Novak, Peter, Systrom, David M, Witte, Alexandra et al. · PloS one · 2026 · DOI
Researchers compared people with Long COVID and ME/CFS to healthy volunteers and found they share very similar patterns of nervous system dysfunction, including problems with blood flow to the brain when standing up, widespread autonomic problems, and nerve damage in the skin. While the two conditions show these striking similarities, the study couldn't identify a single test that clearly separates them from each other, suggesting they may develop through related mechanisms.
This is one of the largest comparative autonomic studies in ME/CFS, providing objective physiological evidence that Long COVID and ME/CFS share common underlying mechanisms rather than being entirely separate diseases. These findings validate patients' reported symptoms through measurable autonomic and neurological abnormalities, strengthening the biological basis for both conditions and potentially opening pathways for shared diagnostic and therapeutic approaches.
This study does not prove that Long COVID and ME/CFS are identical diseases—the overlapping findings may reflect distinct conditions with convergent pathophysiology or represent different manifestations of a shared process. The retrospective design and reliance on existing autonomic laboratory data cannot establish causation or determine whether these autonomic findings are primary drivers of symptoms or secondary consequences. The findings also cannot explain why some individuals develop these conditions after infection while others do not.
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
Novak, Peter, Systrom, David M, Witte, Alexandra, Marciano, Sadie P, Felsenstein, Donna, Milunsky, Jeff M, et al. (2026). Shared autonomic phenotype of long COVID and myalgic encephalomyelitis/chronic fatigue syndrome.. PloS one. https://doi.org/10.1371/journal.pone.0341278
BibTeX
@article{mecfsatlas-novak-2026-shared-autonomic,
author = {Novak, Peter and Systrom, David M and Witte, Alexandra and Marciano, Sadie P and Felsenstein, Donna and Milunsky, Jeff M and Milunsky, Aubrey and Krier, Joel and Fishman, Mark C},
title = {Shared autonomic phenotype of long COVID and myalgic encephalomyelitis/chronic fatigue syndrome.},
journal = {PloS one},
year = {2026},
doi = {10.1371/journal.pone.0341278},
note = {PubMed: 41576003},
url = {https://www.mecfsatlas.com/evidence/novak-2026-shared-autonomic},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/novak-2026-shared-autonomic
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