Wostyn, Peter · Medical hypotheses · 2021 · DOI
This paper proposes a theory about why some people develop prolonged fatigue after COVID-19 that resembles ME/CFS. The author suggests that COVID-19 may damage nerve cells in the nose, which could reduce the brain's ability to clear out waste products, leading to toxic buildup and fatigue. The paper calls for research to test whether treatments that help drain fluid from around the brain might help patients with post-COVID fatigue.
This paper addresses an important concern: whether COVID-19 infections could trigger ME/CFS-like illness in a significant population. Understanding potential biological mechanisms linking infection to prolonged fatigue could guide development of preventive strategies and early interventions. Additionally, research pursuing this hypothesis might reveal new insights into ME/CFS pathophysiology more broadly.
This study does not prove that post-COVID fatigue syndrome exists as a distinct entity or that the proposed glymphatic mechanism is actually responsible for it. The paper presents a theoretical model based on indirect evidence and analogies rather than direct data showing olfactory neuron damage, impaired cerebrospinal fluid flow, or glymphatic dysfunction in COVID-19 patients. Causation between any proposed mechanism and fatigue symptoms is not established.
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
Wostyn, Peter (2021). COVID-19 and chronic fatigue syndrome: Is the worst yet to come?. Medical hypotheses. https://doi.org/10.1016/j.mehy.2020.110469
BibTeX
@article{mecfsatlas-wostyn-2021-covid-chronic,
author = {Wostyn, Peter},
title = {COVID-19 and chronic fatigue syndrome: Is the worst yet to come?},
journal = {Medical hypotheses},
year = {2021},
doi = {10.1016/j.mehy.2020.110469},
note = {PubMed: 33401106},
url = {https://www.mecfsatlas.com/evidence/wostyn-2021-covid-chronic},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/wostyn-2021-covid-chronic
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