Evidence browser

Long COVID's Impact on Patients, Workers, & Society: A review.

Kavanagh, Kevin T, Cormier, Lindsay E, Pontus, Christine et al.·Medicine·2024

About 1 in 10 people who recover from COVID-19 develop long COVID, and roughly 1 in 4 of those people struggle with daily activities like work and self-care. Brain damage has been found in some patients, leading to problems with memory, thinking clearly, and mood changes. The study reviews how long COVID affects patients' jobs, finances, and communities, and emphasizes that gentle recovery approaches work better than pushing too hard, which can cause setbacks lasting days or weeks.

E3 PreliminaryDiagnosticPEM unclearMethods-Paper

Core outcome measurement set for research and clinical practice in post-COVID-19 condition (long COVID) in children and young people: an international Delphi consensus study "PC-COS Children".

Seylanova, Nina, Chernyavskaya, Anastasia, Degtyareva, Natalia et al.·The European respiratory journal·2024

This study developed a standardized list of health outcomes and measurement tools that doctors and researchers should use when evaluating children and young people with long COVID. International experts from 37 countries agreed on seven key areas to measure: fatigue, post-exertion symptoms, changes in work or school, and cardiovascular, neurological, gastrointestinal, and physical problems. They also identified specific questionnaires that work best for measuring fatigue, digestive symptoms, thinking problems, and overall functioning.

E3 PreliminaryCohortPEM unclearCase-Control

Acute Compartment Syndrome and Rhabdomyolysis Caused by a Single Electrical Muscle Stimulation in a 46-Year-Old Female Professional Athlete With Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Disorder: A Case Report.

von Deneen, Karen M, Alemayehu, Dereje Gobena, Khosla, Ajit·Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine·2024

This case report describes a 46-year-old female athlete with ME/CFS and fibromyalgia who experienced a serious muscle injury called rhabdomyolysis after just one session of electrical muscle stimulation (EMS) training. Her muscles broke down severely enough to cause compartment syndrome—a dangerous swelling in the muscle tissue—requiring intensive hospital care with fluids and medications. The report warns that people with ME/CFS and similar chronic conditions should be very cautious with EMS training because their bodies may react more severely to this type of exercise.

E3 PreliminaryBehavioralPEM requiredCase-Control

A patient who recovered from post-COVID myalgic encephalomyelitis/chronic fatigue syndrome: a case report.

Oka, Takakazu·BioPsychoSocial medicine·2023

This case report describes a nurse who developed ME/CFS symptoms after recovering from COVID-19, including severe fatigue, pain, brain fog, and heart palpitations that lasted over 6 months. She received treatment combining dietary advice, supplements, behavioral strategies, exercise conditioning, and two medications (amitriptyline and a Japanese herbal medicine called hochuekkito), and eventually recovered fully and returned to work. This is the first detailed report showing that someone with post-COVID ME/CFS can recover with comprehensive multimodal treatment.

E3 PreliminaryGuidelinePEM unclearGuideline

[Post-COVID Rehabilitation].

Küst, Jutta, Disko, Andreas, Calendo, Luigi Riccardo et al.·Praxis·2023

This guideline explains how to help people recover from post-COVID illness, which can cause lasting fatigue and memory problems that make it hard to work or manage daily life. Since there is no cure yet, treatment focuses on rehabilitation that is tailored to each patient's symptoms and goals, with special attention to gradually rebuilding activity while watching for post-exertional malaise—a worsening of symptoms after physical or mental effort. The approach involves multiple healthcare professionals working together to adjust the workload based on how the patient is doing over time.

Potential molecular mechanisms of chronic fatigue in long haul COVID and other viral diseases.

Gottschalk, Carl Gunnar, Peterson, Daniel, Armstrong, Jan et al.·Infectious agents and cancer·2023

This review article examines how viral infections—including long COVID, EBV, and others—can trigger severe, lasting fatigue and related symptoms. The authors explore the biological mechanisms that might explain why some patients develop chronic muscle fatigue and brain fog after viral illness, and compare these processes to ME/CFS. This research suggests that multiple different viruses may cause fatigue through similar pathways in the body.

Characteristics and Treatment of Exercise Intolerance in Patients With Long COVID.

Edward, Justin A, Peruri, Adithya, Rudofker, Eric et al.·Journal of cardiopulmonary rehabilitation and prevention·2023

Long COVID causes severe fatigue and difficulty exercising, affecting 25-30% of people who had COVID-19. This review suggests that carefully designed exercise programs—tailored to avoid making symptoms worse—may help Long COVID patients recover better. The authors argue that much of Long COVID comes from the body becoming deconditioned (out of shape) from inactivity, and that gentle, personalized exercise can help reduce symptoms.

E3 PreliminaryMechanismPEM requiredObservational

Sex-Dependent Transcriptional Changes in Response to Stress in Patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Pilot Project.

Gamer, Jackson, Van Booven, Derek J, Zarnowski, Oskar et al.·International journal of molecular sciences·2023

This study looked at how genes behave differently in men and women with ME/CFS when their bodies are stressed by exercise. Researchers tested blood samples from 33 ME/CFS patients and 34 healthy people before, during, and after exercise. They found that men and women with ME/CFS showed different patterns of gene activity in response to exercise—men's immune systems showed more dramatic changes, while women's genes related to stress response and virus handling showed bigger changes.

E3 PreliminaryReviewPEM requiredReview-Narrative

[Myalgic Encephalitis/Chronic Fatigue Syndrome: Diagnostic and Therapeutic Approach and Biological Research].

Sato, Wakiro·Brain and nerve = Shinkei kenkyu no shinpo·2023

This article reviews what we currently know about ME/CFS, a serious illness marked by extreme tiredness, sleep problems, difficulty thinking clearly, and difficulty standing up without symptoms getting worse. A key feature is post-exertional malaise—when patients feel much worse after physical or mental activity—which means people with ME/CFS need to carefully manage their activity levels. The article summarizes current approaches to diagnosis and treatment, as well as recent scientific discoveries about what happens in the body during this disease.

E3 PreliminaryGuidelinePEM requiredGuideline

Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) in Adolescents: Practical Guidance and Management Challenges.

Rowe, Katherine·Adolescent health, medicine and therapeutics·2023

ME/CFS is a serious illness causing extreme tiredness that doesn't improve with rest, along with worsening after activity, brain fog, poor sleep, and sometimes dizziness and pain. This paper reviews what we know about treating ME/CFS in teenagers and young people, finding that currently there are no proven cure treatments, but symptom management and lifestyle adjustments help most. The study emphasizes that staying connected to school and having supportive doctors who listen made the biggest difference in how well young people managed their illness over time.

E3 PreliminaryMechanismPEM requiredObservational

Urine Metabolomics Exposes Anomalous Recovery after Maximal Exertion in Female ME/CFS Patients.

Glass, Katherine A, Germain, Arnaud, Huang, Yuhsin V et al.·International journal of molecular sciences·2023

Researchers tested urine samples from ME/CFS patients and healthy people before and after intense exercise. They found that healthy people's urine chemistry changed noticeably after exercise (showing normal recovery), but ME/CFS patients' urine chemistry barely changed. This suggests that ME/CFS patients' bodies may not be adapting properly to physical stress the way healthy bodies do.

Energy MetabolismPost-Exertional Malaise

E3 PreliminaryCommentaryPEM requiredEditorial

The Role of Psychotherapy in the Care of Patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.

Grande, Tilman, Grande, Bettina, Gerner, Patrick et al.·Medicina (Kaunas, Lithuania)·2023

This article discusses how talking therapy (psychotherapy) might help people with ME/CFS cope better, even though it cannot cure the disease itself. The authors emphasize that ME/CFS is a physical illness requiring physical treatments, and they highlight that post-exertional malaise (getting worse after activity) is a key symptom that therapists should understand. They propose a practical approach to therapy that respects these facts while still helping patients manage their emotional wellbeing.

Long COVID OverlapPost-Exertional Malaise

Long COVID: major findings, mechanisms and recommendations.

Davis, Hannah E, McCorkell, Lisa, Vogel, Julia Moore et al.·Nature reviews. Microbiology·2023

Long COVID is a serious illness affecting at least 10% of people who had COVID-19, with an estimated 65 million people worldwide experiencing it. The condition causes over 200 different symptoms affecting many body systems, similar to ME/CFS and other post-viral illnesses. This review examines what scientists have learned about Long COVID's causes and effects, though better diagnostic tests and treatments are still urgently needed.

E3 PreliminaryCohortPEM requiredObservational

Atopy and Elevation of IgE, IgG3, and IgG4 May Be Risk Factors for Post COVID-19 Condition in Children and Adolescents.

Körner, Robert Walter, Bansemir, Ole Yannick, Franke, Rosa et al.·Children (Basel, Switzerland)·2023

This study examined 28 children and teens who developed long-lasting symptoms after COVID-19 infection. The researchers found that most patients had allergies and unusually high levels of immune proteins called IgE, IgG3, and IgG4. About three in ten patients also met criteria for ME/CFS, experiencing severe fatigue, breathing problems, and post-exertional malaise (feeling worse after activity). Most patients gradually improved over about a year, though some took longer to recover.

E3 PreliminaryMechanismPEM requiredMechanistic

Post-COVID exercise intolerance is associated with capillary alterations and immune dysregulations in skeletal muscles.

Aschman, Tom, Wyler, Emanuel, Baum, Oliver et al.·Acta neuropathologica communications·2023

Researchers examined muscle tissue from people with long COVID who experience fatigue and worsening symptoms after activity. They found that these patients had fewer blood vessels in their muscles, thicker vessel walls, and signs of immune cells that might have been triggered by the initial infection. These physical changes in the muscle's blood supply could explain why exercise makes their symptoms worse.

NeuroinflammationPost-Exertional Malaise

Chronic inflammation, neuroglial dysfunction, and plasmalogen deficiency as a new pathobiological hypothesis addressing the overlap between post-COVID-19 symptoms and myalgic encephalomyelitis/chronic fatigue syndrome.

Chaves-Filho, Adriano Maia, Braniff, Olivia, Angelova, Angelina et al.·Brain research bulletin·2023

This study examines how long COVID and ME/CFS may share similar problems in the body, particularly chronic inflammation (ongoing swelling and immune activation) and low levels of plasmalogens, which are protective fats found in cell membranes. The researchers propose that restoring plasmalogen levels through dietary supplements could potentially help reduce symptoms like fatigue, brain fog, and post-exertional malaise in both conditions.

Post-COVID and ME/CFS - DoWe Need New Disease Theories?

Schauenburg, Henning·Zeitschrift fur Psychosomatische Medizin und Psychotherapie·2023

This review examines how post-COVID illness and ME/CFS develop and persist, looking beyond just physical symptoms to understand how the brain perceives and responds to the body. The authors suggest that standard medical tests only partially explain chronic fatigue, and that a newer theory called 'Predictive Coding' may help us understand how the mind and body interact in these complex conditions. The goal is to develop better treatments while avoiding the harmful stigma of labeling these as 'just psychological' problems.

E3 PreliminaryCohortPEM requiredCase-Control

A case of post-COVID-19 myalgic encephalomyelitis/chronic fatigue syndrome characterized by post-exertional malaise and low serum acylcarnitine level.

Jinushi, Ryuhei, Nishiguchi, Sho, Masuda, Sakue et al.·Clinical case reports·2023

This study describes a patient who developed ME/CFS after recovering from COVID-19. The researchers found that this patient had lower-than-normal levels of acylcarnitine, a substance the body uses to produce energy. The study reviews existing research on how COVID-19 can lead to ME/CFS, a condition that causes severe fatigue and symptoms that worsen after physical activity.

BiomarkersPost-Exertional Malaise