Post-COVID fatigue

This week’s expert:
Prof Andrew Lloyd, Infectious Diseases Physician, Prince of Wales Hospital, Sydney and Academic researcher, Kirby Institute at the University of NSW

Drawn from Dr David Lim’s interview with Prof Andrew Lloyd on the Healthed Podcast, ‘Going Viral’.

• Research suggests that up to 50% of patients will experience problematic fatigue post-COVID infection.

• Fatigue occurring in post-COVID patients will usually be associated with one of three conditions:

  1. End-organ injury (heart, lungs or brain) following a severe COVID infection commonly associated with hospitalisation.
  2. Post-viral fatigue syndrome similar to that associated with many viruses such as glandular fever and influenza
  3. Mood disorder followed psychosocial distress

• In assessing the patient presenting with fatigue following COVID-19 infection, it is important to identify any red flags that might indicate underlying pathology

• Determine what is meant by ‘fatigue’. The patient could mean dyspnoea on exertion suggestive of underlying cardiac or respiratory disease. They could mean excess sleepiness indicative of sleep apnoea related to recent weight gain or excess alcohol intake. Or they could mean anhedonia indicative of a mood disorder.

• Ask about exacerbations of fatigue following physical or cognitive activity. This is generally indicative of a post-viral fatigue syndrome.

• Should the post-COVID fatigue persist (beyond 1-2 months) and in the absence of any red flag symptoms, it would be reasonable to order some screening blood tests including a FBC, CRP, LFTs and a TSH.

• Fatigue symptoms need to be managed, even as investigations are put in place.

• It is important to acknowledge and validate the patients experience of post-COVID fatigue as a recognised consequence of the COVID-19 infection.

• Any suspicion of a mood disorder or a sleep disorder should be acted upon and treatment initiated.

• If post-viral fatigue is the diagnosis, patients can be reassured that resolution is likely to occur with time. Evidence from studies of fatigue associated with other viruses shows that even though 30% of patients will have the symptom 1-2 months post-infection, only 10% will be affected at six months and less than 5% at 12 months.

• Patients with post-viral fatigue who experience post-activity exacerbations can be managed with activity pacing. This is where the patients recognise the threshold of activity duration, either cognitive or physical, beyond which they trigger an episode of extreme fatigue. The idea is that they plan activities within that limitation eg they only exercise for 30 minutes rather than 45minutes, and gradually build-up this duration of activity duration over time.

• Fatigue that doesn’t improve, despite treatment, after six months warrants further investigation.

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