COVID-19 has infected almost half a billion people worldwide causing over six million deaths.

Fortunately, most Covid-19 patients survive, especially following complete vaccination. However, some may suffer from what is known as long Covid, where fatigue is a predominant symptom.

Recovery from Covid-19 depends on multiple factors, such as age, existing medical conditions, severity of Covid-19 illness (especially those requiring hospitalisation, or intensive care) and complications of Covid-19.

Those with mild symptoms usually recover in two weeks but those with severe illness may take months. 

THE LONG ROAD

Symptoms persisting beyond two months are called long Covid. Long Covid may follow asymptomatic, mild or severe illness. It covers a broad range of symptoms from physical to neuropsychological.

Common physical symptoms include cough, breathlessness, chest pain, fatigue, body and joint aches and pains, loss of smell and taste, and difficulty sleeping.

Cognitive and psychological symptoms include poor memory and concentration, also known as brain fog, as well as anxiety and depression.

The symptoms of long Covid are debilitating. They affect a person's functional ability, not just in going back to school or work but also in simple tasks such as self-care. Covid-19 fatigue is characterised by extreme tiredness, weakness and exhaustion that are not relieved by rest or sleep.

Covid-19 fatigue symptoms can be divided into two: physical and neuropsychological. Physical symptoms include feeling sleepy and tired, exhaustion after simple activities, performing simple tasks poorly or difficulty in multi-tasking or performing tasks automatically without thinking.

Neuropsychological symptoms include poor memory and concentration, feeling irritable and frustrated and being less communicative. 

MANAGING FATIGUE

Following a Covid-19 infection, adequate rest and good sleep hygiene is critical to combat fatigue. Strategies to manage fatigue formulated by occupational therapists to manage other chronic illnesses have been adopted in Covid-19 fatigue management.

They are called the three Ps — pace, plan and prioritise. "Pace" means to break down an activity into smaller tasks with breaks in between to recharge. The idea is to avoid exhaustion as it will take longer to recover from it.

"Plan" is to spread different activities throughout the day or week, plus the option to obtain help from family or friends where possible. And finally, to "prioritise" — what needs to be done today, and what can be postponed.

Relaxation techniques such as mindful meditation and yoga have also been adopted to manage Covid-19 fatigue but their efficacy is unknown.

A doctor's assessment is warranted when, despite the above strategies, symptoms persist, or are progressively worsening and affecting quality of life. A formal evaluation is important because serious Covid-19 complications can manifest as fatigue.

Your doctor will begin with a series of questions on symptoms and functional status, a physical examination followed by relevant investigations such as chest imaging, lung function testing and ECG.

They would also consider other factors that can worsen fatigue, such as medications, deconditioning, muscle weakness, pain, sleep disturbance, mood disorders, endocrine disease and cardiopulmonary disease.

The principle of Covid-19 fatigue management is to gradually build up tolerance and eventually resume activities as tolerated. These activities include self-care such as bathing, dressing, walking, stair-climbing, housekeeping, and, finally, returning to school or work.

Your doctor will formulate an individual plan or you may work with a physiotherapist and occupational therapist to achieve these goals.

A person may start at a different level depending on the severity of the fatigue and escalate as tolerated. Therapy normally begins with breathing exercises, gentle stretching and light muscle strengthening before aerobic activities.

If a person is unable to progress, they may be enrolled into a formal rehabilitation programme. Those with specific cardiac or pulmonary complications of Covid-19 will benefit from formal cardiac or pulmonary rehabilitation.

Covid-19 is a new illness and we are learning more each day about the recovery process, including long Covid. Research has shown that long Covid tends to be less severe in vaccinated versus unvaccinated individuals.

As with any illness, prevention of Covid-19 infection and therefore, long Covid, is important. Strategies such as masking, social distancing and good hand hygiene must be maintained even with widespread vaccination. 

*The writer is a specialist in internal medicine at Pantai Hospital Cheras (PHC).