How do I differentiate between general fatigue and long Covid fatigue?

“It’s a very unusual type of fatigue, and that you haven’t done anything that would warrant you being tired, you’ve just been living your normal life,” says Dr Margaret O’Hara, founder trustee and lead of research at Long Covid Support.

“It can become much worse by doing really simple things like walking a very short distance, emptying the dishwasher, doing a Zoom meeting etc. Any physical or cognitive effort can cause you to have a return of symptoms.”

And the onset fatigue is usually very sudden, not gradual.

“Usually when you’re tired, it kind of comes on gradually, and then you get to bedtime and think oh I need an early night and the next day you are fine – but with long Covid it’s not a gradual onset,” says O’Hara. “It can be really, really sudden.

“One minute you feel fine, and the next you’ve got to go lie down and sleep. So, it’s kind of unusual patterns of fatigue that don’t really fit with anything that you’ve experienced before.”How long after recovering from COVID-19 can long Covid symptoms persist?

After the acute infection of COVID-19, long Covid can appear at any point.

“This is normally two to six weeks after the initial infection,” notes Asif. “The duration has been noted to be several weeks to several months, however there have been reports of it lasting for many months and even years.”

Symptoms can also come and go.

“It’s the variability that is difficult to deal with,” highlights O’Hara. “You can think, oh, thank goodness it’s going and then it’ll come back some of them some months later, or new symptoms will develop on top of the ones you’ve already got.

“Or you can feel as if you’ve recovered a little bit, and then you try and do too much, and you relapse back to square one again.”

What tests can I take to check if my fatigue is due to long Covid or something else?

“It’s very important that a doctor assesses you if you’re having persistent symptoms of fatigue to distinguish whether this is long Covid or another serious health condition,” says Asif. “This will often be done by your general practitioner and would follow a thorough physical examination.

“Test would include a blood test looking for anaemia, hormonal issues and nutritional deficiencies.”

Sometimes imaging scans are also used to evaluate the heart and lungs.

“Testing to assess one’s exercise tolerance and cardiovascular health are useful in assessing the cause of fatigue and severity, allowing us to manage accordingly,” notes Asif.

Are there any treatments or management strategies for long Covid fatigue?

“Pacing is a useful strategy, but isn’t curative, and takes time to learn, and even then the goal posts can change and it doesn’t doesn’t always work,” recognises Sammie McFarland, CEO and founder of Long Covid Kids. “The aim is to avoid energy crashes by balancing activity with rest.”

Sometimes medication is prescribed to help with symptoms.

“For example, antihistamines (for Mast Cell Activation Syndrome, MCAS), beta-blockers (for POTS, Postural Orthostatic Tachycardia Syndrome), or low-dose naltrexone (for neuroinflammation) may help in some cases,” says McFarland.

Factors like sleep, nutrition and hydration are also important.

“It’s important for patients to optimise sleep hygiene (in some cases, using melatonin) and to ensure adequate hydration, electrolytes, and nutrient intake,” says McFarland. “Gentle physiotherapy and rehabilitation can also help in some cases.”

Should I follow up with a specialist if my symptoms persist?

Don’t take no for an answer, you know your body best.

“If fatigue is severe or affecting daily life, consider seeing apaediatrician or long Covid specialist (if available) or a cardiologist or neurologist for POTS or autonomic symptoms,” advises McFarland.

“Also seek guidance from an immunologist or allergy specialist if MCAS is suspected or a sleep specialist if sleep disorders contribute to fatigue.”