Fatigue

Fatigue is reported in 21% of cases 7 to 9 months after infection, and 16% of cases at 12 months. With the Omicron variant, fatigue is reported in 7.6% of cases 3 months after primary infection.

When describing their fatigue, people suffering from post-COVID say that their bodies feel as if they have been drained of energy (asthenia), they feel listless and become exhausted from the slightest effort. 
It is important when discussing post-COVID fatigue to talk about and look for post-exertional malaise. Post-exertional malaise is the reproduction of symptoms and feelings of fatigue after even the slightest effort (mental or physical).
Patients with post-COVID fatigue  often describe waking up tired and needing to sleep during the day, even when they have not had insomnia.

The level of fatigue can fluctuate during the day, and it can be triggered by physical exertion or, in some people, by hormones, insomnia, stress, anxiety and other factors. In contrast, in people suffering from depression, activity usually causes the level of fatigue to decrease.

A sleep assessment is essential in evaluating fatigue and can be done by your doctor or by using validated scales to identify and classify the severity of any insomnia.

Your primary care physician should go through the relevant symptoms and rule out other causes of fatigue through a clinical evaluation and laboratory tests.

How is it treated ? 

There is no medication to treat post-COVID fatigue if there are no identifiable causes, such as a vitamin deficiency. The goal of treatment is to lessen the impact of the symptoms and to allow the individual to preserve their energy levels. 

Regular follow-up is recommended for people suffering from post-COVID fatigue. Patients should also keep an energy diary to track how their symptoms evolve when following the four Ps: plan, pace, prioritize, position. They should also adjust their daily routine to allow them to focus on everyday activities and avoid exhausting their daily energy reserves. Physical therapy can be helpful in avoiding deconditioning but should be balanced out with pacing and preserving energy levels. A psychiatric evaluation to identify other underlying causes of the fatigue and manage its impact on the individual’s daily life can also be helpful. 

What about work ? 

For patients who have a job, returning to work, gradually if necessary, can help them to adapt and manage the impact of their symptoms. Patients who tire very easily should be offered a reduced workload and increase their level of activity progressively. They should be allowed enough time to stabilize their energy levels at each new activity level before moving to the next level of effort needed for social, professional or other activities.

As with other illnesses characterized by fatigue, a mind-body approach (working on the body and mind at the same time) is helpful in treating the symptoms. Relaxation techniques, exercises for vagal nerve stimulation (cold showers, abdominal breathing, etc.) or meditation can be effective. Tai chi, pilates and yoga can also teach people to manage their symptoms in certain situations.