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By Patricia Purcell, M.Ed. BSN, RN

Fatigue is a common symptom following COVID-19 infection. However, persistent fatigue that goes on for weeks, or even months, combined with impaired daily physical and cognitive function (brain fog) has led many to believe that COVID-19 infection may be followed by myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).

ME/CFS can be triggered by COVID-19 in adolescents and young adults, much the same way it can be brought on by acute viral infections such as infectious mononucleosis (Epstein-Barr virus). In a study done by the Chronic Fatigue Clinic at Johns Hopkins Children’s Center in Baltimore, MD, three adolescent and young adult patients who had confirmed or probable cases of COVID-19 infections early on in the pandemic were referred for evaluation.  



All three of the referred patients reported orthostatic intolerance (OI) symptoms as well as symptoms consistent with postural tachycardia syndrome (POTS). After six months of illness, all three patients met criteria for ME/CFS. All had strong histories of allergies and two had elevated plasma histamine levels, also consistent with ME/CFS (Petracek, et al, 2021).

Postural orthostatic tachycardia syndrome is a condition that affects blood flow, causing the development of symptoms -- usually lightheadedness, fainting and an uncomfortable, rapid increase in heartbeat, that come on when standing up from a reclining position and relieved by sitting or lying back down. POTS is a form of dysautonomia, a disorder of the autonomic nervous system. This branch of the nervous system regulates functions we don’t consciously control, such as heart rate, blood pressure, sweating and body temperature (

Current defined diagnosis of ME/CFS requires a duration of at least six months of symptoms, including substantial impairment in previously tolerated activities, profound fatigue, post-exertional malaise (PEM), unrefreshing sleep and either cognitive impairment or OI. OI refers to a group of conditions in which fatigue, lightheadedness and difficulty concentrating are aggravated by upright posture and are made better by lying down. Among those with ME/CFS, OI is found in 90% of adults and over 95% of adolescents (Petracek, et al, 2021).

The occurrence of CFS and other symptoms following COVID-19 infection has given pause to researchers as they speculate that the COVID-19 pandemic could trigger a wave of new cases of ME/CFS. At the National Institutes of Health and elsewhere, scientists who have been studying post-viral ME/CFS are seizing the opportunity to focus on COVID-19 patients. They want to understand what biological factors separate those who regain their health from those who remain sick. Dr. Tae H. Chung from Johns Hopkins University School of Medicine and Dr. Brent P. Goodman from the Mayo clinic in Arizona report an increase in the number of patients referred to autonomic specialty clinics and say that this is likely to increase as the full impacts of COVID-19 are realized (Petracek, et al 2021).

It will be important that practitioners in the field of autonomic disorders share their expertise and management protocols in order to help their patients as well as other providers to recognize what these symptoms could possibly be and find ways to treat them.  The number of physicians familiar with the care of POTS or ME/CFS is already greatly insufficient for the number of existing patients who suffer from these complicated medical conditions, and the waiting list for care in clinics with expertise in this area can be 6-12 months or longer, leading to long delays in diagnosis and treatment. There needs to be a commitment from medical providers, hospitals and medical administrations to realize that these patients have complicated medical conditions that require longer visits and more health disciplines to address the needs of this population.  



Adolescents and young adult ME/CFS after confirmed or probable Covid-19. Petracek, L.S.; Suskauer, S.J., Vickers, R.F, Patel, N., Violand, R.L, Swope, R.L, Rowe, PC. April 2021.

Researchers warn Covid-19 could cause debilitating long-term illness in some patients. May, 2020. The Washington Post



About Nurse Patti

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Meet Nurse Patti!  

Patti Purcell is a Registered Nurse with 30 years of nursing experience, including 26 as a school nurse. Patti has a passion for helping others to make sense of the many complicated aspects of health and medical terminology. We are delighted that she is bringing her experience to the Massachusetts ME/CFS & FM Association. 

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