.4|'''The SARS-CoV-2 virus causes COVID-19.'''<br>Author: CDC]]
A number of studies have found that some people who test positive for COVID-19 do not have any symptoms of illness or a raised temperature, and have normal blood test results, but are able to infect others, some of whom developed severe COVID-19 [[pneumonia]] as a result of COVID-19.<ref name="Bai2020">{{Cite journal|last=Bai|first=Yan|last2=Yao|first2=Lingsheng|last3=Wei|first3=Tao|last4=Tian|first4=Fei|last5=Jin|first5=Dong-Yan|last6=Chen|first6=Lijuan|last7=Wang|first7=Meiyun|date=2020-02-21|title=Presumed Asymptomatic Carrier Transmission of COVID-19|url=https://jamanetwork.com/journals/jama/fullarticle/2762028|journal=JAMA|language=en|doi=10.1001/jama.2020.2565}}</ref><ref name="Chan2019">{{Cite journal|last=Chan|first=Jasper Fuk-Woo|last2=Yuan|first2=Shuofeng|last3=Kok|first3=Kin-Hang|last4=To|first4=Kelvin Kai-Wang|last5=Chu|first5=Hin|last6=Yang|first6=Jin|last7=Xing|first7=Fanfan|last8=Liu|first8=Jieling|last9=Yip|first9=Cyril Chik-Yan|date=2020-02-15|title=A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster|url=https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30154-9/abstract|journal=The Lancet|language=English|volume=395|issue=10223|pages=514–523|doi=10.1016/S0140-6736(20)30154-9|issn=0140-6736|pmid=31986261}}</ref><ref name="delRio2020">{{Cite journal|last=del Rio|first=Carlos|author-link=|last2=Malani|first2=Preeti N.|author-link2=|last3=|first3=|author-link3=|last4=|first4=|author-link4=|last5=|first5=|author-link5=|last6=|first6=|author-link6=|last7=|first7=|last8=|first8=|date=2020-02-28|title=COVID-19—New Insights on a Rapidly Changing Epidemic|url=https://jamanetwork.com/journals/jama/fullarticle/2762510|journal=JAMA|language=en|volume=|issue=|pages=|doi=10.1001/jama.2020.3072|pmc=|pmid=|access-date=|quote=|via=}}</ref> Some asymptomatic carriers have abnormal chest CT scans, and some do not. False negative tests have also been reported.<ref name="Bai2020" /><ref name="Chan2019" />

Estimates of the number of asymptomatic carriers vary wildly. Mizumoto et al. (2020) estimated that asymptomatic carriers accounted for 17.9% of the COVID-19 positive people on the ''Diamond Princess'' cruise ship, which was quarantined for 14 day after a previous passenger developed the illness.<ref name=":3" />

==<span id="recovered">Recovered patients testing positive</span>==
Lan et al (2020) identified a group of 4 recovered patients who continued to test positive for COVID-19 after recovery; suggesting that they may still be infectious.<ref name="Lan2020">{{Cite journal|last=Lan|first=Lan|last2=Xu|first2=Dan|last3=Ye|first3=Guangming|last4=Xia|first4=Chen|last5=Wang|first5=Shaokang|last6=Li|first6=Yirong|last7=Xu|first7=Haibo|date=2020-02-27|title=Positive RT-PCR Test Results in Patients Recovered From COVID-19|url=https://jamanetwork.com/journals/jama/fullarticle/2762452|journal=JAMA|language=en|doi=10.1001/jama.2020.2783}}</ref> It is not known whether patients who have recovered may be reinfected later, or whether those who later needed treatment actually relapsed, or if recovered patients who later test positive do so because of issues with the diagnostic test's accuracy.<ref>{{Cite web|url=https://www.snopes.com/fact-check/covid-19-reinfection/|title=Can People Who Recover from COVID-19 Become Reinfected?|website=Snopes.com|language=en-US|access-date=2020-03-26}}</ref> Another study found group of 5 recovered patients were found to have reactivated COVID-19.<ref>{{Cite journal|last=Ye|first=Guangming|last2=Pan|first2=Zhenyu|last3=Pan|first3=Yunbao|last4=Deng|first4=Qiaoling|last5=Chen|first5=Liangjun|last6=Li|first6=Jin|last7=Li|first7=Yirong|last8=Wang|first8=Xinghuan|date=2020-03-11|title=Clinical characteristics of severe acute respiratory syndrome coronavirus 2 reactivation|url=https://www.journalofinfection.com/article/S0163-4453(20)30114-6/abstract|journal=Journal of Infection|language=English|volume=0|issue=0|doi=10.1016/j.jinf.2020.03.001|issn=0163-4453|pmid=32171867}}</ref>

==ME/CFS==

{{Video|id=pkGXiJ1jM14|service=youtube|dimensions=550|description=COVID-19 and ME/CFS - Dr Nancy Klimas, Mar 13, 2020|alignment=left|urlargs=}}

{{clear}}

====<span id="catchingcovid19">Risk of COVID-19 in patients with ME/CFS</span>====
There is a lack of evidence about ME/CFS patients developing COVID-19 illness; but a number of medical advisors have given their expert opinions on this. Immunologist and [[Myalgic encephalomyelitis|ME]] researcher Dr [[Nancy Klimas]] has said she believes people with ME/CFS are at a little higher risk of developing COVID-19 after exposure to the virus;<ref name="Klimas20200313">{{Cite web|url=https://www.youtube.com/watch?v=pkGXiJ1jM14|title=COVID-19 and ME/CFS - Dr Nancy Klimas, Mar 13, 2020|last=Klimas|first=Nancy|date=2020-03-13|work=|access-date=Mar 24, 2020|archive-url=|archive-date=|dead-url=|quote=|author-link=Nancy Klimas}}</ref> Dr [[Nigel Speight]], Dr [[William Weir]] and Dr [[Charles Shepherd]] have said they do not think there is an increased risk.<ref name="SpeightWeirMar20" /><ref name="SpeightMar20" /><ref name="MEA16Mar20" /> Dr [[Lucinda Bateman]] has said this is unknown.<ref name="Bateman20200323QA">{{Cite web |title=COVID-19 and ME/CFS/FM Frequently Asked Questions|last=Bateman|first=Lucinda|author-link=Lucinda Bateman|website=Bateman-Horne Center|date=2020-03-23|url=http://www.batemanhornecenter.org/wp-content/uploads/2020/03/COVID-19-FAQ-Public.pdf}}</ref>Klimas, Speight, Weir, Shepherd and Bateman have all advised ME/CFS patients to take additional precautions, and highlighted that there is a risk of ME/CFS becoming significantly worse after viral infections or after COVID-19.<ref name="Klimas20200313" /><ref name="SpeightWeirMar20" /><ref name="SpeightMar20" /><ref name="MEA16Mar20" /><ref name="Bateman20200323QA" />

ME/CFS includes [[:Category:Immune signs and symptoms|immune symptoms]] including a [[sore throat]], [[swollen lymph nodes]], and [[flu-like symptoms]], but patients are generally '''''not''''' considered to be severely immunocompromised, and immunosuppressant medications are unlikely to be used by most ME/CFS patients. <ref name="Klimas20200313" /> <ref name="canadianconsensus">{{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
| url = http://www.investinme.org/Documents/PDFdocuments/CanadianDefinitionME-CFS.pdf
}}</ref><ref name="ICP2011primer">{{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> This means most ME/CFS patients would '''''not''''' be considered to be at very high risk of COVID-19 illness.<ref name="Klimas20200313" />

The unproven [[autoimmune hypothesis]] states that a subtype of ME involves autoimmunity, which is an overactive immune system rather than a weakened immune response.<ref name="OMF2018research">{{Cite web|url=https://www.omf.ngo/2018/02/28/omf-funded-research-t-cells-molecular-immunology/|title=OMF-funded research: T cells and molecular immunology|last=Open Medicine Foundation|first=|authorlink=Open Medicine Foundation|last2=|first2=|authorlink2=|date=Feb 28, 2018|website=Open Medicine Foundation|language=en-US|archive-url=|archive-date=|dead-url=|access-date=2019-07-11}}</ref> Evidence for this theory is limited.

===Drug related risks===
The following drugs may be used for some ME/CFS symptoms and are a possible concern
* '''<span id="ibuprofen">[[Ibuprofen]]</span>''' - Ibuprofen drugs (Nurofen, Bruprofen, Advil, Midol, Motrin, Motrin) are anti-inflammatories commonly used for cold/flu symptoms and for ME/CFS. There have been some reports that ibuprofen taken for COVID-19 may prolong the illness and increase it's severity. Several countries including the UK and France now recommend that people with suspected or confirmed COVID-19 avoid ibuprofen and '''use paracetamol / acetaminophen''' (e.g., Tylenol) instead, although the evidence for this is relatively limited.<ref name="MEA16Mar20" /><ref name="Day20200317">{{Cite journal|last=Day|first=Michael|date=2020-03-17|title=Covid-19: ibuprofen should not be used for managing symptoms, say doctors and scientists|url=https://www.bmj.com/content/368/bmj.m1086|journal=BMJ|language=en|volume=368|doi=10.1136/bmj.m1086|issn=1756-1833|pmid=32184201}}</ref><ref>{{Cite web|url=https://www.nhs.uk/conditions/coronavirus-covid-19/self-isolation-advice/|title=Stay at home advice - Coronavirus (COVID-19)|last=National Health Service|first=|authorlink=National Health Service|last2=|first2=|authorlink2=|date=2020-02-28|website=nhs.uk|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref> There is no suggestion that ibuprofen affects the risk of catching COVID-19.
* '''[[Rituximab]]''' - The MS Society has stated that taking rituximab, which has been used in clinical trials for ME/CFS, may affect the risk of catching COVID-19.<ref name="Covid-19-MS">{{Cite web|url=https://www.mssociety.org.uk/about-ms/treatments-and-therapies/disease-modifying-therapies/covid-19-coronavirus-and-ms|title=COVID-19 coronavirus and MS|last=MS Society|first=|authorlink=|last2=|first2=|authorlink2=|date=|website=www.mssociety.org.uk|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref><ref>{{Cite web|url=https://renal.org/wp-content/uploads/2020/03/BAPN-COVID-19-patient-info-for-HD.PD_.Immunosuppression-17March20.pdf|title=Coronavirus (SARS-CoV-2) and its associated illness (COVID-19) {{!}} Information and Guidance for Children on Haemodialysis, Peritoneal Dialysis and Immune suppression (including Renal Transplants)|last=Renal Association|first=|authorlink=|last2=|first2=|authorlink2=|date=2020-03-17|website=renal.org|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref>
* '''[[Ampligen]]''' - Ampligen or ''rintatolimod'' is sometimes used by ME/CFS patients, it is an [[antiviral]] immunostimulant rather than immunosuppressing drug, and is being tested for the treatment of COVID-19 illness in Japan.<ref>{{Cite web|url=https://adisinsight.springer.com/drugs/800001203|title=Rintatolimod - AIM ImmunoTech - AdisInsight|website=adisinsight.springer.com|access-date=2020-03-23}}</ref> There is no information about whether it may help prevent COVID-19 in ME/CFS patients.
*'''[[Fludrocortisone]]''', a [[corticosteroid]] (steroid) - brand names include Florinef. This may be used by patients with [[POTS]], which is common in ME/CFS patients.<ref name="Fludrocortisone-Drugbank">https://www.drugbank.ca/drugs/DB00687</ref >
* Other '''[[corticosteroid]]s''' (steroids) if they could suppress the immune system.<ref name="UKgov-vulnerable">{{Cite web|url=https://www.gov.uk/government/publications/covid-19-guidance-on-social-distancing-and-for-vulnerable-people/guidance-on-social-distancing-for-everyone-in-the-uk-and-protecting-older-people-and-vulnerable-adults|website=gov.uk|access-date=2020-04-06|title=COVID-19 guidance on social distancing and for vulnerable people|last=Public Health England}}</ref>
* Any other '''immunosuppressant drugs or therapies''', including chemotherapy treatments and certain targeted cancer treatments<ref name="UKgov-vulnerable" /><ref name="UKgov-extremelyvulnerable">{{Cite web|title=Guidance on shielding and protecting extremely vulnerable people from COVID-19|url=https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19|website=gov.uk|access-date=2020-04-06|last=Public Health England}}</ref >
{{Quote box|I have now reached the conclusion that people with pre-existing health conditions that make them more vulnerable to lung complications (which may or may not be the case with ME/CFS – at this stage we just don’t know), or have a condition like ME/CFS where an infection such as this will almost certainly cause a relapse, or significant exacerbation of symptoms, need to be doing far more to protect themselves, and to socially distance themselves from other people, than official NHS guidance indicates.

In particular, for those who are not housebound, this applies to social mobility and what you can do (and cannot do) if you decide to leave your home.<ref name="MEA16Mar20"/>|author=[[Charles Shepherd]], ME Association|date=Mar 16, 2020|title=Advice from the UK's ME Association}}

====<span id="deathrisk">Risk of death or serious complications in ME/CFS patients</span>====
{{Quote box|Although ME is a "chronic condition" my gut feeling is that they are not actually at greater risk of dying from the virus itself than healthy people. The conditions which put people at extra risk would be things like severe asthma or COPD, or immunosuppressed people eg those on chemotherapy for cancer.

The biggest worry therefore for ME sufferers is that catching the virus will make their ME much worse, and of course people in the 25% group do not have much leeway.

It might even be that worsening of their already severe ME could be a bigger threat to life than the virus itself.<ref name="SpeightMar20" />|author=[[Nigel Speight]]|date=Mar 2020|title=25% ME Group for Severe ME}}

====<span id="triggerforME">Risk of developing ME/CFS after COVID-19</span>====
ME/CFS has been linked to many different viruses, but it is not known what the likelihood is of developing ME/CFS after COVID-19 illness.
{{See also|Postviral fatigue syndrome}}

===<span id="medicaladvisors">ME/CFS charity medical advisors' COVID-19 statements</span>===
*Mar 30, 2020, ME Association, [https://www.meassociation.org.uk/2020/03/me-association-full-guidance-coronavirus-and-me-cfs-by-dr-charles-shepherd-30-march-2020/ ME Association full guidance: Coronavirus and ME/CFS by Dr Charles Shepherd]<ref name="MEA30Mar20">{{Cite web|url=https://www.meassociation.org.uk/2020/03/me-association-full-guidance-coronavirus-and-me-cfs-by-dr-charles-shepherd-30-march-2020/|title=ME Association full guidance: Coronavirus and ME/CFS by Dr Charles Shepherd {{!}} 30 March 2020|last=Shepherd|first=Charles|authorlink=Charles Shepherd|last2=|first2=|authorlink2=|date=2020-04-06|website=ME Association|language=en-GB|archive-url=|archive-date=|dead-url=|access-date=2020-03-30}}</ref>
*Mar 23 2020, Bateman Horne Center, [http://www.batemanhornecenter.org/covid19 COVID-19 resources]
*Mar 17, 2020, ME Association, [https://www.meassociation.org.uk/2020/03/coronavirus-covid-19-latest-government-advice-and-what-it-means-for-people-with-me-cfs-17-march-2020/ Coronavirus Covid-19: Latest Government advice and what it means for people with ME/CFS]<ref name="MEA17Mar20">{{Cite web|url=https://www.meassociation.org.uk/2020/03/coronavirus-covid-19-latest-government-advice-and-what-it-means-for-people-with-me-cfs-17-march-2020/|title=Coronavirus Covid-19: Latest Government advice and what it means for people with ME/CFS {{!}} 17 March 2020|last=Shepherd|first=Charles|authorlink=Charles Shepherd|last2=|first2=|authorlink2=|date=2020-03-17|website=ME Association|language=en-GB|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref>
*Mar 16, 2020, ME Association, [https://www.meassociation.org.uk/2020/03/me-association-guidance-coronavirus-covid-19-and-me-cfs-by-dr-charles-shepherd-16-march-2020/ ME Association Guidance: Coronavirus and ME/CFS by Dr Charles Shepherd]<ref name="MEA16Mar20">{{Cite web|url=https://www.meassociation.org.uk/2020/03/me-association-guidance-coronavirus-covid-19-and-me-cfs-by-dr-charles-shepherd-16-march-2020/|title=ME Association Guidance: Coronavirus and ME/CFS by Dr Charles Shepherd {{!}} 16 March 2020|last=Shepherd|first=Charles|authorlink=Charles Shepherd|last2=|first2=|authorlink2=|date=2020-03-16|website=ME Association|language=en-GB|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref>
*Mar 2020, 25% ME Group, [https://25megroup.org/download/1796/?v=3236 re Coronavirus and members of the 25% ME Group, Severe ME charity | Message from Dr Willy Weir and Dr Nigel Speight, Medical Advisor to 25% ME Group | Update to the advice given on 29 February 2020],<ref name="SpeightWeirMar20">{{Cite web|url=https://25megroup.org/download/1796/?v=3236|author-link=Nigel Speight|last=Speight|first=Nigel||last2=Weir|first2=William|author-link2=William Weir|title=re Coronavirus and members of the 25% ME Group, Severe ME charity {{!}} Message from Dr Willy Weir and Dr Nigel Speight, Medical Advisor to 25% ME Group {{!}} Update to the advice given on 29 February 2020 |date=Mar 2020|website=25megroup.org}}</ref>
*Mar 2020, 25% ME Group, [https://25megroup.org/download/1796/?v=3226 re Coronavirus and members of the 25% ME Group, Severe ME charity Types | Message from Dr Nigel Speight, Medical Advisor to 25% ME Group]<ref name="SpeightMar20">{{Cite web|url=https://25megroup.org/download/1796/?v=3226|author-link=Nigel Speight|last=Speight|first=Nigel|title=re Coronavirus and members of the 25% ME Group, Severe ME charity Types {{!}} Message from Dr Nigel Speight, Medical Advisor to 25% ME Group|date=Mar 2020|website=25megroup.org|others=[[William Weir]]}}</ref>

===Research on ME/CFS and COVID-19===
COVID-19 is a new illness and research on the effects on ME/CFS patients has not been published yet. Patient surveys in progress include:
*[https://www.zorgvolg.nl/mecvscor.php Corona ME/CFS study] - [[ME/CVS-Stichting Nederland]] - in Dutch
:A Dutch patient organization survey to assess if the risk of contracting COVID-19 is higher for those with ME/CFS, and if symptoms are more severe in ME/CFS patients.<ref name="EMEA-q12020">http://europeanmealliance.org/news-Q12020-001.shtml?</ref><ref name="MECVS-survey-23Mar2020">https://mecvs.nl/nieuws/persbericht-covid-19-onder-me-cvs-patienten/</ref > The [[European ME Alliance]] is suggesting that non-Dutch speakers use an online translation tool to complete it.<ref name="EMEA-q12020"/>

==Prevention==
[[File:CDC-Coronavirus-badge-300.png|thumb|upright=1|left|Image author: CDC|alt=image of Coronavirus Disease 2019 (COVID-19)|link=https://www.cdc.gov/coronavirus/2019-ncov/index.html]]
<br style="clear:both;line-height:0">
The SARS-CoV-2 coronavirus is an ''enveloped virus'', which means it is easier to kill outside the body than ''non-enveloped'' viruses like [[Coxsackievirus]], or [[Poliovirus]].<ref>{{Cite web|url=https://www.epa.gov/pesticides/coronavirus-cases-trigger-epa-rapid-response|title=Coronavirus Cases Trigger EPA Rapid Response|last=US Environmental Protection Agency|first=|authorlink=|last2=|first2=|authorlink2=|date=2020-01-29|website=US EPA|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref><ref>{{Cite journal|last=Firquet|first=Swan|author-link=|last2=Beaujard|first2=Sophie|author-link2=|last3=Lobert|first3=Pierre-Emmanuel|author-link3=|last4=Sané|first4=Famara|author-link4=|last5=Caloone|first5=Delphine|author-link5=|last6=Izard|first6=Daniel|author-link6=|last7=Hober|first7=Didier|last8=|first8=|date=June 2015|title=Survival of Enveloped and Non-Enveloped Viruses on Inanimate Surfaces|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4462923/|journal=Microbes and Environments|volume=30|issue=2|pages=140–144|doi=10.1264/jsme2.ME14145|issn=1342-6311|pmc=4462923|pmid=25843687|access-date=|quote=|via=}}</ref>
*[https://www.cdc.gov/coronavirus/2019-ncov/prepare/get-your-household-ready-for-COVID-19.html Get your Household Ready for COVID-19] - CDC
*[https://www.americanchemistry.com/Novel-Coronavirus-Fighting-Products-List.pdf Novel Coronavirus (COVID-19)-Fighting Products] - Center for Biocide Chemistries
*[https://www.health.gov.au/sites/default/files/documents/2020/03/coronavirus-covid-19-information-on-social-distancing.pdf Social distancing - Department of Health, Australia]

==== CDC advice ====
* Know How it Spreads
* Clean your hands often
* Avoid close contact
* Stay home if you're sick (may have the virus)
* Cover coughs and sneezes
* Wear a face mask if you are sick (may have the virus)
* Clean and disinfect
<i><div role="note" class="hatnote navigation-not-searchable">{{MediaWiki:Seealso/{{{lang|{{PAGELANGUAGE}}}}}}}{{colon}}
[https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html Coronavirus disease 19 Prevention - CDC]</div></i>

===<span id="high-touch">High touch surfaces: disinfect daily</span>===
[[File:High-touch surfaces-CDC-covid-19.png|alt=High-touch surfaces: disinfect daily. Tables, doorknobs, light switches, countertops, handles, desks, phones keyboards, remote controls, toilets, faucets, sinks, hard-backed chairs. Source: Coronavirus disease 19 Prevention - CDC, March 2020. Public domain image.|thumb|upright=0.7]]<br style="line-height:0" />
The CDC currently recommends people '''clean''' AND '''disinfect''' frequently touched surfaces daily:
<div style="column-count:2;-moz-column-count:2;-webkit-column-count:2">
*tables
*doorknobs
*light switches
*countertops
*handles
*desks
*phones
*keyboards
*remote controls
*toilets
*faucets
*sinks
*hard-backed chairs<ref name="CDC-prevention" /><ref name="CDC-suspectedcases">{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/prepare/cleaning-disinfection.html|title=Coronavirus Disease 2019 (COVID-19) - Environmental Cleaning and Disinfection Recommendations|last=CDC|first=|authorlink=Centers for Disease Control and Prevention|last2=|first2=|authorlink2=|date=2020-02-11|website=Centers for Disease Control and Prevention|language=en-us|archive-url=|archive-date=|dead-url=|access-date=2020-03-18}}</ref>
</div><br style="clear:both; line-height:0" />
:'''To clean use:'''
*Detergent or soap and water prior to disinfection. <ref name="CDC-prevention" />

:'''To disinfect use:'''
*[https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2 '''Disinfectants used against SARS-CoV-2'''] (list)
*'''Most common EPA-registered household disinfectants''' will work, or
* '''Diluted household bleach''' (mix: 5 tablespoons bleach per gallon of water, OR 4 teaspoons bleach per quart of water), or
*'''Alcohol solutions''' with at least 70% alcohol
:Follow manufacturer’s instructions for application and ''proper ventilation''. Check the product is not past its expiration date. ''(Updated Mar 18, 2020)''<ref name="CDC-prevention">{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html|title=Coronavirus Disease 2019 (COVID-19) – Prevention & Treatment|last=CDC|first=|authorlink=Centers for Disease Control and Prevention|last2=|first2=|authorlink2=|date=2020-03-16|website=Centers for Disease Control and Prevention|language=en-us|archive-url=|archive-date=|dead-url=|access-date=2020-03-17}}</ref>

:'''Check for updates:'''
* [https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html Coronavirus disease 19 Prevention - CDC]

'''Suspected or confirmed COVID-19 cases:'''<br />If possible the '''sick person''' should also clean:
<div style="column-count:2;-moz-column-count:2;-webkit-column-count:2">
*soiled items and surfaces (as needed)
*if a separate bathroom is not available, the bathroom should be cleaned and disinfected after each use by an ill person
*provide personal cleaning and disinfectant supplies in ill person's room (unless unsafe, e.g. they are a young child) - include tissues, paper towels, cleaners and EPA-registered disinfectants<ref name="CDC-prevention" /><ref name="CDC-suspectedcases" /></div>

===Coronavirus transmission from surfaces===
The new coronavirus can survive on different surfaces for hours or days:
*small, airborne virus particles (aerosols) - 3 hours
*copper - 4 hours
*cardboard - 24 hours
*stainless steel - 2 to 3 days
*plastic - 2 to 3 days<ref name="stablesurfacesPRMar20">{{Cite web|url=https://www.nih.gov/news-events/news-releases/new-coronavirus-stable-hours-surfaces|title=New coronavirus stable for hours on surfaces|last=National Institutes of Health|first=|authorlink=National Institutes of Health|last2=|first2=|authorlink2=|date=2020-03-17|website=National Institutes of Health (NIH)|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-25}}</ref><ref name="Tellier2006">{{Cite journal|last=Tellier|first=Raymond|author-link=|last2=|first2=|author-link2=|last3=|first3=|author-link3=|last4=|first4=|author-link4=|last5=|first5=|author-link5=|last6=|first6=|author-link6=|last7=|first7=|last8=|first8=|date=Nov 2006|title=Review of Aerosol Transmission of Influenza A Virus|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3372341/|journal=Emerging Infectious Diseases|volume=12|issue=11|pages=1657–1662|doi=10.3201/eid1211.060426|issn=1080-6040|pmc=3372341|pmid=17283614|access-date=|quote=|via=}}</ref>

This means direct contact with an infected person is not needed to contact the illness.<ref name="stablesurfacesPRMar20" /> Surgical [[#facemasks|face masks]] have not been effective against aerosols in previous influenza outbreaks like swine flu, but N95 respirators have been effective.<ref name="Tellier2006" />

==<span id="someoneissick">Disinfecting your home if someone is sick</span>==

The following is an abbreviated bullet-point list from the [[Centers for Disease Control and Prevention]] (CDC) article [https://www.cdc.gov/coronavirus/2019-ncov/prepare/disinfecting-your-home.html "Everyday Steps and Extra Steps When Someone Is Sick"]<ref>{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/disinfecting-your-home.html|title=Coronavirus Disease 2019 (COVID-19)|last=CDC|date=2020-02-11|website=Centers for Disease Control and Prevention|language=en-us|access-date=2020-04-01}}</ref>

'''Suspected or confirmed COVID-19 cases:'''<br />
*'''Clean''' AND '''disinfect''' all [[#High-touch|high-touch]] areas daily.

If possible the '''sick person''' should also clean:
<div style="column-count:2;-moz-column-count:2;-webkit-column-count:2">
*soiled items and surfaces (as needed)
*if a separate bathroom is not available, the bathroom should be cleaned and disinfected after each use by an ill person
*provide personal cleaning and disinfectant supplies in ill person's room (unless unsafe, e.g. they are a young child) - include tissues, paper towels, cleaners and EPA-registered disinfectants<ref name="CDC-prevention" /><ref name="CDC-suspectedcases" /><ref name="CDCDisinfectYourHome">https://www.cdc.gov/coronavirus/2019-ncov/prepare/disinfecting-your-home.html</ref></div>

<div role="note" class="hatnote navigation-searchable" style="padding:0">Take additional steps covering '''soft surfaces, food, laundry, and trash''' as described{{colon}}
*[https://www.cdc.gov/coronavirus/2019-ncov/prepare/disinfecting-your-home.html Disinfecting your home if someone is sick - CDC]

==<span id="sari">COVID-19 pneumonia</span>==
'''Severe Acute Respiratory Infection''' (SARI) is a type of pneumonia caused by COVID-19 which develops in severely ill COVID-19 patients.<ref name="vitCtrial">{{Cite web|url=https://clinicaltrials.gov/ct2/show/NCT04264533|title=Vitamin C Infusion for the Treatment of Severe 2019-nCoV Infected Pneumonia - Full Text View - ClinicalTrials.gov|website=clinicaltrials.gov|language=en|access-date=2020-03-22}}</ref> A clinical trial is in progress to determine if intravenous [[vitamin C]] is an effective treatment for SARI.<ref name="vitCtrial" />

==<span id="ards">Acute Respiratory Distress Syndrome</span>==
ARDS is another complication of severe COVID-19, and may develop after 5-8 data of illness, along with pneumonitis and shortness of breath.<ref name="Jiang2020">{{Cite journal|url=http://techscience.com/cmc/v63n1/38464|title=Towards an Artificial Intelligence Framework for Data-Driven Prediction of Coronavirus Clinical Severity|last=Jiang|first=X|authorlink=|last2=Coffee|first2=M|authorlink2=|date=2020|website=|pages=537-551|archive-url=|archive-date=|dead-url=|access-date=2020-04-01|last3=Bari|first3=A|last4=Wang|first4=J|last5=Jiang|first5=X|last6=Huang|first6=J|last7=Shi|first7=J|last8=Dai|first8=J|last9=Cai|first9=J|last10= et al.|volume=63|issue=1|journal=CMC-Computers, Materials & Continua}}</ref> 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|last2=|first2=|authorlink2=|date=2017-10-17|website=nhs.uk|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-04-01}}</ref>

==Myth, Hoaxes, Scams and Fake News==
Many myths, hoaxes and fake news have been spreading, particularly on social media, some of which claim to be from doctors or health professionals.<ref name="WHOmyths">{{Cite web|url=https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters|title=Coronavirus 2019 {{!}} Myth busters|last=World Health Organization|first=|authorlink=World Health Organization|last2=|first2=|authorlink2=|date=|website=www.who.int|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-17}}</ref><ref name="BuzzfeedHoax3Mar20">{{Cite web|url=https://www.buzzfeednews.com/article/janelytvynenko/coronavirus-disinformation-spread|title=Here Are Some Of The Coronavirus Hoaxes That Spread In The First Few Weeks|website=BuzzFeed News|language=en|access-date=2020-03-17}}</ref> Scam include seeking fake cures or ineffective protective equipment like masks, scammers pretending to be from the World Health Organization asking for donations, or a stranger asking for money on behalf of a relative's medical bills.<ref name="FTC-scams">{{Cite web|url=https://www.consumer.ftc.gov/features/coronavirus-scams-what-ftc-doing|title=Coronavirus Scams: What the FTC is doing|last=FTC|first=|authorlink=|last2=|first2=|authorlink2=|date=2020-03-06|website=Consumer Information|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-17}}</ref><ref name="WHO-cybersecurity">{{Cite web|url=https://www.who.int/about/communications/cyber-security|title=Communications {{!}} Cybersecurity|last=World Health Organization|first=|authorlink=World Health Organization|last2=|first2=|authorlink2=|date=|website=www.who.int|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-17}}</ref>

*[https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters Coronavirus disease (COVID-19) advice for the public: Myth busters] - World Health Organization
*Mar 3, 2020 - [https://www.buzzfeednews.com/article/janelytvynenko/coronavirus-disinformation-spread Here Are Some Of The Coronavirus Hoaxes That Spread In The First Few Weeks] - Buzzfeed News
*Mar 2020 - [https://www.buzzfeednews.com/article/janelytvynenko/heres-a-running-list-of-the-latest-disinformation Here's A Running List Of The Latest Hoaxes Spreading About The Coronavirus] - Buzzfeed News
*[https://www.who.int/about/communications/cyber-security Cybersecurity - World Health Organization]
*[https://www.consumer.ftc.gov/features/coronavirus-scams-what-ftc-doing Coronavirus scams - What the FTC os doing]

==Posters for those self-isolating to avoid infection==
*[https://chronicallyawesome.org.uk/posters-for-those-who-are-self-isolating-as-a-preventative-measure/? Unofficial posters] stating where people should leave deliveries - Chronically Awesome

==Mental health ==
Anxiety around COVID-19 illness may cause anxiety or affect mental health.
*[https://www.nami.org/getattachment/About-NAMI/NAMI-News/2020/NAMI-Updates-on-the-Coronavirus/COVID-19-Updated-Guide-1.pdf?lang=en-US COVID-19 Guide - National Association of Mental Illness]
*[https://www.who.int/docs/default-source/coronaviruse/coping-with-stress.pdf?sfvrsn=9845bc3a_2 Coping with stress during the nCov-2019 outbreak (poster)] - World Health Organization

==News articles and blogs==
* Feb 29, 2020 - [https://www.nytimes.com/2020/02/29/health/coronavirus-reinfection.html They Recovered From the Coronavirus. Were They Infected Again?] - NY Times
*Mar 1, 2020, [http://www.investinme.org//IIMER-Newslet-20-0301covid.shtml COVID-19 and ME] - [[Invest in ME Research]] Newsletter
*Mar 14, 2020, [https://www.cnn.com/2020/03/14/health/coronavirus-covid-19-flu-comparison-frieden-analysis/index.html Former CDC director: Covid-19 is different from flu and we must respond differently, Dr. Tom Frieden] - CNN
*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 8, 2020, [https://www.independent.co.uk/news/world/europe/coronavirus-greece-cases-deaths-flatten-curve-update-a9455436.html Coronavirus: How Greece managed to flatten the curve] - The Independent

==Learn more==
'''Government Health Organizations'''
*[https://www.who.int/emergencies/diseases/novel-coronavirus-2019 Coronavirus disease 19 (COVID-19) - World Health Organization]
*[https://www.cdc.gov/coronavirus/2019-ncov/index.html Coronavirus disease 19 (COVID-19) - CDC]
*[https://www.nhs.uk/conditions/coronavirus-covid-19/ Coronavirus (COVID-19) - NHS]
*[https://www.who.int/gpsc/5may/Guide_to_Local_Production.pdf Guide to Local Production: WHO-recommended Handrub Formulations] - only for when soap and water is not available
*[https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public Protect yourself: Coronavirus disease 19 (COVID-19) - World Health Organization]
*[https://www.who.int/news-room/q-a-detail/q-a-coronaviruses Q&A on coronaviruses (COVID-19) - World Health Organization]
'''ME/CFS Organizations'''
*[http://batemanhornecenter.org/wp-content/uploads/2020/03/Medical-Care-Considerations-Letter-Final.pdf Useful medical information when treating COVID-19 in patients with underlying myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and severe fibromyalgia (FM)] - Dr Lucinda Bateman, Bateman Horne Center
*[https://www.meaction.net/covid-19/ COVID-19 Resources for People with ME - #MEAction]
*[https://www.meassociation.org.uk/2020/03/me-association-guidance-coronavirus-covid-19-update-09-march-2020/ ME Association Guidance: Coronavirus (COVID-19) Update | 09 March 2020] - The ME Association
'''Johns Hopkins University Global Cases Map'''
* [https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6 Desktop]
* [https://www.arcgis.com/apps/opsdashboard/index.html#/85320e2ea5424dfaaa75ae62e5c06e61 Mobile]

==See also ==
*[[Postviral fatigue syndrome]] (PVFS)
*[[Myalgic encephalomyelitis]]
*[[Severe acute respiratory syndrome coronavirus 2]] (SARS-CoV-2)
*[[Severe Acute Respiratory Syndrome]]
*[[Category:Disinfectants|Disinfectants (category)]

==References ==
{{Reflist}}

[[Category:Infectious diseases]]
[[Category:Triggers and risk factors]]
[[Category:Virology]]

Coronavirus disease 19

2020-04-01T16:56:56Z

Loopy:/* Disinfecting your home if someone is sick */ clarification

'''Coronavirus disease 19''', commonly known as '''COVID-19''', is the airborne infectious respiratory illness caused by the novel (new) [[Severe acute respiratory syndrome coronavirus 2]] (SARS-CoV-2), previously known as ''n-2019-nCoV''.<ref name="WHO-QA">{{Cite web|url=https://www.who.int/news-room/q-a-detail/q-a-coronaviruses|title=Q&A on coronaviruses (COVID-19)|last=World Health Organization|first=|authorlink=World Health Organization|last2=|first2=|authorlink2=|date=|website=www.who.int|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-16}}</ref><ref name="CDC-coronoviruses">{{Cite web|url=https://www.cdc.gov/coronavirus/types.html|title=Human Coronavirus Types|last=Centers for Disease Control and Prevention|first=|authorlink=Centers for Disease Control and Prevention|last2=|first2=|authorlink2=|date=2020-02-27|website=www.cdc.gov|language=en-us|archive-url=|archive-date=|dead-url=|access-date=2020-03-16}}</ref><ref>{{Cite journal|last=Li|first=Guangdi|author-link=|last2=Clercq|first2=Erik De|author-link2=|last3=|first3=|author-link3=|last4=|first4=|author-link4=|last5=|first5=|author-link5=|last6=|first6=|author-link6=|last7=|first7=|last8=|first8=|date=Mar 2020|title=Therapeutic options for the 2019 novel coronavirus (2019-nCoV)|url=https://www.nature.com/articles/d41573-020-00016-0|journal=Nature Reviews Drug Discovery|language=en|volume=19|issue=3|pages=149–150|doi=10.1038/d41573-020-00016-0|pmc=|pmid=|access-date=|quote=|via=}}</ref><ref>{{Cite web|url=https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/naming-the-coronavirus-disease-(covid-2019)-and-the-virus-that-causes-it|title=Naming the coronavirus disease (COVID-19) and the virus that causes it|website=www.who.int|language=en|access-date=2020-03-28}}</ref>
[[File:Covid-19-lung-lesions.jpg|thumb|left|alt=Computer-aided identification of lesions on the lungs of COVID-19 patients.|'''COVID-19 can cause lesions on lungs, and pneumonia.'''<br>Author: [https://www.sciencedirect.com/science/article/pii/S2095177920302264 Shen et al. 2020. Journal of Pharmaceutical Analysis]. Copyright: CC-BY-NC-ND-4.0]]{{clear}}
COVID-19 was first identified in Wuhan, China, in December 2019,<ref name="WHO-QA" /> and can infect babies, children, and adults of any age.<ref>{{Cite journal|last=Wei|first=Min|last2=Yuan|first2=Jingping|last3=Liu|first3=Yu|last4=Fu|first4=Tao|last5=Yu|first5=Xue|last6=Zhang|first6=Zhi-Jiang|date=2020-02-14|title=Novel Coronavirus Infection in Hospitalized Infants Under 1 Year of Age in China|url=https://jamanetwork.com/journals/jama/fullarticle/2761659|journal=JAMA|language=en|doi=10.1001/jama.2020.2131}}</ref> It spread globally, resulting in the 2019-2020 coronavirus pandemic.<ref>{{Cite journal|last=Hui|first=David S.|last2=Azhar|first2=Esam I.|last3=Madani|first3=Tariq A.|last4=Ntoumi|first4=Francine|last5=Kock|first5=Richard|last6=Dar|first6=Osman|last7=Ippolito|first7=Giuseppe|last8=Mchugh|first8=Timothy D.|last9=Memish|first9=Ziad A.|date=2020-02-01|title=The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health — The latest 2019 novel coronavirus outbreak in Wuhan, China|url=https://www.ijidonline.com/article/S1201-9712(20)30011-4/abstract|journal=International Journal of Infectious Diseases|language=English|volume=91|pages=264–266|doi=10.1016/j.ijid.2020.01.009|issn=1201-9712|pmid=31953166}}</ref><ref>{{Cite web|url=https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020|title=WHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020|website=www.who.int|language=en|access-date=2020-03-28}}</ref>

== Symptoms ==
Symptoms are usually mild and begin gradually, although around 1 in 6 people with COVID-19 need medical help.<ref name="WHO-QA" /> Some people become infected but don't develop any symptoms and don't feel unwell.<ref name=":0">{{Cite web||last=World Health Organization|first=|authorlink=World Health Organization|url=https://www.who.int/news-room/q-a-detail/q-a-coronaviruses|title=Q&A on coronaviruses (COVID-19)|website=www.who.int|language=en|access-date=2020-03-24}}</ref> These symptoms may appear 1-14 days after exposure; most commonly around five days.<ref name=":0" /><ref name=":1">{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html|title=Coronavirus Disease 2019 (COVID-19) – Symptoms|last=CDC|date=2020-03-20||author-link=Centers for Disease Control|website=Centers for Disease Control and Prevention|language=en-us|access-date=2020-03-24}}</ref>

=== Common Symptoms ===
* [[fever]]
* [[Fatigue|tiredness]]
* continuous cough, coughing episodes or a dry [[cough|cough,]]<ref>{{Cite web|url=https://www.nhs.uk/conditions/coronavirus-covid-19/symptoms-and-what-to-do/|title=Symptoms and what to do - Coronavirus (COVID-19)|last=National Health Service|first=|authorlink=National Health Service|last2=|first2=|authorlink2=|date=2020-03-24|website=nhs.uk|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-26}}</ref><ref name=":0" /> or [[Dyspnea|shortness of breath]]<ref name=":1" />
Most patients only have one or two of the common symptoms.<ref name=":0" /><ref name=":3">{{Cite journal|last=Mizumoto|first=Kenji|last2=Kagaya|first2=Katsushi|last3=Zarebski|first3=Alexander|last4=Chowell|first4=Gerardo|date=2020-03-12|title=Estimating the asymptomatic proportion of coronavirus disease 2019 (COVID-19) cases on board the Diamond Princess cruise ship, Yokohama, Japan, 2020|url=https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.10.2000180|journal=Eurosurveillance|language=en|volume=25|issue=10|pages=2000180|doi=10.2807/1560-7917.ES.2020.25.10.2000180|issn=1560-7917|pmc=PMC7078829|pmid=32183930}}</ref><ref name="Lan2020" />

=== Other Symptoms ===
* aches and [[Pain|pains]]
* nasal congestion
* runny nose
* [[sore throat]]
* [[diarrhea]]<ref name=":0" />

=== Emergency Warning Signs* ===
* trouble breathing
* [[Chest pain|persistent pain or pressure in the chest]]
* new [[confusion]] or inability to arouse (unresponsive)
* bluish lips or face<ref name=":1" />
<nowiki>*</nowiki>This list is not all inclusive. Consult your medical provider for any other symptoms that are severe or concerning.<ref name=":1" />

Additionally, there are reports that patients have lost or have a reduced [[sense of smell]], or [[Changes in taste|lost or distorted of taste]], but are otherwise [[#asymptomaticcarriers|asymptomatic]].<ref name=":2">{{Cite news|url=https://www.nytimes.com/2020/03/22/health/coronavirus-symptoms-smell-taste.html|title=Lost Sense of Smell May Be Peculiar Clue to Coronavirus Infection|last=Rabin|first=Roni Caryn|date=2020-03-22|work=The New York Times|access-date=2020-03-24|language=en-US|issn=0362-4331}}</ref><blockquote>The American Academy of Otolaryngology on Sunday posted information on its website<ref>{{Cite web|url=https://www.entnet.org/content/coronavirus-disease-2019-resources|title=Coronavirus Disease 2019: Resources|last=American Academy of Otolaryngology|date=2020-03-15|website=American Academy of Otolaryngology-Head and Neck Surgery|language=en|access-date=2020-03-24}}</ref> saying that mounting anecdotal evidence indicates that lost or reduced sense of smell and loss of [[Sense of taste|taste]] are significant symptoms associated with Covid-19, and that they have been seen in patients who ultimately tested positive with no other symptoms.<ref name=":2" /></blockquote><blockquote>The symptoms, in the absence of allergies or sinusitis, should alert doctors to screen patients for the virus and “warrant serious consideration for self isolation and testing of these individuals,” the academy said.<ref name=":2" /></blockquote>

==<span id="asymptomaticcarriers">Asymptomatic carriers</span>==
[[File:Covid-19-virus.png|thumb|upright=0.4|'''The SARS-CoV-2 virus causes COVID-19.'''<br>Author: CDC]]
A number of studies have found that some people who test positive for COVID-19 do not have any symptoms of illness or a raised temperature, and have normal blood test results, but are able to infect others, some of whom developed severe COVID-19 [[pneumonia]] as a result of COVID-19.<ref name="Bai2020">{{Cite journal|last=Bai|first=Yan|last2=Yao|first2=Lingsheng|last3=Wei|first3=Tao|last4=Tian|first4=Fei|last5=Jin|first5=Dong-Yan|last6=Chen|first6=Lijuan|last7=Wang|first7=Meiyun|date=2020-02-21|title=Presumed Asymptomatic Carrier Transmission of COVID-19|url=https://jamanetwork.com/journals/jama/fullarticle/2762028|journal=JAMA|language=en|doi=10.1001/jama.2020.2565}}</ref><ref name="Chan2019">{{Cite journal|last=Chan|first=Jasper Fuk-Woo|last2=Yuan|first2=Shuofeng|last3=Kok|first3=Kin-Hang|last4=To|first4=Kelvin Kai-Wang|last5=Chu|first5=Hin|last6=Yang|first6=Jin|last7=Xing|first7=Fanfan|last8=Liu|first8=Jieling|last9=Yip|first9=Cyril Chik-Yan|date=2020-02-15|title=A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster|url=https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30154-9/abstract|journal=The Lancet|language=English|volume=395|issue=10223|pages=514–523|doi=10.1016/S0140-6736(20)30154-9|issn=0140-6736|pmid=31986261}}</ref><ref name="delRio2020">{{Cite journal|last=del Rio|first=Carlos|author-link=|last2=Malani|first2=Preeti N.|author-link2=|last3=|first3=|author-link3=|last4=|first4=|author-link4=|last5=|first5=|author-link5=|last6=|first6=|author-link6=|last7=|first7=|last8=|first8=|date=2020-02-28|title=COVID-19—New Insights on a Rapidly Changing Epidemic|url=https://jamanetwork.com/journals/jama/fullarticle/2762510|journal=JAMA|language=en|volume=|issue=|pages=|doi=10.1001/jama.2020.3072|pmc=|pmid=|access-date=|quote=|via=}}</ref> Some asymptomatic carriers have abnormal chest CT scans, and some do not. False negative tests have also been reported.<ref name="Bai2020" /><ref name="Chan2019" />

Estimates of the number of asymptomatic carriers vary wildly. Mizumoto et al. (2020) estimated that asymptomatic carriers accounted for 17.9% of the COVID-19 positive people on the ''Diamond Princess'' cruise ship, which was quarantined for 14 day after a previous passenger developed the illness.<ref name=":3" />

==<span id="recovered">Recovered patients testing positive</span>==
Lan et al (2020) identified a group of 4 recovered patients who continued to test positive for COVID-19 after recovery; suggesting that they may still be infectious.<ref name="Lan2020">{{Cite journal|last=Lan|first=Lan|last2=Xu|first2=Dan|last3=Ye|first3=Guangming|last4=Xia|first4=Chen|last5=Wang|first5=Shaokang|last6=Li|first6=Yirong|last7=Xu|first7=Haibo|date=2020-02-27|title=Positive RT-PCR Test Results in Patients Recovered From COVID-19|url=https://jamanetwork.com/journals/jama/fullarticle/2762452|journal=JAMA|language=en|doi=10.1001/jama.2020.2783}}</ref> It is not known whether patients who have recovered may be reinfected later, or whether those who later needed treatment actually relapsed, or if recovered patients who later test positive do so because of issues with the diagnostic test's accuracy.<ref>{{Cite web|url=https://www.snopes.com/fact-check/covid-19-reinfection/|title=Can People Who Recover from COVID-19 Become Reinfected?|website=Snopes.com|language=en-US|access-date=2020-03-26}}</ref> Another study found group of 5 recovered patients were found to have reactivated COVID-19.<ref>{{Cite journal|last=Ye|first=Guangming|last2=Pan|first2=Zhenyu|last3=Pan|first3=Yunbao|last4=Deng|first4=Qiaoling|last5=Chen|first5=Liangjun|last6=Li|first6=Jin|last7=Li|first7=Yirong|last8=Wang|first8=Xinghuan|date=2020-03-11|title=Clinical characteristics of severe acute respiratory syndrome coronavirus 2 reactivation|url=https://www.journalofinfection.com/article/S0163-4453(20)30114-6/abstract|journal=Journal of Infection|language=English|volume=0|issue=0|doi=10.1016/j.jinf.2020.03.001|issn=0163-4453|pmid=32171867}}</ref>

==ME/CFS==

{{Video|id=pkGXiJ1jM14|service=youtube|dimensions=550|description=COVID-19 and ME/CFS - Dr Nancy Klimas, Mar 13, 2020|alignment=left|urlargs=}}

{{clear}}

====<span id="catchingcovid19">Risk of COVID-19 in patients with ME/CFS</span>====
There is a lack of evidence about ME/CFS patients developing COVID-19 illness; but a number of medical advisors have given their expert opinions on this. Immunologist and [[Myalgic encephalomyelitis|ME]] researcher Dr [[Nancy Klimas]] has said she believes people with ME/CFS are at a little higher risk of developing COVID-19 after exposure to the virus;<ref name="Klimas20200313">{{Cite web|url=https://www.youtube.com/watch?v=pkGXiJ1jM14|title=COVID-19 and ME/CFS - Dr Nancy Klimas, Mar 13, 2020|last=Klimas|first=Nancy|date=2020-03-13|work=|access-date=Mar 24, 2020|archive-url=|archive-date=|dead-url=|quote=|author-link=Nancy Klimas}}</ref> Dr [[Nigel Speight]], Dr [[William Weir]] and Dr [[Charles Shepherd]] have said they do not think there is an increased risk.<ref name="SpeightWeirMar20" /><ref name="SpeightMar20" /><ref name="MEA16Mar20" /> Klimas, Speight, Weir and Shepherd have all advised ME/CFS patients to take additional precautions, and highlighted that there is a risk of ME/CFS becoming significantly worse after viral infections.<ref name="Klimas20200313" /><ref name="SpeightWeirMar20" /><ref name="SpeightMar20" /><ref name="MEA16Mar20" />

ME/CFS includes [[:Category:Immune signs and symptoms|immune symptoms]] including a [[sore throat]], [[swollen lymph nodes]], and [[flu-like symptoms]], but patients are generally not considered to be severely immunocompromised, and immunosuppressant medications are unlikely to be used by most ME/CFS patients. <ref name="Klimas20200313" /> <ref name="canadianconsensus">{{Citation
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| last4 = Peterson | first4 = Daniel L. | authorlink4 = Daniel Peterson
| last5 = Klimas | first5 = Nancy G. | authorlink5 = Nancy Klimas
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| 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> This means most ME/CFS patients would not be considered to be at very high risk of COVID-19 illness.<ref name="Klimas20200313" />

* '''<span id="ibuprofen">[[Ibuprofen]]</span>''' - Ibuprofen drugs (Nurofen, Bruprofen, Advil, Midol, Motrin, Motrin) are anti-inflammatories commonly used for cold/flu symptoms and for ME/CFS. There have been some reports that ibuprofen taken for COVID-19 may prolong the illness and increase it's severity. Several countries including the UK and France now recommend that people with suspected or confirmed COVID-19 avoid ibuprofen and '''use paracetamol / acetaminophen''' (e.g., Tylenol) instead, although the evidence for this is relatively limited.<ref name="MEA16Mar20" /><ref name="Day20200317">{{Cite journal|last=Day|first=Michael|date=2020-03-17|title=Covid-19: ibuprofen should not be used for managing symptoms, say doctors and scientists|url=https://www.bmj.com/content/368/bmj.m1086|journal=BMJ|language=en|volume=368|doi=10.1136/bmj.m1086|issn=1756-1833|pmid=32184201}}</ref><ref>{{Cite web|url=https://www.nhs.uk/conditions/coronavirus-covid-19/self-isolation-advice/|title=Stay at home advice - Coronavirus (COVID-19)|last=National Health Service|first=|authorlink=National Health Service|last2=|first2=|authorlink2=|date=2020-02-28|website=nhs.uk|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref> There is no suggestion that ibuprofen affects the risk of catching COVID-19.
* '''[[Rituximab]]''' - The MS Society has stated that taking rituximab, which has been used in clinical trials for ME/CFS, may affect the risk of catching COVID-19.<ref name="Covid-19-MS">{{Cite web|url=https://www.mssociety.org.uk/about-ms/treatments-and-therapies/disease-modifying-therapies/covid-19-coronavirus-and-ms|title=COVID-19 coronavirus and MS|last=MS Society|first=|authorlink=|last2=|first2=|authorlink2=|date=|website=www.mssociety.org.uk|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref><ref>{{Cite web|url=https://renal.org/wp-content/uploads/2020/03/BAPN-COVID-19-patient-info-for-HD.PD_.Immunosuppression-17March20.pdf|title=Coronavirus (SARS-CoV-2) and its associated illness (COVID-19) {{!}} Information and Guidance for Children on Haemodialysis, Peritoneal Dialysis and Immune suppression (including Renal Transplants)|last=Renal Association|first=|authorlink=|last2=|first2=|authorlink2=|date=2020-03-17|website=renal.org|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref>
* '''[[Ampligen]]''' - Ampligen or ''rintatolimod'' is sometimes used by ME/CFS patients, it is an [[antiviral]] immunostimulant rather than immunosuppressing drug, and is being tested for the treatment of COVID-19 illness in Japan.<ref>{{Cite web|url=https://adisinsight.springer.com/drugs/800001203|title=Rintatolimod - AIM ImmunoTech - AdisInsight|website=adisinsight.springer.com|access-date=2020-03-23}}</ref> There is no information about whether it may help prevent COVID-19 in ME/CFS patients.
*The unproven [[autoimmune hypothesis]] states that a subtype of ME involves autoimmunity, which is an overactive immune system rather than a weakened immune response.<ref name="OMF2018research">{{Cite web|url=https://www.omf.ngo/2018/02/28/omf-funded-research-t-cells-molecular-immunology/|title=OMF-funded research: T cells and molecular immunology|last=Open Medicine Foundation|first=|authorlink=Open Medicine Foundation|last2=|first2=|authorlink2=|date=Feb 28, 2018|website=Open Medicine Foundation|language=en-US|archive-url=|archive-date=|dead-url=|access-date=2019-07-11}}</ref>
{{Quote box|I have now reached the conclusion that people with pre-existing health conditions that make them more vulnerable to lung complications (which may or may not be the case with ME/CFS – at this stage we just don’t know), or have a condition like ME/CFS where an infection such as this will almost certainly cause a relapse, or significant exacerbation of symptoms, need to be doing far more to protect themselves, and to socially distance themselves from other people, than official NHS guidance indicates.

In particular, for those who are not housebound, this applies to social mobility and what you can do (and cannot do) if you decide to leave your home.<ref name="MEA16Mar20"/>|author=[[Charles Shepherd]], ME Association|date=Mar 16, 2020|title=Advice from the UK's ME Association}}

====<span id="deathrisk">Risk of death or serious complications in ME/CFS patients</span>====
{{Quote box|Although ME is a "chronic condition" my gut feeling is that they are not actually at greater risk of dying from the virus itself than healthy people. The conditions which put people at extra risk would be things like severe asthma or COPD, or immunosuppressed people eg those on chemotherapy for cancer.

The biggest worry therefore for ME sufferers is that catching the virus will make their ME much worse, and of course people in the 25% group do not have much leeway.

It might even be that worsening of their already severe ME could be a bigger threat to life than the virus itself.<ref name="SpeightMar20" />|author=[[Nigel Speight]]|date=Mar 2020|title=25% ME Group for Severe ME}}

====<span id="triggerforME">Risk of developing ME/CFS after COVID-19</span>====
ME/CFS has been linked to many different viruses, but it is not known what the likelihood is of developing ME/CFS after COVID-19 illness.
{{See also|Postviral fatigue syndrome}}

===<span id="medicaladvisors">ME/CFS charity medical advisors' COVID-19 statements</span>===
*Mar 17, 2020, ME Association, [https://www.meassociation.org.uk/2020/03/coronavirus-covid-19-latest-government-advice-and-what-it-means-for-people-with-me-cfs-17-march-2020/ Coronavirus Covid-19: Latest Government advice and what it means for people with ME/CFS]<ref name="MEA17Mar20">{{Cite web|url=https://www.meassociation.org.uk/2020/03/coronavirus-covid-19-latest-government-advice-and-what-it-means-for-people-with-me-cfs-17-march-2020/|title=Coronavirus Covid-19: Latest Government advice and what it means for people with ME/CFS {{!}} 17 March 2020|last=Shepherd|first=Charles|authorlink=Charles Shepherd|last2=|first2=|authorlink2=|date=2020-03-17|website=ME Association|language=en-GB|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref>
*Mar 16, 2020, ME Association, [https://www.meassociation.org.uk/2020/03/me-association-guidance-coronavirus-covid-19-and-me-cfs-by-dr-charles-shepherd-16-march-2020/ ME Association Guidance: Coronavirus and ME/CFS by Dr Charles Shepherd]<ref name="MEA16Mar20">{{Cite web|url=https://www.meassociation.org.uk/2020/03/me-association-guidance-coronavirus-covid-19-and-me-cfs-by-dr-charles-shepherd-16-march-2020/|title=ME Association Guidance: Coronavirus and ME/CFS by Dr Charles Shepherd {{!}} 16 March 2020|last=Shepherd|first=Charles|authorlink=Charles Shepherd|last2=|first2=|authorlink2=|date=2020-03-16|website=ME Association|language=en-GB|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref>
*Mar 2020, 25% ME Group, [https://25megroup.org/download/1796/?v=3236 re Coronavirus and members of the 25% ME Group, Severe ME charity | Message from Dr Willy Weir and Dr Nigel Speight, Medical Advisor to 25% ME Group | Update to the advice given on 29 February 2020],<ref name="SpeightWeirMar20">{{Cite web|url=https://25megroup.org/download/1796/?v=3236|author-link=Nigel Speight|last=Speight|first=Nigel||last2=Weir|first2=William|author-link2=William Weir|title=re Coronavirus and members of the 25% ME Group, Severe ME charity {{!}} Message from Dr Willy Weir and Dr Nigel Speight, Medical Advisor to 25% ME Group {{!}} Update to the advice given on 29 February 2020 |date=Mar 2020|website=25megroup.org}}</ref>
*Mar 2020, 25% ME Group, [https://25megroup.org/download/1796/?v=3226 re Coronavirus and members of the 25% ME Group, Severe ME charity Types | Message from Dr Nigel Speight, Medical Advisor to 25% ME Group]<ref name="SpeightMar20">{{Cite web|url=https://25megroup.org/download/1796/?v=3226|author-link=Nigel Speight|last=Speight|first=Nigel|title=re Coronavirus and members of the 25% ME Group, Severe ME charity Types {{!}} Message from Dr Nigel Speight, Medical Advisor to 25% ME Group|date=Mar 2020|website=25megroup.org|others=[[William Weir]]}}</ref>

==Prevention==
[[File:CDC-Coronavirus-badge-300.png|thumb|upright=1|left|Image author: CDC|alt=image of Coronavirus Disease 2019 (COVID-19)|link=https://www.cdc.gov/coronavirus/2019-ncov/index.html]]
<br style="clear:both;line-height:0">
The SARS-CoV-2 coronavirus is an ''enveloped virus'', which means it is easier to kill outside the body than ''non-enveloped'' viruses like [[Coxsackievirus]], or [[Poliovirus]].<ref>{{Cite web|url=https://www.epa.gov/pesticides/coronavirus-cases-trigger-epa-rapid-response|title=Coronavirus Cases Trigger EPA Rapid Response|last=US Environmental Protection Agency|first=|authorlink=|last2=|first2=|authorlink2=|date=2020-01-29|website=US EPA|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref><ref>{{Cite journal|last=Firquet|first=Swan|author-link=|last2=Beaujard|first2=Sophie|author-link2=|last3=Lobert|first3=Pierre-Emmanuel|author-link3=|last4=Sané|first4=Famara|author-link4=|last5=Caloone|first5=Delphine|author-link5=|last6=Izard|first6=Daniel|author-link6=|last7=Hober|first7=Didier|last8=|first8=|date=June 2015|title=Survival of Enveloped and Non-Enveloped Viruses on Inanimate Surfaces|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4462923/|journal=Microbes and Environments|volume=30|issue=2|pages=140–144|doi=10.1264/jsme2.ME14145|issn=1342-6311|pmc=4462923|pmid=25843687|access-date=|quote=|via=}}</ref>
*[https://www.cdc.gov/coronavirus/2019-ncov/prepare/get-your-household-ready-for-COVID-19.html Get your Household Ready for COVID-19] - CDC
*[https://www.americanchemistry.com/Novel-Coronavirus-Fighting-Products-List.pdf Novel Coronavirus (COVID-19)-Fighting Products] - Center for Biocide Chemistries
*[https://www.health.gov.au/sites/default/files/documents/2020/03/coronavirus-covid-19-information-on-social-distancing.pdf Social distancing - Department of Health, Australia]

==== CDC advice ====
* Know How it Spreads
* Clean your hands often
* Avoid close contact
* Stay home if you're sick (may have the virus)
* Cover coughs and sneezes
* Wear a face mask if you are sick (may have the virus)
* Clean and disinfect
<i><div role="note" class="hatnote navigation-not-searchable">{{MediaWiki:Seealso/{{{lang|{{PAGELANGUAGE}}}}}}}{{colon}}
[https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html Coronavirus disease 19 Prevention - CDC]</div></i>

===<span id="high-touch">High touch surfaces: disinfect daily</span>===
[[File:High-touch surfaces-CDC-covid-19.png|alt=High-touch surfaces: disinfect daily. Tables, doorknobs, light switches, countertops, handles, desks, phones keyboards, remote controls, toilets, faucets, sinks, hard-backed chairs. Source: Coronavirus disease 19 Prevention - CDC, March 2020. Public domain image.|thumb|upright=0.7]]<br style="line-height:0" />
The CDC currently recommends people '''clean''' AND '''disinfect''' frequently touched surfaces daily:
<div style="column-count:2;-moz-column-count:2;-webkit-column-count:2">
*tables
*doorknobs
*light switches
*countertops
*handles
*desks
*phones
*keyboards
*remote controls
*toilets
*faucets
*sinks
*hard-backed chairs<ref name="CDC-prevention" /><ref name="CDC-suspectedcases">{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/prepare/cleaning-disinfection.html|title=Coronavirus Disease 2019 (COVID-19) - Environmental Cleaning and Disinfection Recommendations|last=CDC|first=|authorlink=Centers for Disease Control and Prevention|last2=|first2=|authorlink2=|date=2020-02-11|website=Centers for Disease Control and Prevention|language=en-us|archive-url=|archive-date=|dead-url=|access-date=2020-03-18}}</ref>
</div><br style="clear:both; line-height:0" />
:'''To clean use:'''
*Detergent or soap and water prior to disinfection. <ref name="CDC-prevention" />

:'''To disinfect use:'''
*[https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2 '''Disinfectants used against SARS-CoV-2'''] (list)
*'''Most common EPA-registered household disinfectants''' will work, or
* '''Diluted household bleach''' (mix: 5 tablespoons bleach per gallon of water, OR 4 teaspoons bleach per quart of water), or
*'''Alcohol solutions''' with at least 70% alcohol
:Follow manufacturer’s instructions for application and ''proper ventilation''. Check the product is not past its expiration date. ''(Updated Mar 18, 2020)''<ref name="CDC-prevention">{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html|title=Coronavirus Disease 2019 (COVID-19) – Prevention & Treatment|last=CDC|first=|authorlink=Centers for Disease Control and Prevention|last2=|first2=|authorlink2=|date=2020-03-16|website=Centers for Disease Control and Prevention|language=en-us|archive-url=|archive-date=|dead-url=|access-date=2020-03-17}}</ref>

:'''Check for updates:'''
* [https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html Coronavirus disease 19 Prevention - CDC]

'''Suspected or confirmed COVID-19 cases:'''<br />If possible the '''sick person''' should also clean:
<div style="column-count:2;-moz-column-count:2;-webkit-column-count:2">
*soiled items and surfaces (as needed)
*if a separate bathroom is not available, the bathroom should be cleaned and disinfected after each use by an ill person
*provide personal cleaning and disinfectant supplies in ill person's room (unless unsafe, e.g. they are a young child) - include tissues, paper towels, cleaners and EPA-registered disinfectants<ref name="CDC-prevention" /><ref name="CDC-suspectedcases" /></div>

===Coronavirus transmission from surfaces===
The new coronavirus can survive on different surfaces for hours or days:
*small airborne virus particles (aerosols) - 3 hours
*copper - 4 hours
*cardboard - 24 hours
*stainless steel - 2 to 3 days
*plastic - 2 to 3 days<ref name="stablesurfacesPRMar20">{{Cite web|url=https://www.nih.gov/news-events/news-releases/new-coronavirus-stable-hours-surfaces|title=New coronavirus stable for hours on surfaces|last=National Institutes of Health|first=|authorlink=National Institutes of Health|last2=|first2=|authorlink2=|date=2020-03-17|website=National Institutes of Health (NIH)|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-25}}</ref><ref name="Tellier2006">{{Cite journal|last=Tellier|first=Raymond|author-link=|last2=|first2=|author-link2=|last3=|first3=|author-link3=|last4=|first4=|author-link4=|last5=|first5=|author-link5=|last6=|first6=|author-link6=|last7=|first7=|last8=|first8=|date=Nov 2006|title=Review of Aerosol Transmission of Influenza A Virus|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3372341/|journal=Emerging Infectious Diseases|volume=12|issue=11|pages=1657–1662|doi=10.3201/eid1211.060426|issn=1080-6040|pmc=3372341|pmid=17283614|access-date=|quote=|via=}}</ref>

This means direct contact with an infected person is not needed to contact the illness.<ref name="stablesurfacesPRMar20" /> Surgical [[#facemasks|face masks]] have not been effective against aerosols in previous influenza outbreaks like swine flu, but N95 respirators have been effective.<ref name="Tellier2006" />

==<span id="someoneissick">Disinfecting your home if someone is sick</span>==

The following is an abbreviated bullet-point list from the [[Centers for Disease Control and Prevention]] (CDC) article [https://www.cdc.gov/coronavirus/2019-ncov/prepare/disinfecting-your-home.html "Everyday Steps and Extra Steps When Someone Is Sick"]<ref>{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/disinfecting-your-home.html|title=Coronavirus Disease 2019 (COVID-19)|last=CDC|date=2020-02-11|website=Centers for Disease Control and Prevention|language=en-us|access-date=2020-04-01}}</ref>

'''Suspected or confirmed COVID-19 cases:'''<br />
*'''Clean''' AND '''disinfect''' all [[#High-touch|high-touch]] areas daily.

If possible the '''sick person''' should also clean:
<div style="column-count:2;-moz-column-count:2;-webkit-column-count:2">
*soiled items and surfaces (as needed)
*if a separate bathroom is not available, the bathroom should be cleaned and disinfected after each use by an ill person
*provide personal cleaning and disinfectant supplies in ill person's room (unless unsafe, e.g. they are a young child) - include tissues, paper towels, cleaners and EPA-registered disinfectants<ref name="CDC-prevention" /><ref name="CDC-suspectedcases" /><ref name="CDCDisinfectYourHome">https://www.cdc.gov/coronavirus/2019-ncov/prepare/disinfecting-your-home.html</ref></div>

Additional Steps

*Take additional steps covering '''soft surfaces, food, laundry, and trash'''

==COVID-19 pneumonia==
Severe Acute Respiratory Infection (SARI) is the name for the type of pneumonia caused by COVID-19.<ref name="vitCtrial">{{Cite web|url=https://clinicaltrials.gov/ct2/show/NCT04264533|title=Vitamin C Infusion for the Treatment of Severe 2019-nCoV Infected Pneumonia - Full Text View - ClinicalTrials.gov|website=clinicaltrials.gov|language=en|access-date=2020-03-22}}</ref> A clinical trial is in progress to determine if intravenous [[vitamin C]] is an effective treatment for SARI.<ref name="vitCtrial" />

==Myth, Hoaxes, Scams and Fake News==
Many myths, hoaxes and fake news have been spreading, particularly on social media, some of which claim to be from doctors or health professionals.<ref name="WHOmyths">{{Cite web|url=https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters|title=Coronavirus 2019 {{!}} Myth busters|last=World Health Organization|first=|authorlink=World Health Organization|last2=|first2=|authorlink2=|date=|website=www.who.int|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-17}}</ref><ref name="BuzzfeedHoax3Mar20">{{Cite web|url=https://www.buzzfeednews.com/article/janelytvynenko/coronavirus-disinformation-spread|title=Here Are Some Of The Coronavirus Hoaxes That Spread In The First Few Weeks|website=BuzzFeed News|language=en|access-date=2020-03-17}}</ref> Scam include seeking fake cures or ineffective protective equipment like masks, scammers pretending to be from the World Health Organization asking for donations, or a stranger asking for money on behalf of a relative's medical bills.<ref name="FTC-scams">{{Cite web|url=https://www.consumer.ftc.gov/features/coronavirus-scams-what-ftc-doing|title=Coronavirus Scams: What the FTC is doing|last=FTC|first=|authorlink=|last2=|first2=|authorlink2=|date=2020-03-06|website=Consumer Information|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-17}}</ref><ref name="WHO-cybersecurity">{{Cite web|url=https://www.who.int/about/communications/cyber-security|title=Communications {{!}} Cybersecurity|last=World Health Organization|first=|authorlink=World Health Organization|last2=|first2=|authorlink2=|date=|website=www.who.int|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-17}}</ref>

*[https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters Coronavirus disease (COVID-19) advice for the public: Myth busters] - World Health Organization
*Mar 3, 2020 - [https://www.buzzfeednews.com/article/janelytvynenko/coronavirus-disinformation-spread Here Are Some Of The Coronavirus Hoaxes That Spread In The First Few Weeks] - Buzzfeed News
*Mar 2020 - [https://www.buzzfeednews.com/article/janelytvynenko/heres-a-running-list-of-the-latest-disinformation Here's A Running List Of The Latest Hoaxes Spreading About The Coronavirus] - Buzzfeed News
*[https://www.who.int/about/communications/cyber-security Cybersecurity - World Health Organization]
*[https://www.consumer.ftc.gov/features/coronavirus-scams-what-ftc-doing Coronavirus scams - What the FTC os doing]

==Posters for those self-isolating to avoid infection==
*[https://chronicallyawesome.org.uk/posters-for-those-who-are-self-isolating-as-a-preventative-measure/? Unofficial posters] stating where people should leave deliveries - Chronically Awesome

==Mental health ==
Anxiety around COVID-19 illness may cause anxiety or affect mental health.
*[https://www.nami.org/getattachment/About-NAMI/NAMI-News/2020/NAMI-Updates-on-the-Coronavirus/COVID-19-Updated-Guide-1.pdf?lang=en-US COVID-19 Guide - National Association of Mental Illness]
*[https://www.who.int/docs/default-source/coronaviruse/coping-with-stress.pdf?sfvrsn=9845bc3a_2 Coping with stress during the nCov-2019 outbreak (poster)] - World Health Organization

==News articles ==
*Mar 14, 2020, [https://www.cnn.com/2020/03/14/health/coronavirus-covid-19-flu-comparison-frieden-analysis/index.html Former CDC director: Covid-19 is different from flu and we must respond differently, Dr. Tom Frieden] - CNN

==Learn more==
'''Government Health Organizations'''
*[https://www.who.int/emergencies/diseases/novel-coronavirus-2019 Coronavirus disease 19 (COVID-19) - World Health Organization]
*[https://www.cdc.gov/coronavirus/2019-ncov/index.html Coronavirus disease 19 (COVID-19) - CDC]
*[https://www.nhs.uk/conditions/coronavirus-covid-19/ Coronavirus (COVID-19) - NHS]
*[https://www.who.int/gpsc/5may/Guide_to_Local_Production.pdf Guide to Local Production: WHO-recommended Handrub Formulations] - only for when soap and water is not available
*[https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public Protect yourself: Coronavirus disease 19 (COVID-19) - World Health Organization]
*[https://www.who.int/news-room/q-a-detail/q-a-coronaviruses Q&A on coronaviruses (COVID-19) - World Health Organization]
'''ME/CFS Organizations'''
*[https://www.meaction.net/covid-19/ COVID-19 Resources for People with ME - #MEAction]
*[https://www.meassociation.org.uk/2020/03/me-association-guidance-coronavirus-covid-19-update-09-march-2020/ ME Association Guidance: Coronavirus (covid-19) Update | 09 March 2020] - The ME Association
'''Media'''
* [https://www.nytimes.com/2020/02/29/health/coronavirus-reinfection.html They Recovered From the Coronavirus. Were They Infected Again?] - NY Times
'''Johns Hopkins University Global Cases Map'''
* [https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6 Desktop]
* [https://www.arcgis.com/apps/opsdashboard/index.html#/85320e2ea5424dfaaa75ae62e5c06e61 Mobile]

==See also ==
*[[Postviral fatigue syndrome]] (PVFS)
*[[Myalgic encephalomyelitis]]
*[[Severe Acute Respiratory Syndrome]]

==References ==
{{Reflist}}

[[Category:Infectious agents]]
[[Category:Triggers and risk factors]]
[[Category:Virology]]

Coronavirus disease 19

2020-04-01T16:54:27Z

Loopy:/* Disinfecting your home if someone is sick */ citation

'''Coronavirus disease 19''', commonly known as '''COVID-19''', is the airborne infectious respiratory illness caused by the novel (new) [[Severe acute respiratory syndrome coronavirus 2]] (SARS-CoV-2), previously known as ''n-2019-nCoV''.<ref name="WHO-QA">{{Cite web|url=https://www.who.int/news-room/q-a-detail/q-a-coronaviruses|title=Q&A on coronaviruses (COVID-19)|last=World Health Organization|first=|authorlink=World Health Organization|last2=|first2=|authorlink2=|date=|website=www.who.int|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-16}}</ref><ref name="CDC-coronoviruses">{{Cite web|url=https://www.cdc.gov/coronavirus/types.html|title=Human Coronavirus Types|last=Centers for Disease Control and Prevention|first=|authorlink=Centers for Disease Control and Prevention|last2=|first2=|authorlink2=|date=2020-02-27|website=www.cdc.gov|language=en-us|archive-url=|archive-date=|dead-url=|access-date=2020-03-16}}</ref><ref>{{Cite journal|last=Li|first=Guangdi|author-link=|last2=Clercq|first2=Erik De|author-link2=|last3=|first3=|author-link3=|last4=|first4=|author-link4=|last5=|first5=|author-link5=|last6=|first6=|author-link6=|last7=|first7=|last8=|first8=|date=Mar 2020|title=Therapeutic options for the 2019 novel coronavirus (2019-nCoV)|url=https://www.nature.com/articles/d41573-020-00016-0|journal=Nature Reviews Drug Discovery|language=en|volume=19|issue=3|pages=149–150|doi=10.1038/d41573-020-00016-0|pmc=|pmid=|access-date=|quote=|via=}}</ref><ref>{{Cite web|url=https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/naming-the-coronavirus-disease-(covid-2019)-and-the-virus-that-causes-it|title=Naming the coronavirus disease (COVID-19) and the virus that causes it|website=www.who.int|language=en|access-date=2020-03-28}}</ref>
[[File:Covid-19-lung-lesions.jpg|thumb|left|alt=Computer-aided identification of lesions on the lungs of COVID-19 patients.|'''COVID-19 can cause lesions on lungs, and pneumonia.'''<br>Author: [https://www.sciencedirect.com/science/article/pii/S2095177920302264 Shen et al. 2020. Journal of Pharmaceutical Analysis]. Copyright: CC-BY-NC-ND-4.0]]{{clear}}
COVID-19 was first identified in Wuhan, China, in December 2019,<ref name="WHO-QA" /> and can infect babies, children, and adults of any age.<ref>{{Cite journal|last=Wei|first=Min|last2=Yuan|first2=Jingping|last3=Liu|first3=Yu|last4=Fu|first4=Tao|last5=Yu|first5=Xue|last6=Zhang|first6=Zhi-Jiang|date=2020-02-14|title=Novel Coronavirus Infection in Hospitalized Infants Under 1 Year of Age in China|url=https://jamanetwork.com/journals/jama/fullarticle/2761659|journal=JAMA|language=en|doi=10.1001/jama.2020.2131}}</ref> It spread globally, resulting in the 2019-2020 coronavirus pandemic.<ref>{{Cite journal|last=Hui|first=David S.|last2=Azhar|first2=Esam I.|last3=Madani|first3=Tariq A.|last4=Ntoumi|first4=Francine|last5=Kock|first5=Richard|last6=Dar|first6=Osman|last7=Ippolito|first7=Giuseppe|last8=Mchugh|first8=Timothy D.|last9=Memish|first9=Ziad A.|date=2020-02-01|title=The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health — The latest 2019 novel coronavirus outbreak in Wuhan, China|url=https://www.ijidonline.com/article/S1201-9712(20)30011-4/abstract|journal=International Journal of Infectious Diseases|language=English|volume=91|pages=264–266|doi=10.1016/j.ijid.2020.01.009|issn=1201-9712|pmid=31953166}}</ref><ref>{{Cite web|url=https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020|title=WHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020|website=www.who.int|language=en|access-date=2020-03-28}}</ref>

== Symptoms ==
Symptoms are usually mild and begin gradually, although around 1 in 6 people with COVID-19 need medical help.<ref name="WHO-QA" /> Some people become infected but don't develop any symptoms and don't feel unwell.<ref name=":0">{{Cite web||last=World Health Organization|first=|authorlink=World Health Organization|url=https://www.who.int/news-room/q-a-detail/q-a-coronaviruses|title=Q&A on coronaviruses (COVID-19)|website=www.who.int|language=en|access-date=2020-03-24}}</ref> These symptoms may appear 1-14 days after exposure; most commonly around five days.<ref name=":0" /><ref name=":1">{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html|title=Coronavirus Disease 2019 (COVID-19) – Symptoms|last=CDC|date=2020-03-20||author-link=Centers for Disease Control|website=Centers for Disease Control and Prevention|language=en-us|access-date=2020-03-24}}</ref>

=== Common Symptoms ===
* [[fever]]
* [[Fatigue|tiredness]]
* continuous cough, coughing episodes or a dry [[cough|cough,]]<ref>{{Cite web|url=https://www.nhs.uk/conditions/coronavirus-covid-19/symptoms-and-what-to-do/|title=Symptoms and what to do - Coronavirus (COVID-19)|last=National Health Service|first=|authorlink=National Health Service|last2=|first2=|authorlink2=|date=2020-03-24|website=nhs.uk|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-26}}</ref><ref name=":0" /> or [[Dyspnea|shortness of breath]]<ref name=":1" />
Most patients only have one or two of the common symptoms.<ref name=":0" /><ref name=":3">{{Cite journal|last=Mizumoto|first=Kenji|last2=Kagaya|first2=Katsushi|last3=Zarebski|first3=Alexander|last4=Chowell|first4=Gerardo|date=2020-03-12|title=Estimating the asymptomatic proportion of coronavirus disease 2019 (COVID-19) cases on board the Diamond Princess cruise ship, Yokohama, Japan, 2020|url=https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.10.2000180|journal=Eurosurveillance|language=en|volume=25|issue=10|pages=2000180|doi=10.2807/1560-7917.ES.2020.25.10.2000180|issn=1560-7917|pmc=PMC7078829|pmid=32183930}}</ref><ref name="Lan2020" />

=== Other Symptoms ===
* aches and [[Pain|pains]]
* nasal congestion
* runny nose
* [[sore throat]]
* [[diarrhea]]<ref name=":0" />

=== Emergency Warning Signs* ===
* trouble breathing
* [[Chest pain|persistent pain or pressure in the chest]]
* new [[confusion]] or inability to arouse (unresponsive)
* bluish lips or face<ref name=":1" />
<nowiki>*</nowiki>This list is not all inclusive. Consult your medical provider for any other symptoms that are severe or concerning.<ref name=":1" />

Additionally, there are reports that patients have lost or have a reduced [[sense of smell]], or [[Changes in taste|lost or distorted of taste]], but are otherwise [[#asymptomaticcarriers|asymptomatic]].<ref name=":2">{{Cite news|url=https://www.nytimes.com/2020/03/22/health/coronavirus-symptoms-smell-taste.html|title=Lost Sense of Smell May Be Peculiar Clue to Coronavirus Infection|last=Rabin|first=Roni Caryn|date=2020-03-22|work=The New York Times|access-date=2020-03-24|language=en-US|issn=0362-4331}}</ref><blockquote>The American Academy of Otolaryngology on Sunday posted information on its website<ref>{{Cite web|url=https://www.entnet.org/content/coronavirus-disease-2019-resources|title=Coronavirus Disease 2019: Resources|last=American Academy of Otolaryngology|date=2020-03-15|website=American Academy of Otolaryngology-Head and Neck Surgery|language=en|access-date=2020-03-24}}</ref> saying that mounting anecdotal evidence indicates that lost or reduced sense of smell and loss of [[Sense of taste|taste]] are significant symptoms associated with Covid-19, and that they have been seen in patients who ultimately tested positive with no other symptoms.<ref name=":2" /></blockquote><blockquote>The symptoms, in the absence of allergies or sinusitis, should alert doctors to screen patients for the virus and “warrant serious consideration for self isolation and testing of these individuals,” the academy said.<ref name=":2" /></blockquote>

==<span id="asymptomaticcarriers">Asymptomatic carriers</span>==
[[File:Covid-19-virus.png|thumb|upright=0.4|'''The SARS-CoV-2 virus causes COVID-19.'''<br>Author: CDC]]
A number of studies have found that some people who test positive for COVID-19 do not have any symptoms of illness or a raised temperature, and have normal blood test results, but are able to infect others, some of whom developed severe COVID-19 [[pneumonia]] as a result of COVID-19.<ref name="Bai2020">{{Cite journal|last=Bai|first=Yan|last2=Yao|first2=Lingsheng|last3=Wei|first3=Tao|last4=Tian|first4=Fei|last5=Jin|first5=Dong-Yan|last6=Chen|first6=Lijuan|last7=Wang|first7=Meiyun|date=2020-02-21|title=Presumed Asymptomatic Carrier Transmission of COVID-19|url=https://jamanetwork.com/journals/jama/fullarticle/2762028|journal=JAMA|language=en|doi=10.1001/jama.2020.2565}}</ref><ref name="Chan2019">{{Cite journal|last=Chan|first=Jasper Fuk-Woo|last2=Yuan|first2=Shuofeng|last3=Kok|first3=Kin-Hang|last4=To|first4=Kelvin Kai-Wang|last5=Chu|first5=Hin|last6=Yang|first6=Jin|last7=Xing|first7=Fanfan|last8=Liu|first8=Jieling|last9=Yip|first9=Cyril Chik-Yan|date=2020-02-15|title=A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster|url=https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30154-9/abstract|journal=The Lancet|language=English|volume=395|issue=10223|pages=514–523|doi=10.1016/S0140-6736(20)30154-9|issn=0140-6736|pmid=31986261}}</ref><ref name="delRio2020">{{Cite journal|last=del Rio|first=Carlos|author-link=|last2=Malani|first2=Preeti N.|author-link2=|last3=|first3=|author-link3=|last4=|first4=|author-link4=|last5=|first5=|author-link5=|last6=|first6=|author-link6=|last7=|first7=|last8=|first8=|date=2020-02-28|title=COVID-19—New Insights on a Rapidly Changing Epidemic|url=https://jamanetwork.com/journals/jama/fullarticle/2762510|journal=JAMA|language=en|volume=|issue=|pages=|doi=10.1001/jama.2020.3072|pmc=|pmid=|access-date=|quote=|via=}}</ref> Some asymptomatic carriers have abnormal chest CT scans, and some do not. False negative tests have also been reported.<ref name="Bai2020" /><ref name="Chan2019" />

Estimates of the number of asymptomatic carriers vary wildly. Mizumoto et al. (2020) estimated that asymptomatic carriers accounted for 17.9% of the COVID-19 positive people on the ''Diamond Princess'' cruise ship, which was quarantined for 14 day after a previous passenger developed the illness.<ref name=":3" />

==<span id="recovered">Recovered patients testing positive</span>==
Lan et al (2020) identified a group of 4 recovered patients who continued to test positive for COVID-19 after recovery; suggesting that they may still be infectious.<ref name="Lan2020">{{Cite journal|last=Lan|first=Lan|last2=Xu|first2=Dan|last3=Ye|first3=Guangming|last4=Xia|first4=Chen|last5=Wang|first5=Shaokang|last6=Li|first6=Yirong|last7=Xu|first7=Haibo|date=2020-02-27|title=Positive RT-PCR Test Results in Patients Recovered From COVID-19|url=https://jamanetwork.com/journals/jama/fullarticle/2762452|journal=JAMA|language=en|doi=10.1001/jama.2020.2783}}</ref> It is not known whether patients who have recovered may be reinfected later, or whether those who later needed treatment actually relapsed, or if recovered patients who later test positive do so because of issues with the diagnostic test's accuracy.<ref>{{Cite web|url=https://www.snopes.com/fact-check/covid-19-reinfection/|title=Can People Who Recover from COVID-19 Become Reinfected?|website=Snopes.com|language=en-US|access-date=2020-03-26}}</ref> Another study found group of 5 recovered patients were found to have reactivated COVID-19.<ref>{{Cite journal|last=Ye|first=Guangming|last2=Pan|first2=Zhenyu|last3=Pan|first3=Yunbao|last4=Deng|first4=Qiaoling|last5=Chen|first5=Liangjun|last6=Li|first6=Jin|last7=Li|first7=Yirong|last8=Wang|first8=Xinghuan|date=2020-03-11|title=Clinical characteristics of severe acute respiratory syndrome coronavirus 2 reactivation|url=https://www.journalofinfection.com/article/S0163-4453(20)30114-6/abstract|journal=Journal of Infection|language=English|volume=0|issue=0|doi=10.1016/j.jinf.2020.03.001|issn=0163-4453|pmid=32171867}}</ref>

==ME/CFS==

{{Video|id=pkGXiJ1jM14|service=youtube|dimensions=550|description=COVID-19 and ME/CFS - Dr Nancy Klimas, Mar 13, 2020|alignment=left|urlargs=}}

{{clear}}

====<span id="catchingcovid19">Risk of COVID-19 in patients with ME/CFS</span>====
There is a lack of evidence about ME/CFS patients developing COVID-19 illness; but a number of medical advisors have given their expert opinions on this. Immunologist and [[Myalgic encephalomyelitis|ME]] researcher Dr [[Nancy Klimas]] has said she believes people with ME/CFS are at a little higher risk of developing COVID-19 after exposure to the virus;<ref name="Klimas20200313">{{Cite web|url=https://www.youtube.com/watch?v=pkGXiJ1jM14|title=COVID-19 and ME/CFS - Dr Nancy Klimas, Mar 13, 2020|last=Klimas|first=Nancy|date=2020-03-13|work=|access-date=Mar 24, 2020|archive-url=|archive-date=|dead-url=|quote=|author-link=Nancy Klimas}}</ref> Dr [[Nigel Speight]], Dr [[William Weir]] and Dr [[Charles Shepherd]] have said they do not think there is an increased risk.<ref name="SpeightWeirMar20" /><ref name="SpeightMar20" /><ref name="MEA16Mar20" /> Klimas, Speight, Weir and Shepherd have all advised ME/CFS patients to take additional precautions, and highlighted that there is a risk of ME/CFS becoming significantly worse after viral infections.<ref name="Klimas20200313" /><ref name="SpeightWeirMar20" /><ref name="SpeightMar20" /><ref name="MEA16Mar20" />

ME/CFS includes [[:Category:Immune signs and symptoms|immune symptoms]] including a [[sore throat]], [[swollen lymph nodes]], and [[flu-like symptoms]], but patients are generally not considered to be severely immunocompromised, and immunosuppressant medications are unlikely to be used by most ME/CFS patients. <ref name="Klimas20200313" /> <ref name="canadianconsensus">{{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
| url = http://www.investinme.org/Documents/PDFdocuments/CanadianDefinitionME-CFS.pdf
}}</ref><ref name="ICP2011primer">{{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> This means most ME/CFS patients would not be considered to be at very high risk of COVID-19 illness.<ref name="Klimas20200313" />

* '''<span id="ibuprofen">[[Ibuprofen]]</span>''' - Ibuprofen drugs (Nurofen, Bruprofen, Advil, Midol, Motrin, Motrin) are anti-inflammatories commonly used for cold/flu symptoms and for ME/CFS. There have been some reports that ibuprofen taken for COVID-19 may prolong the illness and increase it's severity. Several countries including the UK and France now recommend that people with suspected or confirmed COVID-19 avoid ibuprofen and '''use paracetamol / acetaminophen''' (e.g., Tylenol) instead, although the evidence for this is relatively limited.<ref name="MEA16Mar20" /><ref name="Day20200317">{{Cite journal|last=Day|first=Michael|date=2020-03-17|title=Covid-19: ibuprofen should not be used for managing symptoms, say doctors and scientists|url=https://www.bmj.com/content/368/bmj.m1086|journal=BMJ|language=en|volume=368|doi=10.1136/bmj.m1086|issn=1756-1833|pmid=32184201}}</ref><ref>{{Cite web|url=https://www.nhs.uk/conditions/coronavirus-covid-19/self-isolation-advice/|title=Stay at home advice - Coronavirus (COVID-19)|last=National Health Service|first=|authorlink=National Health Service|last2=|first2=|authorlink2=|date=2020-02-28|website=nhs.uk|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref> There is no suggestion that ibuprofen affects the risk of catching COVID-19.
* '''[[Rituximab]]''' - The MS Society has stated that taking rituximab, which has been used in clinical trials for ME/CFS, may affect the risk of catching COVID-19.<ref name="Covid-19-MS">{{Cite web|url=https://www.mssociety.org.uk/about-ms/treatments-and-therapies/disease-modifying-therapies/covid-19-coronavirus-and-ms|title=COVID-19 coronavirus and MS|last=MS Society|first=|authorlink=|last2=|first2=|authorlink2=|date=|website=www.mssociety.org.uk|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref><ref>{{Cite web|url=https://renal.org/wp-content/uploads/2020/03/BAPN-COVID-19-patient-info-for-HD.PD_.Immunosuppression-17March20.pdf|title=Coronavirus (SARS-CoV-2) and its associated illness (COVID-19) {{!}} Information and Guidance for Children on Haemodialysis, Peritoneal Dialysis and Immune suppression (including Renal Transplants)|last=Renal Association|first=|authorlink=|last2=|first2=|authorlink2=|date=2020-03-17|website=renal.org|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref>
* '''[[Ampligen]]''' - Ampligen or ''rintatolimod'' is sometimes used by ME/CFS patients, it is an [[antiviral]] immunostimulant rather than immunosuppressing drug, and is being tested for the treatment of COVID-19 illness in Japan.<ref>{{Cite web|url=https://adisinsight.springer.com/drugs/800001203|title=Rintatolimod - AIM ImmunoTech - AdisInsight|website=adisinsight.springer.com|access-date=2020-03-23}}</ref> There is no information about whether it may help prevent COVID-19 in ME/CFS patients.
*The unproven [[autoimmune hypothesis]] states that a subtype of ME involves autoimmunity, which is an overactive immune system rather than a weakened immune response.<ref name="OMF2018research">{{Cite web|url=https://www.omf.ngo/2018/02/28/omf-funded-research-t-cells-molecular-immunology/|title=OMF-funded research: T cells and molecular immunology|last=Open Medicine Foundation|first=|authorlink=Open Medicine Foundation|last2=|first2=|authorlink2=|date=Feb 28, 2018|website=Open Medicine Foundation|language=en-US|archive-url=|archive-date=|dead-url=|access-date=2019-07-11}}</ref>
{{Quote box|I have now reached the conclusion that people with pre-existing health conditions that make them more vulnerable to lung complications (which may or may not be the case with ME/CFS – at this stage we just don’t know), or have a condition like ME/CFS where an infection such as this will almost certainly cause a relapse, or significant exacerbation of symptoms, need to be doing far more to protect themselves, and to socially distance themselves from other people, than official NHS guidance indicates.

In particular, for those who are not housebound, this applies to social mobility and what you can do (and cannot do) if you decide to leave your home.<ref name="MEA16Mar20"/>|author=[[Charles Shepherd]], ME Association|date=Mar 16, 2020|title=Advice from the UK's ME Association}}

====<span id="deathrisk">Risk of death or serious complications in ME/CFS patients</span>====
{{Quote box|Although ME is a "chronic condition" my gut feeling is that they are not actually at greater risk of dying from the virus itself than healthy people. The conditions which put people at extra risk would be things like severe asthma or COPD, or immunosuppressed people eg those on chemotherapy for cancer.

The biggest worry therefore for ME sufferers is that catching the virus will make their ME much worse, and of course people in the 25% group do not have much leeway.

It might even be that worsening of their already severe ME could be a bigger threat to life than the virus itself.<ref name="SpeightMar20" />|author=[[Nigel Speight]]|date=Mar 2020|title=25% ME Group for Severe ME}}

====<span id="triggerforME">Risk of developing ME/CFS after COVID-19</span>====
ME/CFS has been linked to many different viruses, but it is not known what the likelihood is of developing ME/CFS after COVID-19 illness.
{{See also|Postviral fatigue syndrome}}

===<span id="medicaladvisors">ME/CFS charity medical advisors' COVID-19 statements</span>===
*Mar 17, 2020, ME Association, [https://www.meassociation.org.uk/2020/03/coronavirus-covid-19-latest-government-advice-and-what-it-means-for-people-with-me-cfs-17-march-2020/ Coronavirus Covid-19: Latest Government advice and what it means for people with ME/CFS]<ref name="MEA17Mar20">{{Cite web|url=https://www.meassociation.org.uk/2020/03/coronavirus-covid-19-latest-government-advice-and-what-it-means-for-people-with-me-cfs-17-march-2020/|title=Coronavirus Covid-19: Latest Government advice and what it means for people with ME/CFS {{!}} 17 March 2020|last=Shepherd|first=Charles|authorlink=Charles Shepherd|last2=|first2=|authorlink2=|date=2020-03-17|website=ME Association|language=en-GB|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref>
*Mar 16, 2020, ME Association, [https://www.meassociation.org.uk/2020/03/me-association-guidance-coronavirus-covid-19-and-me-cfs-by-dr-charles-shepherd-16-march-2020/ ME Association Guidance: Coronavirus and ME/CFS by Dr Charles Shepherd]<ref name="MEA16Mar20">{{Cite web|url=https://www.meassociation.org.uk/2020/03/me-association-guidance-coronavirus-covid-19-and-me-cfs-by-dr-charles-shepherd-16-march-2020/|title=ME Association Guidance: Coronavirus and ME/CFS by Dr Charles Shepherd {{!}} 16 March 2020|last=Shepherd|first=Charles|authorlink=Charles Shepherd|last2=|first2=|authorlink2=|date=2020-03-16|website=ME Association|language=en-GB|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref>
*Mar 2020, 25% ME Group, [https://25megroup.org/download/1796/?v=3236 re Coronavirus and members of the 25% ME Group, Severe ME charity | Message from Dr Willy Weir and Dr Nigel Speight, Medical Advisor to 25% ME Group | Update to the advice given on 29 February 2020],<ref name="SpeightWeirMar20">{{Cite web|url=https://25megroup.org/download/1796/?v=3236|author-link=Nigel Speight|last=Speight|first=Nigel||last2=Weir|first2=William|author-link2=William Weir|title=re Coronavirus and members of the 25% ME Group, Severe ME charity {{!}} Message from Dr Willy Weir and Dr Nigel Speight, Medical Advisor to 25% ME Group {{!}} Update to the advice given on 29 February 2020 |date=Mar 2020|website=25megroup.org}}</ref>
*Mar 2020, 25% ME Group, [https://25megroup.org/download/1796/?v=3226 re Coronavirus and members of the 25% ME Group, Severe ME charity Types | Message from Dr Nigel Speight, Medical Advisor to 25% ME Group]<ref name="SpeightMar20">{{Cite web|url=https://25megroup.org/download/1796/?v=3226|author-link=Nigel Speight|last=Speight|first=Nigel|title=re Coronavirus and members of the 25% ME Group, Severe ME charity Types {{!}} Message from Dr Nigel Speight, Medical Advisor to 25% ME Group|date=Mar 2020|website=25megroup.org|others=[[William Weir]]}}</ref>

==Prevention==
[[File:CDC-Coronavirus-badge-300.png|thumb|upright=1|left|Image author: CDC|alt=image of Coronavirus Disease 2019 (COVID-19)|link=https://www.cdc.gov/coronavirus/2019-ncov/index.html]]
<br style="clear:both;line-height:0">
The SARS-CoV-2 coronavirus is an ''enveloped virus'', which means it is easier to kill outside the body than ''non-enveloped'' viruses like [[Coxsackievirus]], or [[Poliovirus]].<ref>{{Cite web|url=https://www.epa.gov/pesticides/coronavirus-cases-trigger-epa-rapid-response|title=Coronavirus Cases Trigger EPA Rapid Response|last=US Environmental Protection Agency|first=|authorlink=|last2=|first2=|authorlink2=|date=2020-01-29|website=US EPA|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref><ref>{{Cite journal|last=Firquet|first=Swan|author-link=|last2=Beaujard|first2=Sophie|author-link2=|last3=Lobert|first3=Pierre-Emmanuel|author-link3=|last4=Sané|first4=Famara|author-link4=|last5=Caloone|first5=Delphine|author-link5=|last6=Izard|first6=Daniel|author-link6=|last7=Hober|first7=Didier|last8=|first8=|date=June 2015|title=Survival of Enveloped and Non-Enveloped Viruses on Inanimate Surfaces|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4462923/|journal=Microbes and Environments|volume=30|issue=2|pages=140–144|doi=10.1264/jsme2.ME14145|issn=1342-6311|pmc=4462923|pmid=25843687|access-date=|quote=|via=}}</ref>
*[https://www.cdc.gov/coronavirus/2019-ncov/prepare/get-your-household-ready-for-COVID-19.html Get your Household Ready for COVID-19] - CDC
*[https://www.americanchemistry.com/Novel-Coronavirus-Fighting-Products-List.pdf Novel Coronavirus (COVID-19)-Fighting Products] - Center for Biocide Chemistries
*[https://www.health.gov.au/sites/default/files/documents/2020/03/coronavirus-covid-19-information-on-social-distancing.pdf Social distancing - Department of Health, Australia]

==== CDC advice ====
* Know How it Spreads
* Clean your hands often
* Avoid close contact
* Stay home if you're sick (may have the virus)
* Cover coughs and sneezes
* Wear a face mask if you are sick (may have the virus)
* Clean and disinfect
<i><div role="note" class="hatnote navigation-not-searchable">{{MediaWiki:Seealso/{{{lang|{{PAGELANGUAGE}}}}}}}{{colon}}
[https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html Coronavirus disease 19 Prevention - CDC]</div></i>

===<span id="high-touch">High touch surfaces: disinfect daily</span>===
[[File:High-touch surfaces-CDC-covid-19.png|alt=High-touch surfaces: disinfect daily. Tables, doorknobs, light switches, countertops, handles, desks, phones keyboards, remote controls, toilets, faucets, sinks, hard-backed chairs. Source: Coronavirus disease 19 Prevention - CDC, March 2020. Public domain image.|thumb|upright=0.7]]<br style="line-height:0" />
The CDC currently recommends people '''clean''' AND '''disinfect''' frequently touched surfaces daily:
<div style="column-count:2;-moz-column-count:2;-webkit-column-count:2">
*tables
*doorknobs
*light switches
*countertops
*handles
*desks
*phones
*keyboards
*remote controls
*toilets
*faucets
*sinks
*hard-backed chairs<ref name="CDC-prevention" /><ref name="CDC-suspectedcases">{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/prepare/cleaning-disinfection.html|title=Coronavirus Disease 2019 (COVID-19) - Environmental Cleaning and Disinfection Recommendations|last=CDC|first=|authorlink=Centers for Disease Control and Prevention|last2=|first2=|authorlink2=|date=2020-02-11|website=Centers for Disease Control and Prevention|language=en-us|archive-url=|archive-date=|dead-url=|access-date=2020-03-18}}</ref>
</div><br style="clear:both; line-height:0" />
:'''To clean use:'''
*Detergent or soap and water prior to disinfection. <ref name="CDC-prevention" />

:'''To disinfect use:'''
*[https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2 '''Disinfectants used against SARS-CoV-2'''] (list)
*'''Most common EPA-registered household disinfectants''' will work, or
* '''Diluted household bleach''' (mix: 5 tablespoons bleach per gallon of water, OR 4 teaspoons bleach per quart of water), or
*'''Alcohol solutions''' with at least 70% alcohol
:Follow manufacturer’s instructions for application and ''proper ventilation''. Check the product is not past its expiration date. ''(Updated Mar 18, 2020)''<ref name="CDC-prevention">{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html|title=Coronavirus Disease 2019 (COVID-19) – Prevention & Treatment|last=CDC|first=|authorlink=Centers for Disease Control and Prevention|last2=|first2=|authorlink2=|date=2020-03-16|website=Centers for Disease Control and Prevention|language=en-us|archive-url=|archive-date=|dead-url=|access-date=2020-03-17}}</ref>

:'''Check for updates:'''
* [https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html Coronavirus disease 19 Prevention - CDC]

'''Suspected or confirmed COVID-19 cases:'''<br />If possible the '''sick person''' should also clean:
<div style="column-count:2;-moz-column-count:2;-webkit-column-count:2">
*soiled items and surfaces (as needed)
*if a separate bathroom is not available, the bathroom should be cleaned and disinfected after each use by an ill person
*provide personal cleaning and disinfectant supplies in ill person's room (unless unsafe, e.g. they are a young child) - include tissues, paper towels, cleaners and EPA-registered disinfectants<ref name="CDC-prevention" /><ref name="CDC-suspectedcases" /></div>

===Coronavirus transmission from surfaces===
The new coronavirus can survive on different surfaces for hours or days:
*small airborne virus particles (aerosols) - 3 hours
*copper - 4 hours
*cardboard - 24 hours
*stainless steel - 2 to 3 days
*plastic - 2 to 3 days<ref name="stablesurfacesPRMar20">{{Cite web|url=https://www.nih.gov/news-events/news-releases/new-coronavirus-stable-hours-surfaces|title=New coronavirus stable for hours on surfaces|last=National Institutes of Health|first=|authorlink=National Institutes of Health|last2=|first2=|authorlink2=|date=2020-03-17|website=National Institutes of Health (NIH)|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-25}}</ref><ref name="Tellier2006">{{Cite journal|last=Tellier|first=Raymond|author-link=|last2=|first2=|author-link2=|last3=|first3=|author-link3=|last4=|first4=|author-link4=|last5=|first5=|author-link5=|last6=|first6=|author-link6=|last7=|first7=|last8=|first8=|date=Nov 2006|title=Review of Aerosol Transmission of Influenza A Virus|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3372341/|journal=Emerging Infectious Diseases|volume=12|issue=11|pages=1657–1662|doi=10.3201/eid1211.060426|issn=1080-6040|pmc=3372341|pmid=17283614|access-date=|quote=|via=}}</ref>

This means direct contact with an infected person is not needed to contact the illness.<ref name="stablesurfacesPRMar20" /> Surgical [[#facemasks|face masks]] have not been effective against aerosols in previous influenza outbreaks like swine flu, but N95 respirators have been effective.<ref name="Tellier2006" />

==<span id="someoneissick">Disinfecting your home if someone is sick</span>==

The following abbreviated bullet-point information is provided by the Centers for Disease Control and Prevention in their article [https://www.cdc.gov/coronavirus/2019-ncov/prepare/disinfecting-your-home.html "Everyday Steps and Extra Steps When Someone Is Sick"]<ref>{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/disinfecting-your-home.html|title=Coronavirus Disease 2019 (COVID-19)|last=CDC|date=2020-02-11|website=Centers for Disease Control and Prevention|language=en-us|access-date=2020-04-01}}</ref>

'''Suspected or confirmed COVID-19 cases:'''<br />
*'''Clean''' AND '''disinfect''' all [[#High-touch|high-touch]] areas daily.

If possible the '''sick person''' should also clean:
<div style="column-count:2;-moz-column-count:2;-webkit-column-count:2">
*soiled items and surfaces (as needed)
*if a separate bathroom is not available, the bathroom should be cleaned and disinfected after each use by an ill person
*provide personal cleaning and disinfectant supplies in ill person's room (unless unsafe, e.g. they are a young child) - include tissues, paper towels, cleaners and EPA-registered disinfectants<ref name="CDC-prevention" /><ref name="CDC-suspectedcases" /><ref name="CDCDisinfectYourHome">https://www.cdc.gov/coronavirus/2019-ncov/prepare/disinfecting-your-home.html</ref></div>

Additional Steps

*Take additional steps covering '''soft surfaces, food, laundry, and trash'''

==COVID-19 pneumonia==
Severe Acute Respiratory Infection (SARI) is the name for the type of pneumonia caused by COVID-19.<ref name="vitCtrial">{{Cite web|url=https://clinicaltrials.gov/ct2/show/NCT04264533|title=Vitamin C Infusion for the Treatment of Severe 2019-nCoV Infected Pneumonia - Full Text View - ClinicalTrials.gov|website=clinicaltrials.gov|language=en|access-date=2020-03-22}}</ref> A clinical trial is in progress to determine if intravenous [[vitamin C]] is an effective treatment for SARI.<ref name="vitCtrial" />

==Myth, Hoaxes, Scams and Fake News==
Many myths, hoaxes and fake news have been spreading, particularly on social media, some of which claim to be from doctors or health professionals.<ref name="WHOmyths">{{Cite web|url=https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters|title=Coronavirus 2019 {{!}} Myth busters|last=World Health Organization|first=|authorlink=World Health Organization|last2=|first2=|authorlink2=|date=|website=www.who.int|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-17}}</ref><ref name="BuzzfeedHoax3Mar20">{{Cite web|url=https://www.buzzfeednews.com/article/janelytvynenko/coronavirus-disinformation-spread|title=Here Are Some Of The Coronavirus Hoaxes That Spread In The First Few Weeks|website=BuzzFeed News|language=en|access-date=2020-03-17}}</ref> Scam include seeking fake cures or ineffective protective equipment like masks, scammers pretending to be from the World Health Organization asking for donations, or a stranger asking for money on behalf of a relative's medical bills.<ref name="FTC-scams">{{Cite web|url=https://www.consumer.ftc.gov/features/coronavirus-scams-what-ftc-doing|title=Coronavirus Scams: What the FTC is doing|last=FTC|first=|authorlink=|last2=|first2=|authorlink2=|date=2020-03-06|website=Consumer Information|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-17}}</ref><ref name="WHO-cybersecurity">{{Cite web|url=https://www.who.int/about/communications/cyber-security|title=Communications {{!}} Cybersecurity|last=World Health Organization|first=|authorlink=World Health Organization|last2=|first2=|authorlink2=|date=|website=www.who.int|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-17}}</ref>

*[https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters Coronavirus disease (COVID-19) advice for the public: Myth busters] - World Health Organization
*Mar 3, 2020 - [https://www.buzzfeednews.com/article/janelytvynenko/coronavirus-disinformation-spread Here Are Some Of The Coronavirus Hoaxes That Spread In The First Few Weeks] - Buzzfeed News
*Mar 2020 - [https://www.buzzfeednews.com/article/janelytvynenko/heres-a-running-list-of-the-latest-disinformation Here's A Running List Of The Latest Hoaxes Spreading About The Coronavirus] - Buzzfeed News
*[https://www.who.int/about/communications/cyber-security Cybersecurity - World Health Organization]
*[https://www.consumer.ftc.gov/features/coronavirus-scams-what-ftc-doing Coronavirus scams - What the FTC os doing]

==Posters for those self-isolating to avoid infection==
*[https://chronicallyawesome.org.uk/posters-for-those-who-are-self-isolating-as-a-preventative-measure/? Unofficial posters] stating where people should leave deliveries - Chronically Awesome

==Mental health ==
Anxiety around COVID-19 illness may cause anxiety or affect mental health.
*[https://www.nami.org/getattachment/About-NAMI/NAMI-News/2020/NAMI-Updates-on-the-Coronavirus/COVID-19-Updated-Guide-1.pdf?lang=en-US COVID-19 Guide - National Association of Mental Illness]
*[https://www.who.int/docs/default-source/coronaviruse/coping-with-stress.pdf?sfvrsn=9845bc3a_2 Coping with stress during the nCov-2019 outbreak (poster)] - World Health Organization

==News articles ==
*Mar 14, 2020, [https://www.cnn.com/2020/03/14/health/coronavirus-covid-19-flu-comparison-frieden-analysis/index.html Former CDC director: Covid-19 is different from flu and we must respond differently, Dr. Tom Frieden] - CNN

==Learn more==
'''Government Health Organizations'''
*[https://www.who.int/emergencies/diseases/novel-coronavirus-2019 Coronavirus disease 19 (COVID-19) - World Health Organization]
*[https://www.cdc.gov/coronavirus/2019-ncov/index.html Coronavirus disease 19 (COVID-19) - CDC]
*[https://www.nhs.uk/conditions/coronavirus-covid-19/ Coronavirus (COVID-19) - NHS]
*[https://www.who.int/gpsc/5may/Guide_to_Local_Production.pdf Guide to Local Production: WHO-recommended Handrub Formulations] - only for when soap and water is not available
*[https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public Protect yourself: Coronavirus disease 19 (COVID-19) - World Health Organization]
*[https://www.who.int/news-room/q-a-detail/q-a-coronaviruses Q&A on coronaviruses (COVID-19) - World Health Organization]
'''ME/CFS Organizations'''
*[https://www.meaction.net/covid-19/ COVID-19 Resources for People with ME - #MEAction]
*[https://www.meassociation.org.uk/2020/03/me-association-guidance-coronavirus-covid-19-update-09-march-2020/ ME Association Guidance: Coronavirus (covid-19) Update | 09 March 2020] - The ME Association
'''Media'''
* [https://www.nytimes.com/2020/02/29/health/coronavirus-reinfection.html They Recovered From the Coronavirus. Were They Infected Again?] - NY Times
'''Johns Hopkins University Global Cases Map'''
* [https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6 Desktop]
* [https://www.arcgis.com/apps/opsdashboard/index.html#/85320e2ea5424dfaaa75ae62e5c06e61 Mobile]

==See also ==
*[[Postviral fatigue syndrome]] (PVFS)
*[[Myalgic encephalomyelitis]]
*[[Severe Acute Respiratory Syndrome]]

==References ==
{{Reflist}}

[[Category:Infectious agents]]
[[Category:Triggers and risk factors]]
[[Category:Virology]]

Coronavirus disease 19

2020-04-01T16:51:43Z

Loopy:/* Disinfecting your home if someone is sick */ A little cleanup with bullets and some clarification

'''Coronavirus disease 19''', commonly known as '''COVID-19''', is the airborne infectious respiratory illness caused by the novel (new) [[Severe acute respiratory syndrome coronavirus 2]] (SARS-CoV-2), previously known as ''n-2019-nCoV''.<ref name="WHO-QA">{{Cite web|url=https://www.who.int/news-room/q-a-detail/q-a-coronaviruses|title=Q&A on coronaviruses (COVID-19)|last=World Health Organization|first=|authorlink=World Health Organization|last2=|first2=|authorlink2=|date=|website=www.who.int|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-16}}</ref><ref name="CDC-coronoviruses">{{Cite web|url=https://www.cdc.gov/coronavirus/types.html|title=Human Coronavirus Types|last=Centers for Disease Control and Prevention|first=|authorlink=Centers for Disease Control and Prevention|last2=|first2=|authorlink2=|date=2020-02-27|website=www.cdc.gov|language=en-us|archive-url=|archive-date=|dead-url=|access-date=2020-03-16}}</ref><ref>{{Cite journal|last=Li|first=Guangdi|author-link=|last2=Clercq|first2=Erik De|author-link2=|last3=|first3=|author-link3=|last4=|first4=|author-link4=|last5=|first5=|author-link5=|last6=|first6=|author-link6=|last7=|first7=|last8=|first8=|date=Mar 2020|title=Therapeutic options for the 2019 novel coronavirus (2019-nCoV)|url=https://www.nature.com/articles/d41573-020-00016-0|journal=Nature Reviews Drug Discovery|language=en|volume=19|issue=3|pages=149–150|doi=10.1038/d41573-020-00016-0|pmc=|pmid=|access-date=|quote=|via=}}</ref><ref>{{Cite web|url=https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/naming-the-coronavirus-disease-(covid-2019)-and-the-virus-that-causes-it|title=Naming the coronavirus disease (COVID-19) and the virus that causes it|website=www.who.int|language=en|access-date=2020-03-28}}</ref>
[[File:Covid-19-lung-lesions.jpg|thumb|left|alt=Computer-aided identification of lesions on the lungs of COVID-19 patients.|'''COVID-19 can cause lesions on lungs, and pneumonia.'''<br>Author: [https://www.sciencedirect.com/science/article/pii/S2095177920302264 Shen et al. 2020. Journal of Pharmaceutical Analysis]. Copyright: CC-BY-NC-ND-4.0]]{{clear}}
COVID-19 was first identified in Wuhan, China, in December 2019,<ref name="WHO-QA" /> and can infect babies, children, and adults of any age.<ref>{{Cite journal|last=Wei|first=Min|last2=Yuan|first2=Jingping|last3=Liu|first3=Yu|last4=Fu|first4=Tao|last5=Yu|first5=Xue|last6=Zhang|first6=Zhi-Jiang|date=2020-02-14|title=Novel Coronavirus Infection in Hospitalized Infants Under 1 Year of Age in China|url=https://jamanetwork.com/journals/jama/fullarticle/2761659|journal=JAMA|language=en|doi=10.1001/jama.2020.2131}}</ref> It spread globally, resulting in the 2019-2020 coronavirus pandemic.<ref>{{Cite journal|last=Hui|first=David S.|last2=Azhar|first2=Esam I.|last3=Madani|first3=Tariq A.|last4=Ntoumi|first4=Francine|last5=Kock|first5=Richard|last6=Dar|first6=Osman|last7=Ippolito|first7=Giuseppe|last8=Mchugh|first8=Timothy D.|last9=Memish|first9=Ziad A.|date=2020-02-01|title=The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health — The latest 2019 novel coronavirus outbreak in Wuhan, China|url=https://www.ijidonline.com/article/S1201-9712(20)30011-4/abstract|journal=International Journal of Infectious Diseases|language=English|volume=91|pages=264–266|doi=10.1016/j.ijid.2020.01.009|issn=1201-9712|pmid=31953166}}</ref><ref>{{Cite web|url=https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020|title=WHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020|website=www.who.int|language=en|access-date=2020-03-28}}</ref>

== Symptoms ==
Symptoms are usually mild and begin gradually, although around 1 in 6 people with COVID-19 need medical help.<ref name="WHO-QA" /> Some people become infected but don't develop any symptoms and don't feel unwell.<ref name=":0">{{Cite web||last=World Health Organization|first=|authorlink=World Health Organization|url=https://www.who.int/news-room/q-a-detail/q-a-coronaviruses|title=Q&A on coronaviruses (COVID-19)|website=www.who.int|language=en|access-date=2020-03-24}}</ref> These symptoms may appear 1-14 days after exposure; most commonly around five days.<ref name=":0" /><ref name=":1">{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html|title=Coronavirus Disease 2019 (COVID-19) – Symptoms|last=CDC|date=2020-03-20||author-link=Centers for Disease Control|website=Centers for Disease Control and Prevention|language=en-us|access-date=2020-03-24}}</ref>

=== Common Symptoms ===
* [[fever]]
* [[Fatigue|tiredness]]
* continuous cough, coughing episodes or a dry [[cough|cough,]]<ref>{{Cite web|url=https://www.nhs.uk/conditions/coronavirus-covid-19/symptoms-and-what-to-do/|title=Symptoms and what to do - Coronavirus (COVID-19)|last=National Health Service|first=|authorlink=National Health Service|last2=|first2=|authorlink2=|date=2020-03-24|website=nhs.uk|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-26}}</ref><ref name=":0" /> or [[Dyspnea|shortness of breath]]<ref name=":1" />
Most patients only have one or two of the common symptoms.<ref name=":0" /><ref name=":3">{{Cite journal|last=Mizumoto|first=Kenji|last2=Kagaya|first2=Katsushi|last3=Zarebski|first3=Alexander|last4=Chowell|first4=Gerardo|date=2020-03-12|title=Estimating the asymptomatic proportion of coronavirus disease 2019 (COVID-19) cases on board the Diamond Princess cruise ship, Yokohama, Japan, 2020|url=https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.10.2000180|journal=Eurosurveillance|language=en|volume=25|issue=10|pages=2000180|doi=10.2807/1560-7917.ES.2020.25.10.2000180|issn=1560-7917|pmc=PMC7078829|pmid=32183930}}</ref><ref name="Lan2020" />

=== Other Symptoms ===
* aches and [[Pain|pains]]
* nasal congestion
* runny nose
* [[sore throat]]
* [[diarrhea]]<ref name=":0" />

=== Emergency Warning Signs* ===
* trouble breathing
* [[Chest pain|persistent pain or pressure in the chest]]
* new [[confusion]] or inability to arouse (unresponsive)
* bluish lips or face<ref name=":1" />
<nowiki>*</nowiki>This list is not all inclusive. Consult your medical provider for any other symptoms that are severe or concerning.<ref name=":1" />

Additionally, there are reports that patients have lost or have a reduced [[sense of smell]], or [[Changes in taste|lost or distorted of taste]], but are otherwise [[#asymptomaticcarriers|asymptomatic]].<ref name=":2">{{Cite news|url=https://www.nytimes.com/2020/03/22/health/coronavirus-symptoms-smell-taste.html|title=Lost Sense of Smell May Be Peculiar Clue to Coronavirus Infection|last=Rabin|first=Roni Caryn|date=2020-03-22|work=The New York Times|access-date=2020-03-24|language=en-US|issn=0362-4331}}</ref><blockquote>The American Academy of Otolaryngology on Sunday posted information on its website<ref>{{Cite web|url=https://www.entnet.org/content/coronavirus-disease-2019-resources|title=Coronavirus Disease 2019: Resources|last=American Academy of Otolaryngology|date=2020-03-15|website=American Academy of Otolaryngology-Head and Neck Surgery|language=en|access-date=2020-03-24}}</ref> saying that mounting anecdotal evidence indicates that lost or reduced sense of smell and loss of [[Sense of taste|taste]] are significant symptoms associated with Covid-19, and that they have been seen in patients who ultimately tested positive with no other symptoms.<ref name=":2" /></blockquote><blockquote>The symptoms, in the absence of allergies or sinusitis, should alert doctors to screen patients for the virus and “warrant serious consideration for self isolation and testing of these individuals,” the academy said.<ref name=":2" /></blockquote>

==<span id="asymptomaticcarriers">Asymptomatic carriers</span>==
[[File:Covid-19-virus.png|thumb|upright=0.4|'''The SARS-CoV-2 virus causes COVID-19.'''<br>Author: CDC]]
A number of studies have found that some people who test positive for COVID-19 do not have any symptoms of illness or a raised temperature, and have normal blood test results, but are able to infect others, some of whom developed severe COVID-19 [[pneumonia]] as a result of COVID-19.<ref name="Bai2020">{{Cite journal|last=Bai|first=Yan|last2=Yao|first2=Lingsheng|last3=Wei|first3=Tao|last4=Tian|first4=Fei|last5=Jin|first5=Dong-Yan|last6=Chen|first6=Lijuan|last7=Wang|first7=Meiyun|date=2020-02-21|title=Presumed Asymptomatic Carrier Transmission of COVID-19|url=https://jamanetwork.com/journals/jama/fullarticle/2762028|journal=JAMA|language=en|doi=10.1001/jama.2020.2565}}</ref><ref name="Chan2019">{{Cite journal|last=Chan|first=Jasper Fuk-Woo|last2=Yuan|first2=Shuofeng|last3=Kok|first3=Kin-Hang|last4=To|first4=Kelvin Kai-Wang|last5=Chu|first5=Hin|last6=Yang|first6=Jin|last7=Xing|first7=Fanfan|last8=Liu|first8=Jieling|last9=Yip|first9=Cyril Chik-Yan|date=2020-02-15|title=A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster|url=https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30154-9/abstract|journal=The Lancet|language=English|volume=395|issue=10223|pages=514–523|doi=10.1016/S0140-6736(20)30154-9|issn=0140-6736|pmid=31986261}}</ref><ref name="delRio2020">{{Cite journal|last=del Rio|first=Carlos|author-link=|last2=Malani|first2=Preeti N.|author-link2=|last3=|first3=|author-link3=|last4=|first4=|author-link4=|last5=|first5=|author-link5=|last6=|first6=|author-link6=|last7=|first7=|last8=|first8=|date=2020-02-28|title=COVID-19—New Insights on a Rapidly Changing Epidemic|url=https://jamanetwork.com/journals/jama/fullarticle/2762510|journal=JAMA|language=en|volume=|issue=|pages=|doi=10.1001/jama.2020.3072|pmc=|pmid=|access-date=|quote=|via=}}</ref> Some asymptomatic carriers have abnormal chest CT scans, and some do not. False negative tests have also been reported.<ref name="Bai2020" /><ref name="Chan2019" />

Estimates of the number of asymptomatic carriers vary wildly. Mizumoto et al. (2020) estimated that asymptomatic carriers accounted for 17.9% of the COVID-19 positive people on the ''Diamond Princess'' cruise ship, which was quarantined for 14 day after a previous passenger developed the illness.<ref name=":3" />

==<span id="recovered">Recovered patients testing positive</span>==
Lan et al (2020) identified a group of 4 recovered patients who continued to test positive for COVID-19 after recovery; suggesting that they may still be infectious.<ref name="Lan2020">{{Cite journal|last=Lan|first=Lan|last2=Xu|first2=Dan|last3=Ye|first3=Guangming|last4=Xia|first4=Chen|last5=Wang|first5=Shaokang|last6=Li|first6=Yirong|last7=Xu|first7=Haibo|date=2020-02-27|title=Positive RT-PCR Test Results in Patients Recovered From COVID-19|url=https://jamanetwork.com/journals/jama/fullarticle/2762452|journal=JAMA|language=en|doi=10.1001/jama.2020.2783}}</ref> It is not known whether patients who have recovered may be reinfected later, or whether those who later needed treatment actually relapsed, or if recovered patients who later test positive do so because of issues with the diagnostic test's accuracy.<ref>{{Cite web|url=https://www.snopes.com/fact-check/covid-19-reinfection/|title=Can People Who Recover from COVID-19 Become Reinfected?|website=Snopes.com|language=en-US|access-date=2020-03-26}}</ref> Another study found group of 5 recovered patients were found to have reactivated COVID-19.<ref>{{Cite journal|last=Ye|first=Guangming|last2=Pan|first2=Zhenyu|last3=Pan|first3=Yunbao|last4=Deng|first4=Qiaoling|last5=Chen|first5=Liangjun|last6=Li|first6=Jin|last7=Li|first7=Yirong|last8=Wang|first8=Xinghuan|date=2020-03-11|title=Clinical characteristics of severe acute respiratory syndrome coronavirus 2 reactivation|url=https://www.journalofinfection.com/article/S0163-4453(20)30114-6/abstract|journal=Journal of Infection|language=English|volume=0|issue=0|doi=10.1016/j.jinf.2020.03.001|issn=0163-4453|pmid=32171867}}</ref>

==ME/CFS==

{{Video|id=pkGXiJ1jM14|service=youtube|dimensions=550|description=COVID-19 and ME/CFS - Dr Nancy Klimas, Mar 13, 2020|alignment=left|urlargs=}}

{{clear}}

====<span id="catchingcovid19">Risk of COVID-19 in patients with ME/CFS</span>====
There is a lack of evidence about ME/CFS patients developing COVID-19 illness; but a number of medical advisors have given their expert opinions on this. Immunologist and [[Myalgic encephalomyelitis|ME]] researcher Dr [[Nancy Klimas]] has said she believes people with ME/CFS are at a little higher risk of developing COVID-19 after exposure to the virus;<ref name="Klimas20200313">{{Cite web|url=https://www.youtube.com/watch?v=pkGXiJ1jM14|title=COVID-19 and ME/CFS - Dr Nancy Klimas, Mar 13, 2020|last=Klimas|first=Nancy|date=2020-03-13|work=|access-date=Mar 24, 2020|archive-url=|archive-date=|dead-url=|quote=|author-link=Nancy Klimas}}</ref> Dr [[Nigel Speight]], Dr [[William Weir]] and Dr [[Charles Shepherd]] have said they do not think there is an increased risk.<ref name="SpeightWeirMar20" /><ref name="SpeightMar20" /><ref name="MEA16Mar20" /> Klimas, Speight, Weir and Shepherd have all advised ME/CFS patients to take additional precautions, and highlighted that there is a risk of ME/CFS becoming significantly worse after viral infections.<ref name="Klimas20200313" /><ref name="SpeightWeirMar20" /><ref name="SpeightMar20" /><ref name="MEA16Mar20" />

ME/CFS includes [[:Category:Immune signs and symptoms|immune symptoms]] including a [[sore throat]], [[swollen lymph nodes]], and [[flu-like symptoms]], but patients are generally not considered to be severely immunocompromised, and immunosuppressant medications are unlikely to be used by most ME/CFS patients. <ref name="Klimas20200313" /> <ref name="canadianconsensus">{{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
| url = http://www.investinme.org/Documents/PDFdocuments/CanadianDefinitionME-CFS.pdf
}}</ref><ref name="ICP2011primer">{{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> This means most ME/CFS patients would not be considered to be at very high risk of COVID-19 illness.<ref name="Klimas20200313" />

* '''<span id="ibuprofen">[[Ibuprofen]]</span>''' - Ibuprofen drugs (Nurofen, Bruprofen, Advil, Midol, Motrin, Motrin) are anti-inflammatories commonly used for cold/flu symptoms and for ME/CFS. There have been some reports that ibuprofen taken for COVID-19 may prolong the illness and increase it's severity. Several countries including the UK and France now recommend that people with suspected or confirmed COVID-19 avoid ibuprofen and '''use paracetamol / acetaminophen''' (e.g., Tylenol) instead, although the evidence for this is relatively limited.<ref name="MEA16Mar20" /><ref name="Day20200317">{{Cite journal|last=Day|first=Michael|date=2020-03-17|title=Covid-19: ibuprofen should not be used for managing symptoms, say doctors and scientists|url=https://www.bmj.com/content/368/bmj.m1086|journal=BMJ|language=en|volume=368|doi=10.1136/bmj.m1086|issn=1756-1833|pmid=32184201}}</ref><ref>{{Cite web|url=https://www.nhs.uk/conditions/coronavirus-covid-19/self-isolation-advice/|title=Stay at home advice - Coronavirus (COVID-19)|last=National Health Service|first=|authorlink=National Health Service|last2=|first2=|authorlink2=|date=2020-02-28|website=nhs.uk|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref> There is no suggestion that ibuprofen affects the risk of catching COVID-19.
* '''[[Rituximab]]''' - The MS Society has stated that taking rituximab, which has been used in clinical trials for ME/CFS, may affect the risk of catching COVID-19.<ref name="Covid-19-MS">{{Cite web|url=https://www.mssociety.org.uk/about-ms/treatments-and-therapies/disease-modifying-therapies/covid-19-coronavirus-and-ms|title=COVID-19 coronavirus and MS|last=MS Society|first=|authorlink=|last2=|first2=|authorlink2=|date=|website=www.mssociety.org.uk|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref><ref>{{Cite web|url=https://renal.org/wp-content/uploads/2020/03/BAPN-COVID-19-patient-info-for-HD.PD_.Immunosuppression-17March20.pdf|title=Coronavirus (SARS-CoV-2) and its associated illness (COVID-19) {{!}} Information and Guidance for Children on Haemodialysis, Peritoneal Dialysis and Immune suppression (including Renal Transplants)|last=Renal Association|first=|authorlink=|last2=|first2=|authorlink2=|date=2020-03-17|website=renal.org|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref>
* '''[[Ampligen]]''' - Ampligen or ''rintatolimod'' is sometimes used by ME/CFS patients, it is an [[antiviral]] immunostimulant rather than immunosuppressing drug, and is being tested for the treatment of COVID-19 illness in Japan.<ref>{{Cite web|url=https://adisinsight.springer.com/drugs/800001203|title=Rintatolimod - AIM ImmunoTech - AdisInsight|website=adisinsight.springer.com|access-date=2020-03-23}}</ref> There is no information about whether it may help prevent COVID-19 in ME/CFS patients.
*The unproven [[autoimmune hypothesis]] states that a subtype of ME involves autoimmunity, which is an overactive immune system rather than a weakened immune response.<ref name="OMF2018research">{{Cite web|url=https://www.omf.ngo/2018/02/28/omf-funded-research-t-cells-molecular-immunology/|title=OMF-funded research: T cells and molecular immunology|last=Open Medicine Foundation|first=|authorlink=Open Medicine Foundation|last2=|first2=|authorlink2=|date=Feb 28, 2018|website=Open Medicine Foundation|language=en-US|archive-url=|archive-date=|dead-url=|access-date=2019-07-11}}</ref>
{{Quote box|I have now reached the conclusion that people with pre-existing health conditions that make them more vulnerable to lung complications (which may or may not be the case with ME/CFS – at this stage we just don’t know), or have a condition like ME/CFS where an infection such as this will almost certainly cause a relapse, or significant exacerbation of symptoms, need to be doing far more to protect themselves, and to socially distance themselves from other people, than official NHS guidance indicates.

In particular, for those who are not housebound, this applies to social mobility and what you can do (and cannot do) if you decide to leave your home.<ref name="MEA16Mar20"/>|author=[[Charles Shepherd]], ME Association|date=Mar 16, 2020|title=Advice from the UK's ME Association}}

====<span id="deathrisk">Risk of death or serious complications in ME/CFS patients</span>====
{{Quote box|Although ME is a "chronic condition" my gut feeling is that they are not actually at greater risk of dying from the virus itself than healthy people. The conditions which put people at extra risk would be things like severe asthma or COPD, or immunosuppressed people eg those on chemotherapy for cancer.

The biggest worry therefore for ME sufferers is that catching the virus will make their ME much worse, and of course people in the 25% group do not have much leeway.

It might even be that worsening of their already severe ME could be a bigger threat to life than the virus itself.<ref name="SpeightMar20" />|author=[[Nigel Speight]]|date=Mar 2020|title=25% ME Group for Severe ME}}

====<span id="triggerforME">Risk of developing ME/CFS after COVID-19</span>====
ME/CFS has been linked to many different viruses, but it is not known what the likelihood is of developing ME/CFS after COVID-19 illness.
{{See also|Postviral fatigue syndrome}}

===<span id="medicaladvisors">ME/CFS charity medical advisors' COVID-19 statements</span>===
*Mar 17, 2020, ME Association, [https://www.meassociation.org.uk/2020/03/coronavirus-covid-19-latest-government-advice-and-what-it-means-for-people-with-me-cfs-17-march-2020/ Coronavirus Covid-19: Latest Government advice and what it means for people with ME/CFS]<ref name="MEA17Mar20">{{Cite web|url=https://www.meassociation.org.uk/2020/03/coronavirus-covid-19-latest-government-advice-and-what-it-means-for-people-with-me-cfs-17-march-2020/|title=Coronavirus Covid-19: Latest Government advice and what it means for people with ME/CFS {{!}} 17 March 2020|last=Shepherd|first=Charles|authorlink=Charles Shepherd|last2=|first2=|authorlink2=|date=2020-03-17|website=ME Association|language=en-GB|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref>
*Mar 16, 2020, ME Association, [https://www.meassociation.org.uk/2020/03/me-association-guidance-coronavirus-covid-19-and-me-cfs-by-dr-charles-shepherd-16-march-2020/ ME Association Guidance: Coronavirus and ME/CFS by Dr Charles Shepherd]<ref name="MEA16Mar20">{{Cite web|url=https://www.meassociation.org.uk/2020/03/me-association-guidance-coronavirus-covid-19-and-me-cfs-by-dr-charles-shepherd-16-march-2020/|title=ME Association Guidance: Coronavirus and ME/CFS by Dr Charles Shepherd {{!}} 16 March 2020|last=Shepherd|first=Charles|authorlink=Charles Shepherd|last2=|first2=|authorlink2=|date=2020-03-16|website=ME Association|language=en-GB|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref>
*Mar 2020, 25% ME Group, [https://25megroup.org/download/1796/?v=3236 re Coronavirus and members of the 25% ME Group, Severe ME charity | Message from Dr Willy Weir and Dr Nigel Speight, Medical Advisor to 25% ME Group | Update to the advice given on 29 February 2020],<ref name="SpeightWeirMar20">{{Cite web|url=https://25megroup.org/download/1796/?v=3236|author-link=Nigel Speight|last=Speight|first=Nigel||last2=Weir|first2=William|author-link2=William Weir|title=re Coronavirus and members of the 25% ME Group, Severe ME charity {{!}} Message from Dr Willy Weir and Dr Nigel Speight, Medical Advisor to 25% ME Group {{!}} Update to the advice given on 29 February 2020 |date=Mar 2020|website=25megroup.org}}</ref>
*Mar 2020, 25% ME Group, [https://25megroup.org/download/1796/?v=3226 re Coronavirus and members of the 25% ME Group, Severe ME charity Types | Message from Dr Nigel Speight, Medical Advisor to 25% ME Group]<ref name="SpeightMar20">{{Cite web|url=https://25megroup.org/download/1796/?v=3226|author-link=Nigel Speight|last=Speight|first=Nigel|title=re Coronavirus and members of the 25% ME Group, Severe ME charity Types {{!}} Message from Dr Nigel Speight, Medical Advisor to 25% ME Group|date=Mar 2020|website=25megroup.org|others=[[William Weir]]}}</ref>

==Prevention==
[[File:CDC-Coronavirus-badge-300.png|thumb|upright=1|left|Image author: CDC|alt=image of Coronavirus Disease 2019 (COVID-19)|link=https://www.cdc.gov/coronavirus/2019-ncov/index.html]]
<br style="clear:both;line-height:0">
The SARS-CoV-2 coronavirus is an ''enveloped virus'', which means it is easier to kill outside the body than ''non-enveloped'' viruses like [[Coxsackievirus]], or [[Poliovirus]].<ref>{{Cite web|url=https://www.epa.gov/pesticides/coronavirus-cases-trigger-epa-rapid-response|title=Coronavirus Cases Trigger EPA Rapid Response|last=US Environmental Protection Agency|first=|authorlink=|last2=|first2=|authorlink2=|date=2020-01-29|website=US EPA|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref><ref>{{Cite journal|last=Firquet|first=Swan|author-link=|last2=Beaujard|first2=Sophie|author-link2=|last3=Lobert|first3=Pierre-Emmanuel|author-link3=|last4=Sané|first4=Famara|author-link4=|last5=Caloone|first5=Delphine|author-link5=|last6=Izard|first6=Daniel|author-link6=|last7=Hober|first7=Didier|last8=|first8=|date=June 2015|title=Survival of Enveloped and Non-Enveloped Viruses on Inanimate Surfaces|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4462923/|journal=Microbes and Environments|volume=30|issue=2|pages=140–144|doi=10.1264/jsme2.ME14145|issn=1342-6311|pmc=4462923|pmid=25843687|access-date=|quote=|via=}}</ref>
*[https://www.cdc.gov/coronavirus/2019-ncov/prepare/get-your-household-ready-for-COVID-19.html Get your Household Ready for COVID-19] - CDC
*[https://www.americanchemistry.com/Novel-Coronavirus-Fighting-Products-List.pdf Novel Coronavirus (COVID-19)-Fighting Products] - Center for Biocide Chemistries
*[https://www.health.gov.au/sites/default/files/documents/2020/03/coronavirus-covid-19-information-on-social-distancing.pdf Social distancing - Department of Health, Australia]

==== CDC advice ====
* Know How it Spreads
* Clean your hands often
* Avoid close contact
* Stay home if you're sick (may have the virus)
* Cover coughs and sneezes
* Wear a face mask if you are sick (may have the virus)
* Clean and disinfect
<i><div role="note" class="hatnote navigation-not-searchable">{{MediaWiki:Seealso/{{{lang|{{PAGELANGUAGE}}}}}}}{{colon}}
[https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html Coronavirus disease 19 Prevention - CDC]</div></i>

===<span id="high-touch">High touch surfaces: disinfect daily</span>===
[[File:High-touch surfaces-CDC-covid-19.png|alt=High-touch surfaces: disinfect daily. Tables, doorknobs, light switches, countertops, handles, desks, phones keyboards, remote controls, toilets, faucets, sinks, hard-backed chairs. Source: Coronavirus disease 19 Prevention - CDC, March 2020. Public domain image.|thumb|upright=0.7]]<br style="line-height:0" />
The CDC currently recommends people '''clean''' AND '''disinfect''' frequently touched surfaces daily:
<div style="column-count:2;-moz-column-count:2;-webkit-column-count:2">
*tables
*doorknobs
*light switches
*countertops
*handles
*desks
*phones
*keyboards
*remote controls
*toilets
*faucets
*sinks
*hard-backed chairs<ref name="CDC-prevention" /><ref name="CDC-suspectedcases">{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/prepare/cleaning-disinfection.html|title=Coronavirus Disease 2019 (COVID-19) - Environmental Cleaning and Disinfection Recommendations|last=CDC|first=|authorlink=Centers for Disease Control and Prevention|last2=|first2=|authorlink2=|date=2020-02-11|website=Centers for Disease Control and Prevention|language=en-us|archive-url=|archive-date=|dead-url=|access-date=2020-03-18}}</ref>
</div><br style="clear:both; line-height:0" />
:'''To clean use:'''
*Detergent or soap and water prior to disinfection. <ref name="CDC-prevention" />

:'''To disinfect use:'''
*[https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2 '''Disinfectants used against SARS-CoV-2'''] (list)
*'''Most common EPA-registered household disinfectants''' will work, or
* '''Diluted household bleach''' (mix: 5 tablespoons bleach per gallon of water, OR 4 teaspoons bleach per quart of water), or
*'''Alcohol solutions''' with at least 70% alcohol
:Follow manufacturer’s instructions for application and ''proper ventilation''. Check the product is not past its expiration date. ''(Updated Mar 18, 2020)''<ref name="CDC-prevention">{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html|title=Coronavirus Disease 2019 (COVID-19) – Prevention & Treatment|last=CDC|first=|authorlink=Centers for Disease Control and Prevention|last2=|first2=|authorlink2=|date=2020-03-16|website=Centers for Disease Control and Prevention|language=en-us|archive-url=|archive-date=|dead-url=|access-date=2020-03-17}}</ref>

:'''Check for updates:'''
* [https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html Coronavirus disease 19 Prevention - CDC]

'''Suspected or confirmed COVID-19 cases:'''<br />If possible the '''sick person''' should also clean:
<div style="column-count:2;-moz-column-count:2;-webkit-column-count:2">
*soiled items and surfaces (as needed)
*if a separate bathroom is not available, the bathroom should be cleaned and disinfected after each use by an ill person
*provide personal cleaning and disinfectant supplies in ill person's room (unless unsafe, e.g. they are a young child) - include tissues, paper towels, cleaners and EPA-registered disinfectants<ref name="CDC-prevention" /><ref name="CDC-suspectedcases" /></div>

===Coronavirus transmission from surfaces===
The new coronavirus can survive on different surfaces for hours or days:
*small airborne virus particles (aerosols) - 3 hours
*copper - 4 hours
*cardboard - 24 hours
*stainless steel - 2 to 3 days
*plastic - 2 to 3 days<ref name="stablesurfacesPRMar20">{{Cite web|url=https://www.nih.gov/news-events/news-releases/new-coronavirus-stable-hours-surfaces|title=New coronavirus stable for hours on surfaces|last=National Institutes of Health|first=|authorlink=National Institutes of Health|last2=|first2=|authorlink2=|date=2020-03-17|website=National Institutes of Health (NIH)|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-25}}</ref><ref name="Tellier2006">{{Cite journal|last=Tellier|first=Raymond|author-link=|last2=|first2=|author-link2=|last3=|first3=|author-link3=|last4=|first4=|author-link4=|last5=|first5=|author-link5=|last6=|first6=|author-link6=|last7=|first7=|last8=|first8=|date=Nov 2006|title=Review of Aerosol Transmission of Influenza A Virus|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3372341/|journal=Emerging Infectious Diseases|volume=12|issue=11|pages=1657–1662|doi=10.3201/eid1211.060426|issn=1080-6040|pmc=3372341|pmid=17283614|access-date=|quote=|via=}}</ref>

This means direct contact with an infected person is not needed to contact the illness.<ref name="stablesurfacesPRMar20" /> Surgical [[#facemasks|face masks]] have not been effective against aerosols in previous influenza outbreaks like swine flu, but N95 respirators have been effective.<ref name="Tellier2006" />

==<span id="someoneissick">Disinfecting your home if someone is sick</span>==

The following abbreviated bullet-point information is provided by the Centers for Disease Control and Prevention in their article [https://www.cdc.gov/coronavirus/2019-ncov/prepare/disinfecting-your-home.html "Everyday Steps and Extra Steps When Someone Is Sick"]

'''Suspected or confirmed COVID-19 cases:'''<br />
*'''Clean''' AND '''disinfect''' all [[#High-touch|high-touch]] areas daily.

If possible the '''sick person''' should also clean:
<div style="column-count:2;-moz-column-count:2;-webkit-column-count:2">
*soiled items and surfaces (as needed)
*if a separate bathroom is not available, the bathroom should be cleaned and disinfected after each use by an ill person
*provide personal cleaning and disinfectant supplies in ill person's room (unless unsafe, e.g. they are a young child) - include tissues, paper towels, cleaners and EPA-registered disinfectants<ref name="CDC-prevention" /><ref name="CDC-suspectedcases" /><ref name="CDCDisinfectYourHome">https://www.cdc.gov/coronavirus/2019-ncov/prepare/disinfecting-your-home.html</ref></div>

Additional Steps

*Take additional steps covering '''soft surfaces, food, laundry, and trash'''

==COVID-19 pneumonia==
Severe Acute Respiratory Infection (SARI) is the name for the type of pneumonia caused by COVID-19.<ref name="vitCtrial">{{Cite web|url=https://clinicaltrials.gov/ct2/show/NCT04264533|title=Vitamin C Infusion for the Treatment of Severe 2019-nCoV Infected Pneumonia - Full Text View - ClinicalTrials.gov|website=clinicaltrials.gov|language=en|access-date=2020-03-22}}</ref> A clinical trial is in progress to determine if intravenous [[vitamin C]] is an effective treatment for SARI.<ref name="vitCtrial" />

==Myth, Hoaxes, Scams and Fake News==
Many myths, hoaxes and fake news have been spreading, particularly on social media, some of which claim to be from doctors or health professionals.<ref name="WHOmyths">{{Cite web|url=https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters|title=Coronavirus 2019 {{!}} Myth busters|last=World Health Organization|first=|authorlink=World Health Organization|last2=|first2=|authorlink2=|date=|website=www.who.int|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-17}}</ref><ref name="BuzzfeedHoax3Mar20">{{Cite web|url=https://www.buzzfeednews.com/article/janelytvynenko/coronavirus-disinformation-spread|title=Here Are Some Of The Coronavirus Hoaxes That Spread In The First Few Weeks|website=BuzzFeed News|language=en|access-date=2020-03-17}}</ref> Scam include seeking fake cures or ineffective protective equipment like masks, scammers pretending to be from the World Health Organization asking for donations, or a stranger asking for money on behalf of a relative's medical bills.<ref name="FTC-scams">{{Cite web|url=https://www.consumer.ftc.gov/features/coronavirus-scams-what-ftc-doing|title=Coronavirus Scams: What the FTC is doing|last=FTC|first=|authorlink=|last2=|first2=|authorlink2=|date=2020-03-06|website=Consumer Information|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-17}}</ref><ref name="WHO-cybersecurity">{{Cite web|url=https://www.who.int/about/communications/cyber-security|title=Communications {{!}} Cybersecurity|last=World Health Organization|first=|authorlink=World Health Organization|last2=|first2=|authorlink2=|date=|website=www.who.int|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-17}}</ref>

*[https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters Coronavirus disease (COVID-19) advice for the public: Myth busters] - World Health Organization
*Mar 3, 2020 - [https://www.buzzfeednews.com/article/janelytvynenko/coronavirus-disinformation-spread Here Are Some Of The Coronavirus Hoaxes That Spread In The First Few Weeks] - Buzzfeed News
*Mar 2020 - [https://www.buzzfeednews.com/article/janelytvynenko/heres-a-running-list-of-the-latest-disinformation Here's A Running List Of The Latest Hoaxes Spreading About The Coronavirus] - Buzzfeed News
*[https://www.who.int/about/communications/cyber-security Cybersecurity - World Health Organization]
*[https://www.consumer.ftc.gov/features/coronavirus-scams-what-ftc-doing Coronavirus scams - What the FTC os doing]

==Posters for those self-isolating to avoid infection==
*[https://chronicallyawesome.org.uk/posters-for-those-who-are-self-isolating-as-a-preventative-measure/? Unofficial posters] stating where people should leave deliveries - Chronically Awesome

==Mental health ==
Anxiety around COVID-19 illness may cause anxiety or affect mental health.
*[https://www.nami.org/getattachment/About-NAMI/NAMI-News/2020/NAMI-Updates-on-the-Coronavirus/COVID-19-Updated-Guide-1.pdf?lang=en-US COVID-19 Guide - National Association of Mental Illness]
*[https://www.who.int/docs/default-source/coronaviruse/coping-with-stress.pdf?sfvrsn=9845bc3a_2 Coping with stress during the nCov-2019 outbreak (poster)] - World Health Organization

==News articles ==
*Mar 14, 2020, [https://www.cnn.com/2020/03/14/health/coronavirus-covid-19-flu-comparison-frieden-analysis/index.html Former CDC director: Covid-19 is different from flu and we must respond differently, Dr. Tom Frieden] - CNN

==Learn more==
'''Government Health Organizations'''
*[https://www.who.int/emergencies/diseases/novel-coronavirus-2019 Coronavirus disease 19 (COVID-19) - World Health Organization]
*[https://www.cdc.gov/coronavirus/2019-ncov/index.html Coronavirus disease 19 (COVID-19) - CDC]
*[https://www.nhs.uk/conditions/coronavirus-covid-19/ Coronavirus (COVID-19) - NHS]
*[https://www.who.int/gpsc/5may/Guide_to_Local_Production.pdf Guide to Local Production: WHO-recommended Handrub Formulations] - only for when soap and water is not available
*[https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public Protect yourself: Coronavirus disease 19 (COVID-19) - World Health Organization]
*[https://www.who.int/news-room/q-a-detail/q-a-coronaviruses Q&A on coronaviruses (COVID-19) - World Health Organization]
'''ME/CFS Organizations'''
*[https://www.meaction.net/covid-19/ COVID-19 Resources for People with ME - #MEAction]
*[https://www.meassociation.org.uk/2020/03/me-association-guidance-coronavirus-covid-19-update-09-march-2020/ ME Association Guidance: Coronavirus (covid-19) Update | 09 March 2020] - The ME Association
'''Media'''
* [https://www.nytimes.com/2020/02/29/health/coronavirus-reinfection.html They Recovered From the Coronavirus. Were They Infected Again?] - NY Times
'''Johns Hopkins University Global Cases Map'''
* [https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6 Desktop]
* [https://www.arcgis.com/apps/opsdashboard/index.html#/85320e2ea5424dfaaa75ae62e5c06e61 Mobile]

==See also ==
*[[Postviral fatigue syndrome]] (PVFS)
*[[Myalgic encephalomyelitis]]
*[[Severe Acute Respiratory Syndrome]]

==References ==
{{Reflist}}

[[Category:Infectious agents]]
[[Category:Triggers and risk factors]]
[[Category:Virology]]

Coronavirus disease 19

2020-03-31T17:45:37Z

Loopy:/* Common Symptoms */ il

'''Coronavirus disease 19''', commonly known as '''COVID-19''', is the airborne infectious respiratory illness caused by the novel (new) [[Severe acute respiratory syndrome coronavirus 2]] (SARS-CoV-2), previously known as ''n-2019-nCoV''.<ref name="WHO-QA">{{Cite web|url=https://www.who.int/news-room/q-a-detail/q-a-coronaviruses|title=Q&A on coronaviruses (COVID-19)|last=World Health Organization|first=|authorlink=World Health Organization|last2=|first2=|authorlink2=|date=|website=www.who.int|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-16}}</ref><ref name="CDC-coronoviruses">{{Cite web|url=https://www.cdc.gov/coronavirus/types.html|title=Human Coronavirus Types|last=Centers for Disease Control and Prevention|first=|authorlink=Centers for Disease Control and Prevention|last2=|first2=|authorlink2=|date=2020-02-27|website=www.cdc.gov|language=en-us|archive-url=|archive-date=|dead-url=|access-date=2020-03-16}}</ref><ref>{{Cite journal|last=Li|first=Guangdi|author-link=|last2=Clercq|first2=Erik De|author-link2=|last3=|first3=|author-link3=|last4=|first4=|author-link4=|last5=|first5=|author-link5=|last6=|first6=|author-link6=|last7=|first7=|last8=|first8=|date=Mar 2020|title=Therapeutic options for the 2019 novel coronavirus (2019-nCoV)|url=https://www.nature.com/articles/d41573-020-00016-0|journal=Nature Reviews Drug Discovery|language=en|volume=19|issue=3|pages=149–150|doi=10.1038/d41573-020-00016-0|pmc=|pmid=|access-date=|quote=|via=}}</ref><ref>{{Cite web|url=https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/naming-the-coronavirus-disease-(covid-2019)-and-the-virus-that-causes-it|title=Naming the coronavirus disease (COVID-19) and the virus that causes it|website=www.who.int|language=en|access-date=2020-03-28}}</ref>
[[File:Covid-19-lung-lesions.jpg|thumb|left|alt=Computer-aided identification of lesions on the lungs of COVID-19 patients.|'''COVID-19 can cause lesions on lungs, and pneumonia.'''<br>Author: [https://www.sciencedirect.com/science/article/pii/S2095177920302264 Shen et al. 2020. Journal of Pharmaceutical Analysis]. Copyright: CC-BY-NC-ND-4.0]]{{clear}}
COVID-19 was first identified in Wuhan, China, in December 2019,<ref name="WHO-QA" /> and can infect babies, children, and adults of any age.<ref>{{Cite journal|last=Wei|first=Min|last2=Yuan|first2=Jingping|last3=Liu|first3=Yu|last4=Fu|first4=Tao|last5=Yu|first5=Xue|last6=Zhang|first6=Zhi-Jiang|date=2020-02-14|title=Novel Coronavirus Infection in Hospitalized Infants Under 1 Year of Age in China|url=https://jamanetwork.com/journals/jama/fullarticle/2761659|journal=JAMA|language=en|doi=10.1001/jama.2020.2131}}</ref> It spread globally, resulting in the 2019-2020 coronavirus pandemic.<ref>{{Cite journal|last=Hui|first=David S.|last2=Azhar|first2=Esam I.|last3=Madani|first3=Tariq A.|last4=Ntoumi|first4=Francine|last5=Kock|first5=Richard|last6=Dar|first6=Osman|last7=Ippolito|first7=Giuseppe|last8=Mchugh|first8=Timothy D.|last9=Memish|first9=Ziad A.|date=2020-02-01|title=The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health — The latest 2019 novel coronavirus outbreak in Wuhan, China|url=https://www.ijidonline.com/article/S1201-9712(20)30011-4/abstract|journal=International Journal of Infectious Diseases|language=English|volume=91|pages=264–266|doi=10.1016/j.ijid.2020.01.009|issn=1201-9712|pmid=31953166}}</ref><ref>{{Cite web|url=https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020|title=WHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020|website=www.who.int|language=en|access-date=2020-03-28}}</ref>

== Symptoms ==
Symptoms are usually mild and begin gradually, although around 1 in 6 people with COVID-19 need medical help.<ref name="WHO-QA" /> Some people become infected but don't develop any symptoms and don't feel unwell.<ref name=":0">{{Cite web||last=World Health Organization|first=|authorlink=World Health Organization|url=https://www.who.int/news-room/q-a-detail/q-a-coronaviruses|title=Q&A on coronaviruses (COVID-19)|website=www.who.int|language=en|access-date=2020-03-24}}</ref> These symptoms may appear 1-14 days after exposure; most commonly around five days.<ref name=":0" /><ref name=":1">{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html|title=Coronavirus Disease 2019 (COVID-19) – Symptoms|last=CDC|date=2020-03-20||author-link=Centers for Disease Control|website=Centers for Disease Control and Prevention|language=en-us|access-date=2020-03-24}}</ref>

=== Common Symptoms ===
* [[fever]]
* [[Fatigue|tiredness]]
* continuous cough, coughing episodes or a dry [[cough|cough,]]<ref>{{Cite web|url=https://www.nhs.uk/conditions/coronavirus-covid-19/symptoms-and-what-to-do/|title=Symptoms and what to do - Coronavirus (COVID-19)|last=National Health Service|first=|authorlink=National Health Service|last2=|first2=|authorlink2=|date=2020-03-24|website=nhs.uk|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-26}}</ref><ref name=":0" /> or [[Dyspnea|shortness of breath]]<ref name=":1" />
Most patients only have one or two of the common symptoms.<ref name=":0" /><ref name=":3">{{Cite journal|last=Mizumoto|first=Kenji|last2=Kagaya|first2=Katsushi|last3=Zarebski|first3=Alexander|last4=Chowell|first4=Gerardo|date=2020-03-12|title=Estimating the asymptomatic proportion of coronavirus disease 2019 (COVID-19) cases on board the Diamond Princess cruise ship, Yokohama, Japan, 2020|url=https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.10.2000180|journal=Eurosurveillance|language=en|volume=25|issue=10|pages=2000180|doi=10.2807/1560-7917.ES.2020.25.10.2000180|issn=1560-7917|pmc=PMC7078829|pmid=32183930}}</ref><ref name="Lan2020" />

=== Other Symptoms ===
* aches and [[Pain|pains]]
* nasal congestion
* runny nose
* [[sore throat]]
* [[diarrhea]]<ref name=":0" />

=== Emergency Warning Signs* ===
* trouble breathing
* [[Chest pain|persistent pain or pressure in the chest]]
* new [[confusion]] or inability to arouse (unresponsive)
* bluish lips or face<ref name=":1" />
<nowiki>*</nowiki>This list is not all inclusive. Consult your medical provider for any other symptoms that are severe or concerning.<ref name=":1" />

Additionally, there are reports that patients have lost or have a reduced [[sense of smell]], or [[Changes in taste|lost or distorted of taste]], but are otherwise [[#asymptomaticcarriers|asymptomatic]].<ref name=":2">{{Cite news|url=https://www.nytimes.com/2020/03/22/health/coronavirus-symptoms-smell-taste.html|title=Lost Sense of Smell May Be Peculiar Clue to Coronavirus Infection|last=Rabin|first=Roni Caryn|date=2020-03-22|work=The New York Times|access-date=2020-03-24|language=en-US|issn=0362-4331}}</ref><blockquote>The American Academy of Otolaryngology on Sunday posted information on its website<ref>{{Cite web|url=https://www.entnet.org/content/coronavirus-disease-2019-resources|title=Coronavirus Disease 2019: Resources|last=American Academy of Otolaryngology|date=2020-03-15|website=American Academy of Otolaryngology-Head and Neck Surgery|language=en|access-date=2020-03-24}}</ref> saying that mounting anecdotal evidence indicates that lost or reduced sense of smell and loss of [[Sense of taste|taste]] are significant symptoms associated with Covid-19, and that they have been seen in patients who ultimately tested positive with no other symptoms.<ref name=":2" /></blockquote><blockquote>The symptoms, in the absence of allergies or sinusitis, should alert doctors to screen patients for the virus and “warrant serious consideration for self isolation and testing of these individuals,” the academy said.<ref name=":2" /></blockquote>

==<span id="asymptomaticcarriers">Asymptomatic carriers</span>==
[[File:Covid-19-virus.png|thumb|upright=0.4|'''The SARS-CoV-2 virus causes COVID-19.'''<br>Author: CDC]]
A number of studies have found that some people who test positive for COVID-19 do not have any symptoms of illness or a raised temperature, and have normal blood test results, but are able to infect others, some of whom developed severe COVID-19 [[pneumonia]] as a result of COVID-19.<ref name="Bai2020">{{Cite journal|last=Bai|first=Yan|last2=Yao|first2=Lingsheng|last3=Wei|first3=Tao|last4=Tian|first4=Fei|last5=Jin|first5=Dong-Yan|last6=Chen|first6=Lijuan|last7=Wang|first7=Meiyun|date=2020-02-21|title=Presumed Asymptomatic Carrier Transmission of COVID-19|url=https://jamanetwork.com/journals/jama/fullarticle/2762028|journal=JAMA|language=en|doi=10.1001/jama.2020.2565}}</ref><ref name="Chan2019">{{Cite journal|last=Chan|first=Jasper Fuk-Woo|last2=Yuan|first2=Shuofeng|last3=Kok|first3=Kin-Hang|last4=To|first4=Kelvin Kai-Wang|last5=Chu|first5=Hin|last6=Yang|first6=Jin|last7=Xing|first7=Fanfan|last8=Liu|first8=Jieling|last9=Yip|first9=Cyril Chik-Yan|date=2020-02-15|title=A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster|url=https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30154-9/abstract|journal=The Lancet|language=English|volume=395|issue=10223|pages=514–523|doi=10.1016/S0140-6736(20)30154-9|issn=0140-6736|pmid=31986261}}</ref><ref name="delRio2020">{{Cite journal|last=del Rio|first=Carlos|author-link=|last2=Malani|first2=Preeti N.|author-link2=|last3=|first3=|author-link3=|last4=|first4=|author-link4=|last5=|first5=|author-link5=|last6=|first6=|author-link6=|last7=|first7=|last8=|first8=|date=2020-02-28|title=COVID-19—New Insights on a Rapidly Changing Epidemic|url=https://jamanetwork.com/journals/jama/fullarticle/2762510|journal=JAMA|language=en|volume=|issue=|pages=|doi=10.1001/jama.2020.3072|pmc=|pmid=|access-date=|quote=|via=}}</ref> Some asymptomatic carriers have abnormal chest CT scans, and some do not. False negative tests have also been reported.<ref name="Bai2020" /><ref name="Chan2019" />

Estimates of the number of asymptomatic carriers vary wildly. Mizumoto et al. (2020) estimated that asymptomatic carriers accounted for 17.9% of the COVID-19 positive people on the ''Diamond Princess'' cruise ship, which was quarantined for 14 day after a previous passenger developed the illness.<ref name=":3" />

==<span id="recovered">Recovered patients testing positive</span>==
Lan et al (2020) identified a group of 4 recovered patients who continued to test positive for COVID-19 after recovery; suggesting that they may still be infectious.<ref name="Lan2020">{{Cite journal|last=Lan|first=Lan|last2=Xu|first2=Dan|last3=Ye|first3=Guangming|last4=Xia|first4=Chen|last5=Wang|first5=Shaokang|last6=Li|first6=Yirong|last7=Xu|first7=Haibo|date=2020-02-27|title=Positive RT-PCR Test Results in Patients Recovered From COVID-19|url=https://jamanetwork.com/journals/jama/fullarticle/2762452|journal=JAMA|language=en|doi=10.1001/jama.2020.2783}}</ref> It is not known whether patients who have recovered may be reinfected later, or whether those who later needed treatment actually relapsed, or if recovered patients who later test positive do so because of issues with the diagnostic test's accuracy.<ref>{{Cite web|url=https://www.snopes.com/fact-check/covid-19-reinfection/|title=Can People Who Recover from COVID-19 Become Reinfected?|website=Snopes.com|language=en-US|access-date=2020-03-26}}</ref> Another study found group of 5 recovered patients were found to have reactivated COVID-19.<ref>{{Cite journal|last=Ye|first=Guangming|last2=Pan|first2=Zhenyu|last3=Pan|first3=Yunbao|last4=Deng|first4=Qiaoling|last5=Chen|first5=Liangjun|last6=Li|first6=Jin|last7=Li|first7=Yirong|last8=Wang|first8=Xinghuan|date=2020-03-11|title=Clinical characteristics of severe acute respiratory syndrome coronavirus 2 reactivation|url=https://www.journalofinfection.com/article/S0163-4453(20)30114-6/abstract|journal=Journal of Infection|language=English|volume=0|issue=0|doi=10.1016/j.jinf.2020.03.001|issn=0163-4453|pmid=32171867}}</ref>

==ME/CFS==

{{Video|id=pkGXiJ1jM14|service=youtube|dimensions=550|description=COVID-19 and ME/CFS - Dr Nancy Klimas, Mar 13, 2020|alignment=left|urlargs=}}

{{clear}}

====<span id="catchingcovid19">Risk of COVID-19 in patients with ME/CFS</span>====
There is a lack of evidence about ME/CFS patients developing COVID-19 illness; but a number of medical advisors have given their expert opinions on this. Immunologist and [[Myalgic encephalomyelitis|ME]] researcher Dr [[Nancy Klimas]] has said she believes people with ME/CFS are at a little higher risk of developing COVID-19 after exposure to the virus;<ref name="Klimas20200313">{{Cite web|url=https://www.youtube.com/watch?v=pkGXiJ1jM14|title=COVID-19 and ME/CFS - Dr Nancy Klimas, Mar 13, 2020|last=Klimas|first=Nancy|date=2020-03-13|work=|access-date=Mar 24, 2020|archive-url=|archive-date=|dead-url=|quote=|author-link=Nancy Klimas}}</ref> Dr [[Nigel Speight]], Dr [[William Weir]] and Dr [[Charles Shepherd]] have said they do not think there is an increased risk.<ref name="SpeightWeirMar20" /><ref name="SpeightMar20" /><ref name="MEA16Mar20" /> Klimas, Speight, Weir and Shepherd have all advised ME/CFS patients to take additional precautions, and highlighted that there is a risk of ME/CFS becoming significantly worse after viral infections.<ref name="Klimas20200313" /><ref name="SpeightWeirMar20" /><ref name="SpeightMar20" /><ref name="MEA16Mar20" />

ME/CFS includes [[:Category:Immune signs and symptoms|immune symptoms]] including a [[sore throat]], [[swollen lymph nodes]], and [[flu-like symptoms]], but patients are generally not considered to be severely immunocompromised, and immunosuppressant medications are unlikely to be used by most ME/CFS patients. <ref name="Klimas20200313" /> <ref name="canadianconsensus">{{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
| url = http://www.investinme.org/Documents/PDFdocuments/CanadianDefinitionME-CFS.pdf
}}</ref><ref name="ICP2011primer">{{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> This means most ME/CFS patients would not be considered to be at very high risk of COVID-19 illness.<ref name="Klimas20200313" />

* '''<span id="ibuprofen">[[Ibuprofen]]</span>''' - Ibuprofen drugs (Nurofen, Bruprofen, Advil, Midol, Motrin, Motrin) are anti-inflammatories commonly used for cold/flu symptoms and for ME/CFS. There have been some reports that ibuprofen taken for COVID-19 may prolong the illness and increase it's severity. Several countries including the UK and France now recommend that people with suspected or confirmed COVID-19 avoid ibuprofen and '''use paracetamol / acetaminophen''' (e.g., Tylenol) instead, although the evidence for this is relatively limited.<ref name="MEA16Mar20" /><ref name="Day20200317">{{Cite journal|last=Day|first=Michael|date=2020-03-17|title=Covid-19: ibuprofen should not be used for managing symptoms, say doctors and scientists|url=https://www.bmj.com/content/368/bmj.m1086|journal=BMJ|language=en|volume=368|doi=10.1136/bmj.m1086|issn=1756-1833|pmid=32184201}}</ref><ref>{{Cite web|url=https://www.nhs.uk/conditions/coronavirus-covid-19/self-isolation-advice/|title=Stay at home advice - Coronavirus (COVID-19)|last=National Health Service|first=|authorlink=National Health Service|last2=|first2=|authorlink2=|date=2020-02-28|website=nhs.uk|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref> There is no suggestion that ibuprofen affects the risk of catching COVID-19.
* '''[[Rituximab]]''' - The MS Society has stated that taking rituximab, which has been used in clinical trials for ME/CFS, may affect the risk of catching COVID-19.<ref name="Covid-19-MS">{{Cite web|url=https://www.mssociety.org.uk/about-ms/treatments-and-therapies/disease-modifying-therapies/covid-19-coronavirus-and-ms|title=COVID-19 coronavirus and MS|last=MS Society|first=|authorlink=|last2=|first2=|authorlink2=|date=|website=www.mssociety.org.uk|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref><ref>{{Cite web|url=https://renal.org/wp-content/uploads/2020/03/BAPN-COVID-19-patient-info-for-HD.PD_.Immunosuppression-17March20.pdf|title=Coronavirus (SARS-CoV-2) and its associated illness (COVID-19) {{!}} Information and Guidance for Children on Haemodialysis, Peritoneal Dialysis and Immune suppression (including Renal Transplants)|last=Renal Association|first=|authorlink=|last2=|first2=|authorlink2=|date=2020-03-17|website=renal.org|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref>
* '''[[Ampligen]]''' - Ampligen or ''rintatolimod'' is sometimes used by ME/CFS patients, it is an [[antiviral]] immunostimulant rather than immunosuppressing drug, and is being tested for the treatment of COVID-19 illness in Japan.<ref>{{Cite web|url=https://adisinsight.springer.com/drugs/800001203|title=Rintatolimod - AIM ImmunoTech - AdisInsight|website=adisinsight.springer.com|access-date=2020-03-23}}</ref> There is no information about whether it may help prevent COVID-19 in ME/CFS patients.
*The unproven [[autoimmune hypothesis]] states that a subtype of ME involves autoimmunity, which is an overactive immune system rather than a weakened immune response.<ref name="OMF2018research">{{Cite web|url=https://www.omf.ngo/2018/02/28/omf-funded-research-t-cells-molecular-immunology/|title=OMF-funded research: T cells and molecular immunology|last=Open Medicine Foundation|first=|authorlink=Open Medicine Foundation|last2=|first2=|authorlink2=|date=Feb 28, 2018|website=Open Medicine Foundation|language=en-US|archive-url=|archive-date=|dead-url=|access-date=2019-07-11}}</ref>
{{Quote box|I have now reached the conclusion that people with pre-existing health conditions that make them more vulnerable to lung complications (which may or may not be the case with ME/CFS – at this stage we just don’t know), or have a condition like ME/CFS where an infection such as this will almost certainly cause a relapse, or significant exacerbation of symptoms, need to be doing far more to protect themselves, and to socially distance themselves from other people, than official NHS guidance indicates.

In particular, for those who are not housebound, this applies to social mobility and what you can do (and cannot do) if you decide to leave your home.<ref name="MEA16Mar20"/>|author=[[Charles Shepherd]], ME Association|date=Mar 16, 2020|title=Advice from the UK's ME Association}}

====<span id="deathrisk">Risk of death or serious complications in ME/CFS patients</span>====
{{Quote box|Although ME is a "chronic condition" my gut feeling is that they are not actually at greater risk of dying from the virus itself than healthy people. The conditions which put people at extra risk would be things like severe asthma or COPD, or immunosuppressed people eg those on chemotherapy for cancer.

The biggest worry therefore for ME sufferers is that catching the virus will make their ME much worse, and of course people in the 25% group do not have much leeway.

It might even be that worsening of their already severe ME could be a bigger threat to life than the virus itself.<ref name="SpeightMar20" />|author=[[Nigel Speight]]|date=Mar 2020|title=25% ME Group for Severe ME}}

====<span id="triggerforME">Risk of developing ME/CFS after COVID-19</span>====
ME/CFS has been linked to many different viruses, but it is not known what the likelihood is of developing ME/CFS after COVID-19 illness.
{{See also|Postviral fatigue syndrome}}

===<span id="medicaladvisors">ME/CFS charity medical advisors' COVID-19 statements</span>===
*Mar 17, 2020, ME Association, [https://www.meassociation.org.uk/2020/03/coronavirus-covid-19-latest-government-advice-and-what-it-means-for-people-with-me-cfs-17-march-2020/ Coronavirus Covid-19: Latest Government advice and what it means for people with ME/CFS]<ref name="MEA17Mar20">{{Cite web|url=https://www.meassociation.org.uk/2020/03/coronavirus-covid-19-latest-government-advice-and-what-it-means-for-people-with-me-cfs-17-march-2020/|title=Coronavirus Covid-19: Latest Government advice and what it means for people with ME/CFS {{!}} 17 March 2020|last=Shepherd|first=Charles|authorlink=Charles Shepherd|last2=|first2=|authorlink2=|date=2020-03-17|website=ME Association|language=en-GB|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref>
*Mar 16, 2020, ME Association, [https://www.meassociation.org.uk/2020/03/me-association-guidance-coronavirus-covid-19-and-me-cfs-by-dr-charles-shepherd-16-march-2020/ ME Association Guidance: Coronavirus and ME/CFS by Dr Charles Shepherd]<ref name="MEA16Mar20">{{Cite web|url=https://www.meassociation.org.uk/2020/03/me-association-guidance-coronavirus-covid-19-and-me-cfs-by-dr-charles-shepherd-16-march-2020/|title=ME Association Guidance: Coronavirus and ME/CFS by Dr Charles Shepherd {{!}} 16 March 2020|last=Shepherd|first=Charles|authorlink=Charles Shepherd|last2=|first2=|authorlink2=|date=2020-03-16|website=ME Association|language=en-GB|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref>
*Mar 2020, 25% ME Group, [https://25megroup.org/download/1796/?v=3236 re Coronavirus and members of the 25% ME Group, Severe ME charity | Message from Dr Willy Weir and Dr Nigel Speight, Medical Advisor to 25% ME Group | Update to the advice given on 29 February 2020],<ref name="SpeightWeirMar20">{{Cite web|url=https://25megroup.org/download/1796/?v=3236|author-link=Nigel Speight|last=Speight|first=Nigel||last2=Weir|first2=William|author-link2=William Weir|title=re Coronavirus and members of the 25% ME Group, Severe ME charity {{!}} Message from Dr Willy Weir and Dr Nigel Speight, Medical Advisor to 25% ME Group {{!}} Update to the advice given on 29 February 2020 |date=Mar 2020|website=25megroup.org}}</ref>
*Mar 2020, 25% ME Group, [https://25megroup.org/download/1796/?v=3226 re Coronavirus and members of the 25% ME Group, Severe ME charity Types | Message from Dr Nigel Speight, Medical Advisor to 25% ME Group]<ref name="SpeightMar20">{{Cite web|url=https://25megroup.org/download/1796/?v=3226|author-link=Nigel Speight|last=Speight|first=Nigel|title=re Coronavirus and members of the 25% ME Group, Severe ME charity Types {{!}} Message from Dr Nigel Speight, Medical Advisor to 25% ME Group|date=Mar 2020|website=25megroup.org|others=[[William Weir]]}}</ref>

==Prevention==
[[File:CDC-Coronavirus-badge-300.png|thumb|upright=1|left|Image author: CDC|alt=image of Coronavirus Disease 2019 (COVID-19)|link=https://www.cdc.gov/coronavirus/2019-ncov/index.html]]
<br style="clear:both;line-height:0">
The SARS-CoV-2 coronavirus is an ''enveloped virus'', which means it is easier to kill outside the body than ''non-enveloped'' viruses like [[Coxsackievirus]], or [[Poliovirus]].<ref>{{Cite web|url=https://www.epa.gov/pesticides/coronavirus-cases-trigger-epa-rapid-response|title=Coronavirus Cases Trigger EPA Rapid Response|last=US Environmental Protection Agency|first=|authorlink=|last2=|first2=|authorlink2=|date=2020-01-29|website=US EPA|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref><ref>{{Cite journal|last=Firquet|first=Swan|author-link=|last2=Beaujard|first2=Sophie|author-link2=|last3=Lobert|first3=Pierre-Emmanuel|author-link3=|last4=Sané|first4=Famara|author-link4=|last5=Caloone|first5=Delphine|author-link5=|last6=Izard|first6=Daniel|author-link6=|last7=Hober|first7=Didier|last8=|first8=|date=June 2015|title=Survival of Enveloped and Non-Enveloped Viruses on Inanimate Surfaces|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4462923/|journal=Microbes and Environments|volume=30|issue=2|pages=140–144|doi=10.1264/jsme2.ME14145|issn=1342-6311|pmc=4462923|pmid=25843687|access-date=|quote=|via=}}</ref>
*[https://www.cdc.gov/coronavirus/2019-ncov/prepare/get-your-household-ready-for-COVID-19.html Get your Household Ready for COVID-19] - CDC
*[https://www.americanchemistry.com/Novel-Coronavirus-Fighting-Products-List.pdf Novel Coronavirus (COVID-19)-Fighting Products] - Center for Biocide Chemistries
*[https://www.health.gov.au/sites/default/files/documents/2020/03/coronavirus-covid-19-information-on-social-distancing.pdf Social distancing - Department of Health, Australia]

==== CDC advice ====
* Know How it Spreads
* Clean your hands often
* Avoid close contact
* Stay home if you're sick (may have the virus)
* Cover coughs and sneezes
* Wear a face mask if you are sick (may have the virus)
* Clean and disinfect
<i><div role="note" class="hatnote navigation-not-searchable">{{MediaWiki:Seealso/{{{lang|{{PAGELANGUAGE}}}}}}}{{colon}}
[https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html Coronavirus disease 19 Prevention - CDC]</div></i>

===<span id="high-touch">High touch surfaces: disinfect daily</span>===
[[File:High-touch surfaces-CDC-covid-19.png|alt=High-touch surfaces: disinfect daily. Tables, doorknobs, light switches, countertops, handles, desks, phones keyboards, remote controls, toilets, faucets, sinks, hard-backed chairs. Source: Coronavirus disease 19 Prevention - CDC, March 2020. Public domain image.|thumb|upright=0.7]]<br style="line-height:0" />
The CDC currently recommends people '''clean''' AND '''disinfect''' frequently touched surfaces daily:
<div style="column-count:2;-moz-column-count:2;-webkit-column-count:2">
*tables
*doorknobs
*light switches
*countertops
*handles
*desks
*phones
*keyboards
*remote controls
*toilets
*faucets
*sinks
*hard-backed chairs<ref name="CDC-prevention" /><ref name="CDC-suspectedcases">{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/prepare/cleaning-disinfection.html|title=Coronavirus Disease 2019 (COVID-19) - Environmental Cleaning and Disinfection Recommendations|last=CDC|first=|authorlink=Centers for Disease Control and Prevention|last2=|first2=|authorlink2=|date=2020-02-11|website=Centers for Disease Control and Prevention|language=en-us|archive-url=|archive-date=|dead-url=|access-date=2020-03-18}}</ref>
</div><br style="clear:both; line-height:0" />
:'''To clean use:'''
*Detergent or soap and water prior to disinfection. <ref name="CDC-prevention" />

:'''To disinfect use:'''
*[https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2 '''Disinfectants used against SARS-CoV-2'''] (list)
*'''Most common EPA-registered household disinfectants''' will work, or
* '''Diluted household bleach''' (mix: 5 tablespoons bleach per gallon of water, OR 4 teaspoons bleach per quart of water), or
*'''Alcohol solutions''' with at least 70% alcohol
:Follow manufacturer’s instructions for application and ''proper ventilation''. Check the product is not past its expiration date. ''(Updated Mar 18, 2020)''<ref name="CDC-prevention">{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html|title=Coronavirus Disease 2019 (COVID-19) – Prevention & Treatment|last=CDC|first=|authorlink=Centers for Disease Control and Prevention|last2=|first2=|authorlink2=|date=2020-03-16|website=Centers for Disease Control and Prevention|language=en-us|archive-url=|archive-date=|dead-url=|access-date=2020-03-17}}</ref>

:'''Check for updates:'''
* [https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html Coronavirus disease 19 Prevention - CDC]

'''Suspected or confirmed COVID-19 cases:'''<br />If possible the '''sick person''' should also clean:
<div style="column-count:2;-moz-column-count:2;-webkit-column-count:2">
*soiled items and surfaces (as needed)
*if a separate bathroom is not available, the bathroom should be cleaned and disinfected after each use by an ill person
*provide personal cleaning and disinfectant supplies in ill person's room (unless unsafe, e.g. they are a young child) - include tissues, paper towels, cleaners and EPA-registered disinfectants<ref name="CDC-prevention" /><ref name="CDC-suspectedcases" /></div>

===Coronavirus transmission from surfaces===
The new coronavirus can survive on different surfaces for hours or days:
*small airborne virus particles (aerosols) - 3 hours
*copper - 4 hours
*cardboard - 24 hours
*stainless steel - 2 to 3 days
*plastic - 2 to 3 days<ref name="stablesurfacesPRMar20">{{Cite web|url=https://www.nih.gov/news-events/news-releases/new-coronavirus-stable-hours-surfaces|title=New coronavirus stable for hours on surfaces|last=National Institutes of Health|first=|authorlink=National Institutes of Health|last2=|first2=|authorlink2=|date=2020-03-17|website=National Institutes of Health (NIH)|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-25}}</ref><ref name="Tellier2006">{{Cite journal|last=Tellier|first=Raymond|author-link=|last2=|first2=|author-link2=|last3=|first3=|author-link3=|last4=|first4=|author-link4=|last5=|first5=|author-link5=|last6=|first6=|author-link6=|last7=|first7=|last8=|first8=|date=Nov 2006|title=Review of Aerosol Transmission of Influenza A Virus|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3372341/|journal=Emerging Infectious Diseases|volume=12|issue=11|pages=1657–1662|doi=10.3201/eid1211.060426|issn=1080-6040|pmc=3372341|pmid=17283614|access-date=|quote=|via=}}</ref>

This means direct contact with an infected person is not needed to contact the illness.<ref name="stablesurfacesPRMar20" /> Surgical [[#facemasks|face masks]] have not been effective against aerosols in previous influenza outbreaks like swine flu, but N95 respirators have been effective.<ref name="Tellier2006" />

==<span id="someoneissick">Disinfecting your home if someone is sick</span>==
'''Suspected or confirmed COVID-19 cases:'''<br />
*'''Clean''' AND '''disinfect''' all [[#High-touch|high-touch]] areas daily.
If possible the '''sick person''' should also clean:
<div style="column-count:2;-moz-column-count:2;-webkit-column-count:2">
*soiled items and surfaces (as needed)
*if a separate bathroom is not available, the bathroom should be cleaned and disinfected after each use by an ill person
*provide personal cleaning and disinfectant supplies in ill person's room (unless unsafe, e.g. they are a young child) - include tissues, paper towels, cleaners and EPA-registered disinfectants<ref name="CDC-prevention" /><ref name="CDC-suspectedcases" /><ref name="CDCDisinfectYourHome">https://www.cdc.gov/coronavirus/2019-ncov/prepare/disinfecting-your-home.html</ref></div>
*<div role="note" class="hatnote navigation-not-searchable">Take additional steps covering '''soft surfaces, food, laundry, and trash'''{{colon}}
*[https://www.cdc.gov/coronavirus/2019-ncov/prepare/disinfecting-your-home.html Disinfecting your home if someone is sick - CDC]

==COVID-19 pneumonia==
Severe Acute Respiratory Infection (SARI) is the name for the type of pneumonia caused by COVID-19.<ref name="vitCtrial">{{Cite web|url=https://clinicaltrials.gov/ct2/show/NCT04264533|title=Vitamin C Infusion for the Treatment of Severe 2019-nCoV Infected Pneumonia - Full Text View - ClinicalTrials.gov|website=clinicaltrials.gov|language=en|access-date=2020-03-22}}</ref> A clinical trial is in progress to determine if intravenous [[vitamin C]] is an effective treatment for SARI.<ref name="vitCtrial" />

==Myth, Hoaxes, Scams and Fake News==
Many myths, hoaxes and fake news have been spreading, particularly on social media, some of which claim to be from doctors or health professionals.<ref name="WHOmyths">{{Cite web|url=https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters|title=Coronavirus 2019 {{!}} Myth busters|last=World Health Organization|first=|authorlink=World Health Organization|last2=|first2=|authorlink2=|date=|website=www.who.int|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-17}}</ref><ref name="BuzzfeedHoax3Mar20">{{Cite web|url=https://www.buzzfeednews.com/article/janelytvynenko/coronavirus-disinformation-spread|title=Here Are Some Of The Coronavirus Hoaxes That Spread In The First Few Weeks|website=BuzzFeed News|language=en|access-date=2020-03-17}}</ref> Scam include seeking fake cures or ineffective protective equipment like masks, scammers pretending to be from the World Health Organization asking for donations, or a stranger asking for money on behalf of a relative's medical bills.<ref name="FTC-scams">{{Cite web|url=https://www.consumer.ftc.gov/features/coronavirus-scams-what-ftc-doing|title=Coronavirus Scams: What the FTC is doing|last=FTC|first=|authorlink=|last2=|first2=|authorlink2=|date=2020-03-06|website=Consumer Information|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-17}}</ref><ref name="WHO-cybersecurity">{{Cite web|url=https://www.who.int/about/communications/cyber-security|title=Communications {{!}} Cybersecurity|last=World Health Organization|first=|authorlink=World Health Organization|last2=|first2=|authorlink2=|date=|website=www.who.int|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-17}}</ref>

*[https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters Coronavirus disease (COVID-19) advice for the public: Myth busters] - World Health Organization
*Mar 3, 2020 - [https://www.buzzfeednews.com/article/janelytvynenko/coronavirus-disinformation-spread Here Are Some Of The Coronavirus Hoaxes That Spread In The First Few Weeks] - Buzzfeed News
*Mar 2020 - [https://www.buzzfeednews.com/article/janelytvynenko/heres-a-running-list-of-the-latest-disinformation Here's A Running List Of The Latest Hoaxes Spreading About The Coronavirus] - Buzzfeed News
*[https://www.who.int/about/communications/cyber-security Cybersecurity - World Health Organization]
*[https://www.consumer.ftc.gov/features/coronavirus-scams-what-ftc-doing Coronavirus scams - What the FTC os doing]

==Posters for those self-isolating to avoid infection==
*[https://chronicallyawesome.org.uk/posters-for-those-who-are-self-isolating-as-a-preventative-measure/? Unofficial posters] stating where people should leave deliveries - Chronically Awesome

==Mental health ==
Anxiety around COVID-19 illness may cause anxiety or affect mental health.
*[https://www.nami.org/getattachment/About-NAMI/NAMI-News/2020/NAMI-Updates-on-the-Coronavirus/COVID-19-Updated-Guide-1.pdf?lang=en-US COVID-19 Guide - National Association of Mental Illness]
*[https://www.who.int/docs/default-source/coronaviruse/coping-with-stress.pdf?sfvrsn=9845bc3a_2 Coping with stress during the nCov-2019 outbreak (poster)] - World Health Organization

==News articles ==
*Mar 14, 2020, [https://www.cnn.com/2020/03/14/health/coronavirus-covid-19-flu-comparison-frieden-analysis/index.html Former CDC director: Covid-19 is different from flu and we must respond differently, Dr. Tom Frieden] - CNN

==Learn more==
'''Government Health Organizations'''
*[https://www.who.int/emergencies/diseases/novel-coronavirus-2019 Coronavirus disease 19 (COVID-19) - World Health Organization]
*[https://www.cdc.gov/coronavirus/2019-ncov/index.html Coronavirus disease 19 (COVID-19) - CDC]
*[https://www.nhs.uk/conditions/coronavirus-covid-19/ Coronavirus (COVID-19) - NHS]
*[https://www.who.int/gpsc/5may/Guide_to_Local_Production.pdf Guide to Local Production: WHO-recommended Handrub Formulations] - only for when soap and water is not available
*[https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public Protect yourself: Coronavirus disease 19 (COVID-19) - World Health Organization]
*[https://www.who.int/news-room/q-a-detail/q-a-coronaviruses Q&A on coronaviruses (COVID-19) - World Health Organization]
'''ME/CFS Organizations'''
*[https://www.meaction.net/covid-19/ COVID-19 Resources for People with ME - #MEAction]
*[https://www.meassociation.org.uk/2020/03/me-association-guidance-coronavirus-covid-19-update-09-march-2020/ ME Association Guidance: Coronavirus (covid-19) Update | 09 March 2020] - The ME Association
'''Media'''
* [https://www.nytimes.com/2020/02/29/health/coronavirus-reinfection.html They Recovered From the Coronavirus. Were They Infected Again?] - NY Times
'''Johns Hopkins University Global Cases Map'''
* [https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6 Desktop]
* [https://www.arcgis.com/apps/opsdashboard/index.html#/85320e2ea5424dfaaa75ae62e5c06e61 Mobile]

==See also ==
*[[Postviral fatigue syndrome]] (PVFS)
*[[Myalgic encephalomyelitis]]
*[[Severe Acute Respiratory Syndrome]]

==References ==
{{Reflist}}

[[Category:Infectious agents]]
[[Category:Triggers and risk factors]]
[[Category:Virology]]

Coronavirus disease 19

2020-03-29T11:44:44Z

Loopy:/* Learn more */ Media and JHU Map

'''Coronavirus disease 19''', commonly known as '''COVID-19''', is the airborne infectious respiratory illness caused by the novel (new) [[SARS-CoV-2 coronavirus]] (severe acute respiratory syndrome 2), previously known as ''n-2019-nCoV''.<ref name="WHO-QA">{{Cite web|url=https://www.who.int/news-room/q-a-detail/q-a-coronaviruses|title=Q&A on coronaviruses (COVID-19)|last=World Health Organization|first=|authorlink=World Health Organization|last2=|first2=|authorlink2=|date=|website=www.who.int|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-16}}</ref><ref name="CDC-coronoviruses">{{Cite web|url=https://www.cdc.gov/coronavirus/types.html|title=Human Coronavirus Types|last=Centers for Disease Control and Prevention|first=|authorlink=Centers for Disease Control and Prevention|last2=|first2=|authorlink2=|date=2020-02-27|website=www.cdc.gov|language=en-us|archive-url=|archive-date=|dead-url=|access-date=2020-03-16}}</ref><ref>{{Cite journal|last=Li|first=Guangdi|author-link=|last2=Clercq|first2=Erik De|author-link2=|last3=|first3=|author-link3=|last4=|first4=|author-link4=|last5=|first5=|author-link5=|last6=|first6=|author-link6=|last7=|first7=|last8=|first8=|date=Mar 2020|title=Therapeutic options for the 2019 novel coronavirus (2019-nCoV)|url=https://www.nature.com/articles/d41573-020-00016-0|journal=Nature Reviews Drug Discovery|language=en|volume=19|issue=3|pages=149–150|doi=10.1038/d41573-020-00016-0|pmc=|pmid=|access-date=|quote=|via=}}</ref><ref>{{Cite web|url=https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/naming-the-coronavirus-disease-(covid-2019)-and-the-virus-that-causes-it|title=Naming the coronavirus disease (COVID-19) and the virus that causes it|website=www.who.int|language=en|access-date=2020-03-28}}</ref>
[[File:Covid-19-lung-lesions.jpg|thumb|left|alt=Computer-aided identification of lesions on the lungs of COVID-19 patients.|'''COVID-19 can cause lesions on lungs, and pneumonia.'''<br>Author: [https://www.sciencedirect.com/science/article/pii/S2095177920302264 Shen et al. 2020. Journal of Pharmaceutical Analysis]. Copyright: CC-BY-NC-ND-4.0]]{{clear}}
COVID-19 was first identified in Wuhan, China, in December 2019,<ref name="WHO-QA" /> and can infect babies, children, and adults of any age.<ref>{{Cite journal|last=Wei|first=Min|last2=Yuan|first2=Jingping|last3=Liu|first3=Yu|last4=Fu|first4=Tao|last5=Yu|first5=Xue|last6=Zhang|first6=Zhi-Jiang|date=2020-02-14|title=Novel Coronavirus Infection in Hospitalized Infants Under 1 Year of Age in China|url=https://jamanetwork.com/journals/jama/fullarticle/2761659|journal=JAMA|language=en|doi=10.1001/jama.2020.2131}}</ref> It spread globally, resulting in the 2019-2020 coronavirus pandemic.<ref>{{Cite journal|last=Hui|first=David S.|last2=Azhar|first2=Esam I.|last3=Madani|first3=Tariq A.|last4=Ntoumi|first4=Francine|last5=Kock|first5=Richard|last6=Dar|first6=Osman|last7=Ippolito|first7=Giuseppe|last8=Mchugh|first8=Timothy D.|last9=Memish|first9=Ziad A.|date=2020-02-01|title=The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health — The latest 2019 novel coronavirus outbreak in Wuhan, China|url=https://www.ijidonline.com/article/S1201-9712(20)30011-4/abstract|journal=International Journal of Infectious Diseases|language=English|volume=91|pages=264–266|doi=10.1016/j.ijid.2020.01.009|issn=1201-9712|pmid=31953166}}</ref><ref>{{Cite web|url=https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020|title=WHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020|website=www.who.int|language=en|access-date=2020-03-28}}</ref>

== Symptoms ==
Symptoms are usually mild and begin gradually, although around 1 in 6 people with COVID-19 need medical help.<ref name="WHO-QA" /> Some people become infected but don't develop any symptoms and don't feel unwell.<ref name=":0">{{Cite web||last=World Health Organization|first=|authorlink=World Health Organization|url=https://www.who.int/news-room/q-a-detail/q-a-coronaviruses|title=Q&A on coronaviruses (COVID-19)|website=www.who.int|language=en|access-date=2020-03-24}}</ref> These symptoms may appear 1-14 days after exposure; most commonly around five days.<ref name=":0" /><ref name=":1">{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html|title=Coronavirus Disease 2019 (COVID-19) – Symptoms|last=CDC|date=2020-03-20||author-link=Centers for Disease Control|website=Centers for Disease Control and Prevention|language=en-us|access-date=2020-03-24}}</ref>

=== Common Symptoms ===
* [[fever]]
* tiredness
* continuous cough, coughing episodes or a dry [[cough|cough,]]<ref>{{Cite web|url=https://www.nhs.uk/conditions/coronavirus-covid-19/symptoms-and-what-to-do/|title=Symptoms and what to do - Coronavirus (COVID-19)|last=National Health Service|first=|authorlink=National Health Service|last2=|first2=|authorlink2=|date=2020-03-24|website=nhs.uk|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-26}}</ref><ref name=":0" /> or [[Dyspnea|shortness of breath]]<ref name=":1" />
Most patients only have one or two of the common symptoms.<ref name=":0" /><ref name=":3">{{Cite journal|last=Mizumoto|first=Kenji|last2=Kagaya|first2=Katsushi|last3=Zarebski|first3=Alexander|last4=Chowell|first4=Gerardo|date=2020-03-12|title=Estimating the asymptomatic proportion of coronavirus disease 2019 (COVID-19) cases on board the Diamond Princess cruise ship, Yokohama, Japan, 2020|url=https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.10.2000180|journal=Eurosurveillance|language=en|volume=25|issue=10|pages=2000180|doi=10.2807/1560-7917.ES.2020.25.10.2000180|issn=1560-7917|pmc=PMC7078829|pmid=32183930}}</ref><ref name="Lan2020" />

=== Other Symptoms ===
* aches and [[Pain|pains]]
* nasal congestion
* runny nose
* [[sore throat]]
* [[diarrhea]]<ref name=":0" />

=== Emergency Warning Signs* ===
* trouble breathing
* [[Chest pain|persistent pain or pressure in the chest]]
* new [[confusion]] or inability to arouse (unresponsive)
* bluish lips or face<ref name=":1" />
<nowiki>*</nowiki>This list is not all inclusive. Consult your medical provider for any other symptoms that are severe or concerning.<ref name=":1" />

Additionally, there are reports that patients have lost or have a reduced [[sense of smell]], or [[Changes in taste|lost or distorted of taste]], but are otherwise [[#asymptomaticcarriers|asymptomatic]].<ref name=":2">{{Cite news|url=https://www.nytimes.com/2020/03/22/health/coronavirus-symptoms-smell-taste.html|title=Lost Sense of Smell May Be Peculiar Clue to Coronavirus Infection|last=Rabin|first=Roni Caryn|date=2020-03-22|work=The New York Times|access-date=2020-03-24|language=en-US|issn=0362-4331}}</ref><blockquote>The American Academy of Otolaryngology on Sunday posted information on its website<ref>{{Cite web|url=https://www.entnet.org/content/coronavirus-disease-2019-resources|title=Coronavirus Disease 2019: Resources|last=American Academy of Otolaryngology|date=2020-03-15|website=American Academy of Otolaryngology-Head and Neck Surgery|language=en|access-date=2020-03-24}}</ref> saying that mounting anecdotal evidence indicates that lost or reduced sense of smell and loss of [[Sense of taste|taste]] are significant symptoms associated with Covid-19, and that they have been seen in patients who ultimately tested positive with no other symptoms.<ref name=":2" /></blockquote><blockquote>The symptoms, in the absence of allergies or sinusitis, should alert doctors to screen patients for the virus and “warrant serious consideration for self isolation and testing of these individuals,” the academy said.<ref name=":2" /></blockquote>

==<span id="asymptomaticcarriers">Asymptomatic carriers</span>==
[[File:Covid-19-virus.png|thumb|upright=0.4|'''The SARS-CoV-2 virus causes COVID-19.'''<br>Author: CDC]]
A number of studies have found that some people who test positive for COVID-19 do not have any symptoms of illness or a raised temperature, and have normal blood test results, but are able to infect others, some of whom developed severe COVID-19 [[pneumonia]] as a result of COVID-19.<ref name="Bai2020">{{Cite journal|last=Bai|first=Yan|last2=Yao|first2=Lingsheng|last3=Wei|first3=Tao|last4=Tian|first4=Fei|last5=Jin|first5=Dong-Yan|last6=Chen|first6=Lijuan|last7=Wang|first7=Meiyun|date=2020-02-21|title=Presumed Asymptomatic Carrier Transmission of COVID-19|url=https://jamanetwork.com/journals/jama/fullarticle/2762028|journal=JAMA|language=en|doi=10.1001/jama.2020.2565}}</ref><ref name="Chan2019">{{Cite journal|last=Chan|first=Jasper Fuk-Woo|last2=Yuan|first2=Shuofeng|last3=Kok|first3=Kin-Hang|last4=To|first4=Kelvin Kai-Wang|last5=Chu|first5=Hin|last6=Yang|first6=Jin|last7=Xing|first7=Fanfan|last8=Liu|first8=Jieling|last9=Yip|first9=Cyril Chik-Yan|date=2020-02-15|title=A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster|url=https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30154-9/abstract|journal=The Lancet|language=English|volume=395|issue=10223|pages=514–523|doi=10.1016/S0140-6736(20)30154-9|issn=0140-6736|pmid=31986261}}</ref><ref name="delRio2020">{{Cite journal|last=del Rio|first=Carlos|author-link=|last2=Malani|first2=Preeti N.|author-link2=|last3=|first3=|author-link3=|last4=|first4=|author-link4=|last5=|first5=|author-link5=|last6=|first6=|author-link6=|last7=|first7=|last8=|first8=|date=2020-02-28|title=COVID-19—New Insights on a Rapidly Changing Epidemic|url=https://jamanetwork.com/journals/jama/fullarticle/2762510|journal=JAMA|language=en|volume=|issue=|pages=|doi=10.1001/jama.2020.3072|pmc=|pmid=|access-date=|quote=|via=}}</ref> Some asymptomatic carriers have abnormal chest CT scans, and some do not. False negative tests have also been reported.<ref name="Bai2020" /><ref name="Chan2019" />

Estimates of the number of asymptomatic carriers vary wildly. Mizumoto et al. (2020) estimated that asymptomatic carriers accounted for 17.9% of the COVID-19 positive people on the ''Diamond Princess'' cruise ship, which was quarantined for 14 day after a previous passenger developed the illness.<ref name=":3" />

==<span id="recovered">Recovered patients testing positive</span>==
Lan et al (2020) identified a group of 4 recovered patients who continued to test positive for COVID-19 after recovery; suggesting that they may still be infectious.<ref name="Lan2020">{{Cite journal|last=Lan|first=Lan|last2=Xu|first2=Dan|last3=Ye|first3=Guangming|last4=Xia|first4=Chen|last5=Wang|first5=Shaokang|last6=Li|first6=Yirong|last7=Xu|first7=Haibo|date=2020-02-27|title=Positive RT-PCR Test Results in Patients Recovered From COVID-19|url=https://jamanetwork.com/journals/jama/fullarticle/2762452|journal=JAMA|language=en|doi=10.1001/jama.2020.2783}}</ref> It is not known whether patients who have recovered may be reinfected later, or whether those who later needed treatment actually relapsed, or if recovered patients who later test positive do so because of issues with the diagnostic test's accuracy.<ref>{{Cite web|url=https://www.snopes.com/fact-check/covid-19-reinfection/|title=Can People Who Recover from COVID-19 Become Reinfected?|website=Snopes.com|language=en-US|access-date=2020-03-26}}</ref> Another study found group of 5 recovered patients were found to have reactivated COVID-19.<ref>{{Cite journal|last=Ye|first=Guangming|last2=Pan|first2=Zhenyu|last3=Pan|first3=Yunbao|last4=Deng|first4=Qiaoling|last5=Chen|first5=Liangjun|last6=Li|first6=Jin|last7=Li|first7=Yirong|last8=Wang|first8=Xinghuan|date=2020-03-11|title=Clinical characteristics of severe acute respiratory syndrome coronavirus 2 reactivation|url=https://www.journalofinfection.com/article/S0163-4453(20)30114-6/abstract|journal=Journal of Infection|language=English|volume=0|issue=0|doi=10.1016/j.jinf.2020.03.001|issn=0163-4453|pmid=32171867}}</ref>

==ME/CFS==

{{Video|id=pkGXiJ1jM14|service=youtube|dimensions=550|description=COVID-19 and ME/CFS - Dr Nancy Klimas, Mar 13, 2020|alignment=left|urlargs=}}

{{clear}}

====<span id="catchingcovid19">Risk of COVID-19 in patients with ME/CFS</span>====
There is a lack of evidence about ME/CFS patients developing COVID-19 illness; but a number of medical advisors have given their expert opinions on this. Immunologist and [[Myalgic encephalomyelitis|ME]] researcher Dr [[Nancy Klimas]] has said she believes people with ME/CFS are at a little higher risk of developing COVID-19 after exposure to the virus;<ref name="Klimas20200313">{{Cite web|url=https://www.youtube.com/watch?v=pkGXiJ1jM14|title=COVID-19 and ME/CFS - Dr Nancy Klimas, Mar 13, 2020|last=Klimas|first=Nancy|date=2020-03-13|work=|access-date=Mar 24, 2020|archive-url=|archive-date=|dead-url=|quote=|author-link=Nancy Klimas}}</ref> Dr [[Nigel Speight]], Dr [[William Weir]] and Dr [[Charles Shepherd]] have said they do not think there is an increased risk.<ref name="SpeightWeirMar20" /><ref name="SpeightMar20" /><ref name="MEA16Mar20" /> Klimas, Speight, Weir and Shepherd have all advised ME/CFS patients to take additional precautions, and highlighted that there is a risk of ME/CFS becoming significantly worse after viral infections.<ref name="Klimas20200313" /><ref name="SpeightWeirMar20" /><ref name="SpeightMar20" /><ref name="MEA16Mar20" />

ME/CFS includes [[:Category:Immune signs and symptoms|immune symptoms]] including a [[sore throat]], [[swollen lymph nodes]], and [[flu-like symptoms]], but patients are generally not considered to be severely immunocompromised, and immunosuppressant medications are unlikely to be used by most ME/CFS patients. <ref name="Klimas20200313" /> <ref name="canadianconsensus">{{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
| url = http://www.investinme.org/Documents/PDFdocuments/CanadianDefinitionME-CFS.pdf
}}</ref><ref name="ICP2011primer">{{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> This means most ME/CFS patients would not be considered to be at very high risk of COVID-19 illness.<ref name="Klimas20200313" />

* '''<span id="ibuprofen">[[Ibuprofen]]</span>''' - Ibuprofen drugs (Nurofen, Bruprofen, Advil, Midol, Motrin, Motrin) are anti-inflammatories commonly used for cold/flu symptoms and for ME/CFS. There have been some reports that ibuprofen taken for COVID-19 may prolong the illness and increase it's severity. Several countries including the UK and France now recommend that people with suspected or confirmed COVID-19 avoid ibuprofen and '''use paracetamol / acetaminophen''' (e.g., Tylenol) instead, although the evidence for this is relatively limited.<ref name="MEA16Mar20" /><ref name="Day20200317">{{Cite journal|last=Day|first=Michael|date=2020-03-17|title=Covid-19: ibuprofen should not be used for managing symptoms, say doctors and scientists|url=https://www.bmj.com/content/368/bmj.m1086|journal=BMJ|language=en|volume=368|doi=10.1136/bmj.m1086|issn=1756-1833|pmid=32184201}}</ref><ref>{{Cite web|url=https://www.nhs.uk/conditions/coronavirus-covid-19/self-isolation-advice/|title=Stay at home advice - Coronavirus (COVID-19)|last=National Health Service|first=|authorlink=National Health Service|last2=|first2=|authorlink2=|date=2020-02-28|website=nhs.uk|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref> There is no suggestion that ibuprofen affects the risk of catching COVID-19.
* '''[[Rituximab]]''' - The MS Society has stated that taking rituximab, which has been used in clinical trials for ME/CFS, may affect the risk of catching COVID-19.<ref name="Covid-19-MS">{{Cite web|url=https://www.mssociety.org.uk/about-ms/treatments-and-therapies/disease-modifying-therapies/covid-19-coronavirus-and-ms|title=COVID-19 coronavirus and MS|last=MS Society|first=|authorlink=|last2=|first2=|authorlink2=|date=|website=www.mssociety.org.uk|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref><ref>{{Cite web|url=https://renal.org/wp-content/uploads/2020/03/BAPN-COVID-19-patient-info-for-HD.PD_.Immunosuppression-17March20.pdf|title=Coronavirus (SARS-CoV-2) and its associated illness (COVID-19) {{!}} Information and Guidance for Children on Haemodialysis, Peritoneal Dialysis and Immune suppression (including Renal Transplants)|last=Renal Association|first=|authorlink=|last2=|first2=|authorlink2=|date=2020-03-17|website=renal.org|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref>
* '''[[Ampligen]]''' - Ampligen or ''rintatolimod'' is sometimes used by ME/CFS patients, it is an [[antiviral]] immunostimulant rather than immunosuppressing drug, and is being tested for the treatment of COVID-19 illness in Japan.<ref>{{Cite web|url=https://adisinsight.springer.com/drugs/800001203|title=Rintatolimod - AIM ImmunoTech - AdisInsight|website=adisinsight.springer.com|access-date=2020-03-23}}</ref> There is no information about whether it may help prevent COVID-19 in ME/CFS patients.
*The unproven [[autoimmune hypothesis]] states that a subtype of ME involves autoimmunity, which is an overactive immune system rather than a weakened immune response.<ref name="OMF2018research">{{Cite web|url=https://www.omf.ngo/2018/02/28/omf-funded-research-t-cells-molecular-immunology/|title=OMF-funded research: T cells and molecular immunology|last=Open Medicine Foundation|first=|authorlink=Open Medicine Foundation|last2=|first2=|authorlink2=|date=Feb 28, 2018|website=Open Medicine Foundation|language=en-US|archive-url=|archive-date=|dead-url=|access-date=2019-07-11}}</ref>
{{Quote box|I have now reached the conclusion that people with pre-existing health conditions that make them more vulnerable to lung complications (which may or may not be the case with ME/CFS – at this stage we just don’t know), or have a condition like ME/CFS where an infection such as this will almost certainly cause a relapse, or significant exacerbation of symptoms, need to be doing far more to protect themselves, and to socially distance themselves from other people, than official NHS guidance indicates.

In particular, for those who are not housebound, this applies to social mobility and what you can do (and cannot do) if you decide to leave your home.<ref name="MEA16Mar20"/>|author=[[Charles Shepherd]], ME Association|date=Mar 16, 2020|title=Advice from the UK's ME Association}}

====<span id="deathrisk">Risk of death or serious complications in ME/CFS patients</span>====
{{Quote box|Although ME is a "chronic condition" my gut feeling is that they are not actually at greater risk of dying from the virus itself than healthy people. The conditions which put people at extra risk would be things like severe asthma or COPD, or immunosuppressed people eg those on chemotherapy for cancer.

The biggest worry therefore for ME sufferers is that catching the virus will make their ME much worse, and of course people in the 25% group do not have much leeway.

It might even be that worsening of their already severe ME could be a bigger threat to life than the virus itself.<ref name="SpeightMar20" />|author=[[Nigel Speight]]|date=Mar 2020|title=25% ME Group for Severe ME}}

====<span id="triggerforME">Risk of developing ME/CFS after COVID-19</span>====
ME/CFS has been linked to many different viruses, but it is not known what the likelihood is of developing ME/CFS after COVID-19 illness.
{{See also|Postviral fatigue syndrome}}

==ME/CFS charity medical advisors COVID-19 statements==
*Mar 17, 2020, ME Association, [https://www.meassociation.org.uk/2020/03/coronavirus-covid-19-latest-government-advice-and-what-it-means-for-people-with-me-cfs-17-march-2020/ Coronavirus Covid-19: Latest Government advice and what it means for people with ME/CFS]<ref name="MEA17Mar20">{{Cite web|url=https://www.meassociation.org.uk/2020/03/coronavirus-covid-19-latest-government-advice-and-what-it-means-for-people-with-me-cfs-17-march-2020/|title=Coronavirus Covid-19: Latest Government advice and what it means for people with ME/CFS {{!}} 17 March 2020|last=Shepherd|first=Charles|authorlink=Charles Shepherd|last2=|first2=|authorlink2=|date=2020-03-17|website=ME Association|language=en-GB|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref>
*Mar 16, 2020, ME Association, [https://www.meassociation.org.uk/2020/03/me-association-guidance-coronavirus-covid-19-and-me-cfs-by-dr-charles-shepherd-16-march-2020/ ME Association Guidance: Coronavirus and ME/CFS by Dr Charles Shepherd]<ref name="MEA16Mar20">{{Cite web|url=https://www.meassociation.org.uk/2020/03/me-association-guidance-coronavirus-covid-19-and-me-cfs-by-dr-charles-shepherd-16-march-2020/|title=ME Association Guidance: Coronavirus and ME/CFS by Dr Charles Shepherd {{!}} 16 March 2020|last=Shepherd|first=Charles|authorlink=Charles Shepherd|last2=|first2=|authorlink2=|date=2020-03-16|website=ME Association|language=en-GB|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref>
*Mar 2020, 25% ME Group, [https://25megroup.org/download/1796/?v=3236 re Coronavirus and members of the 25% ME Group, Severe ME charity | Message from Dr Willy Weir and Dr Nigel Speight, Medical Advisor to 25% ME Group | Update to the advice given on 29 February 2020],<ref name="SpeightWeirMar20">{{Cite web|url=https://25megroup.org/download/1796/?v=3236|author-link=Nigel Speight|last=Speight|first=Nigel||last2=Weir|first2=William|author-link2=William Weir|title=re Coronavirus and members of the 25% ME Group, Severe ME charity {{!}} Message from Dr Willy Weir and Dr Nigel Speight, Medical Advisor to 25% ME Group {{!}} Update to the advice given on 29 February 2020 |date=Mar 2020|website=25megroup.org}}</ref>
*Mar 2020, 25% ME Group, [https://25megroup.org/download/1796/?v=3226 re Coronavirus and members of the 25% ME Group, Severe ME charity Types | Message from Dr Nigel Speight, Medical Advisor to 25% ME Group]<ref name="SpeightMar20">{{Cite web|url=https://25megroup.org/download/1796/?v=3226|author-link=Nigel Speight|last=Speight|first=Nigel|title=re Coronavirus and members of the 25% ME Group, Severe ME charity Types {{!}} Message from Dr Nigel Speight, Medical Advisor to 25% ME Group|date=Mar 2020|website=25megroup.org|others=[[William Weir]]}}</ref>

==Prevention==
[[File:CDC-Coronavirus-badge-300.png|thumb|upright=1|left|Image author: CDC|alt=image of Coronavirus Disease 2019 (COVID-19)|link=https://www.cdc.gov/coronavirus/2019-ncov/index.html]]
<br style="clear:both;line-height:0">
The SARS-CoV-2 coronavirus is an ''enveloped virus'', which means it is easier to kill outside the body than ''non-enveloped'' viruses like [[Coxsackievirus]], or [[Poliovirus]].<ref>{{Cite web|url=https://www.epa.gov/pesticides/coronavirus-cases-trigger-epa-rapid-response|title=Coronavirus Cases Trigger EPA Rapid Response|last=US Environmental Protection Agency|first=|authorlink=|last2=|first2=|authorlink2=|date=2020-01-29|website=US EPA|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref><ref>{{Cite journal|last=Firquet|first=Swan|author-link=|last2=Beaujard|first2=Sophie|author-link2=|last3=Lobert|first3=Pierre-Emmanuel|author-link3=|last4=Sané|first4=Famara|author-link4=|last5=Caloone|first5=Delphine|author-link5=|last6=Izard|first6=Daniel|author-link6=|last7=Hober|first7=Didier|last8=|first8=|date=June 2015|title=Survival of Enveloped and Non-Enveloped Viruses on Inanimate Surfaces|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4462923/|journal=Microbes and Environments|volume=30|issue=2|pages=140–144|doi=10.1264/jsme2.ME14145|issn=1342-6311|pmc=4462923|pmid=25843687|access-date=|quote=|via=}}</ref>
*[https://www.cdc.gov/coronavirus/2019-ncov/prepare/get-your-household-ready-for-COVID-19.html Get your Household Ready for COVID-19] - CDC
*[https://www.americanchemistry.com/Novel-Coronavirus-Fighting-Products-List.pdf Novel Coronavirus (COVID-19)-Fighting Products] - Center for Biocide Chemistries
*[https://www.health.gov.au/sites/default/files/documents/2020/03/coronavirus-covid-19-information-on-social-distancing.pdf Social distancing - Department of Health, Australia]

==== CDC advice ====
* Know How it Spreads
* Clean your hands often
* Avoid close contact
* Stay home if you're sick (may have the virus)
* Cover coughs and sneezes
* Wear a face mask if you are sick (may have the virus)
* Clean and disinfect
<i><div role="note" class="hatnote navigation-not-searchable">{{MediaWiki:Seealso/{{{lang|{{PAGELANGUAGE}}}}}}}{{colon}}
[https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html Coronavirus disease 19 Prevention - CDC]</div></i>

===<span id="high-touch">High touch surfaces: disinfect daily</span>===
[[File:High-touch surfaces-CDC-covid-19.png|alt=High-touch surfaces: disinfect daily. Tables, doorknobs, light switches, countertops, handles, desks, phones keyboards, remote controls, toilets, faucets, sinks, hard-backed chairs. Source: Coronavirus disease 19 Prevention - CDC, March 2020. Public domain image.|thumb|upright=0.7]]<br style="line-height:0" />
The CDC currently recommends people '''clean''' AND '''disinfect''' frequently touched surfaces daily:
<div style="column-count:2;-moz-column-count:2;-webkit-column-count:2">
*tables
*doorknobs
*light switches
*countertops
*handles
*desks
*phones
*keyboards
*remote controls
*toilets
*faucets
*sinks
*hard-backed chairs<ref name="CDC-prevention" /><ref name="CDC-suspectedcases">{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/prepare/cleaning-disinfection.html|title=Coronavirus Disease 2019 (COVID-19) - Environmental Cleaning and Disinfection Recommendations|last=CDC|first=|authorlink=Centers for Disease Control and Prevention|last2=|first2=|authorlink2=|date=2020-02-11|website=Centers for Disease Control and Prevention|language=en-us|archive-url=|archive-date=|dead-url=|access-date=2020-03-18}}</ref>
</div><br style="clear:both; line-height:0" />
:'''To clean use:'''
*Detergent or soap and water prior to disinfection. <ref name="CDC-prevention" />

:'''To disinfect use:'''
*[https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2 '''Disinfectants used against SARS-CoV-2'''] (list)
*'''Most common EPA-registered household disinfectants''' will work, or
* '''Diluted household bleach''' (mix: 5 tablespoons bleach per gallon of water, OR 4 teaspoons bleach per quart of water), or
*'''Alcohol solutions''' with at least 70% alcohol
:Follow manufacturer’s instructions for application and ''proper ventilation''. Check the product is not past its expiration date. ''(Updated Mar 18, 2020)''<ref name="CDC-prevention">{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html|title=Coronavirus Disease 2019 (COVID-19) – Prevention & Treatment|last=CDC|first=|authorlink=Centers for Disease Control and Prevention|last2=|first2=|authorlink2=|date=2020-03-16|website=Centers for Disease Control and Prevention|language=en-us|archive-url=|archive-date=|dead-url=|access-date=2020-03-17}}</ref>

:'''Check for updates:'''
* [https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html Coronavirus disease 19 Prevention - CDC]

'''Suspected or confirmed COVID-19 cases:'''<br />If possible the '''sick person''' should also clean:
<div style="column-count:2;-moz-column-count:2;-webkit-column-count:2">
*soiled items and surfaces (as needed)
*if a separate bathroom is not available, the bathroom should be cleaned and disinfected after each use by an ill person
*provide personal cleaning and disinfectant supplies in ill person's room (unless unsafe, e.g. they are a young child) - include tissues, paper towels, cleaners and EPA-registered disinfectants<ref name="CDC-prevention" /><ref name="CDC-suspectedcases" /></div>

===Coronavirus transmission from surfaces===
The new coronavirus can survive on different surfaces for hours or days:
*small airborne virus particles (aerosols) - 3 hours
*copper - 4 hours
*cardboard - 24 hours
*stainless steel - 2 to 3 days
*plastic - 2 to 3 days<ref name="stablesurfacesPRMar20">{{Cite web|url=https://www.nih.gov/news-events/news-releases/new-coronavirus-stable-hours-surfaces|title=New coronavirus stable for hours on surfaces|last=National Institutes of Health|first=|authorlink=National Institutes of Health|last2=|first2=|authorlink2=|date=2020-03-17|website=National Institutes of Health (NIH)|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-25}}</ref><ref name="Tellier2006">{{Cite journal|last=Tellier|first=Raymond|author-link=|last2=|first2=|author-link2=|last3=|first3=|author-link3=|last4=|first4=|author-link4=|last5=|first5=|author-link5=|last6=|first6=|author-link6=|last7=|first7=|last8=|first8=|date=Nov 2006|title=Review of Aerosol Transmission of Influenza A Virus|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3372341/|journal=Emerging Infectious Diseases|volume=12|issue=11|pages=1657–1662|doi=10.3201/eid1211.060426|issn=1080-6040|pmc=3372341|pmid=17283614|access-date=|quote=|via=}}</ref>

This means direct contact with an infected person is not needed to contact the illness.<ref name="stablesurfacesPRMar20" /> Surgical [[#facemasks|face masks]] have not been effective against aerosols in previous influenza outbreaks like swine flu, but N95 respirators have been effective.<ref name="Tellier2006" />

==<span id="someoneissick">Disinfecting your home if someone is sick</span>==
'''Suspected or confirmed COVID-19 cases:'''<br />
*'''Clean''' AND '''disinfect''' all [[#High-touch|high-touch]] areas daily.
If possible the '''sick person''' should also clean:
<div style="column-count:2;-moz-column-count:2;-webkit-column-count:2">
*soiled items and surfaces (as needed)
*if a separate bathroom is not available, the bathroom should be cleaned and disinfected after each use by an ill person
*provide personal cleaning and disinfectant supplies in ill person's room (unless unsafe, e.g. they are a young child) - include tissues, paper towels, cleaners and EPA-registered disinfectants<ref name="CDC-prevention" /><ref name="CDC-suspectedcases" /><ref name="CDCDisinfectYourHome">https://www.cdc.gov/coronavirus/2019-ncov/prepare/disinfecting-your-home.html</ref></div>
*<div role="note" class="hatnote navigation-not-searchable">Take additional steps covering '''soft surfaces, food, laundry, and trash'''{{colon}}
*[https://www.cdc.gov/coronavirus/2019-ncov/prepare/disinfecting-your-home.html Disinfecting your home if someone is sick - CDC]

==COVID-19 pneumonia==
Severe Acute Respiratory Infection (SARI) is the name for the type of pneumonia caused by COVID-19.<ref name="vitCtrial">{{Cite web|url=https://clinicaltrials.gov/ct2/show/NCT04264533|title=Vitamin C Infusion for the Treatment of Severe 2019-nCoV Infected Pneumonia - Full Text View - ClinicalTrials.gov|website=clinicaltrials.gov|language=en|access-date=2020-03-22}}</ref> A clinical trial is in progress to determine if intravenous [[vitamin C]] is an effective treatment for SARI.<ref name="vitCtrial" />

==Myth, Hoaxes, Scams and Fake News==
Many myths, hoaxes and fake news have been spreading, particularly on social media, some of which claim to be from doctors or health professionals.<ref name="WHOmyths">{{Cite web|url=https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters|title=Coronavirus 2019 {{!}} Myth busters|last=World Health Organization|first=|authorlink=World Health Organization|last2=|first2=|authorlink2=|date=|website=www.who.int|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-17}}</ref><ref name="BuzzfeedHoax3Mar20">{{Cite web|url=https://www.buzzfeednews.com/article/janelytvynenko/coronavirus-disinformation-spread|title=Here Are Some Of The Coronavirus Hoaxes That Spread In The First Few Weeks|website=BuzzFeed News|language=en|access-date=2020-03-17}}</ref> Scam include seeking fake cures or ineffective protective equipment like masks, scammers pretending to be from the World Health Organization asking for donations, or a stranger asking for money on behalf of a relative's medical bills.<ref name="FTC-scams">{{Cite web|url=https://www.consumer.ftc.gov/features/coronavirus-scams-what-ftc-doing|title=Coronavirus Scams: What the FTC is doing|last=FTC|first=|authorlink=|last2=|first2=|authorlink2=|date=2020-03-06|website=Consumer Information|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-17}}</ref><ref name="WHO-cybersecurity">{{Cite web|url=https://www.who.int/about/communications/cyber-security|title=Communications {{!}} Cybersecurity|last=World Health Organization|first=|authorlink=World Health Organization|last2=|first2=|authorlink2=|date=|website=www.who.int|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-17}}</ref>

*[https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters Coronavirus disease (COVID-19) advice for the public: Myth busters] - World Health Organization
*Mar 3, 2020 - [https://www.buzzfeednews.com/article/janelytvynenko/coronavirus-disinformation-spread Here Are Some Of The Coronavirus Hoaxes That Spread In The First Few Weeks] - Buzzfeed News
*Mar 2020 - [https://www.buzzfeednews.com/article/janelytvynenko/heres-a-running-list-of-the-latest-disinformation Here's A Running List Of The Latest Hoaxes Spreading About The Coronavirus] - Buzzfeed News
*[https://www.who.int/about/communications/cyber-security Cybersecurity - World Health Organization]
*[https://www.consumer.ftc.gov/features/coronavirus-scams-what-ftc-doing Coronavirus scams - What the FTC os doing]

==Posters for those self-isolating to avoid infection==
*[https://chronicallyawesome.org.uk/posters-for-those-who-are-self-isolating-as-a-preventative-measure/? Unofficial posters] stating where people should leave deliveries - Chronically Awesome

==Mental health ==
Anxiety around COVID-19 illness may cause anxiety or affect mental health.
*[https://www.nami.org/getattachment/About-NAMI/NAMI-News/2020/NAMI-Updates-on-the-Coronavirus/COVID-19-Updated-Guide-1.pdf?lang=en-US COVID-19 Guide - National Association of Mental Illness]
*[https://www.who.int/docs/default-source/coronaviruse/coping-with-stress.pdf?sfvrsn=9845bc3a_2 Coping with stress during the nCov-2019 outbreak (poster)] - World Health Organization

==News articles ==
*Mar 14, 2020, [https://www.cnn.com/2020/03/14/health/coronavirus-covid-19-flu-comparison-frieden-analysis/index.html Former CDC director: Covid-19 is different from flu and we must respond differently, Dr. Tom Frieden] - CNN

==Learn more==
'''Government Health Organizations'''
*[https://www.who.int/emergencies/diseases/novel-coronavirus-2019 Coronavirus disease 19 (COVID-19) - World Health Organization]
*[https://www.cdc.gov/coronavirus/2019-ncov/index.html Coronavirus disease 19 (COVID-19) - CDC]
*[https://www.nhs.uk/conditions/coronavirus-covid-19/ Coronavirus (COVID-19) - NHS]
*[https://www.who.int/gpsc/5may/Guide_to_Local_Production.pdf Guide to Local Production: WHO-recommended Handrub Formulations] - only for when soap and water is not available
*[https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public Protect yourself: Coronavirus disease 19 (COVID-19) - World Health Organization]
*[https://www.who.int/news-room/q-a-detail/q-a-coronaviruses Q&A on coronaviruses (COVID-19) - World Health Organization]
'''ME/CFS Organizations'''
*[https://www.meaction.net/covid-19/ COVID-19 Resources for People with ME - #MEAction]
*[https://www.meassociation.org.uk/2020/03/me-association-guidance-coronavirus-covid-19-update-09-march-2020/ ME Association Guidance: Coronavirus (covid-19) Update | 09 March 2020] - The ME Association
'''Media'''
* [https://www.nytimes.com/2020/02/29/health/coronavirus-reinfection.html They Recovered From the Coronavirus. Were They Infected Again?] - NY Times
'''Johns Hopkins University Global Cases Map'''
* [https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6 Desktop]
* [https://www.arcgis.com/apps/opsdashboard/index.html#/85320e2ea5424dfaaa75ae62e5c06e61 Mobile]

==See also ==
*[[Postviral fatigue syndrome]] (PVFS)
*[[Myalgic encephalomyelitis]]
*[[Severe Acute Respiratory Syndrome]]

==References ==
{{Reflist}}

[[Category:Infectious agents]]
[[Category:Triggers and risk factors]]
[[Category:Virology]]
[[Category:Viruses]]
[[Category:Coronaviruses]]

Coronavirus disease 19

2020-03-29T11:37:46Z

Loopy:/* Learn more */ NYT article

'''Coronavirus disease 19''', commonly known as '''COVID-19''', is the airborne infectious respiratory illness caused by the novel (new) [[SARS-CoV-2 coronavirus]] (severe acute respiratory syndrome 2), previously known as ''n-2019-nCoV''.<ref name="WHO-QA">{{Cite web|url=https://www.who.int/news-room/q-a-detail/q-a-coronaviruses|title=Q&A on coronaviruses (COVID-19)|last=World Health Organization|first=|authorlink=World Health Organization|last2=|first2=|authorlink2=|date=|website=www.who.int|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-16}}</ref><ref name="CDC-coronoviruses">{{Cite web|url=https://www.cdc.gov/coronavirus/types.html|title=Human Coronavirus Types|last=Centers for Disease Control and Prevention|first=|authorlink=Centers for Disease Control and Prevention|last2=|first2=|authorlink2=|date=2020-02-27|website=www.cdc.gov|language=en-us|archive-url=|archive-date=|dead-url=|access-date=2020-03-16}}</ref><ref>{{Cite journal|last=Li|first=Guangdi|author-link=|last2=Clercq|first2=Erik De|author-link2=|last3=|first3=|author-link3=|last4=|first4=|author-link4=|last5=|first5=|author-link5=|last6=|first6=|author-link6=|last7=|first7=|last8=|first8=|date=Mar 2020|title=Therapeutic options for the 2019 novel coronavirus (2019-nCoV)|url=https://www.nature.com/articles/d41573-020-00016-0|journal=Nature Reviews Drug Discovery|language=en|volume=19|issue=3|pages=149–150|doi=10.1038/d41573-020-00016-0|pmc=|pmid=|access-date=|quote=|via=}}</ref><ref>{{Cite web|url=https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/naming-the-coronavirus-disease-(covid-2019)-and-the-virus-that-causes-it|title=Naming the coronavirus disease (COVID-19) and the virus that causes it|website=www.who.int|language=en|access-date=2020-03-28}}</ref>
[[File:Covid-19-lung-lesions.jpg|thumb|left|alt=Computer-aided identification of lesions on the lungs of COVID-19 patients.|'''COVID-19 can cause lesions on lungs, and pneumonia.'''<br>Author: [https://www.sciencedirect.com/science/article/pii/S2095177920302264 Shen et al. 2020. Journal of Pharmaceutical Analysis]. Copyright: CC-BY-NC-ND-4.0]]{{clear}}
COVID-19 was first identified in Wuhan, China, in December 2019,<ref name="WHO-QA" /> and can infect babies, children, and adults of any age.<ref>{{Cite journal|last=Wei|first=Min|last2=Yuan|first2=Jingping|last3=Liu|first3=Yu|last4=Fu|first4=Tao|last5=Yu|first5=Xue|last6=Zhang|first6=Zhi-Jiang|date=2020-02-14|title=Novel Coronavirus Infection in Hospitalized Infants Under 1 Year of Age in China|url=https://jamanetwork.com/journals/jama/fullarticle/2761659|journal=JAMA|language=en|doi=10.1001/jama.2020.2131}}</ref> It spread globally, resulting in the 2019-2020 coronavirus pandemic.<ref>{{Cite journal|last=Hui|first=David S.|last2=Azhar|first2=Esam I.|last3=Madani|first3=Tariq A.|last4=Ntoumi|first4=Francine|last5=Kock|first5=Richard|last6=Dar|first6=Osman|last7=Ippolito|first7=Giuseppe|last8=Mchugh|first8=Timothy D.|last9=Memish|first9=Ziad A.|date=2020-02-01|title=The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health — The latest 2019 novel coronavirus outbreak in Wuhan, China|url=https://www.ijidonline.com/article/S1201-9712(20)30011-4/abstract|journal=International Journal of Infectious Diseases|language=English|volume=91|pages=264–266|doi=10.1016/j.ijid.2020.01.009|issn=1201-9712|pmid=31953166}}</ref><ref>{{Cite web|url=https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020|title=WHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020|website=www.who.int|language=en|access-date=2020-03-28}}</ref>

== Symptoms ==
Symptoms are usually mild and begin gradually, although around 1 in 6 people with COVID-19 need medical help.<ref name="WHO-QA" /> Some people become infected but don't develop any symptoms and don't feel unwell.<ref name=":0">{{Cite web||last=World Health Organization|first=|authorlink=World Health Organization|url=https://www.who.int/news-room/q-a-detail/q-a-coronaviruses|title=Q&A on coronaviruses (COVID-19)|website=www.who.int|language=en|access-date=2020-03-24}}</ref> These symptoms may appear 1-14 days after exposure; most commonly around five days.<ref name=":0" /><ref name=":1">{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html|title=Coronavirus Disease 2019 (COVID-19) – Symptoms|last=CDC|date=2020-03-20||author-link=Centers for Disease Control|website=Centers for Disease Control and Prevention|language=en-us|access-date=2020-03-24}}</ref>

=== Common Symptoms ===
* [[fever]]
* tiredness
* continuous cough, coughing episodes or a dry [[cough|cough,]]<ref>{{Cite web|url=https://www.nhs.uk/conditions/coronavirus-covid-19/symptoms-and-what-to-do/|title=Symptoms and what to do - Coronavirus (COVID-19)|last=National Health Service|first=|authorlink=National Health Service|last2=|first2=|authorlink2=|date=2020-03-24|website=nhs.uk|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-26}}</ref><ref name=":0" /> or [[Dyspnea|shortness of breath]]<ref name=":1" />
Most patients only have one or two of the common symptoms.<ref name=":0" /><ref name=":3">{{Cite journal|last=Mizumoto|first=Kenji|last2=Kagaya|first2=Katsushi|last3=Zarebski|first3=Alexander|last4=Chowell|first4=Gerardo|date=2020-03-12|title=Estimating the asymptomatic proportion of coronavirus disease 2019 (COVID-19) cases on board the Diamond Princess cruise ship, Yokohama, Japan, 2020|url=https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.10.2000180|journal=Eurosurveillance|language=en|volume=25|issue=10|pages=2000180|doi=10.2807/1560-7917.ES.2020.25.10.2000180|issn=1560-7917|pmc=PMC7078829|pmid=32183930}}</ref><ref name="Lan2020" />

=== Other Symptoms ===
* aches and [[Pain|pains]]
* nasal congestion
* runny nose
* [[sore throat]]
* [[diarrhea]]<ref name=":0" />

=== Emergency Warning Signs* ===
* trouble breathing
* [[Chest pain|persistent pain or pressure in the chest]]
* new [[confusion]] or inability to arouse (unresponsive)
* bluish lips or face<ref name=":1" />
<nowiki>*</nowiki>This list is not all inclusive. Consult your medical provider for any other symptoms that are severe or concerning.<ref name=":1" />

Additionally, there are reports that patients have lost or have a reduced [[sense of smell]], or [[Changes in taste|lost or distorted of taste]], but are otherwise [[#asymptomaticcarriers|asymptomatic]].<ref name=":2">{{Cite news|url=https://www.nytimes.com/2020/03/22/health/coronavirus-symptoms-smell-taste.html|title=Lost Sense of Smell May Be Peculiar Clue to Coronavirus Infection|last=Rabin|first=Roni Caryn|date=2020-03-22|work=The New York Times|access-date=2020-03-24|language=en-US|issn=0362-4331}}</ref><blockquote>The American Academy of Otolaryngology on Sunday posted information on its website<ref>{{Cite web|url=https://www.entnet.org/content/coronavirus-disease-2019-resources|title=Coronavirus Disease 2019: Resources|last=American Academy of Otolaryngology|date=2020-03-15|website=American Academy of Otolaryngology-Head and Neck Surgery|language=en|access-date=2020-03-24}}</ref> saying that mounting anecdotal evidence indicates that lost or reduced sense of smell and loss of [[Sense of taste|taste]] are significant symptoms associated with Covid-19, and that they have been seen in patients who ultimately tested positive with no other symptoms.<ref name=":2" /></blockquote><blockquote>The symptoms, in the absence of allergies or sinusitis, should alert doctors to screen patients for the virus and “warrant serious consideration for self isolation and testing of these individuals,” the academy said.<ref name=":2" /></blockquote>

==<span id="asymptomaticcarriers">Asymptomatic carriers</span>==
[[File:Covid-19-virus.png|thumb|upright=0.4|'''The SARS-CoV-2 virus causes COVID-19.'''<br>Author: CDC]]
A number of studies have found that some people who test positive for COVID-19 do not have any symptoms of illness or a raised temperature, and have normal blood test results, but are able to infect others, some of whom developed severe COVID-19 [[pneumonia]] as a result of COVID-19.<ref name="Bai2020">{{Cite journal|last=Bai|first=Yan|last2=Yao|first2=Lingsheng|last3=Wei|first3=Tao|last4=Tian|first4=Fei|last5=Jin|first5=Dong-Yan|last6=Chen|first6=Lijuan|last7=Wang|first7=Meiyun|date=2020-02-21|title=Presumed Asymptomatic Carrier Transmission of COVID-19|url=https://jamanetwork.com/journals/jama/fullarticle/2762028|journal=JAMA|language=en|doi=10.1001/jama.2020.2565}}</ref><ref name="Chan2019">{{Cite journal|last=Chan|first=Jasper Fuk-Woo|last2=Yuan|first2=Shuofeng|last3=Kok|first3=Kin-Hang|last4=To|first4=Kelvin Kai-Wang|last5=Chu|first5=Hin|last6=Yang|first6=Jin|last7=Xing|first7=Fanfan|last8=Liu|first8=Jieling|last9=Yip|first9=Cyril Chik-Yan|date=2020-02-15|title=A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster|url=https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30154-9/abstract|journal=The Lancet|language=English|volume=395|issue=10223|pages=514–523|doi=10.1016/S0140-6736(20)30154-9|issn=0140-6736|pmid=31986261}}</ref><ref name="delRio2020">{{Cite journal|last=del Rio|first=Carlos|author-link=|last2=Malani|first2=Preeti N.|author-link2=|last3=|first3=|author-link3=|last4=|first4=|author-link4=|last5=|first5=|author-link5=|last6=|first6=|author-link6=|last7=|first7=|last8=|first8=|date=2020-02-28|title=COVID-19—New Insights on a Rapidly Changing Epidemic|url=https://jamanetwork.com/journals/jama/fullarticle/2762510|journal=JAMA|language=en|volume=|issue=|pages=|doi=10.1001/jama.2020.3072|pmc=|pmid=|access-date=|quote=|via=}}</ref> Some asymptomatic carriers have abnormal chest CT scans, and some do not. False negative tests have also been reported.<ref name="Bai2020" /><ref name="Chan2019" />

Estimates of the number of asymptomatic carriers vary wildly. Mizumoto et al. (2020) estimated that asymptomatic carriers accounted for 17.9% of the COVID-19 positive people on the ''Diamond Princess'' cruise ship, which was quarantined for 14 day after a previous passenger developed the illness.<ref name=":3" />

==<span id="recovered">Recovered patients testing positive</span>==
Lan et al (2020) identified a group of 4 recovered patients who continued to test positive for COVID-19 after recovery; suggesting that they may still be infectious.<ref name="Lan2020">{{Cite journal|last=Lan|first=Lan|last2=Xu|first2=Dan|last3=Ye|first3=Guangming|last4=Xia|first4=Chen|last5=Wang|first5=Shaokang|last6=Li|first6=Yirong|last7=Xu|first7=Haibo|date=2020-02-27|title=Positive RT-PCR Test Results in Patients Recovered From COVID-19|url=https://jamanetwork.com/journals/jama/fullarticle/2762452|journal=JAMA|language=en|doi=10.1001/jama.2020.2783}}</ref> It is not known whether patients who have recovered may be reinfected later, or whether those who later needed treatment actually relapsed, or if recovered patients who later test positive do so because of issues with the diagnostic test's accuracy.<ref>{{Cite web|url=https://www.snopes.com/fact-check/covid-19-reinfection/|title=Can People Who Recover from COVID-19 Become Reinfected?|website=Snopes.com|language=en-US|access-date=2020-03-26}}</ref> Another study found group of 5 recovered patients were found to have reactivated COVID-19.<ref>{{Cite journal|last=Ye|first=Guangming|last2=Pan|first2=Zhenyu|last3=Pan|first3=Yunbao|last4=Deng|first4=Qiaoling|last5=Chen|first5=Liangjun|last6=Li|first6=Jin|last7=Li|first7=Yirong|last8=Wang|first8=Xinghuan|date=2020-03-11|title=Clinical characteristics of severe acute respiratory syndrome coronavirus 2 reactivation|url=https://www.journalofinfection.com/article/S0163-4453(20)30114-6/abstract|journal=Journal of Infection|language=English|volume=0|issue=0|doi=10.1016/j.jinf.2020.03.001|issn=0163-4453|pmid=32171867}}</ref>

==ME/CFS==

{{Video|id=pkGXiJ1jM14|service=youtube|dimensions=550|description=COVID-19 and ME/CFS - Dr Nancy Klimas, Mar 13, 2020|alignment=left|urlargs=}}

{{clear}}

====<span id="catchingcovid19">Risk of COVID-19 in patients with ME/CFS</span>====
There is a lack of evidence about ME/CFS patients developing COVID-19 illness; but a number of medical advisors have given their expert opinions on this. Immunologist and [[Myalgic encephalomyelitis|ME]] researcher Dr [[Nancy Klimas]] has said she believes people with ME/CFS are at a little higher risk of developing COVID-19 after exposure to the virus;<ref name="Klimas20200313">{{Cite web|url=https://www.youtube.com/watch?v=pkGXiJ1jM14|title=COVID-19 and ME/CFS - Dr Nancy Klimas, Mar 13, 2020|last=Klimas|first=Nancy|date=2020-03-13|work=|access-date=Mar 24, 2020|archive-url=|archive-date=|dead-url=|quote=|author-link=Nancy Klimas}}</ref> Dr [[Nigel Speight]], Dr [[William Weir]] and Dr [[Charles Shepherd]] have said they do not think there is an increased risk.<ref name="SpeightWeirMar20" /><ref name="SpeightMar20" /><ref name="MEA16Mar20" /> Klimas, Speight, Weir and Shepherd have all advised ME/CFS patients to take additional precautions, and highlighted that there is a risk of ME/CFS becoming significantly worse after viral infections.<ref name="Klimas20200313" /><ref name="SpeightWeirMar20" /><ref name="SpeightMar20" /><ref name="MEA16Mar20" />

ME/CFS includes [[:Category:Immune signs and symptoms|immune symptoms]] including a [[sore throat]], [[swollen lymph nodes]], and [[flu-like symptoms]], but patients are generally not considered to be severely immunocompromised, and immunosuppressant medications are unlikely to be used by most ME/CFS patients. <ref name="Klimas20200313" /> <ref name="canadianconsensus">{{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
| url = http://www.investinme.org/Documents/PDFdocuments/CanadianDefinitionME-CFS.pdf
}}</ref><ref name="ICP2011primer">{{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> This means most ME/CFS patients would not be considered to be at very high risk of COVID-19 illness.<ref name="Klimas20200313" />

* '''<span id="ibuprofen">[[Ibuprofen]]</span>''' - Ibuprofen drugs (Nurofen, Bruprofen, Advil, Midol, Motrin, Motrin) are anti-inflammatories commonly used for cold/flu symptoms and for ME/CFS. There have been some reports that ibuprofen taken for COVID-19 may prolong the illness and increase it's severity. Several countries including the UK and France now recommend that people with suspected or confirmed COVID-19 avoid ibuprofen and '''use paracetamol / acetaminophen''' (e.g., Tylenol) instead, although the evidence for this is relatively limited.<ref name="MEA16Mar20" /><ref name="Day20200317">{{Cite journal|last=Day|first=Michael|date=2020-03-17|title=Covid-19: ibuprofen should not be used for managing symptoms, say doctors and scientists|url=https://www.bmj.com/content/368/bmj.m1086|journal=BMJ|language=en|volume=368|doi=10.1136/bmj.m1086|issn=1756-1833|pmid=32184201}}</ref><ref>{{Cite web|url=https://www.nhs.uk/conditions/coronavirus-covid-19/self-isolation-advice/|title=Stay at home advice - Coronavirus (COVID-19)|last=National Health Service|first=|authorlink=National Health Service|last2=|first2=|authorlink2=|date=2020-02-28|website=nhs.uk|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref> There is no suggestion that ibuprofen affects the risk of catching COVID-19.
* '''[[Rituximab]]''' - The MS Society has stated that taking rituximab, which has been used in clinical trials for ME/CFS, may affect the risk of catching COVID-19.<ref name="Covid-19-MS">{{Cite web|url=https://www.mssociety.org.uk/about-ms/treatments-and-therapies/disease-modifying-therapies/covid-19-coronavirus-and-ms|title=COVID-19 coronavirus and MS|last=MS Society|first=|authorlink=|last2=|first2=|authorlink2=|date=|website=www.mssociety.org.uk|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref><ref>{{Cite web|url=https://renal.org/wp-content/uploads/2020/03/BAPN-COVID-19-patient-info-for-HD.PD_.Immunosuppression-17March20.pdf|title=Coronavirus (SARS-CoV-2) and its associated illness (COVID-19) {{!}} Information and Guidance for Children on Haemodialysis, Peritoneal Dialysis and Immune suppression (including Renal Transplants)|last=Renal Association|first=|authorlink=|last2=|first2=|authorlink2=|date=2020-03-17|website=renal.org|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref>
* '''[[Ampligen]]''' - Ampligen or ''rintatolimod'' is sometimes used by ME/CFS patients, it is an [[antiviral]] immunostimulant rather than immunosuppressing drug, and is being tested for the treatment of COVID-19 illness in Japan.<ref>{{Cite web|url=https://adisinsight.springer.com/drugs/800001203|title=Rintatolimod - AIM ImmunoTech - AdisInsight|website=adisinsight.springer.com|access-date=2020-03-23}}</ref> There is no information about whether it may help prevent COVID-19 in ME/CFS patients.
*The unproven [[autoimmune hypothesis]] states that a subtype of ME involves autoimmunity, which is an overactive immune system rather than a weakened immune response.<ref name="OMF2018research">{{Cite web|url=https://www.omf.ngo/2018/02/28/omf-funded-research-t-cells-molecular-immunology/|title=OMF-funded research: T cells and molecular immunology|last=Open Medicine Foundation|first=|authorlink=Open Medicine Foundation|last2=|first2=|authorlink2=|date=Feb 28, 2018|website=Open Medicine Foundation|language=en-US|archive-url=|archive-date=|dead-url=|access-date=2019-07-11}}</ref>
{{Quote box|I have now reached the conclusion that people with pre-existing health conditions that make them more vulnerable to lung complications (which may or may not be the case with ME/CFS – at this stage we just don’t know), or have a condition like ME/CFS where an infection such as this will almost certainly cause a relapse, or significant exacerbation of symptoms, need to be doing far more to protect themselves, and to socially distance themselves from other people, than official NHS guidance indicates.

In particular, for those who are not housebound, this applies to social mobility and what you can do (and cannot do) if you decide to leave your home.<ref name="MEA16Mar20"/>|author=[[Charles Shepherd]], ME Association|date=Mar 16, 2020|title=Advice from the UK's ME Association}}

====<span id="deathrisk">Risk of death or serious complications in ME/CFS patients</span>====
{{Quote box|Although ME is a "chronic condition" my gut feeling is that they are not actually at greater risk of dying from the virus itself than healthy people. The conditions which put people at extra risk would be things like severe asthma or COPD, or immunosuppressed people eg those on chemotherapy for cancer.

The biggest worry therefore for ME sufferers is that catching the virus will make their ME much worse, and of course people in the 25% group do not have much leeway.

It might even be that worsening of their already severe ME could be a bigger threat to life than the virus itself.<ref name="SpeightMar20" />|author=[[Nigel Speight]]|date=Mar 2020|title=25% ME Group for Severe ME}}

====<span id="triggerforME">Risk of developing ME/CFS after COVID-19</span>====
ME/CFS has been linked to many different viruses, but it is not known what the likelihood is of developing ME/CFS after COVID-19 illness.
{{See also|Postviral fatigue syndrome}}

==ME/CFS charity medical advisors COVID-19 statements==
*Mar 17, 2020, ME Association, [https://www.meassociation.org.uk/2020/03/coronavirus-covid-19-latest-government-advice-and-what-it-means-for-people-with-me-cfs-17-march-2020/ Coronavirus Covid-19: Latest Government advice and what it means for people with ME/CFS]<ref name="MEA17Mar20">{{Cite web|url=https://www.meassociation.org.uk/2020/03/coronavirus-covid-19-latest-government-advice-and-what-it-means-for-people-with-me-cfs-17-march-2020/|title=Coronavirus Covid-19: Latest Government advice and what it means for people with ME/CFS {{!}} 17 March 2020|last=Shepherd|first=Charles|authorlink=Charles Shepherd|last2=|first2=|authorlink2=|date=2020-03-17|website=ME Association|language=en-GB|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref>
*Mar 16, 2020, ME Association, [https://www.meassociation.org.uk/2020/03/me-association-guidance-coronavirus-covid-19-and-me-cfs-by-dr-charles-shepherd-16-march-2020/ ME Association Guidance: Coronavirus and ME/CFS by Dr Charles Shepherd]<ref name="MEA16Mar20">{{Cite web|url=https://www.meassociation.org.uk/2020/03/me-association-guidance-coronavirus-covid-19-and-me-cfs-by-dr-charles-shepherd-16-march-2020/|title=ME Association Guidance: Coronavirus and ME/CFS by Dr Charles Shepherd {{!}} 16 March 2020|last=Shepherd|first=Charles|authorlink=Charles Shepherd|last2=|first2=|authorlink2=|date=2020-03-16|website=ME Association|language=en-GB|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref>
*Mar 2020, 25% ME Group, [https://25megroup.org/download/1796/?v=3236 re Coronavirus and members of the 25% ME Group, Severe ME charity | Message from Dr Willy Weir and Dr Nigel Speight, Medical Advisor to 25% ME Group | Update to the advice given on 29 February 2020],<ref name="SpeightWeirMar20">{{Cite web|url=https://25megroup.org/download/1796/?v=3236|author-link=Nigel Speight|last=Speight|first=Nigel||last2=Weir|first2=William|author-link2=William Weir|title=re Coronavirus and members of the 25% ME Group, Severe ME charity {{!}} Message from Dr Willy Weir and Dr Nigel Speight, Medical Advisor to 25% ME Group {{!}} Update to the advice given on 29 February 2020 |date=Mar 2020|website=25megroup.org}}</ref>
*Mar 2020, 25% ME Group, [https://25megroup.org/download/1796/?v=3226 re Coronavirus and members of the 25% ME Group, Severe ME charity Types | Message from Dr Nigel Speight, Medical Advisor to 25% ME Group]<ref name="SpeightMar20">{{Cite web|url=https://25megroup.org/download/1796/?v=3226|author-link=Nigel Speight|last=Speight|first=Nigel|title=re Coronavirus and members of the 25% ME Group, Severe ME charity Types {{!}} Message from Dr Nigel Speight, Medical Advisor to 25% ME Group|date=Mar 2020|website=25megroup.org|others=[[William Weir]]}}</ref>

==Prevention==
[[File:CDC-Coronavirus-badge-300.png|thumb|upright=1|left|Image author: CDC|alt=image of Coronavirus Disease 2019 (COVID-19)|link=https://www.cdc.gov/coronavirus/2019-ncov/index.html]]
<br style="clear:both;line-height:0">
The SARS-CoV-2 coronavirus is an ''enveloped virus'', which means it is easier to kill outside the body than ''non-enveloped'' viruses like [[Coxsackievirus]], or [[Poliovirus]].<ref>{{Cite web|url=https://www.epa.gov/pesticides/coronavirus-cases-trigger-epa-rapid-response|title=Coronavirus Cases Trigger EPA Rapid Response|last=US Environmental Protection Agency|first=|authorlink=|last2=|first2=|authorlink2=|date=2020-01-29|website=US EPA|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref><ref>{{Cite journal|last=Firquet|first=Swan|author-link=|last2=Beaujard|first2=Sophie|author-link2=|last3=Lobert|first3=Pierre-Emmanuel|author-link3=|last4=Sané|first4=Famara|author-link4=|last5=Caloone|first5=Delphine|author-link5=|last6=Izard|first6=Daniel|author-link6=|last7=Hober|first7=Didier|last8=|first8=|date=June 2015|title=Survival of Enveloped and Non-Enveloped Viruses on Inanimate Surfaces|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4462923/|journal=Microbes and Environments|volume=30|issue=2|pages=140–144|doi=10.1264/jsme2.ME14145|issn=1342-6311|pmc=4462923|pmid=25843687|access-date=|quote=|via=}}</ref>
*[https://www.cdc.gov/coronavirus/2019-ncov/prepare/get-your-household-ready-for-COVID-19.html Get your Household Ready for COVID-19] - CDC
*[https://www.americanchemistry.com/Novel-Coronavirus-Fighting-Products-List.pdf Novel Coronavirus (COVID-19)-Fighting Products] - Center for Biocide Chemistries
*[https://www.health.gov.au/sites/default/files/documents/2020/03/coronavirus-covid-19-information-on-social-distancing.pdf Social distancing - Department of Health, Australia]

==== CDC advice ====
* Know How it Spreads
* Clean your hands often
* Avoid close contact
* Stay home if you're sick (may have the virus)
* Cover coughs and sneezes
* Wear a face mask if you are sick (may have the virus)
* Clean and disinfect
<i><div role="note" class="hatnote navigation-not-searchable">{{MediaWiki:Seealso/{{{lang|{{PAGELANGUAGE}}}}}}}{{colon}}
[https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html Coronavirus disease 19 Prevention - CDC]</div></i>

===<span id="high-touch">High touch surfaces: disinfect daily</span>===
[[File:High-touch surfaces-CDC-covid-19.png|alt=High-touch surfaces: disinfect daily. Tables, doorknobs, light switches, countertops, handles, desks, phones keyboards, remote controls, toilets, faucets, sinks, hard-backed chairs. Source: Coronavirus disease 19 Prevention - CDC, March 2020. Public domain image.|thumb|upright=0.7]]<br style="line-height:0" />
The CDC currently recommends people '''clean''' AND '''disinfect''' frequently touched surfaces daily:
<div style="column-count:2;-moz-column-count:2;-webkit-column-count:2">
*tables
*doorknobs
*light switches
*countertops
*handles
*desks
*phones
*keyboards
*remote controls
*toilets
*faucets
*sinks
*hard-backed chairs<ref name="CDC-prevention" /><ref name="CDC-suspectedcases">{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/prepare/cleaning-disinfection.html|title=Coronavirus Disease 2019 (COVID-19) - Environmental Cleaning and Disinfection Recommendations|last=CDC|first=|authorlink=Centers for Disease Control and Prevention|last2=|first2=|authorlink2=|date=2020-02-11|website=Centers for Disease Control and Prevention|language=en-us|archive-url=|archive-date=|dead-url=|access-date=2020-03-18}}</ref>
</div><br style="clear:both; line-height:0" />
:'''To clean use:'''
*Detergent or soap and water prior to disinfection. <ref name="CDC-prevention" />

:'''To disinfect use:'''
*[https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2 '''Disinfectants used against SARS-CoV-2'''] (list)
*'''Most common EPA-registered household disinfectants''' will work, or
* '''Diluted household bleach''' (mix: 5 tablespoons bleach per gallon of water, OR 4 teaspoons bleach per quart of water), or
*'''Alcohol solutions''' with at least 70% alcohol
:Follow manufacturer’s instructions for application and ''proper ventilation''. Check the product is not past its expiration date. ''(Updated Mar 18, 2020)''<ref name="CDC-prevention">{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html|title=Coronavirus Disease 2019 (COVID-19) – Prevention & Treatment|last=CDC|first=|authorlink=Centers for Disease Control and Prevention|last2=|first2=|authorlink2=|date=2020-03-16|website=Centers for Disease Control and Prevention|language=en-us|archive-url=|archive-date=|dead-url=|access-date=2020-03-17}}</ref>

:'''Check for updates:'''
* [https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html Coronavirus disease 19 Prevention - CDC]

'''Suspected or confirmed COVID-19 cases:'''<br />If possible the '''sick person''' should also clean:
<div style="column-count:2;-moz-column-count:2;-webkit-column-count:2">
*soiled items and surfaces (as needed)
*if a separate bathroom is not available, the bathroom should be cleaned and disinfected after each use by an ill person
*provide personal cleaning and disinfectant supplies in ill person's room (unless unsafe, e.g. they are a young child) - include tissues, paper towels, cleaners and EPA-registered disinfectants<ref name="CDC-prevention" /><ref name="CDC-suspectedcases" /></div>

===Coronavirus transmission from surfaces===
The new coronavirus can survive on different surfaces for hours or days:
*small airborne virus particles (aerosols) - 3 hours
*copper - 4 hours
*cardboard - 24 hours
*stainless steel - 2 to 3 days
*plastic - 2 to 3 days<ref name="stablesurfacesPRMar20">{{Cite web|url=https://www.nih.gov/news-events/news-releases/new-coronavirus-stable-hours-surfaces|title=New coronavirus stable for hours on surfaces|last=National Institutes of Health|first=|authorlink=National Institutes of Health|last2=|first2=|authorlink2=|date=2020-03-17|website=National Institutes of Health (NIH)|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-25}}</ref><ref name="Tellier2006">{{Cite journal|last=Tellier|first=Raymond|author-link=|last2=|first2=|author-link2=|last3=|first3=|author-link3=|last4=|first4=|author-link4=|last5=|first5=|author-link5=|last6=|first6=|author-link6=|last7=|first7=|last8=|first8=|date=Nov 2006|title=Review of Aerosol Transmission of Influenza A Virus|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3372341/|journal=Emerging Infectious Diseases|volume=12|issue=11|pages=1657–1662|doi=10.3201/eid1211.060426|issn=1080-6040|pmc=3372341|pmid=17283614|access-date=|quote=|via=}}</ref>

This means direct contact with an infected person is not needed to contact the illness.<ref name="stablesurfacesPRMar20" /> Surgical [[#facemasks|face masks]] have not been effective against aerosols in previous influenza outbreaks like swine flu, but N95 respirators have been effective.<ref name="Tellier2006" />

==<span id="someoneissick">Disinfecting your home if someone is sick</span>==
'''Suspected or confirmed COVID-19 cases:'''<br />
*'''Clean''' AND '''disinfect''' all [[#High-touch|high-touch]] areas daily.
If possible the '''sick person''' should also clean:
<div style="column-count:2;-moz-column-count:2;-webkit-column-count:2">
*soiled items and surfaces (as needed)
*if a separate bathroom is not available, the bathroom should be cleaned and disinfected after each use by an ill person
*provide personal cleaning and disinfectant supplies in ill person's room (unless unsafe, e.g. they are a young child) - include tissues, paper towels, cleaners and EPA-registered disinfectants<ref name="CDC-prevention" /><ref name="CDC-suspectedcases" /><ref name="CDCDisinfectYourHome">https://www.cdc.gov/coronavirus/2019-ncov/prepare/disinfecting-your-home.html</ref></div>
*<div role="note" class="hatnote navigation-not-searchable">Take additional steps covering '''soft surfaces, food, laundry, and trash'''{{colon}}
*[https://www.cdc.gov/coronavirus/2019-ncov/prepare/disinfecting-your-home.html Disinfecting your home if someone is sick - CDC]

==COVID-19 pneumonia==
Severe Acute Respiratory Infection (SARI) is the name for the type of pneumonia caused by COVID-19.<ref name="vitCtrial">{{Cite web|url=https://clinicaltrials.gov/ct2/show/NCT04264533|title=Vitamin C Infusion for the Treatment of Severe 2019-nCoV Infected Pneumonia - Full Text View - ClinicalTrials.gov|website=clinicaltrials.gov|language=en|access-date=2020-03-22}}</ref> A clinical trial is in progress to determine if intravenous [[vitamin C]] is an effective treatment for SARI.<ref name="vitCtrial" />

==Myth, Hoaxes, Scams and Fake News==
Many myths, hoaxes and fake news have been spreading, particularly on social media, some of which claim to be from doctors or health professionals.<ref name="WHOmyths">{{Cite web|url=https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters|title=Coronavirus 2019 {{!}} Myth busters|last=World Health Organization|first=|authorlink=World Health Organization|last2=|first2=|authorlink2=|date=|website=www.who.int|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-17}}</ref><ref name="BuzzfeedHoax3Mar20">{{Cite web|url=https://www.buzzfeednews.com/article/janelytvynenko/coronavirus-disinformation-spread|title=Here Are Some Of The Coronavirus Hoaxes That Spread In The First Few Weeks|website=BuzzFeed News|language=en|access-date=2020-03-17}}</ref> Scam include seeking fake cures or ineffective protective equipment like masks, scammers pretending to be from the World Health Organization asking for donations, or a stranger asking for money on behalf of a relative's medical bills.<ref name="FTC-scams">{{Cite web|url=https://www.consumer.ftc.gov/features/coronavirus-scams-what-ftc-doing|title=Coronavirus Scams: What the FTC is doing|last=FTC|first=|authorlink=|last2=|first2=|authorlink2=|date=2020-03-06|website=Consumer Information|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-17}}</ref><ref name="WHO-cybersecurity">{{Cite web|url=https://www.who.int/about/communications/cyber-security|title=Communications {{!}} Cybersecurity|last=World Health Organization|first=|authorlink=World Health Organization|last2=|first2=|authorlink2=|date=|website=www.who.int|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-17}}</ref>

*[https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters Coronavirus disease (COVID-19) advice for the public: Myth busters] - World Health Organization
*Mar 3, 2020 - [https://www.buzzfeednews.com/article/janelytvynenko/coronavirus-disinformation-spread Here Are Some Of The Coronavirus Hoaxes That Spread In The First Few Weeks] - Buzzfeed News
*Mar 2020 - [https://www.buzzfeednews.com/article/janelytvynenko/heres-a-running-list-of-the-latest-disinformation Here's A Running List Of The Latest Hoaxes Spreading About The Coronavirus] - Buzzfeed News
*[https://www.who.int/about/communications/cyber-security Cybersecurity - World Health Organization]
*[https://www.consumer.ftc.gov/features/coronavirus-scams-what-ftc-doing Coronavirus scams - What the FTC os doing]

==Posters for those self-isolating to avoid infection==
*[https://chronicallyawesome.org.uk/posters-for-those-who-are-self-isolating-as-a-preventative-measure/? Unofficial posters] stating where people should leave deliveries - Chronically Awesome

==Mental health ==
Anxiety around COVID-19 illness may cause anxiety or affect mental health.
*[https://www.nami.org/getattachment/About-NAMI/NAMI-News/2020/NAMI-Updates-on-the-Coronavirus/COVID-19-Updated-Guide-1.pdf?lang=en-US COVID-19 Guide - National Association of Mental Illness]
*[https://www.who.int/docs/default-source/coronaviruse/coping-with-stress.pdf?sfvrsn=9845bc3a_2 Coping with stress during the nCov-2019 outbreak (poster)] - World Health Organization

==News articles ==
*Mar 14, 2020, [https://www.cnn.com/2020/03/14/health/coronavirus-covid-19-flu-comparison-frieden-analysis/index.html Former CDC director: Covid-19 is different from flu and we must respond differently, Dr. Tom Frieden] - CNN

==Learn more==
'''Government Health Organizations'''
*[https://www.who.int/emergencies/diseases/novel-coronavirus-2019 Coronavirus disease 19 (COVID-19) - World Health Organization]
*[https://www.cdc.gov/coronavirus/2019-ncov/index.html Coronavirus disease 19 (COVID-19) - CDC]
*[https://www.nhs.uk/conditions/coronavirus-covid-19/ Coronavirus (COVID-19) - NHS]
*[https://www.who.int/gpsc/5may/Guide_to_Local_Production.pdf Guide to Local Production: WHO-recommended Handrub Formulations] - only for when soap and water is not available
*[https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public Protect yourself: Coronavirus disease 19 (COVID-19) - World Health Organization]
*[https://www.who.int/news-room/q-a-detail/q-a-coronaviruses Q&A on coronaviruses (COVID-19) - World Health Organization]
'''ME/CFS Organizations'''
*[https://www.meaction.net/covid-19/ COVID-19 Resources for People with ME - #MEAction]
*[https://www.meassociation.org.uk/2020/03/me-association-guidance-coronavirus-covid-19-update-09-march-2020/ ME Association Guidance: Coronavirus (covid-19) Update | 09 March 2020] - The ME Association
'''Media'''
* [https://www.nytimes.com/2020/02/29/health/coronavirus-reinfection.html They Recovered From the Coronavirus. Were They Infected Again?] - NY Times

==See also ==
*[[Postviral fatigue syndrome]] (PVFS)
*[[Myalgic encephalomyelitis]]
*[[Severe Acute Respiratory Syndrome]]

==References ==
{{Reflist}}

[[Category:Infectious agents]]
[[Category:Triggers and risk factors]]
[[Category:Virology]]
[[Category:Viruses]]
[[Category:Coronaviruses]]

Coronavirus disease 19

2020-03-29T11:20:45Z

Loopy:/* Emergency Warning Signs* */ il

'''Coronavirus disease 19''', commonly known as '''COVID-19''', is the airborne infectious respiratory illness caused by the novel (new) [[SARS-CoV-2 coronavirus]] (severe acute respiratory syndrome 2), previously known as ''n-2019-nCoV''.<ref name="WHO-QA">{{Cite web|url=https://www.who.int/news-room/q-a-detail/q-a-coronaviruses|title=Q&A on coronaviruses (COVID-19)|last=World Health Organization|first=|authorlink=World Health Organization|last2=|first2=|authorlink2=|date=|website=www.who.int|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-16}}</ref><ref name="CDC-coronoviruses">{{Cite web|url=https://www.cdc.gov/coronavirus/types.html|title=Human Coronavirus Types|last=Centers for Disease Control and Prevention|first=|authorlink=Centers for Disease Control and Prevention|last2=|first2=|authorlink2=|date=2020-02-27|website=www.cdc.gov|language=en-us|archive-url=|archive-date=|dead-url=|access-date=2020-03-16}}</ref><ref>{{Cite journal|last=Li|first=Guangdi|author-link=|last2=Clercq|first2=Erik De|author-link2=|last3=|first3=|author-link3=|last4=|first4=|author-link4=|last5=|first5=|author-link5=|last6=|first6=|author-link6=|last7=|first7=|last8=|first8=|date=Mar 2020|title=Therapeutic options for the 2019 novel coronavirus (2019-nCoV)|url=https://www.nature.com/articles/d41573-020-00016-0|journal=Nature Reviews Drug Discovery|language=en|volume=19|issue=3|pages=149–150|doi=10.1038/d41573-020-00016-0|pmc=|pmid=|access-date=|quote=|via=}}</ref><ref>{{Cite web|url=https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/naming-the-coronavirus-disease-(covid-2019)-and-the-virus-that-causes-it|title=Naming the coronavirus disease (COVID-19) and the virus that causes it|website=www.who.int|language=en|access-date=2020-03-28}}</ref>
[[File:Covid-19-lung-lesions.jpg|thumb|left|alt=Computer-aided identification of lesions on the lungs of COVID-19 patients.|'''COVID-19 can cause lesions on lungs, and pneumonia.'''<br>Author: [https://www.sciencedirect.com/science/article/pii/S2095177920302264 Shen et al. 2020. Journal of Pharmaceutical Analysis]. Copyright: CC-BY-NC-ND-4.0]]{{clear}}
COVID-19 was first identified in Wuhan, China, in December 2019,<ref name="WHO-QA" /> and can infect babies, children, and adults of any age.<ref>{{Cite journal|last=Wei|first=Min|last2=Yuan|first2=Jingping|last3=Liu|first3=Yu|last4=Fu|first4=Tao|last5=Yu|first5=Xue|last6=Zhang|first6=Zhi-Jiang|date=2020-02-14|title=Novel Coronavirus Infection in Hospitalized Infants Under 1 Year of Age in China|url=https://jamanetwork.com/journals/jama/fullarticle/2761659|journal=JAMA|language=en|doi=10.1001/jama.2020.2131}}</ref> It spread globally, resulting in the 2019-2020 coronavirus pandemic.<ref>{{Cite journal|last=Hui|first=David S.|last2=Azhar|first2=Esam I.|last3=Madani|first3=Tariq A.|last4=Ntoumi|first4=Francine|last5=Kock|first5=Richard|last6=Dar|first6=Osman|last7=Ippolito|first7=Giuseppe|last8=Mchugh|first8=Timothy D.|last9=Memish|first9=Ziad A.|date=2020-02-01|title=The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health — The latest 2019 novel coronavirus outbreak in Wuhan, China|url=https://www.ijidonline.com/article/S1201-9712(20)30011-4/abstract|journal=International Journal of Infectious Diseases|language=English|volume=91|pages=264–266|doi=10.1016/j.ijid.2020.01.009|issn=1201-9712|pmid=31953166}}</ref><ref>{{Cite web|url=https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020|title=WHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020|website=www.who.int|language=en|access-date=2020-03-28}}</ref>

== Symptoms ==
Symptoms are usually mild and begin gradually, although around 1 in 6 people with COVID-19 need medical help.<ref name="WHO-QA" /> Some people become infected but don't develop any symptoms and don't feel unwell.<ref name=":0">{{Cite web||last=World Health Organization|first=|authorlink=World Health Organization|url=https://www.who.int/news-room/q-a-detail/q-a-coronaviruses|title=Q&A on coronaviruses (COVID-19)|website=www.who.int|language=en|access-date=2020-03-24}}</ref> These symptoms may appear 1-14 days after exposure; most commonly around five days.<ref name=":0" /><ref name=":1">{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html|title=Coronavirus Disease 2019 (COVID-19) – Symptoms|last=CDC|date=2020-03-20||author-link=Centers for Disease Control|website=Centers for Disease Control and Prevention|language=en-us|access-date=2020-03-24}}</ref>

=== Common Symptoms ===
* [[fever]]
* tiredness
* continuous cough, coughing episodes or a dry [[cough|cough,]]<ref>{{Cite web|url=https://www.nhs.uk/conditions/coronavirus-covid-19/symptoms-and-what-to-do/|title=Symptoms and what to do - Coronavirus (COVID-19)|last=National Health Service|first=|authorlink=National Health Service|last2=|first2=|authorlink2=|date=2020-03-24|website=nhs.uk|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-26}}</ref><ref name=":0" /> or [[Dyspnea|shortness of breath]]<ref name=":1" />
Most patients only have one or two of the common symptoms.<ref name=":0" /><ref name=":3">{{Cite journal|last=Mizumoto|first=Kenji|last2=Kagaya|first2=Katsushi|last3=Zarebski|first3=Alexander|last4=Chowell|first4=Gerardo|date=2020-03-12|title=Estimating the asymptomatic proportion of coronavirus disease 2019 (COVID-19) cases on board the Diamond Princess cruise ship, Yokohama, Japan, 2020|url=https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.10.2000180|journal=Eurosurveillance|language=en|volume=25|issue=10|pages=2000180|doi=10.2807/1560-7917.ES.2020.25.10.2000180|issn=1560-7917|pmc=PMC7078829|pmid=32183930}}</ref><ref name="Lan2020" />

=== Other Symptoms ===
* aches and [[Pain|pains]]
* nasal congestion
* runny nose
* [[sore throat]]
* [[diarrhea]]<ref name=":0" />

=== Emergency Warning Signs* ===
* trouble breathing
* [[Chest pain|persistent pain or pressure in the chest]]
* new [[confusion]] or inability to arouse (unresponsive)
* bluish lips or face<ref name=":1" />
<nowiki>*</nowiki>This list is not all inclusive. Consult your medical provider for any other symptoms that are severe or concerning.<ref name=":1" />

Additionally, there are reports that patients have lost or have a reduced [[sense of smell]], or [[Changes in taste|lost or distorted of taste]], but are otherwise [[#asymptomaticcarriers|asymptomatic]].<ref name=":2">{{Cite news|url=https://www.nytimes.com/2020/03/22/health/coronavirus-symptoms-smell-taste.html|title=Lost Sense of Smell May Be Peculiar Clue to Coronavirus Infection|last=Rabin|first=Roni Caryn|date=2020-03-22|work=The New York Times|access-date=2020-03-24|language=en-US|issn=0362-4331}}</ref><blockquote>The American Academy of Otolaryngology on Sunday posted information on its website<ref>{{Cite web|url=https://www.entnet.org/content/coronavirus-disease-2019-resources|title=Coronavirus Disease 2019: Resources|last=American Academy of Otolaryngology|date=2020-03-15|website=American Academy of Otolaryngology-Head and Neck Surgery|language=en|access-date=2020-03-24}}</ref> saying that mounting anecdotal evidence indicates that lost or reduced sense of smell and loss of [[Sense of taste|taste]] are significant symptoms associated with Covid-19, and that they have been seen in patients who ultimately tested positive with no other symptoms.<ref name=":2" /></blockquote><blockquote>The symptoms, in the absence of allergies or sinusitis, should alert doctors to screen patients for the virus and “warrant serious consideration for self isolation and testing of these individuals,” the academy said.<ref name=":2" /></blockquote>

==<span id="asymptomaticcarriers">Asymptomatic carriers</span>==
[[File:Covid-19-virus.png|thumb|upright=0.4|'''The SARS-CoV-2 virus causes COVID-19.'''<br>Author: CDC]]
A number of studies have found that some people who test positive for COVID-19 do not have any symptoms of illness or a raised temperature, and have normal blood test results, but are able to infect others, some of whom developed severe COVID-19 [[pneumonia]] as a result of COVID-19.<ref name="Bai2020">{{Cite journal|last=Bai|first=Yan|last2=Yao|first2=Lingsheng|last3=Wei|first3=Tao|last4=Tian|first4=Fei|last5=Jin|first5=Dong-Yan|last6=Chen|first6=Lijuan|last7=Wang|first7=Meiyun|date=2020-02-21|title=Presumed Asymptomatic Carrier Transmission of COVID-19|url=https://jamanetwork.com/journals/jama/fullarticle/2762028|journal=JAMA|language=en|doi=10.1001/jama.2020.2565}}</ref><ref name="Chan2019">{{Cite journal|last=Chan|first=Jasper Fuk-Woo|last2=Yuan|first2=Shuofeng|last3=Kok|first3=Kin-Hang|last4=To|first4=Kelvin Kai-Wang|last5=Chu|first5=Hin|last6=Yang|first6=Jin|last7=Xing|first7=Fanfan|last8=Liu|first8=Jieling|last9=Yip|first9=Cyril Chik-Yan|date=2020-02-15|title=A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster|url=https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30154-9/abstract|journal=The Lancet|language=English|volume=395|issue=10223|pages=514–523|doi=10.1016/S0140-6736(20)30154-9|issn=0140-6736|pmid=31986261}}</ref><ref name="delRio2020">{{Cite journal|last=del Rio|first=Carlos|author-link=|last2=Malani|first2=Preeti N.|author-link2=|last3=|first3=|author-link3=|last4=|first4=|author-link4=|last5=|first5=|author-link5=|last6=|first6=|author-link6=|last7=|first7=|last8=|first8=|date=2020-02-28|title=COVID-19—New Insights on a Rapidly Changing Epidemic|url=https://jamanetwork.com/journals/jama/fullarticle/2762510|journal=JAMA|language=en|volume=|issue=|pages=|doi=10.1001/jama.2020.3072|pmc=|pmid=|access-date=|quote=|via=}}</ref> Some asymptomatic carriers have abnormal chest CT scans, and some do not. False negative tests have also been reported.<ref name="Bai2020" /><ref name="Chan2019" />

Estimates of the number of asymptomatic carriers vary wildly. Mizumoto et al. (2020) estimated that asymptomatic carriers accounted for 17.9% of the COVID-19 positive people on the ''Diamond Princess'' cruise ship, which was quarantined for 14 day after a previous passenger developed the illness.<ref name=":3" />

==<span id="recovered">Recovered patients testing positive</span>==
Lan et al (2020) identified a group of 4 recovered patients who continued to test positive for COVID-19 after recovery; suggesting that they may still be infectious.<ref name="Lan2020">{{Cite journal|last=Lan|first=Lan|last2=Xu|first2=Dan|last3=Ye|first3=Guangming|last4=Xia|first4=Chen|last5=Wang|first5=Shaokang|last6=Li|first6=Yirong|last7=Xu|first7=Haibo|date=2020-02-27|title=Positive RT-PCR Test Results in Patients Recovered From COVID-19|url=https://jamanetwork.com/journals/jama/fullarticle/2762452|journal=JAMA|language=en|doi=10.1001/jama.2020.2783}}</ref> It is not known whether patients who have recovered may be reinfected later, or whether those who later needed treatment actually relapsed, or if recovered patients who later test positive do so because of issues with the diagnostic test's accuracy.<ref>{{Cite web|url=https://www.snopes.com/fact-check/covid-19-reinfection/|title=Can People Who Recover from COVID-19 Become Reinfected?|website=Snopes.com|language=en-US|access-date=2020-03-26}}</ref> Another study found group of 5 recovered patients were found to have reactivated COVID-19.<ref>{{Cite journal|last=Ye|first=Guangming|last2=Pan|first2=Zhenyu|last3=Pan|first3=Yunbao|last4=Deng|first4=Qiaoling|last5=Chen|first5=Liangjun|last6=Li|first6=Jin|last7=Li|first7=Yirong|last8=Wang|first8=Xinghuan|date=2020-03-11|title=Clinical characteristics of severe acute respiratory syndrome coronavirus 2 reactivation|url=https://www.journalofinfection.com/article/S0163-4453(20)30114-6/abstract|journal=Journal of Infection|language=English|volume=0|issue=0|doi=10.1016/j.jinf.2020.03.001|issn=0163-4453|pmid=32171867}}</ref>

==ME/CFS==

{{Video|id=pkGXiJ1jM14|service=youtube|dimensions=550|description=COVID-19 and ME/CFS - Dr Nancy Klimas, Mar 13, 2020|alignment=left|urlargs=}}

{{clear}}

====<span id="catchingcovid19">Risk of COVID-19 in patients with ME/CFS</span>====
There is a lack of evidence about ME/CFS patients developing COVID-19 illness; but a number of medical advisors have given their expert opinions on this. Immunologist and [[Myalgic encephalomyelitis|ME]] researcher Dr [[Nancy Klimas]] has said she believes people with ME/CFS are at a little higher risk of developing COVID-19 after exposure to the virus;<ref name="Klimas20200313">{{Cite web|url=https://www.youtube.com/watch?v=pkGXiJ1jM14|title=COVID-19 and ME/CFS - Dr Nancy Klimas, Mar 13, 2020|last=Klimas|first=Nancy|date=2020-03-13|work=|access-date=Mar 24, 2020|archive-url=|archive-date=|dead-url=|quote=|author-link=Nancy Klimas}}</ref> Dr [[Nigel Speight]], Dr [[William Weir]] and Dr [[Charles Shepherd]] have said they do not think there is an increased risk.<ref name="SpeightWeirMar20" /><ref name="SpeightMar20" /><ref name="MEA16Mar20" /> Klimas, Speight, Weir and Shepherd have all advised ME/CFS patients to take additional precautions, and highlighted that there is a risk of ME/CFS becoming significantly worse after viral infections.<ref name="Klimas20200313" /><ref name="SpeightWeirMar20" /><ref name="SpeightMar20" /><ref name="MEA16Mar20" />

ME/CFS includes [[:Category:Immune signs and symptoms|immune symptoms]] including a [[sore throat]], [[swollen lymph nodes]], and [[flu-like symptoms]], but patients are generally not considered to be severely immunocompromised, and immunosuppressant medications are unlikely to be used by most ME/CFS patients. <ref name="Klimas20200313" /> <ref name="canadianconsensus">{{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
| url = http://www.investinme.org/Documents/PDFdocuments/CanadianDefinitionME-CFS.pdf
}}</ref><ref name="ICP2011primer">{{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> This means most ME/CFS patients would not be considered to be at very high risk of COVID-19 illness.<ref name="Klimas20200313" />

* '''<span id="ibuprofen">[[Ibuprofen]]</span>''' - Ibuprofen drugs (Nurofen, Bruprofen, Advil, Midol, Motrin, Motrin) are anti-inflammatories commonly used for cold/flu symptoms and for ME/CFS. There have been some reports that ibuprofen taken for COVID-19 may prolong the illness and increase it's severity. Several countries including the UK and France now recommend that people with suspected or confirmed COVID-19 avoid ibuprofen and '''use paracetamol / acetaminophen''' (e.g., Tylenol) instead, although the evidence for this is relatively limited.<ref name="MEA16Mar20" /><ref name="Day20200317">{{Cite journal|last=Day|first=Michael|date=2020-03-17|title=Covid-19: ibuprofen should not be used for managing symptoms, say doctors and scientists|url=https://www.bmj.com/content/368/bmj.m1086|journal=BMJ|language=en|volume=368|doi=10.1136/bmj.m1086|issn=1756-1833|pmid=32184201}}</ref><ref>{{Cite web|url=https://www.nhs.uk/conditions/coronavirus-covid-19/self-isolation-advice/|title=Stay at home advice - Coronavirus (COVID-19)|last=National Health Service|first=|authorlink=National Health Service|last2=|first2=|authorlink2=|date=2020-02-28|website=nhs.uk|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref> There is no suggestion that ibuprofen affects the risk of catching COVID-19.
* '''[[Rituximab]]''' - The MS Society has stated that taking rituximab, which has been used in clinical trials for ME/CFS, may affect the risk of catching COVID-19.<ref name="Covid-19-MS">{{Cite web|url=https://www.mssociety.org.uk/about-ms/treatments-and-therapies/disease-modifying-therapies/covid-19-coronavirus-and-ms|title=COVID-19 coronavirus and MS|last=MS Society|first=|authorlink=|last2=|first2=|authorlink2=|date=|website=www.mssociety.org.uk|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref><ref>{{Cite web|url=https://renal.org/wp-content/uploads/2020/03/BAPN-COVID-19-patient-info-for-HD.PD_.Immunosuppression-17March20.pdf|title=Coronavirus (SARS-CoV-2) and its associated illness (COVID-19) {{!}} Information and Guidance for Children on Haemodialysis, Peritoneal Dialysis and Immune suppression (including Renal Transplants)|last=Renal Association|first=|authorlink=|last2=|first2=|authorlink2=|date=2020-03-17|website=renal.org|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref>
* '''[[Ampligen]]''' - Ampligen or ''rintatolimod'' is sometimes used by ME/CFS patients, it is an [[antiviral]] immunostimulant rather than immunosuppressing drug, and is being tested for the treatment of COVID-19 illness in Japan.<ref>{{Cite web|url=https://adisinsight.springer.com/drugs/800001203|title=Rintatolimod - AIM ImmunoTech - AdisInsight|website=adisinsight.springer.com|access-date=2020-03-23}}</ref> There is no information about whether it may help prevent COVID-19 in ME/CFS patients.
*The unproven [[autoimmune hypothesis]] states that a subtype of ME involves autoimmunity, which is an overactive immune system rather than a weakened immune response.<ref name="OMF2018research">{{Cite web|url=https://www.omf.ngo/2018/02/28/omf-funded-research-t-cells-molecular-immunology/|title=OMF-funded research: T cells and molecular immunology|last=Open Medicine Foundation|first=|authorlink=Open Medicine Foundation|last2=|first2=|authorlink2=|date=Feb 28, 2018|website=Open Medicine Foundation|language=en-US|archive-url=|archive-date=|dead-url=|access-date=2019-07-11}}</ref>
{{Quote box|I have now reached the conclusion that people with pre-existing health conditions that make them more vulnerable to lung complications (which may or may not be the case with ME/CFS – at this stage we just don’t know), or have a condition like ME/CFS where an infection such as this will almost certainly cause a relapse, or significant exacerbation of symptoms, need to be doing far more to protect themselves, and to socially distance themselves from other people, than official NHS guidance indicates.

In particular, for those who are not housebound, this applies to social mobility and what you can do (and cannot do) if you decide to leave your home.<ref name="MEA16Mar20"/>|author=[[Charles Shepherd]], ME Association|date=Mar 16, 2020|title=Advice from the UK's ME Association}}

====<span id="deathrisk">Risk of death or serious complications in ME/CFS patients</span>====
{{Quote box|Although ME is a "chronic condition" my gut feeling is that they are not actually at greater risk of dying from the virus itself than healthy people. The conditions which put people at extra risk would be things like severe asthma or COPD, or immunosuppressed people eg those on chemotherapy for cancer.

The biggest worry therefore for ME sufferers is that catching the virus will make their ME much worse, and of course people in the 25% group do not have much leeway.

It might even be that worsening of their already severe ME could be a bigger threat to life than the virus itself.<ref name="SpeightMar20" />|author=[[Nigel Speight]]|date=Mar 2020|title=25% ME Group for Severe ME}}

====<span id="triggerforME">Risk of developing ME/CFS after COVID-19</span>====
ME/CFS has been linked to many different viruses, but it is not known what the likelihood is of developing ME/CFS after COVID-19 illness.
{{See also|Postviral fatigue syndrome}}

==ME/CFS charity medical advisors COVID-19 statements==
*Mar 17, 2020, ME Association, [https://www.meassociation.org.uk/2020/03/coronavirus-covid-19-latest-government-advice-and-what-it-means-for-people-with-me-cfs-17-march-2020/ Coronavirus Covid-19: Latest Government advice and what it means for people with ME/CFS]<ref name="MEA17Mar20">{{Cite web|url=https://www.meassociation.org.uk/2020/03/coronavirus-covid-19-latest-government-advice-and-what-it-means-for-people-with-me-cfs-17-march-2020/|title=Coronavirus Covid-19: Latest Government advice and what it means for people with ME/CFS {{!}} 17 March 2020|last=Shepherd|first=Charles|authorlink=Charles Shepherd|last2=|first2=|authorlink2=|date=2020-03-17|website=ME Association|language=en-GB|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref>
*Mar 16, 2020, ME Association, [https://www.meassociation.org.uk/2020/03/me-association-guidance-coronavirus-covid-19-and-me-cfs-by-dr-charles-shepherd-16-march-2020/ ME Association Guidance: Coronavirus and ME/CFS by Dr Charles Shepherd]<ref name="MEA16Mar20">{{Cite web|url=https://www.meassociation.org.uk/2020/03/me-association-guidance-coronavirus-covid-19-and-me-cfs-by-dr-charles-shepherd-16-march-2020/|title=ME Association Guidance: Coronavirus and ME/CFS by Dr Charles Shepherd {{!}} 16 March 2020|last=Shepherd|first=Charles|authorlink=Charles Shepherd|last2=|first2=|authorlink2=|date=2020-03-16|website=ME Association|language=en-GB|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref>
*Mar 2020, 25% ME Group, [https://25megroup.org/download/1796/?v=3236 re Coronavirus and members of the 25% ME Group, Severe ME charity | Message from Dr Willy Weir and Dr Nigel Speight, Medical Advisor to 25% ME Group | Update to the advice given on 29 February 2020],<ref name="SpeightWeirMar20">{{Cite web|url=https://25megroup.org/download/1796/?v=3236|author-link=Nigel Speight|last=Speight|first=Nigel||last2=Weir|first2=William|author-link2=William Weir|title=re Coronavirus and members of the 25% ME Group, Severe ME charity {{!}} Message from Dr Willy Weir and Dr Nigel Speight, Medical Advisor to 25% ME Group {{!}} Update to the advice given on 29 February 2020 |date=Mar 2020|website=25megroup.org}}</ref>
*Mar 2020, 25% ME Group, [https://25megroup.org/download/1796/?v=3226 re Coronavirus and members of the 25% ME Group, Severe ME charity Types | Message from Dr Nigel Speight, Medical Advisor to 25% ME Group]<ref name="SpeightMar20">{{Cite web|url=https://25megroup.org/download/1796/?v=3226|author-link=Nigel Speight|last=Speight|first=Nigel|title=re Coronavirus and members of the 25% ME Group, Severe ME charity Types {{!}} Message from Dr Nigel Speight, Medical Advisor to 25% ME Group|date=Mar 2020|website=25megroup.org|others=[[William Weir]]}}</ref>

==Prevention==
[[File:CDC-Coronavirus-badge-300.png|thumb|upright=1|left|Image author: CDC|alt=image of Coronavirus Disease 2019 (COVID-19)|link=https://www.cdc.gov/coronavirus/2019-ncov/index.html]]
<br style="clear:both;line-height:0">
The SARS-CoV-2 coronavirus is an ''enveloped virus'', which means it is easier to kill outside the body than ''non-enveloped'' viruses like [[Coxsackievirus]], or [[Poliovirus]].<ref>{{Cite web|url=https://www.epa.gov/pesticides/coronavirus-cases-trigger-epa-rapid-response|title=Coronavirus Cases Trigger EPA Rapid Response|last=US Environmental Protection Agency|first=|authorlink=|last2=|first2=|authorlink2=|date=2020-01-29|website=US EPA|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref><ref>{{Cite journal|last=Firquet|first=Swan|author-link=|last2=Beaujard|first2=Sophie|author-link2=|last3=Lobert|first3=Pierre-Emmanuel|author-link3=|last4=Sané|first4=Famara|author-link4=|last5=Caloone|first5=Delphine|author-link5=|last6=Izard|first6=Daniel|author-link6=|last7=Hober|first7=Didier|last8=|first8=|date=June 2015|title=Survival of Enveloped and Non-Enveloped Viruses on Inanimate Surfaces|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4462923/|journal=Microbes and Environments|volume=30|issue=2|pages=140–144|doi=10.1264/jsme2.ME14145|issn=1342-6311|pmc=4462923|pmid=25843687|access-date=|quote=|via=}}</ref>
*[https://www.cdc.gov/coronavirus/2019-ncov/prepare/get-your-household-ready-for-COVID-19.html Get your Household Ready for COVID-19] - CDC
*[https://www.americanchemistry.com/Novel-Coronavirus-Fighting-Products-List.pdf Novel Coronavirus (COVID-19)-Fighting Products] - Center for Biocide Chemistries
*[https://www.health.gov.au/sites/default/files/documents/2020/03/coronavirus-covid-19-information-on-social-distancing.pdf Social distancing - Department of Health, Australia]

==== CDC advice ====
* Know How it Spreads
* Clean your hands often
* Avoid close contact
* Stay home if you're sick (may have the virus)
* Cover coughs and sneezes
* Wear a face mask if you are sick (may have the virus)
* Clean and disinfect
<i><div role="note" class="hatnote navigation-not-searchable">{{MediaWiki:Seealso/{{{lang|{{PAGELANGUAGE}}}}}}}{{colon}}
[https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html Coronavirus disease 19 Prevention - CDC]</div></i>

===<span id="high-touch">High touch surfaces: disinfect daily</span>===
[[File:High-touch surfaces-CDC-covid-19.png|alt=High-touch surfaces: disinfect daily. Tables, doorknobs, light switches, countertops, handles, desks, phones keyboards, remote controls, toilets, faucets, sinks, hard-backed chairs. Source: Coronavirus disease 19 Prevention - CDC, March 2020. Public domain image.|thumb|upright=0.7]]<br style="line-height:0" />
The CDC currently recommends people '''clean''' AND '''disinfect''' frequently touched surfaces daily:
<div style="column-count:2;-moz-column-count:2;-webkit-column-count:2">
*tables
*doorknobs
*light switches
*countertops
*handles
*desks
*phones
*keyboards
*remote controls
*toilets
*faucets
*sinks
*hard-backed chairs<ref name="CDC-prevention" /><ref name="CDC-suspectedcases">{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/prepare/cleaning-disinfection.html|title=Coronavirus Disease 2019 (COVID-19) - Environmental Cleaning and Disinfection Recommendations|last=CDC|first=|authorlink=Centers for Disease Control and Prevention|last2=|first2=|authorlink2=|date=2020-02-11|website=Centers for Disease Control and Prevention|language=en-us|archive-url=|archive-date=|dead-url=|access-date=2020-03-18}}</ref>
</div><br style="clear:both; line-height:0" />
:'''To clean use:'''
*Detergent or soap and water prior to disinfection. <ref name="CDC-prevention" />

:'''To disinfect use:'''
*[https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2 '''Disinfectants used against SARS-CoV-2'''] (list)
*'''Most common EPA-registered household disinfectants''' will work, or
* '''Diluted household bleach''' (mix: 5 tablespoons bleach per gallon of water, OR 4 teaspoons bleach per quart of water), or
*'''Alcohol solutions''' with at least 70% alcohol
:Follow manufacturer’s instructions for application and ''proper ventilation''. Check the product is not past its expiration date. ''(Updated Mar 18, 2020)''<ref name="CDC-prevention">{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html|title=Coronavirus Disease 2019 (COVID-19) – Prevention & Treatment|last=CDC|first=|authorlink=Centers for Disease Control and Prevention|last2=|first2=|authorlink2=|date=2020-03-16|website=Centers for Disease Control and Prevention|language=en-us|archive-url=|archive-date=|dead-url=|access-date=2020-03-17}}</ref>

:'''Check for updates:'''
* [https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html Coronavirus disease 19 Prevention - CDC]

'''Suspected or confirmed COVID-19 cases:'''<br />If possible the '''sick person''' should also clean:
<div style="column-count:2;-moz-column-count:2;-webkit-column-count:2">
*soiled items and surfaces (as needed)
*if a separate bathroom is not available, the bathroom should be cleaned and disinfected after each use by an ill person
*provide personal cleaning and disinfectant supplies in ill person's room (unless unsafe, e.g. they are a young child) - include tissues, paper towels, cleaners and EPA-registered disinfectants<ref name="CDC-prevention" /><ref name="CDC-suspectedcases" /></div>

===Coronavirus transmission from surfaces===
The new coronavirus can survive on different surfaces for hours or days:
*small airborne virus particles (aerosols) - 3 hours
*copper - 4 hours
*cardboard - 24 hours
*stainless steel - 2 to 3 days
*plastic - 2 to 3 days<ref name="stablesurfacesPRMar20">{{Cite web|url=https://www.nih.gov/news-events/news-releases/new-coronavirus-stable-hours-surfaces|title=New coronavirus stable for hours on surfaces|last=National Institutes of Health|first=|authorlink=National Institutes of Health|last2=|first2=|authorlink2=|date=2020-03-17|website=National Institutes of Health (NIH)|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-25}}</ref><ref name="Tellier2006">{{Cite journal|last=Tellier|first=Raymond|author-link=|last2=|first2=|author-link2=|last3=|first3=|author-link3=|last4=|first4=|author-link4=|last5=|first5=|author-link5=|last6=|first6=|author-link6=|last7=|first7=|last8=|first8=|date=Nov 2006|title=Review of Aerosol Transmission of Influenza A Virus|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3372341/|journal=Emerging Infectious Diseases|volume=12|issue=11|pages=1657–1662|doi=10.3201/eid1211.060426|issn=1080-6040|pmc=3372341|pmid=17283614|access-date=|quote=|via=}}</ref>

This means direct contact with an infected person is not needed to contact the illness.<ref name="stablesurfacesPRMar20" /> Surgical [[#facemasks|face masks]] have not been effective against aerosols in previous influenza outbreaks like swine flu, but N95 respirators have been effective.<ref name="Tellier2006" />

==<span id="someoneissick">Disinfecting your home if someone is sick</span>==
'''Suspected or confirmed COVID-19 cases:'''<br />
*'''Clean''' AND '''disinfect''' all [[#High-touch|high-touch]] areas daily.
If possible the '''sick person''' should also clean:
<div style="column-count:2;-moz-column-count:2;-webkit-column-count:2">
*soiled items and surfaces (as needed)
*if a separate bathroom is not available, the bathroom should be cleaned and disinfected after each use by an ill person
*provide personal cleaning and disinfectant supplies in ill person's room (unless unsafe, e.g. they are a young child) - include tissues, paper towels, cleaners and EPA-registered disinfectants<ref name="CDC-prevention" /><ref name="CDC-suspectedcases" /><ref name="CDCDisinfectYourHome">https://www.cdc.gov/coronavirus/2019-ncov/prepare/disinfecting-your-home.html</ref></div>
*<div role="note" class="hatnote navigation-not-searchable">Take additional steps covering '''soft surfaces, food, laundry, and trash'''{{colon}}
*[https://www.cdc.gov/coronavirus/2019-ncov/prepare/disinfecting-your-home.html Disinfecting your home if someone is sick - CDC]

==COVID-19 pneumonia==
Severe Acute Respiratory Infection (SARI) is the name for the type of pneumonia caused by COVID-19.<ref name="vitCtrial">{{Cite web|url=https://clinicaltrials.gov/ct2/show/NCT04264533|title=Vitamin C Infusion for the Treatment of Severe 2019-nCoV Infected Pneumonia - Full Text View - ClinicalTrials.gov|website=clinicaltrials.gov|language=en|access-date=2020-03-22}}</ref> A clinical trial is in progress to determine if intravenous [[vitamin C]] is an effective treatment for SARI.<ref name="vitCtrial" />

==Myth, Hoaxes, Scams and Fake News==
Many myths, hoaxes and fake news have been spreading, particularly on social media, some of which claim to be from doctors or health professionals.<ref name="WHOmyths">{{Cite web|url=https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters|title=Coronavirus 2019 {{!}} Myth busters|last=World Health Organization|first=|authorlink=World Health Organization|last2=|first2=|authorlink2=|date=|website=www.who.int|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-17}}</ref><ref name="BuzzfeedHoax3Mar20">{{Cite web|url=https://www.buzzfeednews.com/article/janelytvynenko/coronavirus-disinformation-spread|title=Here Are Some Of The Coronavirus Hoaxes That Spread In The First Few Weeks|website=BuzzFeed News|language=en|access-date=2020-03-17}}</ref> Scam include seeking fake cures or ineffective protective equipment like masks, scammers pretending to be from the World Health Organization asking for donations, or a stranger asking for money on behalf of a relative's medical bills.<ref name="FTC-scams">{{Cite web|url=https://www.consumer.ftc.gov/features/coronavirus-scams-what-ftc-doing|title=Coronavirus Scams: What the FTC is doing|last=FTC|first=|authorlink=|last2=|first2=|authorlink2=|date=2020-03-06|website=Consumer Information|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-17}}</ref><ref name="WHO-cybersecurity">{{Cite web|url=https://www.who.int/about/communications/cyber-security|title=Communications {{!}} Cybersecurity|last=World Health Organization|first=|authorlink=World Health Organization|last2=|first2=|authorlink2=|date=|website=www.who.int|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-17}}</ref>

*[https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters Coronavirus disease (COVID-19) advice for the public: Myth busters] - World Health Organization
*Mar 3, 2020 - [https://www.buzzfeednews.com/article/janelytvynenko/coronavirus-disinformation-spread Here Are Some Of The Coronavirus Hoaxes That Spread In The First Few Weeks] - Buzzfeed News
*Mar 2020 - [https://www.buzzfeednews.com/article/janelytvynenko/heres-a-running-list-of-the-latest-disinformation Here's A Running List Of The Latest Hoaxes Spreading About The Coronavirus] - Buzzfeed News
*[https://www.who.int/about/communications/cyber-security Cybersecurity - World Health Organization]
*[https://www.consumer.ftc.gov/features/coronavirus-scams-what-ftc-doing Coronavirus scams - What the FTC os doing]

==Posters for those self-isolating to avoid infection==
*[https://chronicallyawesome.org.uk/posters-for-those-who-are-self-isolating-as-a-preventative-measure/? Unofficial posters] stating where people should leave deliveries - Chronically Awesome

==Mental health ==
Anxiety around COVID-19 illness may cause anxiety or affect mental health.
*[https://www.nami.org/getattachment/About-NAMI/NAMI-News/2020/NAMI-Updates-on-the-Coronavirus/COVID-19-Updated-Guide-1.pdf?lang=en-US COVID-19 Guide - National Association of Mental Illness]
*[https://www.who.int/docs/default-source/coronaviruse/coping-with-stress.pdf?sfvrsn=9845bc3a_2 Coping with stress during the nCov-2019 outbreak (poster)] - World Health Organization

==News articles ==
*Mar 14, 2020, [https://www.cnn.com/2020/03/14/health/coronavirus-covid-19-flu-comparison-frieden-analysis/index.html Former CDC director: Covid-19 is different from flu and we must respond differently, Dr. Tom Frieden] - CNN

==Learn more==
*[https://www.meaction.net/covid-19/ COVID-19 Resources for People with ME - #MEAction]
*[https://www.meassociation.org.uk/2020/03/me-association-guidance-coronavirus-covid-19-update-09-march-2020/ ME Association Guidance: Coronavirus (covid-19) Update | 09 March 2020] - The ME Association
*[https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public Protect yourself: Coronavirus disease 19 (COVID-19) - World Health Organization]
*[https://www.who.int/news-room/q-a-detail/q-a-coronaviruses Q&A on coronaviruses (COVID-19) - World Health Organization]
*[https://www.who.int/emergencies/diseases/novel-coronavirus-2019 Coronavirus disease 19 (COVID-19) - World Health Organization]
*[https://www.cdc.gov/coronavirus/2019-ncov/index.html Coronavirus disease 19 (COVID-19) - CDC]
*[https://www.nhs.uk/conditions/coronavirus-covid-19/ Coronavirus (COVID-19) - NHS]
*[https://www.who.int/gpsc/5may/Guide_to_Local_Production.pdf Guide to Local Production: WHO-recommended Handrub Formulations] - only for when soap and water is not available

==See also ==
*[[Postviral fatigue syndrome]] (PVFS)
*[[Myalgic encephalomyelitis]]
*[[Severe Acute Respiratory Syndrome]]

==References ==
{{Reflist}}

[[Category:Infectious agents]]
[[Category:Triggers and risk factors]]
[[Category:Virology]]
[[Category:Viruses]]
[[Category:Coronaviruses]]

Coronavirus disease 19

2020-03-28T12:50:34Z

Loopy:citation

'''Coronavirus disease 19''', commonly known as '''COVID-19''', is the airborne infectious respiratory illness caused by the novel (new) [[SARS-CoV-2 coronavirus]] (severe acute respiratory syndrome 2), previously known as ''n-2019-nCoV''.<ref name="WHO-QA">{{Cite web|url=https://www.who.int/news-room/q-a-detail/q-a-coronaviruses|title=Q&A on coronaviruses (COVID-19)|last=World Health Organization|first=|authorlink=World Health Organization|last2=|first2=|authorlink2=|date=|website=www.who.int|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-16}}</ref><ref name="CDC-coronoviruses">{{Cite web|url=https://www.cdc.gov/coronavirus/types.html|title=Human Coronavirus Types|last=Centers for Disease Control and Prevention|first=|authorlink=Centers for Disease Control and Prevention|last2=|first2=|authorlink2=|date=2020-02-27|website=www.cdc.gov|language=en-us|archive-url=|archive-date=|dead-url=|access-date=2020-03-16}}</ref><ref>{{Cite journal|last=Li|first=Guangdi|author-link=|last2=Clercq|first2=Erik De|author-link2=|last3=|first3=|author-link3=|last4=|first4=|author-link4=|last5=|first5=|author-link5=|last6=|first6=|author-link6=|last7=|first7=|last8=|first8=|date=Mar 2020|title=Therapeutic options for the 2019 novel coronavirus (2019-nCoV)|url=https://www.nature.com/articles/d41573-020-00016-0|journal=Nature Reviews Drug Discovery|language=en|volume=19|issue=3|pages=149–150|doi=10.1038/d41573-020-00016-0|pmc=|pmid=|access-date=|quote=|via=}}</ref><ref>{{Cite web|url=https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/naming-the-coronavirus-disease-(covid-2019)-and-the-virus-that-causes-it|title=Naming the coronavirus disease (COVID-19) and the virus that causes it|website=www.who.int|language=en|access-date=2020-03-28}}</ref>
[[File:Covid-19-lung-lesions.jpg|thumb|left|alt=Computer-aided identification of lesions on the lungs of COVID-19 patients.|'''COVID-19 can cause lesions on lungs, and pneumonia.'''<br>Author: [https://www.sciencedirect.com/science/article/pii/S2095177920302264 Shen et al. 2020. Journal of Pharmaceutical Analysis]. Copyright: CC-BY-NC-ND-4.0]]{{clear}}
COVID-19 was first identified in Wuhan, China, in December 2019,<ref name="WHO-QA" /> and can infect babies, children, and adults of any age.<ref>{{Cite journal|last=Wei|first=Min|last2=Yuan|first2=Jingping|last3=Liu|first3=Yu|last4=Fu|first4=Tao|last5=Yu|first5=Xue|last6=Zhang|first6=Zhi-Jiang|date=2020-02-14|title=Novel Coronavirus Infection in Hospitalized Infants Under 1 Year of Age in China|url=https://jamanetwork.com/journals/jama/fullarticle/2761659|journal=JAMA|language=en|doi=10.1001/jama.2020.2131}}</ref> It spread globally, resulting in the 2019-2020 coronavirus pandemic.<ref>{{Cite journal|last=Hui|first=David S.|last2=Azhar|first2=Esam I.|last3=Madani|first3=Tariq A.|last4=Ntoumi|first4=Francine|last5=Kock|first5=Richard|last6=Dar|first6=Osman|last7=Ippolito|first7=Giuseppe|last8=Mchugh|first8=Timothy D.|last9=Memish|first9=Ziad A.|date=2020-02-01|title=The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health — The latest 2019 novel coronavirus outbreak in Wuhan, China|url=https://www.ijidonline.com/article/S1201-9712(20)30011-4/abstract|journal=International Journal of Infectious Diseases|language=English|volume=91|pages=264–266|doi=10.1016/j.ijid.2020.01.009|issn=1201-9712|pmid=31953166}}</ref><ref>{{Cite web|url=https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020|title=WHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020|website=www.who.int|language=en|access-date=2020-03-28}}</ref>

== Symptoms ==
Symptoms are usually mild and begin gradually, although around 1 in 6 people with COVID-19 need medical help.<ref name="WHO-QA" /> Some people become infected but don't develop any symptoms and don't feel unwell.<ref name=":0">{{Cite web||last=World Health Organization|first=|authorlink=World Health Organization|url=https://www.who.int/news-room/q-a-detail/q-a-coronaviruses|title=Q&A on coronaviruses (COVID-19)|website=www.who.int|language=en|access-date=2020-03-24}}</ref> These symptoms may appear 1-14 days after exposure; most commonly around five days.<ref name=":0" /><ref name=":1">{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html|title=Coronavirus Disease 2019 (COVID-19) – Symptoms|last=CDC|date=2020-03-20||author-link=Centers for Disease Control|website=Centers for Disease Control and Prevention|language=en-us|access-date=2020-03-24}}</ref>

'''Common Symptoms'''
* [[fever]]
* tiredness
* continuous cough, coughing episodes or a dry [[cough|cough,]]<ref>{{Cite web|url=https://www.nhs.uk/conditions/coronavirus-covid-19/symptoms-and-what-to-do/|title=Symptoms and what to do - Coronavirus (COVID-19)|last=National Health Service|first=|authorlink=National Health Service|last2=|first2=|authorlink2=|date=2020-03-24|website=nhs.uk|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-26}}</ref><ref name=":0" /> or [[Dyspnea|shortness of breath]]<ref name=":1" />
Most patients only have one or two of the common symptoms.<ref name=":0" /><ref name=":3">{{Cite journal|last=Mizumoto|first=Kenji|last2=Kagaya|first2=Katsushi|last3=Zarebski|first3=Alexander|last4=Chowell|first4=Gerardo|date=2020-03-12|title=Estimating the asymptomatic proportion of coronavirus disease 2019 (COVID-19) cases on board the Diamond Princess cruise ship, Yokohama, Japan, 2020|url=https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.10.2000180|journal=Eurosurveillance|language=en|volume=25|issue=10|pages=2000180|doi=10.2807/1560-7917.ES.2020.25.10.2000180|issn=1560-7917|pmc=PMC7078829|pmid=32183930}}</ref><ref name="Lan2020" />

'''Other Symptoms'''
* aches and [[Pain|pains]]
* nasal congestion
* runny nose
* [[sore throat]]
* [[diarrhea]]<ref name=":0" />
'''Emergency Warning Signs'''*
* trouble breathing
* [[Chest pain|persistent pain or pressure in the chest]]
* new [[confusion]] or inability to arouse (unresponsive)
* bluish lips or face<ref name=":1" />
<nowiki>*</nowiki>This list is not all inclusive. Consult your medical provider for any other symptoms that are severe or concerning.<ref name=":1" />

Additionally, there are reports that patients have lost or have a reduced sense of smell, or lost or distorted of taste, but are otherwise [[#asymptomaticcarriers|asymptomatic]].<ref name=":2">{{Cite news|url=https://www.nytimes.com/2020/03/22/health/coronavirus-symptoms-smell-taste.html|title=Lost Sense of Smell May Be Peculiar Clue to Coronavirus Infection|last=Rabin|first=Roni Caryn|date=2020-03-22|work=The New York Times|access-date=2020-03-24|language=en-US|issn=0362-4331}}</ref><blockquote>The American Academy of Otolaryngology on Sunday posted information on its website<ref>{{Cite web|url=https://www.entnet.org/content/coronavirus-disease-2019-resources|title=Coronavirus Disease 2019: Resources|last=American Academy of Otolaryngology|date=2020-03-15|website=American Academy of Otolaryngology-Head and Neck Surgery|language=en|access-date=2020-03-24}}</ref> saying that mounting anecdotal evidence indicates that lost or reduced sense of smell and loss of taste are significant symptoms associated with Covid-19, and that they have been seen in patients who ultimately tested positive with no other symptoms.<ref name=":2" /></blockquote><blockquote>The symptoms, in the absence of allergies or sinusitis, should alert doctors to screen patients for the virus and “warrant serious consideration for self isolation and testing of these individuals,” the academy said.<ref name=":2" /></blockquote>

==<span id="asymptomaticcarriers">Asymptomatic carriers</span>==
[[File:Covid-19-virus.png|thumb|upright=0.4|'''The SARS-CoV-2 virus causes COVID-19.'''<br>Author: CDC]]
A number of studies have found that some people who test positive for COVID-19 do not have any symptoms of illness or a raised temperature, and have normal blood test results, but are able to infect others, some of whom developed severe COVID-19 [[pneumonia]] as a result of COVID-19.<ref name="Bai2020">{{Cite journal|last=Bai|first=Yan|last2=Yao|first2=Lingsheng|last3=Wei|first3=Tao|last4=Tian|first4=Fei|last5=Jin|first5=Dong-Yan|last6=Chen|first6=Lijuan|last7=Wang|first7=Meiyun|date=2020-02-21|title=Presumed Asymptomatic Carrier Transmission of COVID-19|url=https://jamanetwork.com/journals/jama/fullarticle/2762028|journal=JAMA|language=en|doi=10.1001/jama.2020.2565}}</ref><ref name="Chan2019">{{Cite journal|last=Chan|first=Jasper Fuk-Woo|last2=Yuan|first2=Shuofeng|last3=Kok|first3=Kin-Hang|last4=To|first4=Kelvin Kai-Wang|last5=Chu|first5=Hin|last6=Yang|first6=Jin|last7=Xing|first7=Fanfan|last8=Liu|first8=Jieling|last9=Yip|first9=Cyril Chik-Yan|date=2020-02-15|title=A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster|url=https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30154-9/abstract|journal=The Lancet|language=English|volume=395|issue=10223|pages=514–523|doi=10.1016/S0140-6736(20)30154-9|issn=0140-6736|pmid=31986261}}</ref><ref name="delRio2020">{{Cite journal|last=del Rio|first=Carlos|author-link=|last2=Malani|first2=Preeti N.|author-link2=|last3=|first3=|author-link3=|last4=|first4=|author-link4=|last5=|first5=|author-link5=|last6=|first6=|author-link6=|last7=|first7=|last8=|first8=|date=2020-02-28|title=COVID-19—New Insights on a Rapidly Changing Epidemic|url=https://jamanetwork.com/journals/jama/fullarticle/2762510|journal=JAMA|language=en|volume=|issue=|pages=|doi=10.1001/jama.2020.3072|pmc=|pmid=|access-date=|quote=|via=}}</ref> Some asymptomatic carriers have abnormal chest CT scans, and some do not. False negative tests have also been reported.<ref name="Bai2020" /><ref name="Chan2019" />

Estimates of the number of asymptomatic carriers vary wildly. Mizumoto et al. (2020) estimated that asymptomatic carriers accounted for 17.9% of the COVID-19 positive people on the ''Diamond Princess'' cruise ship, which was quarantined for 14 day after a previous passenger developed the illness.<ref name=":3" />

==<span id="recovered">Recovered patients testing positive</span>==
Lan et al (2020) identified a group of 4 recovered patients who continued to test positive for COVID-19 after recovery; suggesting that they may still be infectious.<ref name="Lan2020">{{Cite journal|last=Lan|first=Lan|last2=Xu|first2=Dan|last3=Ye|first3=Guangming|last4=Xia|first4=Chen|last5=Wang|first5=Shaokang|last6=Li|first6=Yirong|last7=Xu|first7=Haibo|date=2020-02-27|title=Positive RT-PCR Test Results in Patients Recovered From COVID-19|url=https://jamanetwork.com/journals/jama/fullarticle/2762452|journal=JAMA|language=en|doi=10.1001/jama.2020.2783}}</ref> It is not known whether patients who have recovered may be reinfected later, or whether those who later needed treatment actually relapsed, or if recovered patients who later test positive do so because of issues with the diagnostic test's accuracy.<ref>{{Cite web|url=https://www.snopes.com/fact-check/covid-19-reinfection/|title=Can People Who Recover from COVID-19 Become Reinfected?|website=Snopes.com|language=en-US|access-date=2020-03-26}}</ref> Another study found group of 5 recovered patients were found to have reactivated COVID-19.<ref>{{Cite journal|last=Ye|first=Guangming|last2=Pan|first2=Zhenyu|last3=Pan|first3=Yunbao|last4=Deng|first4=Qiaoling|last5=Chen|first5=Liangjun|last6=Li|first6=Jin|last7=Li|first7=Yirong|last8=Wang|first8=Xinghuan|date=2020-03-11|title=Clinical characteristics of severe acute respiratory syndrome coronavirus 2 reactivation|url=https://www.journalofinfection.com/article/S0163-4453(20)30114-6/abstract|journal=Journal of Infection|language=English|volume=0|issue=0|doi=10.1016/j.jinf.2020.03.001|issn=0163-4453|pmid=32171867}}</ref>

==ME/CFS==

{{Video|id=pkGXiJ1jM14|service=youtube|dimensions=550|description=COVID-19 and ME/CFS - Dr Nancy Klimas, Mar 13, 2020|alignment=left|urlargs=}}

{{clear}}

====<span id="catchingcovid19">Risk of COVID-19 in patients with ME/CFS</span>====
There is a lack of evidence about ME/CFS patients developing COVID-19 illness; but a number of medical advisors have given their expert opinions on this. Immunologist and [[Myalgic encephalomyelitis|ME]] researcher Dr [[Nancy Klimas]] has said she believes people with ME/CFS are at a little higher risk of developing COVID-19 after exposure to the virus;<ref name="Klimas20200313">{{Cite web|url=https://www.youtube.com/watch?v=pkGXiJ1jM14|title=COVID-19 and ME/CFS - Dr Nancy Klimas, Mar 13, 2020|last=Klimas|first=Nancy|date=2020-03-13|work=|access-date=Mar 24, 2020|archive-url=|archive-date=|dead-url=|quote=|author-link=Nancy Klimas}}</ref> Dr [[Nigel Speight]], Dr [[William Weir]] and Dr [[Charles Shepherd]] have said they do not think there is an increased risk.<ref name="SpeightWeirMar20" /><ref name="SpeightMar20" /><ref name="MEA16Mar20" /> Klimas, Speight, Weir and Shepherd have all advised ME/CFS patients to take additional precautions, and highlighted that there is a risk of ME/CFS becoming significantly worse after viral infections.<ref name="Klimas20200313" /><ref name="SpeightWeirMar20" /><ref name="SpeightMar20" /><ref name="MEA16Mar20" />

ME/CFS includes [[:Category:Immune signs and symptoms|immune symptoms]] including a [[sore throat]], [[swollen lymph nodes]], and [[flu-like symptoms]], but patients are generally not considered to be severely immunocompromised, and immunosuppressant medications are unlikely to be used by most ME/CFS patients. <ref name="Klimas20200313" /> <ref name="canadianconsensus">{{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
| url = http://www.investinme.org/Documents/PDFdocuments/CanadianDefinitionME-CFS.pdf
}}</ref><ref name="ICP2011primer">{{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> This means most ME/CFS patients would not be considered to be at very high risk of COVID-19 illness.<ref name="Klimas20200313" />

* '''<span id="ibuprofen">[[Ibuprofen]]</span>''' - Ibuprofen drugs (Nurofen, Bruprofen, Advil, Midol, Motrin, Motrin) are anti-inflammatories commonly used for cold/flu symptoms and for ME/CFS. There have been some reports that ibuprofen taken for COVID-19 may prolong the illness and increase it's severity. Several countries including the UK and France now recommend that people with suspected or confirmed COVID-19 avoid ibuprofen and '''use paracetamol / acetaminophen''' (e.g., Tylenol) instead, although the evidence for this is relatively limited.<ref name="MEA16Mar20" /><ref name="Day20200317">{{Cite journal|last=Day|first=Michael|date=2020-03-17|title=Covid-19: ibuprofen should not be used for managing symptoms, say doctors and scientists|url=https://www.bmj.com/content/368/bmj.m1086|journal=BMJ|language=en|volume=368|doi=10.1136/bmj.m1086|issn=1756-1833|pmid=32184201}}</ref><ref>{{Cite web|url=https://www.nhs.uk/conditions/coronavirus-covid-19/self-isolation-advice/|title=Stay at home advice - Coronavirus (COVID-19)|last=National Health Service|first=|authorlink=National Health Service|last2=|first2=|authorlink2=|date=2020-02-28|website=nhs.uk|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref> There is no suggestion that ibuprofen affects the risk of catching COVID-19.
* '''[[Rituximab]]''' - The MS Society has stated that taking rituximab, which has been used in clinical trials for ME/CFS, may affect the risk of catching COVID-19.<ref name="Covid-19-MS">{{Cite web|url=https://www.mssociety.org.uk/about-ms/treatments-and-therapies/disease-modifying-therapies/covid-19-coronavirus-and-ms|title=COVID-19 coronavirus and MS|last=MS Society|first=|authorlink=|last2=|first2=|authorlink2=|date=|website=www.mssociety.org.uk|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref><ref>{{Cite web|url=https://renal.org/wp-content/uploads/2020/03/BAPN-COVID-19-patient-info-for-HD.PD_.Immunosuppression-17March20.pdf|title=Coronavirus (SARS-CoV-2) and its associated illness (COVID-19) {{!}} Information and Guidance for Children on Haemodialysis, Peritoneal Dialysis and Immune suppression (including Renal Transplants)|last=Renal Association|first=|authorlink=|last2=|first2=|authorlink2=|date=2020-03-17|website=renal.org|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref>
* '''[[Ampligen]]''' - Ampligen or ''rintatolimod'' is sometimes used by ME/CFS patients, it is an [[antiviral]] immunostimulant rather than immunosuppressing drug, and is being tested for the treatment of COVID-19 illness in Japan.<ref>{{Cite web|url=https://adisinsight.springer.com/drugs/800001203|title=Rintatolimod - AIM ImmunoTech - AdisInsight|website=adisinsight.springer.com|access-date=2020-03-23}}</ref> There is no information about whether it may help prevent COVID-19 in ME/CFS patients.
*The unproven [[autoimmune hypothesis]] states that a subtype of ME involves autoimmunity, which is an overactive immune system rather than a weakened immune response.<ref name="OMF2018research">{{Cite web|url=https://www.omf.ngo/2018/02/28/omf-funded-research-t-cells-molecular-immunology/|title=OMF-funded research: T cells and molecular immunology|last=Open Medicine Foundation|first=|authorlink=Open Medicine Foundation|last2=|first2=|authorlink2=|date=Feb 28, 2018|website=Open Medicine Foundation|language=en-US|archive-url=|archive-date=|dead-url=|access-date=2019-07-11}}</ref>
{{Quote box|I have now reached the conclusion that people with pre-existing health conditions that make them more vulnerable to lung complications (which may or may not be the case with ME/CFS – at this stage we just don’t know), or have a condition like ME/CFS where an infection such as this will almost certainly cause a relapse, or significant exacerbation of symptoms, need to be doing far more to protect themselves, and to socially distance themselves from other people, than official NHS guidance indicates.

In particular, for those who are not housebound, this applies to social mobility and what you can do (and cannot do) if you decide to leave your home.<ref name="MEA16Mar20"/>|author=[[Charles Shepherd]], ME Association|date=Mar 16, 2020|title=Advice from the UK's ME Association}}

====<span id="deathrisk">Risk of death or serious complications in ME/CFS patients</span>====
{{Quote box|Although ME is a "chronic condition" my gut feeling is that they are not actually at greater risk of dying from the virus itself than healthy people. The conditions which put people at extra risk would be things like severe asthma or COPD, or immunosuppressed people eg those on chemotherapy for cancer.

The biggest worry therefore for ME sufferers is that catching the virus will make their ME much worse, and of course people in the 25% group do not have much leeway.

It might even be that worsening of their already severe ME could be a bigger threat to life than the virus itself.<ref name="SpeightMar20" />|author=[[Nigel Speight]]|date=Mar 2020|title=25% ME Group for Severe ME}}

====<span id="triggerforME">Risk of developing ME/CFS after COVID-19</span>====
ME/CFS has been linked to many different viruses, but it is not known what the likelihood is of developing ME/CFS after COVID-19 illness.
{{See also|Postviral fatigue syndrome}}

==ME/CFS charity medical advisors COVID-19 statements==
*Mar 17, 2020, ME Association, [https://www.meassociation.org.uk/2020/03/coronavirus-covid-19-latest-government-advice-and-what-it-means-for-people-with-me-cfs-17-march-2020/ Coronavirus Covid-19: Latest Government advice and what it means for people with ME/CFS]<ref name="MEA17Mar20">{{Cite web|url=https://www.meassociation.org.uk/2020/03/coronavirus-covid-19-latest-government-advice-and-what-it-means-for-people-with-me-cfs-17-march-2020/|title=Coronavirus Covid-19: Latest Government advice and what it means for people with ME/CFS {{!}} 17 March 2020|last=Shepherd|first=Charles|authorlink=Charles Shepherd|last2=|first2=|authorlink2=|date=2020-03-17|website=ME Association|language=en-GB|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref>
*Mar 16, 2020, ME Association, [https://www.meassociation.org.uk/2020/03/me-association-guidance-coronavirus-covid-19-and-me-cfs-by-dr-charles-shepherd-16-march-2020/ ME Association Guidance: Coronavirus and ME/CFS by Dr Charles Shepherd]<ref name="MEA16Mar20">{{Cite web|url=https://www.meassociation.org.uk/2020/03/me-association-guidance-coronavirus-covid-19-and-me-cfs-by-dr-charles-shepherd-16-march-2020/|title=ME Association Guidance: Coronavirus and ME/CFS by Dr Charles Shepherd {{!}} 16 March 2020|last=Shepherd|first=Charles|authorlink=Charles Shepherd|last2=|first2=|authorlink2=|date=2020-03-16|website=ME Association|language=en-GB|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref>
*Mar 2020, 25% ME Group, [https://25megroup.org/download/1796/?v=3236 re Coronavirus and members of the 25% ME Group, Severe ME charity | Message from Dr Willy Weir and Dr Nigel Speight, Medical Advisor to 25% ME Group | Update to the advice given on 29 February 2020],<ref name="SpeightWeirMar20">{{Cite web|url=https://25megroup.org/download/1796/?v=3236|author-link=Nigel Speight|last=Speight|first=Nigel||last2=Weir|first2=William|author-link2=William Weir|title=re Coronavirus and members of the 25% ME Group, Severe ME charity {{!}} Message from Dr Willy Weir and Dr Nigel Speight, Medical Advisor to 25% ME Group {{!}} Update to the advice given on 29 February 2020 |date=Mar 2020|website=25megroup.org}}</ref>
*Mar 2020, 25% ME Group, [https://25megroup.org/download/1796/?v=3226 re Coronavirus and members of the 25% ME Group, Severe ME charity Types | Message from Dr Nigel Speight, Medical Advisor to 25% ME Group]<ref name="SpeightMar20">{{Cite web|url=https://25megroup.org/download/1796/?v=3226|author-link=Nigel Speight|last=Speight|first=Nigel|title=re Coronavirus and members of the 25% ME Group, Severe ME charity Types {{!}} Message from Dr Nigel Speight, Medical Advisor to 25% ME Group|date=Mar 2020|website=25megroup.org|others=[[William Weir]]}}</ref>

==Prevention==
[[File:CDC-Coronavirus-badge-300.png|thumb|upright=1|left|Image author: CDC|alt=image of Coronavirus Disease 2019 (COVID-19)|link=https://www.cdc.gov/coronavirus/2019-ncov/index.html]]
<br style="clear:both;line-height:0">
The SARS-CoV-2 coronavirus is an ''enveloped virus'', which means it is easier to kill outside the body than ''non-enveloped'' viruses like [[Coxsackievirus]], or [[Poliovirus]].<ref>{{Cite web|url=https://www.epa.gov/pesticides/coronavirus-cases-trigger-epa-rapid-response|title=Coronavirus Cases Trigger EPA Rapid Response|last=US Environmental Protection Agency|first=|authorlink=|last2=|first2=|authorlink2=|date=2020-01-29|website=US EPA|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref><ref>{{Cite journal|last=Firquet|first=Swan|author-link=|last2=Beaujard|first2=Sophie|author-link2=|last3=Lobert|first3=Pierre-Emmanuel|author-link3=|last4=Sané|first4=Famara|author-link4=|last5=Caloone|first5=Delphine|author-link5=|last6=Izard|first6=Daniel|author-link6=|last7=Hober|first7=Didier|last8=|first8=|date=June 2015|title=Survival of Enveloped and Non-Enveloped Viruses on Inanimate Surfaces|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4462923/|journal=Microbes and Environments|volume=30|issue=2|pages=140–144|doi=10.1264/jsme2.ME14145|issn=1342-6311|pmc=4462923|pmid=25843687|access-date=|quote=|via=}}</ref>
*[https://www.cdc.gov/coronavirus/2019-ncov/prepare/get-your-household-ready-for-COVID-19.html Get your Household Ready for COVID-19] - CDC
*[https://www.americanchemistry.com/Novel-Coronavirus-Fighting-Products-List.pdf Novel Coronavirus (COVID-19)-Fighting Products] - Center for Biocide Chemistries
*[https://www.health.gov.au/sites/default/files/documents/2020/03/coronavirus-covid-19-information-on-social-distancing.pdf Social distancing - Department of Health, Australia]

==== CDC advice ====
* Know How it Spreads
* Clean your hands often
* Avoid close contact
* Stay home if you're sick (may have the virus)
* Cover coughs and sneezes
* Wear a face mask if you are sick (may have the virus)
* Clean and disinfect
<i><div role="note" class="hatnote navigation-not-searchable">{{MediaWiki:Seealso/{{{lang|{{PAGELANGUAGE}}}}}}}{{colon}}
[https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html Coronavirus disease 19 Prevention - CDC]</div></i>

===<span id="high-touch">High touch surfaces: disinfect daily</span>===
[[File:High-touch surfaces-CDC-covid-19.png|alt=High-touch surfaces: disinfect daily. Tables, doorknobs, light switches, countertops, handles, desks, phones keyboards, remote controls, toilets, faucets, sinks, hard-backed chairs. Source: Coronavirus disease 19 Prevention - CDC, March 2020. Public domain image.|thumb|upright=0.7]]<br style="line-height:0" />
The CDC currently recommends people '''clean''' AND '''disinfect''' frequently touched surfaces daily:
<div style="column-count:2;-moz-column-count:2;-webkit-column-count:2">
*tables
*doorknobs
*light switches
*countertops
*handles
*desks
*phones
*keyboards
*remote controls
*toilets
*faucets
*sinks
*hard-backed chairs<ref name="CDC-prevention" /><ref name="CDC-suspectedcases">{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/prepare/cleaning-disinfection.html|title=Coronavirus Disease 2019 (COVID-19) - Environmental Cleaning and Disinfection Recommendations|last=CDC|first=|authorlink=Centers for Disease Control and Prevention|last2=|first2=|authorlink2=|date=2020-02-11|website=Centers for Disease Control and Prevention|language=en-us|archive-url=|archive-date=|dead-url=|access-date=2020-03-18}}</ref>
</div><br style="clear:both; line-height:0" />
:'''To clean use:'''
*Detergent or soap and water prior to disinfection. <ref name="CDC-prevention" />

:'''To disinfect use:'''
*[https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2 '''Disinfectants used against SARS-CoV-2'''] (list)
*'''Most common EPA-registered household disinfectants''' will work, or
* '''Diluted household bleach''' (mix: 5 tablespoons bleach per gallon of water, OR 4 teaspoons bleach per quart of water), or
*'''Alcohol solutions''' with at least 70% alcohol
:Follow manufacturer’s instructions for application and ''proper ventilation''. Check the product is not past its expiration date. ''(Updated Mar 18, 2020)''<ref name="CDC-prevention">{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html|title=Coronavirus Disease 2019 (COVID-19) – Prevention & Treatment|last=CDC|first=|authorlink=Centers for Disease Control and Prevention|last2=|first2=|authorlink2=|date=2020-03-16|website=Centers for Disease Control and Prevention|language=en-us|archive-url=|archive-date=|dead-url=|access-date=2020-03-17}}</ref>

:'''Check for updates:'''
* [https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html Coronavirus disease 19 Prevention - CDC]

'''Suspected or confirmed COVID-19 cases:'''<br />If possible the '''sick person''' should also clean:
<div style="column-count:2;-moz-column-count:2;-webkit-column-count:2">
*soiled items and surfaces (as needed)
*if a separate bathroom is not available, the bathroom should be cleaned and disinfected after each use by an ill person
*provide personal cleaning and disinfectant supplies in ill person's room (unless unsafe, e.g. they are a young child) - include tissues, paper towels, cleaners and EPA-registered disinfectants<ref name="CDC-prevention" /><ref name="CDC-suspectedcases" /></div>

===Coronavirus transmission from surfaces===
The new coronavirus can survive on different surfaces for hours or days:
*small airborne virus particles (aerosols) - 3 hours
*copper - 4 hours
*cardboard - 24 hours
*stainless steel - 2 to 3 days
*plastic - 2 to 3 days<ref name="stablesurfacesPRMar20">{{Cite web|url=https://www.nih.gov/news-events/news-releases/new-coronavirus-stable-hours-surfaces|title=New coronavirus stable for hours on surfaces|last=National Institutes of Health|first=|authorlink=National Institutes of Health|last2=|first2=|authorlink2=|date=2020-03-17|website=National Institutes of Health (NIH)|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-25}}</ref><ref name="Tellier2006">{{Cite journal|last=Tellier|first=Raymond|author-link=|last2=|first2=|author-link2=|last3=|first3=|author-link3=|last4=|first4=|author-link4=|last5=|first5=|author-link5=|last6=|first6=|author-link6=|last7=|first7=|last8=|first8=|date=Nov 2006|title=Review of Aerosol Transmission of Influenza A Virus|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3372341/|journal=Emerging Infectious Diseases|volume=12|issue=11|pages=1657–1662|doi=10.3201/eid1211.060426|issn=1080-6040|pmc=3372341|pmid=17283614|access-date=|quote=|via=}}</ref>

This means direct contact with an infected person is not needed to contact the illness.<ref name="stablesurfacesPRMar20" /> Surgical [[#facemasks|face masks]] have not been effective against aerosols in previous influenza outbreaks like swine flu, but N95 respirators have been effective.<ref name="Tellier2006" />

==<span id="someoneissick">Disinfecting your home if someone is sick</span>==
'''Suspected or confirmed COVID-19 cases:'''<br />
*'''Clean''' AND '''disinfect''' all [[#High-touch|high-touch]] areas daily.
If possible the '''sick person''' should also clean:
<div style="column-count:2;-moz-column-count:2;-webkit-column-count:2">
*soiled items and surfaces (as needed)
*if a separate bathroom is not available, the bathroom should be cleaned and disinfected after each use by an ill person
*provide personal cleaning and disinfectant supplies in ill person's room (unless unsafe, e.g. they are a young child) - include tissues, paper towels, cleaners and EPA-registered disinfectants<ref name="CDC-prevention" /><ref name="CDC-suspectedcases" /><ref name="CDCDisinfectYourHome">https://www.cdc.gov/coronavirus/2019-ncov/prepare/disinfecting-your-home.html</ref></div>
*<div role="note" class="hatnote navigation-not-searchable">Take additional steps covering '''soft surfaces, food, laundry, and trash'''{{colon}}
*[https://www.cdc.gov/coronavirus/2019-ncov/prepare/disinfecting-your-home.html Disinfecting your home if someone is sick - CDC]

==COVID-19 pneumonia==
Severe Acute Respiratory Infection (SARI) is the name for the type of pneumonia caused by COVID-19.<ref name="vitCtrial">{{Cite web|url=https://clinicaltrials.gov/ct2/show/NCT04264533|title=Vitamin C Infusion for the Treatment of Severe 2019-nCoV Infected Pneumonia - Full Text View - ClinicalTrials.gov|website=clinicaltrials.gov|language=en|access-date=2020-03-22}}</ref> A clinical trial is in progress to determine if intravenous [[vitamin C]] is an effective treatment for SARI.<ref name="vitCtrial" />

==Myth, Hoaxes, Scams and Fake News==
Many myths, hoaxes and fake news have been spreading, particularly on social media, some of which claim to be from doctors or health professionals.<ref name="WHOmyths">{{Cite web|url=https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters|title=Coronavirus 2019 {{!}} Myth busters|last=World Health Organization|first=|authorlink=World Health Organization|last2=|first2=|authorlink2=|date=|website=www.who.int|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-17}}</ref><ref name="BuzzfeedHoax3Mar20">{{Cite web|url=https://www.buzzfeednews.com/article/janelytvynenko/coronavirus-disinformation-spread|title=Here Are Some Of The Coronavirus Hoaxes That Spread In The First Few Weeks|website=BuzzFeed News|language=en|access-date=2020-03-17}}</ref> Scam include seeking fake cures or ineffective protective equipment like masks, scammers pretending to be from the World Health Organization asking for donations, or a stranger asking for money on behalf of a relative's medical bills.<ref name="FTC-scams">{{Cite web|url=https://www.consumer.ftc.gov/features/coronavirus-scams-what-ftc-doing|title=Coronavirus Scams: What the FTC is doing|last=FTC|first=|authorlink=|last2=|first2=|authorlink2=|date=2020-03-06|website=Consumer Information|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-17}}</ref><ref name="WHO-cybersecurity">{{Cite web|url=https://www.who.int/about/communications/cyber-security|title=Communications {{!}} Cybersecurity|last=World Health Organization|first=|authorlink=World Health Organization|last2=|first2=|authorlink2=|date=|website=www.who.int|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-17}}</ref>

*[https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters Coronavirus disease (COVID-19) advice for the public: Myth busters] - World Health Organization
*Mar 3, 2020 - [https://www.buzzfeednews.com/article/janelytvynenko/coronavirus-disinformation-spread Here Are Some Of The Coronavirus Hoaxes That Spread In The First Few Weeks] - Buzzfeed News
*Mar 2020 - [https://www.buzzfeednews.com/article/janelytvynenko/heres-a-running-list-of-the-latest-disinformation Here's A Running List Of The Latest Hoaxes Spreading About The Coronavirus] - Buzzfeed News
*[https://www.who.int/about/communications/cyber-security Cybersecurity - World Health Organization]
*[https://www.consumer.ftc.gov/features/coronavirus-scams-what-ftc-doing Coronavirus scams - What the FTC os doing]

==Posters for those self-isolating to avoid infection==
*[https://chronicallyawesome.org.uk/posters-for-those-who-are-self-isolating-as-a-preventative-measure/? Unofficial posters] stating where people should leave deliveries - Chronically Awesome

==Mental health ==
Anxiety around COVID-19 illness may cause anxiety or affect mental health.
*[https://www.nami.org/getattachment/About-NAMI/NAMI-News/2020/NAMI-Updates-on-the-Coronavirus/COVID-19-Updated-Guide-1.pdf?lang=en-US COVID-19 Guide - National Association of Mental Illness]
*[https://www.who.int/docs/default-source/coronaviruse/coping-with-stress.pdf?sfvrsn=9845bc3a_2 Coping with stress during the nCov-2019 outbreak (poster)] - World Health Organization

==News articles ==
*Mar 14, 2020, [https://www.cnn.com/2020/03/14/health/coronavirus-covid-19-flu-comparison-frieden-analysis/index.html Former CDC director: Covid-19 is different from flu and we must respond differently, Dr. Tom Frieden] - CNN

==Learn more==
*[https://www.meaction.net/covid-19/ COVID-19 Resources for People with ME - #MEAction]
*[https://www.meassociation.org.uk/2020/03/me-association-guidance-coronavirus-covid-19-update-09-march-2020/ ME Association Guidance: Coronavirus (covid-19) Update | 09 March 2020] - The ME Association
*[https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public Protect yourself: Coronavirus disease 19 (COVID-19) - World Health Organization]
*[https://www.who.int/news-room/q-a-detail/q-a-coronaviruses Q&A on coronaviruses (COVID-19) - World Health Organization]
*[https://www.who.int/emergencies/diseases/novel-coronavirus-2019 Coronavirus disease 19 (COVID-19) - World Health Organization]
*[https://www.cdc.gov/coronavirus/2019-ncov/index.html Coronavirus disease 19 (COVID-19) - CDC]
*[https://www.nhs.uk/conditions/coronavirus-covid-19/ Coronavirus (COVID-19) - NHS]
*[https://www.who.int/gpsc/5may/Guide_to_Local_Production.pdf Guide to Local Production: WHO-recommended Handrub Formulations] - only for when soap and water is not available

==See also ==
*[[Postviral fatigue syndrome]] (PVFS)
*[[Myalgic encephalomyelitis]]
*[[Severe Acute Respiratory Syndrome]]

==References ==
{{Reflist}}

[[Category:Infectious agents]]
[[Category:Triggers and risk factors]]
[[Category:Virology]]
[[Category:Viruses]]
[[Category:Coronaviruses]]

Coronavirus disease 19

2020-03-28T12:49:55Z

Loopy:name

'''Coronavirus disease 19''', commonly known as '''COVID-19''', is the airborne infectious respiratory illness caused by the novel (new) [[SARS-CoV-2 coronavirus]] (severe acute respiratory syndrome 2), previously known as ''n-2019-nCoV''.<ref name="WHO-QA">{{Cite web|url=https://www.who.int/news-room/q-a-detail/q-a-coronaviruses|title=Q&A on coronaviruses (COVID-19)|last=World Health Organization|first=|authorlink=World Health Organization|last2=|first2=|authorlink2=|date=|website=www.who.int|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-16}}</ref><ref name="CDC-coronoviruses">{{Cite web|url=https://www.cdc.gov/coronavirus/types.html|title=Human Coronavirus Types|last=Centers for Disease Control and Prevention|first=|authorlink=Centers for Disease Control and Prevention|last2=|first2=|authorlink2=|date=2020-02-27|website=www.cdc.gov|language=en-us|archive-url=|archive-date=|dead-url=|access-date=2020-03-16}}</ref><ref>{{Cite journal|last=Li|first=Guangdi|author-link=|last2=Clercq|first2=Erik De|author-link2=|last3=|first3=|author-link3=|last4=|first4=|author-link4=|last5=|first5=|author-link5=|last6=|first6=|author-link6=|last7=|first7=|last8=|first8=|date=Mar 2020|title=Therapeutic options for the 2019 novel coronavirus (2019-nCoV)|url=https://www.nature.com/articles/d41573-020-00016-0|journal=Nature Reviews Drug Discovery|language=en|volume=19|issue=3|pages=149–150|doi=10.1038/d41573-020-00016-0|pmc=|pmid=|access-date=|quote=|via=}}</ref>
[[File:Covid-19-lung-lesions.jpg|thumb|left|alt=Computer-aided identification of lesions on the lungs of COVID-19 patients.|'''COVID-19 can cause lesions on lungs, and pneumonia.'''<br>Author: [https://www.sciencedirect.com/science/article/pii/S2095177920302264 Shen et al. 2020. Journal of Pharmaceutical Analysis]. Copyright: CC-BY-NC-ND-4.0]]{{clear}}
COVID-19 was first identified in Wuhan, China, in December 2019,<ref name="WHO-QA" /> and can infect babies, children, and adults of any age.<ref>{{Cite journal|last=Wei|first=Min|last2=Yuan|first2=Jingping|last3=Liu|first3=Yu|last4=Fu|first4=Tao|last5=Yu|first5=Xue|last6=Zhang|first6=Zhi-Jiang|date=2020-02-14|title=Novel Coronavirus Infection in Hospitalized Infants Under 1 Year of Age in China|url=https://jamanetwork.com/journals/jama/fullarticle/2761659|journal=JAMA|language=en|doi=10.1001/jama.2020.2131}}</ref> It spread globally, resulting in the 2019-2020 coronavirus pandemic.<ref>{{Cite journal|last=Hui|first=David S.|last2=Azhar|first2=Esam I.|last3=Madani|first3=Tariq A.|last4=Ntoumi|first4=Francine|last5=Kock|first5=Richard|last6=Dar|first6=Osman|last7=Ippolito|first7=Giuseppe|last8=Mchugh|first8=Timothy D.|last9=Memish|first9=Ziad A.|date=2020-02-01|title=The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health — The latest 2019 novel coronavirus outbreak in Wuhan, China|url=https://www.ijidonline.com/article/S1201-9712(20)30011-4/abstract|journal=International Journal of Infectious Diseases|language=English|volume=91|pages=264–266|doi=10.1016/j.ijid.2020.01.009|issn=1201-9712|pmid=31953166}}</ref><ref>{{Cite web|url=https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020|title=WHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020|website=www.who.int|language=en|access-date=2020-03-28}}</ref>

== Symptoms ==
Symptoms are usually mild and begin gradually, although around 1 in 6 people with COVID-19 need medical help.<ref name="WHO-QA" /> Some people become infected but don't develop any symptoms and don't feel unwell.<ref name=":0">{{Cite web||last=World Health Organization|first=|authorlink=World Health Organization|url=https://www.who.int/news-room/q-a-detail/q-a-coronaviruses|title=Q&A on coronaviruses (COVID-19)|website=www.who.int|language=en|access-date=2020-03-24}}</ref> These symptoms may appear 1-14 days after exposure; most commonly around five days.<ref name=":0" /><ref name=":1">{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html|title=Coronavirus Disease 2019 (COVID-19) – Symptoms|last=CDC|date=2020-03-20||author-link=Centers for Disease Control|website=Centers for Disease Control and Prevention|language=en-us|access-date=2020-03-24}}</ref>

'''Common Symptoms'''
* [[fever]]
* tiredness
* continuous cough, coughing episodes or a dry [[cough|cough,]]<ref>{{Cite web|url=https://www.nhs.uk/conditions/coronavirus-covid-19/symptoms-and-what-to-do/|title=Symptoms and what to do - Coronavirus (COVID-19)|last=National Health Service|first=|authorlink=National Health Service|last2=|first2=|authorlink2=|date=2020-03-24|website=nhs.uk|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-26}}</ref><ref name=":0" /> or [[Dyspnea|shortness of breath]]<ref name=":1" />
Most patients only have one or two of the common symptoms.<ref name=":0" /><ref name=":3">{{Cite journal|last=Mizumoto|first=Kenji|last2=Kagaya|first2=Katsushi|last3=Zarebski|first3=Alexander|last4=Chowell|first4=Gerardo|date=2020-03-12|title=Estimating the asymptomatic proportion of coronavirus disease 2019 (COVID-19) cases on board the Diamond Princess cruise ship, Yokohama, Japan, 2020|url=https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.10.2000180|journal=Eurosurveillance|language=en|volume=25|issue=10|pages=2000180|doi=10.2807/1560-7917.ES.2020.25.10.2000180|issn=1560-7917|pmc=PMC7078829|pmid=32183930}}</ref><ref name="Lan2020" />

'''Other Symptoms'''
* aches and [[Pain|pains]]
* nasal congestion
* runny nose
* [[sore throat]]
* [[diarrhea]]<ref name=":0" />
'''Emergency Warning Signs'''*
* trouble breathing
* [[Chest pain|persistent pain or pressure in the chest]]
* new [[confusion]] or inability to arouse (unresponsive)
* bluish lips or face<ref name=":1" />
<nowiki>*</nowiki>This list is not all inclusive. Consult your medical provider for any other symptoms that are severe or concerning.<ref name=":1" />

Additionally, there are reports that patients have lost or have a reduced sense of smell, or lost or distorted of taste, but are otherwise [[#asymptomaticcarriers|asymptomatic]].<ref name=":2">{{Cite news|url=https://www.nytimes.com/2020/03/22/health/coronavirus-symptoms-smell-taste.html|title=Lost Sense of Smell May Be Peculiar Clue to Coronavirus Infection|last=Rabin|first=Roni Caryn|date=2020-03-22|work=The New York Times|access-date=2020-03-24|language=en-US|issn=0362-4331}}</ref><blockquote>The American Academy of Otolaryngology on Sunday posted information on its website<ref>{{Cite web|url=https://www.entnet.org/content/coronavirus-disease-2019-resources|title=Coronavirus Disease 2019: Resources|last=American Academy of Otolaryngology|date=2020-03-15|website=American Academy of Otolaryngology-Head and Neck Surgery|language=en|access-date=2020-03-24}}</ref> saying that mounting anecdotal evidence indicates that lost or reduced sense of smell and loss of taste are significant symptoms associated with Covid-19, and that they have been seen in patients who ultimately tested positive with no other symptoms.<ref name=":2" /></blockquote><blockquote>The symptoms, in the absence of allergies or sinusitis, should alert doctors to screen patients for the virus and “warrant serious consideration for self isolation and testing of these individuals,” the academy said.<ref name=":2" /></blockquote>

==<span id="asymptomaticcarriers">Asymptomatic carriers</span>==
[[File:Covid-19-virus.png|thumb|upright=0.4|'''The SARS-CoV-2 virus causes COVID-19.'''<br>Author: CDC]]
A number of studies have found that some people who test positive for COVID-19 do not have any symptoms of illness or a raised temperature, and have normal blood test results, but are able to infect others, some of whom developed severe COVID-19 [[pneumonia]] as a result of COVID-19.<ref name="Bai2020">{{Cite journal|last=Bai|first=Yan|last2=Yao|first2=Lingsheng|last3=Wei|first3=Tao|last4=Tian|first4=Fei|last5=Jin|first5=Dong-Yan|last6=Chen|first6=Lijuan|last7=Wang|first7=Meiyun|date=2020-02-21|title=Presumed Asymptomatic Carrier Transmission of COVID-19|url=https://jamanetwork.com/journals/jama/fullarticle/2762028|journal=JAMA|language=en|doi=10.1001/jama.2020.2565}}</ref><ref name="Chan2019">{{Cite journal|last=Chan|first=Jasper Fuk-Woo|last2=Yuan|first2=Shuofeng|last3=Kok|first3=Kin-Hang|last4=To|first4=Kelvin Kai-Wang|last5=Chu|first5=Hin|last6=Yang|first6=Jin|last7=Xing|first7=Fanfan|last8=Liu|first8=Jieling|last9=Yip|first9=Cyril Chik-Yan|date=2020-02-15|title=A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster|url=https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30154-9/abstract|journal=The Lancet|language=English|volume=395|issue=10223|pages=514–523|doi=10.1016/S0140-6736(20)30154-9|issn=0140-6736|pmid=31986261}}</ref><ref name="delRio2020">{{Cite journal|last=del Rio|first=Carlos|author-link=|last2=Malani|first2=Preeti N.|author-link2=|last3=|first3=|author-link3=|last4=|first4=|author-link4=|last5=|first5=|author-link5=|last6=|first6=|author-link6=|last7=|first7=|last8=|first8=|date=2020-02-28|title=COVID-19—New Insights on a Rapidly Changing Epidemic|url=https://jamanetwork.com/journals/jama/fullarticle/2762510|journal=JAMA|language=en|volume=|issue=|pages=|doi=10.1001/jama.2020.3072|pmc=|pmid=|access-date=|quote=|via=}}</ref> Some asymptomatic carriers have abnormal chest CT scans, and some do not. False negative tests have also been reported.<ref name="Bai2020" /><ref name="Chan2019" />

Estimates of the number of asymptomatic carriers vary wildly. Mizumoto et al. (2020) estimated that asymptomatic carriers accounted for 17.9% of the COVID-19 positive people on the ''Diamond Princess'' cruise ship, which was quarantined for 14 day after a previous passenger developed the illness.<ref name=":3" />

==<span id="recovered">Recovered patients testing positive</span>==
Lan et al (2020) identified a group of 4 recovered patients who continued to test positive for COVID-19 after recovery; suggesting that they may still be infectious.<ref name="Lan2020">{{Cite journal|last=Lan|first=Lan|last2=Xu|first2=Dan|last3=Ye|first3=Guangming|last4=Xia|first4=Chen|last5=Wang|first5=Shaokang|last6=Li|first6=Yirong|last7=Xu|first7=Haibo|date=2020-02-27|title=Positive RT-PCR Test Results in Patients Recovered From COVID-19|url=https://jamanetwork.com/journals/jama/fullarticle/2762452|journal=JAMA|language=en|doi=10.1001/jama.2020.2783}}</ref> It is not known whether patients who have recovered may be reinfected later, or whether those who later needed treatment actually relapsed, or if recovered patients who later test positive do so because of issues with the diagnostic test's accuracy.<ref>{{Cite web|url=https://www.snopes.com/fact-check/covid-19-reinfection/|title=Can People Who Recover from COVID-19 Become Reinfected?|website=Snopes.com|language=en-US|access-date=2020-03-26}}</ref> Another study found group of 5 recovered patients were found to have reactivated COVID-19.<ref>{{Cite journal|last=Ye|first=Guangming|last2=Pan|first2=Zhenyu|last3=Pan|first3=Yunbao|last4=Deng|first4=Qiaoling|last5=Chen|first5=Liangjun|last6=Li|first6=Jin|last7=Li|first7=Yirong|last8=Wang|first8=Xinghuan|date=2020-03-11|title=Clinical characteristics of severe acute respiratory syndrome coronavirus 2 reactivation|url=https://www.journalofinfection.com/article/S0163-4453(20)30114-6/abstract|journal=Journal of Infection|language=English|volume=0|issue=0|doi=10.1016/j.jinf.2020.03.001|issn=0163-4453|pmid=32171867}}</ref>

==ME/CFS==

{{Video|id=pkGXiJ1jM14|service=youtube|dimensions=550|description=COVID-19 and ME/CFS - Dr Nancy Klimas, Mar 13, 2020|alignment=left|urlargs=}}

{{clear}}

====<span id="catchingcovid19">Risk of COVID-19 in patients with ME/CFS</span>====
There is a lack of evidence about ME/CFS patients developing COVID-19 illness; but a number of medical advisors have given their expert opinions on this. Immunologist and [[Myalgic encephalomyelitis|ME]] researcher Dr [[Nancy Klimas]] has said she believes people with ME/CFS are at a little higher risk of developing COVID-19 after exposure to the virus;<ref name="Klimas20200313">{{Cite web|url=https://www.youtube.com/watch?v=pkGXiJ1jM14|title=COVID-19 and ME/CFS - Dr Nancy Klimas, Mar 13, 2020|last=Klimas|first=Nancy|date=2020-03-13|work=|access-date=Mar 24, 2020|archive-url=|archive-date=|dead-url=|quote=|author-link=Nancy Klimas}}</ref> Dr [[Nigel Speight]], Dr [[William Weir]] and Dr [[Charles Shepherd]] have said they do not think there is an increased risk.<ref name="SpeightWeirMar20" /><ref name="SpeightMar20" /><ref name="MEA16Mar20" /> Klimas, Speight, Weir and Shepherd have all advised ME/CFS patients to take additional precautions, and highlighted that there is a risk of ME/CFS becoming significantly worse after viral infections.<ref name="Klimas20200313" /><ref name="SpeightWeirMar20" /><ref name="SpeightMar20" /><ref name="MEA16Mar20" />

ME/CFS includes [[:Category:Immune signs and symptoms|immune symptoms]] including a [[sore throat]], [[swollen lymph nodes]], and [[flu-like symptoms]], but patients are generally not considered to be severely immunocompromised, and immunosuppressant medications are unlikely to be used by most ME/CFS patients. <ref name="Klimas20200313" /> <ref name="canadianconsensus">{{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
| url = http://www.investinme.org/Documents/PDFdocuments/CanadianDefinitionME-CFS.pdf
}}</ref><ref name="ICP2011primer">{{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> This means most ME/CFS patients would not be considered to be at very high risk of COVID-19 illness.<ref name="Klimas20200313" />

* '''<span id="ibuprofen">[[Ibuprofen]]</span>''' - Ibuprofen drugs (Nurofen, Bruprofen, Advil, Midol, Motrin, Motrin) are anti-inflammatories commonly used for cold/flu symptoms and for ME/CFS. There have been some reports that ibuprofen taken for COVID-19 may prolong the illness and increase it's severity. Several countries including the UK and France now recommend that people with suspected or confirmed COVID-19 avoid ibuprofen and '''use paracetamol / acetaminophen''' (e.g., Tylenol) instead, although the evidence for this is relatively limited.<ref name="MEA16Mar20" /><ref name="Day20200317">{{Cite journal|last=Day|first=Michael|date=2020-03-17|title=Covid-19: ibuprofen should not be used for managing symptoms, say doctors and scientists|url=https://www.bmj.com/content/368/bmj.m1086|journal=BMJ|language=en|volume=368|doi=10.1136/bmj.m1086|issn=1756-1833|pmid=32184201}}</ref><ref>{{Cite web|url=https://www.nhs.uk/conditions/coronavirus-covid-19/self-isolation-advice/|title=Stay at home advice - Coronavirus (COVID-19)|last=National Health Service|first=|authorlink=National Health Service|last2=|first2=|authorlink2=|date=2020-02-28|website=nhs.uk|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref> There is no suggestion that ibuprofen affects the risk of catching COVID-19.
* '''[[Rituximab]]''' - The MS Society has stated that taking rituximab, which has been used in clinical trials for ME/CFS, may affect the risk of catching COVID-19.<ref name="Covid-19-MS">{{Cite web|url=https://www.mssociety.org.uk/about-ms/treatments-and-therapies/disease-modifying-therapies/covid-19-coronavirus-and-ms|title=COVID-19 coronavirus and MS|last=MS Society|first=|authorlink=|last2=|first2=|authorlink2=|date=|website=www.mssociety.org.uk|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref><ref>{{Cite web|url=https://renal.org/wp-content/uploads/2020/03/BAPN-COVID-19-patient-info-for-HD.PD_.Immunosuppression-17March20.pdf|title=Coronavirus (SARS-CoV-2) and its associated illness (COVID-19) {{!}} Information and Guidance for Children on Haemodialysis, Peritoneal Dialysis and Immune suppression (including Renal Transplants)|last=Renal Association|first=|authorlink=|last2=|first2=|authorlink2=|date=2020-03-17|website=renal.org|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref>
* '''[[Ampligen]]''' - Ampligen or ''rintatolimod'' is sometimes used by ME/CFS patients, it is an [[antiviral]] immunostimulant rather than immunosuppressing drug, and is being tested for the treatment of COVID-19 illness in Japan.<ref>{{Cite web|url=https://adisinsight.springer.com/drugs/800001203|title=Rintatolimod - AIM ImmunoTech - AdisInsight|website=adisinsight.springer.com|access-date=2020-03-23}}</ref> There is no information about whether it may help prevent COVID-19 in ME/CFS patients.
*The unproven [[autoimmune hypothesis]] states that a subtype of ME involves autoimmunity, which is an overactive immune system rather than a weakened immune response.<ref name="OMF2018research">{{Cite web|url=https://www.omf.ngo/2018/02/28/omf-funded-research-t-cells-molecular-immunology/|title=OMF-funded research: T cells and molecular immunology|last=Open Medicine Foundation|first=|authorlink=Open Medicine Foundation|last2=|first2=|authorlink2=|date=Feb 28, 2018|website=Open Medicine Foundation|language=en-US|archive-url=|archive-date=|dead-url=|access-date=2019-07-11}}</ref>
{{Quote box|I have now reached the conclusion that people with pre-existing health conditions that make them more vulnerable to lung complications (which may or may not be the case with ME/CFS – at this stage we just don’t know), or have a condition like ME/CFS where an infection such as this will almost certainly cause a relapse, or significant exacerbation of symptoms, need to be doing far more to protect themselves, and to socially distance themselves from other people, than official NHS guidance indicates.

In particular, for those who are not housebound, this applies to social mobility and what you can do (and cannot do) if you decide to leave your home.<ref name="MEA16Mar20"/>|author=[[Charles Shepherd]], ME Association|date=Mar 16, 2020|title=Advice from the UK's ME Association}}

====<span id="deathrisk">Risk of death or serious complications in ME/CFS patients</span>====
{{Quote box|Although ME is a "chronic condition" my gut feeling is that they are not actually at greater risk of dying from the virus itself than healthy people. The conditions which put people at extra risk would be things like severe asthma or COPD, or immunosuppressed people eg those on chemotherapy for cancer.

The biggest worry therefore for ME sufferers is that catching the virus will make their ME much worse, and of course people in the 25% group do not have much leeway.

It might even be that worsening of their already severe ME could be a bigger threat to life than the virus itself.<ref name="SpeightMar20" />|author=[[Nigel Speight]]|date=Mar 2020|title=25% ME Group for Severe ME}}

====<span id="triggerforME">Risk of developing ME/CFS after COVID-19</span>====
ME/CFS has been linked to many different viruses, but it is not known what the likelihood is of developing ME/CFS after COVID-19 illness.
{{See also|Postviral fatigue syndrome}}

==ME/CFS charity medical advisors COVID-19 statements==
*Mar 17, 2020, ME Association, [https://www.meassociation.org.uk/2020/03/coronavirus-covid-19-latest-government-advice-and-what-it-means-for-people-with-me-cfs-17-march-2020/ Coronavirus Covid-19: Latest Government advice and what it means for people with ME/CFS]<ref name="MEA17Mar20">{{Cite web|url=https://www.meassociation.org.uk/2020/03/coronavirus-covid-19-latest-government-advice-and-what-it-means-for-people-with-me-cfs-17-march-2020/|title=Coronavirus Covid-19: Latest Government advice and what it means for people with ME/CFS {{!}} 17 March 2020|last=Shepherd|first=Charles|authorlink=Charles Shepherd|last2=|first2=|authorlink2=|date=2020-03-17|website=ME Association|language=en-GB|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref>
*Mar 16, 2020, ME Association, [https://www.meassociation.org.uk/2020/03/me-association-guidance-coronavirus-covid-19-and-me-cfs-by-dr-charles-shepherd-16-march-2020/ ME Association Guidance: Coronavirus and ME/CFS by Dr Charles Shepherd]<ref name="MEA16Mar20">{{Cite web|url=https://www.meassociation.org.uk/2020/03/me-association-guidance-coronavirus-covid-19-and-me-cfs-by-dr-charles-shepherd-16-march-2020/|title=ME Association Guidance: Coronavirus and ME/CFS by Dr Charles Shepherd {{!}} 16 March 2020|last=Shepherd|first=Charles|authorlink=Charles Shepherd|last2=|first2=|authorlink2=|date=2020-03-16|website=ME Association|language=en-GB|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref>
*Mar 2020, 25% ME Group, [https://25megroup.org/download/1796/?v=3236 re Coronavirus and members of the 25% ME Group, Severe ME charity | Message from Dr Willy Weir and Dr Nigel Speight, Medical Advisor to 25% ME Group | Update to the advice given on 29 February 2020],<ref name="SpeightWeirMar20">{{Cite web|url=https://25megroup.org/download/1796/?v=3236|author-link=Nigel Speight|last=Speight|first=Nigel||last2=Weir|first2=William|author-link2=William Weir|title=re Coronavirus and members of the 25% ME Group, Severe ME charity {{!}} Message from Dr Willy Weir and Dr Nigel Speight, Medical Advisor to 25% ME Group {{!}} Update to the advice given on 29 February 2020 |date=Mar 2020|website=25megroup.org}}</ref>
*Mar 2020, 25% ME Group, [https://25megroup.org/download/1796/?v=3226 re Coronavirus and members of the 25% ME Group, Severe ME charity Types | Message from Dr Nigel Speight, Medical Advisor to 25% ME Group]<ref name="SpeightMar20">{{Cite web|url=https://25megroup.org/download/1796/?v=3226|author-link=Nigel Speight|last=Speight|first=Nigel|title=re Coronavirus and members of the 25% ME Group, Severe ME charity Types {{!}} Message from Dr Nigel Speight, Medical Advisor to 25% ME Group|date=Mar 2020|website=25megroup.org|others=[[William Weir]]}}</ref>

==Prevention==
[[File:CDC-Coronavirus-badge-300.png|thumb|upright=1|left|Image author: CDC|alt=image of Coronavirus Disease 2019 (COVID-19)|link=https://www.cdc.gov/coronavirus/2019-ncov/index.html]]
<br style="clear:both;line-height:0">
The SARS-CoV-2 coronavirus is an ''enveloped virus'', which means it is easier to kill outside the body than ''non-enveloped'' viruses like [[Coxsackievirus]], or [[Poliovirus]].<ref>{{Cite web|url=https://www.epa.gov/pesticides/coronavirus-cases-trigger-epa-rapid-response|title=Coronavirus Cases Trigger EPA Rapid Response|last=US Environmental Protection Agency|first=|authorlink=|last2=|first2=|authorlink2=|date=2020-01-29|website=US EPA|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref><ref>{{Cite journal|last=Firquet|first=Swan|author-link=|last2=Beaujard|first2=Sophie|author-link2=|last3=Lobert|first3=Pierre-Emmanuel|author-link3=|last4=Sané|first4=Famara|author-link4=|last5=Caloone|first5=Delphine|author-link5=|last6=Izard|first6=Daniel|author-link6=|last7=Hober|first7=Didier|last8=|first8=|date=June 2015|title=Survival of Enveloped and Non-Enveloped Viruses on Inanimate Surfaces|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4462923/|journal=Microbes and Environments|volume=30|issue=2|pages=140–144|doi=10.1264/jsme2.ME14145|issn=1342-6311|pmc=4462923|pmid=25843687|access-date=|quote=|via=}}</ref>
*[https://www.cdc.gov/coronavirus/2019-ncov/prepare/get-your-household-ready-for-COVID-19.html Get your Household Ready for COVID-19] - CDC
*[https://www.americanchemistry.com/Novel-Coronavirus-Fighting-Products-List.pdf Novel Coronavirus (COVID-19)-Fighting Products] - Center for Biocide Chemistries
*[https://www.health.gov.au/sites/default/files/documents/2020/03/coronavirus-covid-19-information-on-social-distancing.pdf Social distancing - Department of Health, Australia]

==== CDC advice ====
* Know How it Spreads
* Clean your hands often
* Avoid close contact
* Stay home if you're sick (may have the virus)
* Cover coughs and sneezes
* Wear a face mask if you are sick (may have the virus)
* Clean and disinfect
<i><div role="note" class="hatnote navigation-not-searchable">{{MediaWiki:Seealso/{{{lang|{{PAGELANGUAGE}}}}}}}{{colon}}
[https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html Coronavirus disease 19 Prevention - CDC]</div></i>

===<span id="high-touch">High touch surfaces: disinfect daily</span>===
[[File:High-touch surfaces-CDC-covid-19.png|alt=High-touch surfaces: disinfect daily. Tables, doorknobs, light switches, countertops, handles, desks, phones keyboards, remote controls, toilets, faucets, sinks, hard-backed chairs. Source: Coronavirus disease 19 Prevention - CDC, March 2020. Public domain image.|thumb|upright=0.7]]<br style="line-height:0" />
The CDC currently recommends people '''clean''' AND '''disinfect''' frequently touched surfaces daily:
<div style="column-count:2;-moz-column-count:2;-webkit-column-count:2">
*tables
*doorknobs
*light switches
*countertops
*handles
*desks
*phones
*keyboards
*remote controls
*toilets
*faucets
*sinks
*hard-backed chairs<ref name="CDC-prevention" /><ref name="CDC-suspectedcases">{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/prepare/cleaning-disinfection.html|title=Coronavirus Disease 2019 (COVID-19) - Environmental Cleaning and Disinfection Recommendations|last=CDC|first=|authorlink=Centers for Disease Control and Prevention|last2=|first2=|authorlink2=|date=2020-02-11|website=Centers for Disease Control and Prevention|language=en-us|archive-url=|archive-date=|dead-url=|access-date=2020-03-18}}</ref>
</div><br style="clear:both; line-height:0" />
:'''To clean use:'''
*Detergent or soap and water prior to disinfection. <ref name="CDC-prevention" />

:'''To disinfect use:'''
*[https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2 '''Disinfectants used against SARS-CoV-2'''] (list)
*'''Most common EPA-registered household disinfectants''' will work, or
* '''Diluted household bleach''' (mix: 5 tablespoons bleach per gallon of water, OR 4 teaspoons bleach per quart of water), or
*'''Alcohol solutions''' with at least 70% alcohol
:Follow manufacturer’s instructions for application and ''proper ventilation''. Check the product is not past its expiration date. ''(Updated Mar 18, 2020)''<ref name="CDC-prevention">{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html|title=Coronavirus Disease 2019 (COVID-19) – Prevention & Treatment|last=CDC|first=|authorlink=Centers for Disease Control and Prevention|last2=|first2=|authorlink2=|date=2020-03-16|website=Centers for Disease Control and Prevention|language=en-us|archive-url=|archive-date=|dead-url=|access-date=2020-03-17}}</ref>

:'''Check for updates:'''
* [https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html Coronavirus disease 19 Prevention - CDC]

'''Suspected or confirmed COVID-19 cases:'''<br />If possible the '''sick person''' should also clean:
<div style="column-count:2;-moz-column-count:2;-webkit-column-count:2">
*soiled items and surfaces (as needed)
*if a separate bathroom is not available, the bathroom should be cleaned and disinfected after each use by an ill person
*provide personal cleaning and disinfectant supplies in ill person's room (unless unsafe, e.g. they are a young child) - include tissues, paper towels, cleaners and EPA-registered disinfectants<ref name="CDC-prevention" /><ref name="CDC-suspectedcases" /></div>

===Coronavirus transmission from surfaces===
The new coronavirus can survive on different surfaces for hours or days:
*small airborne virus particles (aerosols) - 3 hours
*copper - 4 hours
*cardboard - 24 hours
*stainless steel - 2 to 3 days
*plastic - 2 to 3 days<ref name="stablesurfacesPRMar20">{{Cite web|url=https://www.nih.gov/news-events/news-releases/new-coronavirus-stable-hours-surfaces|title=New coronavirus stable for hours on surfaces|last=National Institutes of Health|first=|authorlink=National Institutes of Health|last2=|first2=|authorlink2=|date=2020-03-17|website=National Institutes of Health (NIH)|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-25}}</ref><ref name="Tellier2006">{{Cite journal|last=Tellier|first=Raymond|author-link=|last2=|first2=|author-link2=|last3=|first3=|author-link3=|last4=|first4=|author-link4=|last5=|first5=|author-link5=|last6=|first6=|author-link6=|last7=|first7=|last8=|first8=|date=Nov 2006|title=Review of Aerosol Transmission of Influenza A Virus|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3372341/|journal=Emerging Infectious Diseases|volume=12|issue=11|pages=1657–1662|doi=10.3201/eid1211.060426|issn=1080-6040|pmc=3372341|pmid=17283614|access-date=|quote=|via=}}</ref>

This means direct contact with an infected person is not needed to contact the illness.<ref name="stablesurfacesPRMar20" /> Surgical [[#facemasks|face masks]] have not been effective against aerosols in previous influenza outbreaks like swine flu, but N95 respirators have been effective.<ref name="Tellier2006" />

==<span id="someoneissick">Disinfecting your home if someone is sick</span>==
'''Suspected or confirmed COVID-19 cases:'''<br />
*'''Clean''' AND '''disinfect''' all [[#High-touch|high-touch]] areas daily.
If possible the '''sick person''' should also clean:
<div style="column-count:2;-moz-column-count:2;-webkit-column-count:2">
*soiled items and surfaces (as needed)
*if a separate bathroom is not available, the bathroom should be cleaned and disinfected after each use by an ill person
*provide personal cleaning and disinfectant supplies in ill person's room (unless unsafe, e.g. they are a young child) - include tissues, paper towels, cleaners and EPA-registered disinfectants<ref name="CDC-prevention" /><ref name="CDC-suspectedcases" /><ref name="CDCDisinfectYourHome">https://www.cdc.gov/coronavirus/2019-ncov/prepare/disinfecting-your-home.html</ref></div>
*<div role="note" class="hatnote navigation-not-searchable">Take additional steps covering '''soft surfaces, food, laundry, and trash'''{{colon}}
*[https://www.cdc.gov/coronavirus/2019-ncov/prepare/disinfecting-your-home.html Disinfecting your home if someone is sick - CDC]

==COVID-19 pneumonia==
Severe Acute Respiratory Infection (SARI) is the name for the type of pneumonia caused by COVID-19.<ref name="vitCtrial">{{Cite web|url=https://clinicaltrials.gov/ct2/show/NCT04264533|title=Vitamin C Infusion for the Treatment of Severe 2019-nCoV Infected Pneumonia - Full Text View - ClinicalTrials.gov|website=clinicaltrials.gov|language=en|access-date=2020-03-22}}</ref> A clinical trial is in progress to determine if intravenous [[vitamin C]] is an effective treatment for SARI.<ref name="vitCtrial" />

==Myth, Hoaxes, Scams and Fake News==
Many myths, hoaxes and fake news have been spreading, particularly on social media, some of which claim to be from doctors or health professionals.<ref name="WHOmyths">{{Cite web|url=https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters|title=Coronavirus 2019 {{!}} Myth busters|last=World Health Organization|first=|authorlink=World Health Organization|last2=|first2=|authorlink2=|date=|website=www.who.int|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-17}}</ref><ref name="BuzzfeedHoax3Mar20">{{Cite web|url=https://www.buzzfeednews.com/article/janelytvynenko/coronavirus-disinformation-spread|title=Here Are Some Of The Coronavirus Hoaxes That Spread In The First Few Weeks|website=BuzzFeed News|language=en|access-date=2020-03-17}}</ref> Scam include seeking fake cures or ineffective protective equipment like masks, scammers pretending to be from the World Health Organization asking for donations, or a stranger asking for money on behalf of a relative's medical bills.<ref name="FTC-scams">{{Cite web|url=https://www.consumer.ftc.gov/features/coronavirus-scams-what-ftc-doing|title=Coronavirus Scams: What the FTC is doing|last=FTC|first=|authorlink=|last2=|first2=|authorlink2=|date=2020-03-06|website=Consumer Information|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-17}}</ref><ref name="WHO-cybersecurity">{{Cite web|url=https://www.who.int/about/communications/cyber-security|title=Communications {{!}} Cybersecurity|last=World Health Organization|first=|authorlink=World Health Organization|last2=|first2=|authorlink2=|date=|website=www.who.int|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-17}}</ref>

*[https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters Coronavirus disease (COVID-19) advice for the public: Myth busters] - World Health Organization
*Mar 3, 2020 - [https://www.buzzfeednews.com/article/janelytvynenko/coronavirus-disinformation-spread Here Are Some Of The Coronavirus Hoaxes That Spread In The First Few Weeks] - Buzzfeed News
*Mar 2020 - [https://www.buzzfeednews.com/article/janelytvynenko/heres-a-running-list-of-the-latest-disinformation Here's A Running List Of The Latest Hoaxes Spreading About The Coronavirus] - Buzzfeed News
*[https://www.who.int/about/communications/cyber-security Cybersecurity - World Health Organization]
*[https://www.consumer.ftc.gov/features/coronavirus-scams-what-ftc-doing Coronavirus scams - What the FTC os doing]

==Posters for those self-isolating to avoid infection==
*[https://chronicallyawesome.org.uk/posters-for-those-who-are-self-isolating-as-a-preventative-measure/? Unofficial posters] stating where people should leave deliveries - Chronically Awesome

==Mental health ==
Anxiety around COVID-19 illness may cause anxiety or affect mental health.
*[https://www.nami.org/getattachment/About-NAMI/NAMI-News/2020/NAMI-Updates-on-the-Coronavirus/COVID-19-Updated-Guide-1.pdf?lang=en-US COVID-19 Guide - National Association of Mental Illness]
*[https://www.who.int/docs/default-source/coronaviruse/coping-with-stress.pdf?sfvrsn=9845bc3a_2 Coping with stress during the nCov-2019 outbreak (poster)] - World Health Organization

==News articles ==
*Mar 14, 2020, [https://www.cnn.com/2020/03/14/health/coronavirus-covid-19-flu-comparison-frieden-analysis/index.html Former CDC director: Covid-19 is different from flu and we must respond differently, Dr. Tom Frieden] - CNN

==Learn more==
*[https://www.meaction.net/covid-19/ COVID-19 Resources for People with ME - #MEAction]
*[https://www.meassociation.org.uk/2020/03/me-association-guidance-coronavirus-covid-19-update-09-march-2020/ ME Association Guidance: Coronavirus (covid-19) Update | 09 March 2020] - The ME Association
*[https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public Protect yourself: Coronavirus disease 19 (COVID-19) - World Health Organization]
*[https://www.who.int/news-room/q-a-detail/q-a-coronaviruses Q&A on coronaviruses (COVID-19) - World Health Organization]
*[https://www.who.int/emergencies/diseases/novel-coronavirus-2019 Coronavirus disease 19 (COVID-19) - World Health Organization]
*[https://www.cdc.gov/coronavirus/2019-ncov/index.html Coronavirus disease 19 (COVID-19) - CDC]
*[https://www.nhs.uk/conditions/coronavirus-covid-19/ Coronavirus (COVID-19) - NHS]
*[https://www.who.int/gpsc/5may/Guide_to_Local_Production.pdf Guide to Local Production: WHO-recommended Handrub Formulations] - only for when soap and water is not available

==See also ==
*[[Postviral fatigue syndrome]] (PVFS)
*[[Myalgic encephalomyelitis]]
*[[Severe Acute Respiratory Syndrome]]

==References ==
{{Reflist}}

[[Category:Infectious agents]]
[[Category:Triggers and risk factors]]
[[Category:Virology]]
[[Category:Viruses]]
[[Category:Coronaviruses]]

Coronavirus disease 19

2020-03-28T12:45:54Z

Loopy:merge info

'''Coronavirus disease 19''', commonly known as '''COVID-19''', is the airborne infectious respiratory illness caused by the novel (new) [[SARS-CoV-2 coronavirus]], previously known as ''n-2019-nCoV''.<ref name="WHO-QA">{{Cite web|url=https://www.who.int/news-room/q-a-detail/q-a-coronaviruses|title=Q&A on coronaviruses (COVID-19)|last=World Health Organization|first=|authorlink=World Health Organization|last2=|first2=|authorlink2=|date=|website=www.who.int|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-16}}</ref><ref name="CDC-coronoviruses">{{Cite web|url=https://www.cdc.gov/coronavirus/types.html|title=Human Coronavirus Types|last=Centers for Disease Control and Prevention|first=|authorlink=Centers for Disease Control and Prevention|last2=|first2=|authorlink2=|date=2020-02-27|website=www.cdc.gov|language=en-us|archive-url=|archive-date=|dead-url=|access-date=2020-03-16}}</ref><ref>{{Cite journal|last=Li|first=Guangdi|author-link=|last2=Clercq|first2=Erik De|author-link2=|last3=|first3=|author-link3=|last4=|first4=|author-link4=|last5=|first5=|author-link5=|last6=|first6=|author-link6=|last7=|first7=|last8=|first8=|date=Mar 2020|title=Therapeutic options for the 2019 novel coronavirus (2019-nCoV)|url=https://www.nature.com/articles/d41573-020-00016-0|journal=Nature Reviews Drug Discovery|language=en|volume=19|issue=3|pages=149–150|doi=10.1038/d41573-020-00016-0|pmc=|pmid=|access-date=|quote=|via=}}</ref>
[[File:Covid-19-lung-lesions.jpg|thumb|left|alt=Computer-aided identification of lesions on the lungs of COVID-19 patients.|'''COVID-19 can cause lesions on lungs, and pneumonia.'''<br>Author: [https://www.sciencedirect.com/science/article/pii/S2095177920302264 Shen et al. 2020. Journal of Pharmaceutical Analysis]. Copyright: CC-BY-NC-ND-4.0]]{{clear}}
COVID-19 was first identified in Wuhan, China, in December 2019,<ref name="WHO-QA" /> and can infect babies, children, and adults of any age.<ref>{{Cite journal|last=Wei|first=Min|last2=Yuan|first2=Jingping|last3=Liu|first3=Yu|last4=Fu|first4=Tao|last5=Yu|first5=Xue|last6=Zhang|first6=Zhi-Jiang|date=2020-02-14|title=Novel Coronavirus Infection in Hospitalized Infants Under 1 Year of Age in China|url=https://jamanetwork.com/journals/jama/fullarticle/2761659|journal=JAMA|language=en|doi=10.1001/jama.2020.2131}}</ref> It spread globally, resulting in the 2019-2020 coronavirus pandemic.<ref>{{Cite journal|last=Hui|first=David S.|last2=Azhar|first2=Esam I.|last3=Madani|first3=Tariq A.|last4=Ntoumi|first4=Francine|last5=Kock|first5=Richard|last6=Dar|first6=Osman|last7=Ippolito|first7=Giuseppe|last8=Mchugh|first8=Timothy D.|last9=Memish|first9=Ziad A.|date=2020-02-01|title=The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health — The latest 2019 novel coronavirus outbreak in Wuhan, China|url=https://www.ijidonline.com/article/S1201-9712(20)30011-4/abstract|journal=International Journal of Infectious Diseases|language=English|volume=91|pages=264–266|doi=10.1016/j.ijid.2020.01.009|issn=1201-9712|pmid=31953166}}</ref><ref>{{Cite web|url=https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020|title=WHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020|website=www.who.int|language=en|access-date=2020-03-28}}</ref>

== Symptoms ==
Symptoms are usually mild and begin gradually, although around 1 in 6 people with COVID-19 need medical help.<ref name="WHO-QA" /> Some people become infected but don't develop any symptoms and don't feel unwell.<ref name=":0">{{Cite web||last=World Health Organization|first=|authorlink=World Health Organization|url=https://www.who.int/news-room/q-a-detail/q-a-coronaviruses|title=Q&A on coronaviruses (COVID-19)|website=www.who.int|language=en|access-date=2020-03-24}}</ref> These symptoms may appear 1-14 days after exposure; most commonly around five days.<ref name=":0" /><ref name=":1">{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html|title=Coronavirus Disease 2019 (COVID-19) – Symptoms|last=CDC|date=2020-03-20||author-link=Centers for Disease Control|website=Centers for Disease Control and Prevention|language=en-us|access-date=2020-03-24}}</ref>

'''Common Symptoms'''
* [[fever]]
* tiredness
* continuous cough, coughing episodes or a dry [[cough|cough,]]<ref>{{Cite web|url=https://www.nhs.uk/conditions/coronavirus-covid-19/symptoms-and-what-to-do/|title=Symptoms and what to do - Coronavirus (COVID-19)|last=National Health Service|first=|authorlink=National Health Service|last2=|first2=|authorlink2=|date=2020-03-24|website=nhs.uk|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-26}}</ref><ref name=":0" /> or [[Dyspnea|shortness of breath]]<ref name=":1" />
Most patients only have one or two of the common symptoms.<ref name=":0" /><ref name=":3">{{Cite journal|last=Mizumoto|first=Kenji|last2=Kagaya|first2=Katsushi|last3=Zarebski|first3=Alexander|last4=Chowell|first4=Gerardo|date=2020-03-12|title=Estimating the asymptomatic proportion of coronavirus disease 2019 (COVID-19) cases on board the Diamond Princess cruise ship, Yokohama, Japan, 2020|url=https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.10.2000180|journal=Eurosurveillance|language=en|volume=25|issue=10|pages=2000180|doi=10.2807/1560-7917.ES.2020.25.10.2000180|issn=1560-7917|pmc=PMC7078829|pmid=32183930}}</ref><ref name="Lan2020" />

'''Other Symptoms'''
* aches and [[Pain|pains]]
* nasal congestion
* runny nose
* [[sore throat]]
* [[diarrhea]]<ref name=":0" />
'''Emergency Warning Signs'''*
* trouble breathing
* [[Chest pain|persistent pain or pressure in the chest]]
* new [[confusion]] or inability to arouse (unresponsive)
* bluish lips or face<ref name=":1" />
<nowiki>*</nowiki>This list is not all inclusive. Consult your medical provider for any other symptoms that are severe or concerning.<ref name=":1" />

Additionally, there are reports that patients have lost or have a reduced sense of smell, or lost or distorted of taste, but are otherwise [[#asymptomaticcarriers|asymptomatic]].<ref name=":2">{{Cite news|url=https://www.nytimes.com/2020/03/22/health/coronavirus-symptoms-smell-taste.html|title=Lost Sense of Smell May Be Peculiar Clue to Coronavirus Infection|last=Rabin|first=Roni Caryn|date=2020-03-22|work=The New York Times|access-date=2020-03-24|language=en-US|issn=0362-4331}}</ref><blockquote>The American Academy of Otolaryngology on Sunday posted information on its website<ref>{{Cite web|url=https://www.entnet.org/content/coronavirus-disease-2019-resources|title=Coronavirus Disease 2019: Resources|last=American Academy of Otolaryngology|date=2020-03-15|website=American Academy of Otolaryngology-Head and Neck Surgery|language=en|access-date=2020-03-24}}</ref> saying that mounting anecdotal evidence indicates that lost or reduced sense of smell and loss of taste are significant symptoms associated with Covid-19, and that they have been seen in patients who ultimately tested positive with no other symptoms.<ref name=":2" /></blockquote><blockquote>The symptoms, in the absence of allergies or sinusitis, should alert doctors to screen patients for the virus and “warrant serious consideration for self isolation and testing of these individuals,” the academy said.<ref name=":2" /></blockquote>

==<span id="asymptomaticcarriers">Asymptomatic carriers</span>==
[[File:Covid-19-virus.png|thumb|upright=0.4|'''The SARS-CoV-2 virus causes COVID-19.'''<br>Author: CDC]]
A number of studies have found that some people who test positive for COVID-19 do not have any symptoms of illness or a raised temperature, and have normal blood test results, but are able to infect others, some of whom developed severe COVID-19 [[pneumonia]] as a result of COVID-19.<ref name="Bai2020">{{Cite journal|last=Bai|first=Yan|last2=Yao|first2=Lingsheng|last3=Wei|first3=Tao|last4=Tian|first4=Fei|last5=Jin|first5=Dong-Yan|last6=Chen|first6=Lijuan|last7=Wang|first7=Meiyun|date=2020-02-21|title=Presumed Asymptomatic Carrier Transmission of COVID-19|url=https://jamanetwork.com/journals/jama/fullarticle/2762028|journal=JAMA|language=en|doi=10.1001/jama.2020.2565}}</ref><ref name="Chan2019">{{Cite journal|last=Chan|first=Jasper Fuk-Woo|last2=Yuan|first2=Shuofeng|last3=Kok|first3=Kin-Hang|last4=To|first4=Kelvin Kai-Wang|last5=Chu|first5=Hin|last6=Yang|first6=Jin|last7=Xing|first7=Fanfan|last8=Liu|first8=Jieling|last9=Yip|first9=Cyril Chik-Yan|date=2020-02-15|title=A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster|url=https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30154-9/abstract|journal=The Lancet|language=English|volume=395|issue=10223|pages=514–523|doi=10.1016/S0140-6736(20)30154-9|issn=0140-6736|pmid=31986261}}</ref><ref name="delRio2020">{{Cite journal|last=del Rio|first=Carlos|author-link=|last2=Malani|first2=Preeti N.|author-link2=|last3=|first3=|author-link3=|last4=|first4=|author-link4=|last5=|first5=|author-link5=|last6=|first6=|author-link6=|last7=|first7=|last8=|first8=|date=2020-02-28|title=COVID-19—New Insights on a Rapidly Changing Epidemic|url=https://jamanetwork.com/journals/jama/fullarticle/2762510|journal=JAMA|language=en|volume=|issue=|pages=|doi=10.1001/jama.2020.3072|pmc=|pmid=|access-date=|quote=|via=}}</ref> Some asymptomatic carriers have abnormal chest CT scans, and some do not. False negative tests have also been reported.<ref name="Bai2020" /><ref name="Chan2019" />

Estimates of the number of asymptomatic carriers vary wildly. Mizumoto et al. (2020) estimated that asymptomatic carriers accounted for 17.9% of the COVID-19 positive people on the ''Diamond Princess'' cruise ship, which was quarantined for 14 day after a previous passenger developed the illness.<ref name=":3" />

==<span id="recovered">Recovered patients testing positive</span>==
Lan et al (2020) identified a group of 4 recovered patients who continued to test positive for COVID-19 after recovery; suggesting that they may still be infectious.<ref name="Lan2020">{{Cite journal|last=Lan|first=Lan|last2=Xu|first2=Dan|last3=Ye|first3=Guangming|last4=Xia|first4=Chen|last5=Wang|first5=Shaokang|last6=Li|first6=Yirong|last7=Xu|first7=Haibo|date=2020-02-27|title=Positive RT-PCR Test Results in Patients Recovered From COVID-19|url=https://jamanetwork.com/journals/jama/fullarticle/2762452|journal=JAMA|language=en|doi=10.1001/jama.2020.2783}}</ref> It is not known whether patients who have recovered may be reinfected later, or whether those who later needed treatment actually relapsed, or if recovered patients who later test positive do so because of issues with the diagnostic test's accuracy.<ref>{{Cite web|url=https://www.snopes.com/fact-check/covid-19-reinfection/|title=Can People Who Recover from COVID-19 Become Reinfected?|website=Snopes.com|language=en-US|access-date=2020-03-26}}</ref> Another study found group of 5 recovered patients were found to have reactivated COVID-19.<ref>{{Cite journal|last=Ye|first=Guangming|last2=Pan|first2=Zhenyu|last3=Pan|first3=Yunbao|last4=Deng|first4=Qiaoling|last5=Chen|first5=Liangjun|last6=Li|first6=Jin|last7=Li|first7=Yirong|last8=Wang|first8=Xinghuan|date=2020-03-11|title=Clinical characteristics of severe acute respiratory syndrome coronavirus 2 reactivation|url=https://www.journalofinfection.com/article/S0163-4453(20)30114-6/abstract|journal=Journal of Infection|language=English|volume=0|issue=0|doi=10.1016/j.jinf.2020.03.001|issn=0163-4453|pmid=32171867}}</ref>

==ME/CFS==

{{Video|id=pkGXiJ1jM14|service=youtube|dimensions=550|description=COVID-19 and ME/CFS - Dr Nancy Klimas, Mar 13, 2020|alignment=left|urlargs=}}

{{clear}}

====<span id="catchingcovid19">Risk of COVID-19 in patients with ME/CFS</span>====
There is a lack of evidence about ME/CFS patients developing COVID-19 illness; but a number of medical advisors have given their expert opinions on this. Immunologist and [[Myalgic encephalomyelitis|ME]] researcher Dr [[Nancy Klimas]] has said she believes people with ME/CFS are at a little higher risk of developing COVID-19 after exposure to the virus;<ref name="Klimas20200313">{{Cite web|url=https://www.youtube.com/watch?v=pkGXiJ1jM14|title=COVID-19 and ME/CFS - Dr Nancy Klimas, Mar 13, 2020|last=Klimas|first=Nancy|date=2020-03-13|work=|access-date=Mar 24, 2020|archive-url=|archive-date=|dead-url=|quote=|author-link=Nancy Klimas}}</ref> Dr [[Nigel Speight]], Dr [[William Weir]] and Dr [[Charles Shepherd]] have said they do not think there is an increased risk.<ref name="SpeightWeirMar20" /><ref name="SpeightMar20" /><ref name="MEA16Mar20" /> Klimas, Speight, Weir and Shepherd have all advised ME/CFS patients to take additional precautions, and highlighted that there is a risk of ME/CFS becoming significantly worse after viral infections.<ref name="Klimas20200313" /><ref name="SpeightWeirMar20" /><ref name="SpeightMar20" /><ref name="MEA16Mar20" />

ME/CFS includes [[:Category:Immune signs and symptoms|immune symptoms]] including a [[sore throat]], [[swollen lymph nodes]], and [[flu-like symptoms]], but patients are generally not considered to be severely immunocompromised, and immunosuppressant medications are unlikely to be used by most ME/CFS patients. <ref name="Klimas20200313" /> <ref name="canadianconsensus">{{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
| url = http://www.investinme.org/Documents/PDFdocuments/CanadianDefinitionME-CFS.pdf
}}</ref><ref name="ICP2011primer">{{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> This means most ME/CFS patients would not be considered to be at very high risk of COVID-19 illness.<ref name="Klimas20200313" />

* '''<span id="ibuprofen">[[Ibuprofen]]</span>''' - Ibuprofen drugs (Nurofen, Bruprofen, Advil, Midol, Motrin, Motrin) are anti-inflammatories commonly used for cold/flu symptoms and for ME/CFS. There have been some reports that ibuprofen taken for COVID-19 may prolong the illness and increase it's severity. Several countries including the UK and France now recommend that people with suspected or confirmed COVID-19 avoid ibuprofen and '''use paracetamol / acetaminophen''' (e.g., Tylenol) instead, although the evidence for this is relatively limited.<ref name="MEA16Mar20" /><ref name="Day20200317">{{Cite journal|last=Day|first=Michael|date=2020-03-17|title=Covid-19: ibuprofen should not be used for managing symptoms, say doctors and scientists|url=https://www.bmj.com/content/368/bmj.m1086|journal=BMJ|language=en|volume=368|doi=10.1136/bmj.m1086|issn=1756-1833|pmid=32184201}}</ref><ref>{{Cite web|url=https://www.nhs.uk/conditions/coronavirus-covid-19/self-isolation-advice/|title=Stay at home advice - Coronavirus (COVID-19)|last=National Health Service|first=|authorlink=National Health Service|last2=|first2=|authorlink2=|date=2020-02-28|website=nhs.uk|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref> There is no suggestion that ibuprofen affects the risk of catching COVID-19.
* '''[[Rituximab]]''' - The MS Society has stated that taking rituximab, which has been used in clinical trials for ME/CFS, may affect the risk of catching COVID-19.<ref name="Covid-19-MS">{{Cite web|url=https://www.mssociety.org.uk/about-ms/treatments-and-therapies/disease-modifying-therapies/covid-19-coronavirus-and-ms|title=COVID-19 coronavirus and MS|last=MS Society|first=|authorlink=|last2=|first2=|authorlink2=|date=|website=www.mssociety.org.uk|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref><ref>{{Cite web|url=https://renal.org/wp-content/uploads/2020/03/BAPN-COVID-19-patient-info-for-HD.PD_.Immunosuppression-17March20.pdf|title=Coronavirus (SARS-CoV-2) and its associated illness (COVID-19) {{!}} Information and Guidance for Children on Haemodialysis, Peritoneal Dialysis and Immune suppression (including Renal Transplants)|last=Renal Association|first=|authorlink=|last2=|first2=|authorlink2=|date=2020-03-17|website=renal.org|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref>
* '''[[Ampligen]]''' - Ampligen or ''rintatolimod'' is sometimes used by ME/CFS patients, it is an [[antiviral]] immunostimulant rather than immunosuppressing drug, and is being tested for the treatment of COVID-19 illness in Japan.<ref>{{Cite web|url=https://adisinsight.springer.com/drugs/800001203|title=Rintatolimod - AIM ImmunoTech - AdisInsight|website=adisinsight.springer.com|access-date=2020-03-23}}</ref> There is no information about whether it may help prevent COVID-19 in ME/CFS patients.
*The unproven [[autoimmune hypothesis]] states that a subtype of ME involves autoimmunity, which is an overactive immune system rather than a weakened immune response.<ref name="OMF2018research">{{Cite web|url=https://www.omf.ngo/2018/02/28/omf-funded-research-t-cells-molecular-immunology/|title=OMF-funded research: T cells and molecular immunology|last=Open Medicine Foundation|first=|authorlink=Open Medicine Foundation|last2=|first2=|authorlink2=|date=Feb 28, 2018|website=Open Medicine Foundation|language=en-US|archive-url=|archive-date=|dead-url=|access-date=2019-07-11}}</ref>
{{Quote box|I have now reached the conclusion that people with pre-existing health conditions that make them more vulnerable to lung complications (which may or may not be the case with ME/CFS – at this stage we just don’t know), or have a condition like ME/CFS where an infection such as this will almost certainly cause a relapse, or significant exacerbation of symptoms, need to be doing far more to protect themselves, and to socially distance themselves from other people, than official NHS guidance indicates.

In particular, for those who are not housebound, this applies to social mobility and what you can do (and cannot do) if you decide to leave your home.<ref name="MEA16Mar20"/>|author=[[Charles Shepherd]], ME Association|date=Mar 16, 2020|title=Advice from the UK's ME Association}}

====<span id="deathrisk">Risk of death or serious complications in ME/CFS patients</span>====
{{Quote box|Although ME is a "chronic condition" my gut feeling is that they are not actually at greater risk of dying from the virus itself than healthy people. The conditions which put people at extra risk would be things like severe asthma or COPD, or immunosuppressed people eg those on chemotherapy for cancer.

The biggest worry therefore for ME sufferers is that catching the virus will make their ME much worse, and of course people in the 25% group do not have much leeway.

It might even be that worsening of their already severe ME could be a bigger threat to life than the virus itself.<ref name="SpeightMar20" />|author=[[Nigel Speight]]|date=Mar 2020|title=25% ME Group for Severe ME}}

====<span id="triggerforME">Risk of developing ME/CFS after COVID-19</span>====
ME/CFS has been linked to many different viruses, but it is not known what the likelihood is of developing ME/CFS after COVID-19 illness.
{{See also|Postviral fatigue syndrome}}

==ME/CFS charity medical advisors COVID-19 statements==
*Mar 17, 2020, ME Association, [https://www.meassociation.org.uk/2020/03/coronavirus-covid-19-latest-government-advice-and-what-it-means-for-people-with-me-cfs-17-march-2020/ Coronavirus Covid-19: Latest Government advice and what it means for people with ME/CFS]<ref name="MEA17Mar20">{{Cite web|url=https://www.meassociation.org.uk/2020/03/coronavirus-covid-19-latest-government-advice-and-what-it-means-for-people-with-me-cfs-17-march-2020/|title=Coronavirus Covid-19: Latest Government advice and what it means for people with ME/CFS {{!}} 17 March 2020|last=Shepherd|first=Charles|authorlink=Charles Shepherd|last2=|first2=|authorlink2=|date=2020-03-17|website=ME Association|language=en-GB|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref>
*Mar 16, 2020, ME Association, [https://www.meassociation.org.uk/2020/03/me-association-guidance-coronavirus-covid-19-and-me-cfs-by-dr-charles-shepherd-16-march-2020/ ME Association Guidance: Coronavirus and ME/CFS by Dr Charles Shepherd]<ref name="MEA16Mar20">{{Cite web|url=https://www.meassociation.org.uk/2020/03/me-association-guidance-coronavirus-covid-19-and-me-cfs-by-dr-charles-shepherd-16-march-2020/|title=ME Association Guidance: Coronavirus and ME/CFS by Dr Charles Shepherd {{!}} 16 March 2020|last=Shepherd|first=Charles|authorlink=Charles Shepherd|last2=|first2=|authorlink2=|date=2020-03-16|website=ME Association|language=en-GB|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref>
*Mar 2020, 25% ME Group, [https://25megroup.org/download/1796/?v=3236 re Coronavirus and members of the 25% ME Group, Severe ME charity | Message from Dr Willy Weir and Dr Nigel Speight, Medical Advisor to 25% ME Group | Update to the advice given on 29 February 2020],<ref name="SpeightWeirMar20">{{Cite web|url=https://25megroup.org/download/1796/?v=3236|author-link=Nigel Speight|last=Speight|first=Nigel||last2=Weir|first2=William|author-link2=William Weir|title=re Coronavirus and members of the 25% ME Group, Severe ME charity {{!}} Message from Dr Willy Weir and Dr Nigel Speight, Medical Advisor to 25% ME Group {{!}} Update to the advice given on 29 February 2020 |date=Mar 2020|website=25megroup.org}}</ref>
*Mar 2020, 25% ME Group, [https://25megroup.org/download/1796/?v=3226 re Coronavirus and members of the 25% ME Group, Severe ME charity Types | Message from Dr Nigel Speight, Medical Advisor to 25% ME Group]<ref name="SpeightMar20">{{Cite web|url=https://25megroup.org/download/1796/?v=3226|author-link=Nigel Speight|last=Speight|first=Nigel|title=re Coronavirus and members of the 25% ME Group, Severe ME charity Types {{!}} Message from Dr Nigel Speight, Medical Advisor to 25% ME Group|date=Mar 2020|website=25megroup.org|others=[[William Weir]]}}</ref>

==Prevention==
[[File:CDC-Coronavirus-badge-300.png|thumb|upright=1|left|Image author: CDC|alt=image of Coronavirus Disease 2019 (COVID-19)|link=https://www.cdc.gov/coronavirus/2019-ncov/index.html]]
<br style="clear:both;line-height:0">
The SARS-CoV-2 coronavirus is an ''enveloped virus'', which means it is easier to kill outside the body than ''non-enveloped'' viruses like [[Coxsackievirus]], or [[Poliovirus]].<ref>{{Cite web|url=https://www.epa.gov/pesticides/coronavirus-cases-trigger-epa-rapid-response|title=Coronavirus Cases Trigger EPA Rapid Response|last=US Environmental Protection Agency|first=|authorlink=|last2=|first2=|authorlink2=|date=2020-01-29|website=US EPA|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-23}}</ref><ref>{{Cite journal|last=Firquet|first=Swan|author-link=|last2=Beaujard|first2=Sophie|author-link2=|last3=Lobert|first3=Pierre-Emmanuel|author-link3=|last4=Sané|first4=Famara|author-link4=|last5=Caloone|first5=Delphine|author-link5=|last6=Izard|first6=Daniel|author-link6=|last7=Hober|first7=Didier|last8=|first8=|date=June 2015|title=Survival of Enveloped and Non-Enveloped Viruses on Inanimate Surfaces|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4462923/|journal=Microbes and Environments|volume=30|issue=2|pages=140–144|doi=10.1264/jsme2.ME14145|issn=1342-6311|pmc=4462923|pmid=25843687|access-date=|quote=|via=}}</ref>
*[https://www.cdc.gov/coronavirus/2019-ncov/prepare/get-your-household-ready-for-COVID-19.html Get your Household Ready for COVID-19] - CDC
*[https://www.americanchemistry.com/Novel-Coronavirus-Fighting-Products-List.pdf Novel Coronavirus (COVID-19)-Fighting Products] - Center for Biocide Chemistries
*[https://www.health.gov.au/sites/default/files/documents/2020/03/coronavirus-covid-19-information-on-social-distancing.pdf Social distancing - Department of Health, Australia]

==== CDC advice ====
* Know How it Spreads
* Clean your hands often
* Avoid close contact
* Stay home if you're sick (may have the virus)
* Cover coughs and sneezes
* Wear a face mask if you are sick (may have the virus)
* Clean and disinfect
<i><div role="note" class="hatnote navigation-not-searchable">{{MediaWiki:Seealso/{{{lang|{{PAGELANGUAGE}}}}}}}{{colon}}
[https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html Coronavirus disease 19 Prevention - CDC]</div></i>

===<span id="high-touch">High touch surfaces: disinfect daily</span>===
[[File:High-touch surfaces-CDC-covid-19.png|alt=High-touch surfaces: disinfect daily. Tables, doorknobs, light switches, countertops, handles, desks, phones keyboards, remote controls, toilets, faucets, sinks, hard-backed chairs. Source: Coronavirus disease 19 Prevention - CDC, March 2020. Public domain image.|thumb|upright=0.7]]<br style="line-height:0" />
The CDC currently recommends people '''clean''' AND '''disinfect''' frequently touched surfaces daily:
<div style="column-count:2;-moz-column-count:2;-webkit-column-count:2">
*tables
*doorknobs
*light switches
*countertops
*handles
*desks
*phones
*keyboards
*remote controls
*toilets
*faucets
*sinks
*hard-backed chairs<ref name="CDC-prevention" /><ref name="CDC-suspectedcases">{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/prepare/cleaning-disinfection.html|title=Coronavirus Disease 2019 (COVID-19) - Environmental Cleaning and Disinfection Recommendations|last=CDC|first=|authorlink=Centers for Disease Control and Prevention|last2=|first2=|authorlink2=|date=2020-02-11|website=Centers for Disease Control and Prevention|language=en-us|archive-url=|archive-date=|dead-url=|access-date=2020-03-18}}</ref>
</div><br style="clear:both; line-height:0" />
:'''To clean use:'''
*Detergent or soap and water prior to disinfection. <ref name="CDC-prevention" />

:'''To disinfect use:'''
*[https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2 '''Disinfectants used against SARS-CoV-2'''] (list)
*'''Most common EPA-registered household disinfectants''' will work, or
* '''Diluted household bleach''' (mix: 5 tablespoons bleach per gallon of water, OR 4 teaspoons bleach per quart of water), or
*'''Alcohol solutions''' with at least 70% alcohol
:Follow manufacturer’s instructions for application and ''proper ventilation''. Check the product is not past its expiration date. ''(Updated Mar 18, 2020)''<ref name="CDC-prevention">{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html|title=Coronavirus Disease 2019 (COVID-19) – Prevention & Treatment|last=CDC|first=|authorlink=Centers for Disease Control and Prevention|last2=|first2=|authorlink2=|date=2020-03-16|website=Centers for Disease Control and Prevention|language=en-us|archive-url=|archive-date=|dead-url=|access-date=2020-03-17}}</ref>

:'''Check for updates:'''
* [https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html Coronavirus disease 19 Prevention - CDC]

'''Suspected or confirmed COVID-19 cases:'''<br />If possible the '''sick person''' should also clean:
<div style="column-count:2;-moz-column-count:2;-webkit-column-count:2">
*soiled items and surfaces (as needed)
*if a separate bathroom is not available, the bathroom should be cleaned and disinfected after each use by an ill person
*provide personal cleaning and disinfectant supplies in ill person's room (unless unsafe, e.g. they are a young child) - include tissues, paper towels, cleaners and EPA-registered disinfectants<ref name="CDC-prevention" /><ref name="CDC-suspectedcases" /></div>

===Coronavirus transmission from surfaces===
The new coronavirus can survive on different surfaces for hours or days:
*small airborne virus particles (aerosols) - 3 hours
*copper - 4 hours
*cardboard - 24 hours
*stainless steel - 2 to 3 days
*plastic - 2 to 3 days<ref name="stablesurfacesPRMar20">{{Cite web|url=https://www.nih.gov/news-events/news-releases/new-coronavirus-stable-hours-surfaces|title=New coronavirus stable for hours on surfaces|last=National Institutes of Health|first=|authorlink=National Institutes of Health|last2=|first2=|authorlink2=|date=2020-03-17|website=National Institutes of Health (NIH)|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-25}}</ref><ref name="Tellier2006">{{Cite journal|last=Tellier|first=Raymond|author-link=|last2=|first2=|author-link2=|last3=|first3=|author-link3=|last4=|first4=|author-link4=|last5=|first5=|author-link5=|last6=|first6=|author-link6=|last7=|first7=|last8=|first8=|date=Nov 2006|title=Review of Aerosol Transmission of Influenza A Virus|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3372341/|journal=Emerging Infectious Diseases|volume=12|issue=11|pages=1657–1662|doi=10.3201/eid1211.060426|issn=1080-6040|pmc=3372341|pmid=17283614|access-date=|quote=|via=}}</ref>

This means direct contact with an infected person is not needed to contact the illness.<ref name="stablesurfacesPRMar20" /> Surgical [[#facemasks|face masks]] have not been effective against aerosols in previous influenza outbreaks like swine flu, but N95 respirators have been effective.<ref name="Tellier2006" />

==<span id="someoneissick">Disinfecting your home if someone is sick</span>==
'''Suspected or confirmed COVID-19 cases:'''<br />
*'''Clean''' AND '''disinfect''' all [[#High-touch|high-touch]] areas daily.
If possible the '''sick person''' should also clean:
<div style="column-count:2;-moz-column-count:2;-webkit-column-count:2">
*soiled items and surfaces (as needed)
*if a separate bathroom is not available, the bathroom should be cleaned and disinfected after each use by an ill person
*provide personal cleaning and disinfectant supplies in ill person's room (unless unsafe, e.g. they are a young child) - include tissues, paper towels, cleaners and EPA-registered disinfectants<ref name="CDC-prevention" /><ref name="CDC-suspectedcases" /><ref name="CDCDisinfectYourHome">https://www.cdc.gov/coronavirus/2019-ncov/prepare/disinfecting-your-home.html</ref></div>
*<div role="note" class="hatnote navigation-not-searchable">Take additional steps covering '''soft surfaces, food, laundry, and trash'''{{colon}}
*[https://www.cdc.gov/coronavirus/2019-ncov/prepare/disinfecting-your-home.html Disinfecting your home if someone is sick - CDC]

==COVID-19 pneumonia==
Severe Acute Respiratory Infection (SARI) is the name for the type of pneumonia caused by COVID-19.<ref name="vitCtrial">{{Cite web|url=https://clinicaltrials.gov/ct2/show/NCT04264533|title=Vitamin C Infusion for the Treatment of Severe 2019-nCoV Infected Pneumonia - Full Text View - ClinicalTrials.gov|website=clinicaltrials.gov|language=en|access-date=2020-03-22}}</ref> A clinical trial is in progress to determine if intravenous [[vitamin C]] is an effective treatment for SARI.<ref name="vitCtrial" />

==Myth, Hoaxes, Scams and Fake News==
Many myths, hoaxes and fake news have been spreading, particularly on social media, some of which claim to be from doctors or health professionals.<ref name="WHOmyths">{{Cite web|url=https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters|title=Coronavirus 2019 {{!}} Myth busters|last=World Health Organization|first=|authorlink=World Health Organization|last2=|first2=|authorlink2=|date=|website=www.who.int|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-17}}</ref><ref name="BuzzfeedHoax3Mar20">{{Cite web|url=https://www.buzzfeednews.com/article/janelytvynenko/coronavirus-disinformation-spread|title=Here Are Some Of The Coronavirus Hoaxes That Spread In The First Few Weeks|website=BuzzFeed News|language=en|access-date=2020-03-17}}</ref> Scam include seeking fake cures or ineffective protective equipment like masks, scammers pretending to be from the World Health Organization asking for donations, or a stranger asking for money on behalf of a relative's medical bills.<ref name="FTC-scams">{{Cite web|url=https://www.consumer.ftc.gov/features/coronavirus-scams-what-ftc-doing|title=Coronavirus Scams: What the FTC is doing|last=FTC|first=|authorlink=|last2=|first2=|authorlink2=|date=2020-03-06|website=Consumer Information|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-17}}</ref><ref name="WHO-cybersecurity">{{Cite web|url=https://www.who.int/about/communications/cyber-security|title=Communications {{!}} Cybersecurity|last=World Health Organization|first=|authorlink=World Health Organization|last2=|first2=|authorlink2=|date=|website=www.who.int|language=en|archive-url=|archive-date=|dead-url=|access-date=2020-03-17}}</ref>

*[https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters Coronavirus disease (COVID-19) advice for the public: Myth busters] - World Health Organization
*Mar 3, 2020 - [https://www.buzzfeednews.com/article/janelytvynenko/coronavirus-disinformation-spread Here Are Some Of The Coronavirus Hoaxes That Spread In The First Few Weeks] - Buzzfeed News
*Mar 2020 - [https://www.buzzfeednews.com/article/janelytvynenko/heres-a-running-list-of-the-latest-disinformation Here's A Running List Of The Latest Hoaxes Spreading About The Coronavirus] - Buzzfeed News
*[https://www.who.int/about/communications/cyber-security Cybersecurity - World Health Organization]
*[https://www.consumer.ftc.gov/features/coronavirus-scams-what-ftc-doing Coronavirus scams - What the FTC os doing]

==Posters for those self-isolating to avoid infection==
*[https://chronicallyawesome.org.uk/posters-for-those-who-are-self-isolating-as-a-preventative-measure/? Unofficial posters] stating where people should leave deliveries - Chronically Awesome

==Mental health ==
Anxiety around COVID-19 illness may cause anxiety or affect mental health.
*[https://www.nami.org/getattachment/About-NAMI/NAMI-News/2020/NAMI-Updates-on-the-Coronavirus/COVID-19-Updated-Guide-1.pdf?lang=en-US COVID-19 Guide - National Association of Mental Illness]
*[https://www.who.int/docs/default-source/coronaviruse/coping-with-stress.pdf?sfvrsn=9845bc3a_2 Coping with stress during the nCov-2019 outbreak (poster)] - World Health Organization

==News articles ==
*Mar 14, 2020, [https://www.cnn.com/2020/03/14/health/coronavirus-covid-19-flu-comparison-frieden-analysis/index.html Former CDC director: Covid-19 is different from flu and we must respond differently, Dr. Tom Frieden] - CNN

==Learn more==
*[https://www.meaction.net/covid-19/ COVID-19 Resources for People with ME - #MEAction]
*[https://www.meassociation.org.uk/2020/03/me-association-guidance-coronavirus-covid-19-update-09-march-2020/ ME Association Guidance: Coronavirus (covid-19) Update | 09 March 2020] - The ME Association
*[https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public Protect yourself: Coronavirus disease 19 (COVID-19) - World Health Organization]
*[https://www.who.int/news-room/q-a-detail/q-a-coronaviruses Q&A on coronaviruses (COVID-19) - World Health Organization]
*[https://www.who.int/emergencies/diseases/novel-coronavirus-2019 Coronavirus disease 19 (COVID-19) - World Health Organization]
*[https://www.cdc.gov/coronavirus/2019-ncov/index.html Coronavirus disease 19 (COVID-19) - CDC]
*[https://www.nhs.uk/conditions/coronavirus-covid-19/ Coronavirus (COVID-19) - NHS]
*[https://www.who.int/gpsc/5may/Guide_to_Local_Production.pdf Guide to Local Production: WHO-recommended Handrub Formulations] - only for when soap and water is not available

==See also ==
*[[Postviral fatigue syndrome]] (PVFS)
*[[Myalgic encephalomyelitis]]
*[[Severe Acute Respiratory Syndrome]]

==References ==
{{Reflist}}

[[Category:Infectious agents]]
[[Category:Triggers and risk factors]]
[[Category:Virology]]
[[Category:Viruses]]
[[Category:Coronaviruses]]