Sherif, Zaki A, Gomez, Christian R, Connors, Thomas J et al. · eLife · 2023 · DOI
This review examines how COVID-19 can lead to Long COVID, a condition where people experience ongoing fatigue, difficulty with exercise, and brain fog that can last months or years. The researchers explored multiple possible explanations for why this happens, including lingering virus in the body, problems with blood clotting, nerve signaling problems, immune system dysfunction, and reactivation of old viruses like Epstein-Barr. Since Long COVID affects different people in different ways, the authors suggest that different patients may need different treatments.
This work is crucial because it recognizes that Long COVID and ME/CFS share similar features and may involve common underlying mechanisms—a perspective that validates ME/CFS patients' experiences and suggests that research and treatments developed for one condition could benefit the other. Understanding these multiple potential pathways is essential for developing targeted therapies rather than one-size-fits-all approaches.
This review does not prove which mechanisms are actually causing Long COVID in individual patients, nor does it establish which proposed mechanisms are primary versus secondary effects. The paper identifies correlations and hypothesized pathways rather than demonstrating direct causation, and it cannot determine which mechanism (or combination) is responsible in any specific person.
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
Sherif, Zaki A, Gomez, Christian R, Connors, Thomas J, Henrich, Timothy J, Reeves, William Brian, & RECOVER Mechanistic Pathway Task Force (2023). Pathogenic mechanisms of post-acute sequelae of SARS-CoV-2 infection (PASC).. eLife. https://doi.org/10.7554/eLife.86002
BibTeX
@article{mecfsatlas-sherif-2023-pathogenic-mechanisms,
author = {Sherif, Zaki A and Gomez, Christian R and Connors, Thomas J and Henrich, Timothy J and Reeves, William Brian and RECOVER Mechanistic Pathway Task Force},
title = {Pathogenic mechanisms of post-acute sequelae of SARS-CoV-2 infection (PASC).},
journal = {eLife},
year = {2023},
doi = {10.7554/eLife.86002},
note = {PubMed: 36947108},
url = {https://www.mecfsatlas.com/evidence/sherif-2023-pathogenic-mechanisms},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-29. https://www.mecfsatlas.com/evidence/sherif-2023-pathogenic-mechanisms
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