Araja, Diana, Berkis, Uldis, Lunga, Asja et al. · Journal of clinical medicine · 2021 · DOI
This study examined how many people in Latvia may have ME/CFS symptoms but have never received a diagnosis, and investigated whether COVID-19 might cause similar long-term problems. Researchers compared symptom reports from diagnosed ME/CFS patients with undiagnosed people experiencing similar symptoms, and also tracked people who had recovered from COVID-19. The research found that undiagnosed patients face a significant financial burden on the healthcare system and themselves, and that COVID-19 can trigger ME/CFS-like symptoms in some people.
This study highlights the substantial 'hidden' population of undiagnosed ME/CFS patients who face significant healthcare costs and disability without recognition or appropriate treatment. Given the emerging risk of post-viral ME/CFS following COVID-19, these findings underscore the urgent need for improved diagnostic pathways and disease awareness, particularly as post-pandemic cases may substantially increase the societal burden of ME/CFS.
This study does not prove causation between COVID-19 and ME/CFS development—it identifies symptom overlap at a single timepoint (6 months post-infection). The study cannot establish why undiagnosed patients remain undiagnosed (healthcare access, clinician awareness, patient factors) or predict the actual percentage of COVID-19 patients who will develop true ME/CFS. The financial estimates are based on Latvia's healthcare system and may not generalize to other countries.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Araja, Diana, Berkis, Uldis, Lunga, Asja, & Murovska, Modra (2021). Shadow Burden of Undiagnosed Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) on Society: Retrospective and Prospective-In Light of COVID-19.. Journal of clinical medicine. https://doi.org/10.3390/jcm10143017
BibTeX
@article{mecfsatlas-araja-2021-shadow-burden,
author = {Araja, Diana and Berkis, Uldis and Lunga, Asja and Murovska, Modra},
title = {Shadow Burden of Undiagnosed Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) on Society: Retrospective and Prospective-In Light of COVID-19.},
journal = {Journal of clinical medicine},
year = {2021},
doi = {10.3390/jcm10143017},
note = {PubMed: 34300183},
url = {https://www.mecfsatlas.com/evidence/araja-2021-shadow-burden},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/araja-2021-shadow-burden
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