Chronic fatigue syndrome: an old public health issue highlighted by the COVID-19 pandemic, 2022, Bonk and Khedkar

“Oh I need a coffee! I am so tired!” Something would feel amiss if one does not hear this exclamation at least once on a workday. More often than not a cup of coffee is exactly what you need to help you focus, be it the third paper on a Monday morning or the patient rounds that have made your eyes heavy. However, for some people ‘tired’ could mean not being sure if they could make it to the post box or being too exhausted to stand long enough to take a shower or even answer a simple phone call, all of it despite enough number of hours spent sleeping. Such severe examples are gaining more attention in the wake of the ongoing C O VID-19 pandemic that hit the world in March 2020. Fatigue is a major symptom associated with long COVID, but what does it entail?

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While such fatigue i.e. exhaustion caused by physical activity can be relieved by resting, persistent fatigue that cannot be alleviated by sleep may indicate chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME). CFS/ME is a complex condition that affects multiple organ systems. Its symptoms can therefore be multifaceted and vary in severity. According to the new definition by the Institute of Medicine (now National Academy of Medicine (NAM)), USA, to be diagnosed with CFS/ME, a patient must exhibit three main symptoms: (1) A substantial inability to perform pre-illness levels of activity that lasts for more than 6 months. This should be accompanied by profound fatigue of new onset that is not a result of unusual cognitive, physical, emotional or social exertion and is not significantly relieved by rest. (2) Post-exertional malaise (PEM) after an activity that would not have been an issue before the illness. Symptoms worsen after activity with a delay of hours or even days and a recovery time that is disproportional to the activity itself (hours to weeks). (3) Unrefreshing sleep despite the absence of objective alterations in sleep. Other than these, at least one of two additional manifestations must be present: (1) cognitive impairment (aka “brain fog”) that exacerbates by exertion and (2) orthostatic intolerance, in which a patient develops symptoms such as increased heart rate and blood pressure abnormalities while in an upright or standing position.

Open access, https://onlinelibrary.wiley.com/doi/abs/10.1111/apha.13863

 

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The first paragraph was certainly well put, and overall this is a fairly accurate piece. Though the emphasis on fatigue is as always problematic, the severity and impact of ME/CFS symptoms are well described, and the mention of the IOM criteria, which include PEM, is useful.

 

Indeed too much focus on fatigue and the use of CFS/ME, although they do refer to the new NICE guidelines that uses ME/CFS, but otherwise it is a helpful piece.