At the time of writing this editorial (13th April 2021) there have been over 136 million confirmed cases of Coronavirus worldwide. What is perhaps less well known is that of this 136 million, approximately 10% will have developed long-COVID. Recovery time from COVID-19 is different for every individual, and while many will have their symptoms resolved by 12 weeks, several will have ongoing issues for longer; it is too soon to tell the long-term effects as this is still a relatively new condition. The most common symptoms of long-COVID are fatigue, breathlessness, and brain fog, but it can also include muscle aches, headaches, anxiety, depression, chest pain and heart palpitations. As fatigue is so common after any viral illness, this month I am going to focus on the fatigue associated with COVID-19 and how you can help yourself.
Fatigue is a common symptom of any illness. It is the body’s natural way of fighting off an infection, and some people will continue to experience fatigue for some time after the virus has cleared. This may include needing more sleep, feeling unsteady on your feet or finding it exhausting standing for long periods of time. For some however, fatigue can develop into a long-term, chronic illness, where performing normal daily activities, including selfcare and housework, are too challenging.
It is so important if you have any viral illness, to rest until you have recovered; this however is easier said than done! Expectations are high both physically and emotionally - to return to work for example or to look after your children. It is thought that the risk of developing a chronic illness increases without the opportunity to properly rest and recover from your virus.
So what is rest?
It may not be what you are thinking! You need to rest your body AND your mind. Watching TV, reading a book or using a phone or the internet is NOT rest. These require your mind to process information and can worsen mental fatigue. Relaxation, breathing or meditation apps may help you relax; or soothing music, a warm blanket or your favourite fragrance may also help. Now it is spring I find just sitting in the garden, feeling the warmth of the sun, and listening to the birds, helps my mind and my body relax. If something doesn’t work for you, try something different!
Sleep: If you feel you need to sleep, then sleep! You are likely to need more sleep when fighting off the virus and when recovering.
Movement: Keep yourself moving a few times slowly each day. Be gentle, but keep your body moving to help your circulation. This can be as little as walking to the kitchen for a coffee.
Activity: This needs to be kept at low levels until you have fully recovered; both physical and mental activity as they both use energy.
Nutrition: Keep eating and drinking as normally as possible. If your appetite is low, eat little and often, and increase your fluid intake to keep hydrated. We need to drink at least two litres a day.
Allow time: COVID-19 affects everyone differently, so give yourself the time you need to recover. You do not need to have suffered severely from the virus to have fatigue afterwards. Do not rush!
Have fun: It is important not to forget this! Practice some low energy activities that you enjoy, like reading a book or watching TV for a short period, then rest.
Progress: If you are improving, slowly start increasing movement and activity. Start with resuming your daily routine of sleep, self-care, eating and other daily activities; if this is too much then set yourself a new realistic routine for now. If you continue to improve then start to build small amounts of light exercise and mental tasks into your routine. Mental tasks include everyday activities like checking your emails, writing a shopping list, or worrying about other family members; you’ll be surprised how demanding these can be; remember and rest between tasks!
SLOWLY INCREASE ACTIVITY –
It is common to try and increase activity levels quickly; trying to push through fatigue can set you back. If in doubt go more slowly but steadily. If unsure, seek professional advice.
Wait until you are fully recovered before returning to work. You may require longer off than you initially thought, and it may have to be a gradual return. Speak to your manager and your GP.
When to seek advice:If your fatigue isn’t improving 3-4 months after having a virus, then you should ask your GP for advice. Chronic fatigue clinics may be available locally and The National institute for Health and Care Excellence (NICE) have developed rapid guidelines to facilitate setting-up multi-disciplinary long-COVID support services in the NHS. The majority of my tips and advice have come from the Yorkshire Fatigue Clinic in Leeds. If you are looking at the private route, make sure you choose a fully qualified and regulated healthcare professional who is trained in chronic fatigue management.
Joanne Pritchard BSc (Hons), MSc, MCSP, HCPC registered Principal Physiotherapist and Director Physio Pilates Retford.
“the slightest thing was an effort in a way I’ve never conceived before, it is the most fatigued I’ve ever been…. things like changing my bedding, I did in stages like one pillowcase and then later in the day I’d do another pillowcase, it was that kind of level of difficulty with day-to-day tasks”
(Humphreys et al, 2021).
Yorkshire Fatigue Clinic (2020) Post-viral Fatigue - COVID19 YFC2020 V2 (accessed online: 28/02/2021)
Humphreys H, Kilby L, Kudiersky N, et al. Long COVID and the role of physical activity: a qualitative study. BMJ Open 2021: 11: e047632. Doi:10.1136/bmjopen-2020-047632 Published 10th March 2021
BMJ 2021:372:n136 http://dx.doi.org/10.1136/bmj.n136 Published: 22nd January 2021
Covid map: Coronavirus cases, deaths, vaccinations by country - BBC News (accessed online; 13/04/2021)