Long COVID, ME/CFS, and POTS

In an interview with Alba Azola, MD, lead author of the AAPM&R autonomic dysfunction guidance and member of the Johns Hopkins Post-Acute COVID-19 Team, key insights were shared about the overlap between Long COVID and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Both conditions share debilitating symptoms like fatigue, brain fog, and post-exertional malaise (PEM), but their underlying mechanisms remain under investigation. Azola noted that many Long COVID patients meet ME/CFS criteria and benefit from similar symptom management approaches.

Long COVID is defined as a chronic condition lasting at least three months post-COVID-19 infection, presenting with diverse symptoms such as fatigue, cognitive difficulties, and postural orthostatic tachycardia syndrome (POTS). It affects people across all severity levels of initial infection and can significantly impair daily activities. Diagnosis relies on clinical assessment due to a lack of biomarkers.

PEM, a hallmark of both conditions, is a severe exacerbation of symptoms following minimal activity, distinct from typical fatigue. Azola emphasized that this can severely limit patients’ functionality, likening their challenges to those faced by individuals recovering from neurological injuries.

Research is crucial to understanding the similarities and differences between Long COVID and ME/CFS, including their pathophysiology and treatment. Existing ME/CFS rehabilitation protocols offer a foundation for treating Long COVID, but further studies are needed to refine approaches and explore biomarkers.