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Having Fatigue After COVID? Here’s What to Do.

Written by Beth Holloway, RN, M.Ed

What Is Long-Haul COVID Fatigue?

Fatigue after COVID -i.e. in long-haul COVID (or long COVID) is a common symptom. Long COVID symptoms are those that occur at least 4 weeks after the initial COVID infection. These symptoms can last for several weeks or months. 

In fact, fatigue is the most common symptom of long-haul COVID based on many studies. And it’s not just feeling a little tired. Tiredness after COVID can be severe, making it impossible to work, manage daily activities, or take part in family events.

Other symptoms of long COVID - trouble sleeping, or breathlessness, for example - can worsen fatigue. The opposite is also true. Fatigue can worsen other symptoms such as brain fog, or trouble with memory, concentration, and attention.

Below, we'll examine fatigue, share the story of someone with long COVID fatigue, and cover tips for dealing with fatigue.

  1. What are the Types of Long COVID Fatigue?

  2. Long-Haul COVID Fatigue: Melissa's Story

  3. What is Chronic Fatigue?

  4. Fatigue and Energy Conservation: the Four Ps

  5. Goodpath's Long COVID Program

What are the Types of Long COVID Fatigue?

Severe Fatigue

Severe fatigue occurs in some long-term (chronic) conditions like long-haul COVID.

The American Academy of Physical Medicine and Rehabilitation (AAPMR) describes fatigue in post-acute sequelae of SARS-CoV-2 infection (PASC) patients as “a feeling of weariness, tiredness, or lack of energy. It can be physical, cognitive, or emotional, mild to severe, intermittent to persistent, and affect a person’s energy, motivation, and concentration.” Other terms to describe fatigue are tiredness, lack of energy, or exhaustion

Fatigue in long-haulers can affect their overall functioning and energy; their mood and motivation; and their thinking and concentration. In long-haulers it can be quite severe and chronic. Consequently, it can affect their overall well-being and quality of life.

Post-Exertional Malaise (PEM)

Post-exertional malaise is a specific type of fatigue that can occur in those with long COVID. It may also be present in some chronic conditions, like chronic fatigue syndrome (CFS). Post-exertional means “after activity” and malaise refers to feeling poorly. In this type of fatigue, you have extreme tiredness and may have other symptoms following activity. 

The activities leading to PEM may not be what you think. They’re not necessarily physical, nor do they need to be strenuous. The activities may require mental work and may seem effortless. For example, reading a challenging book or watching your favorite team play football may cause post-exertional malaise. Both activities work your brain - reading requires concentration and focus while watching an intense sporting event may cause stress and anxiety.

You may not feel the effects of post-exertional malaise (PEM) right away. It may be hours or days later that you feel intense fatigue. At the same time, other long COVID symptoms may also worsen, including symptoms such as, brain fog, pain, fever, breathlessness, palpitations (irregular heartbeat), or trouble sleeping. 

With long COVID you may have severe fatigue and/or post-exertional malaise (PEM). In either case, fatigue creates daily challenges and can be disabling for many.

What follows is a brief summary of one woman’s COVID, long-haul COVID, and long-hauler fatigue journey.

The story may sound familiar to you. Maybe you’ve had something similar or perhaps you have a friend, family member, or colleague who’s had the experience. Unfortunately, it’s all too common. 

Long-Haul COVID Fatigue: Melissa’s Story

Melissa is a new member of Goodpath, participating in our long COVID program through her employer. Here’s her story.

Melissa has two young boys. She is an active volunteer at their school and a coach for her older son’s soccer team. She works long hours and weekends in her full-time job as a program manager for a software company. She even makes time for workouts most mornings before work.

COVID Infection

A few months ago everything started to change. Even though she was committed to wearing a mask and received her COVID vaccinations and booster, she tested positive for COVID-19 after a potential exposure. 

She developed mild symptoms a few days later - mostly a stuffy nose, tiredness, and body aches. She followed the testing and quarantine protocols while she was sick. Luckily the symptoms didn’t last long. She was able to resume her activities and return to work.

Long-Haul COVID

Fast forward about three weeks. Melissa wasn’t feeling well one day at work. She went home early to lie down and woke up a few hours later with a headache and chills. For the next few days, she continued to feel unwell. 

No matter what she did throughout the day, she was always tired, and she was having trouble sleeping. She wasn’t able to work, even though her job was home-based. She wasn’t able to work out or take part in her children’s activities. She really couldn’t do much at all. 

So Melissa made an appointment with her doctor who told her she most likely had long COVID. His advice? Go home and rest. Of course, she did, but just like the weeks leading up to her appointment, rest did little to help. It was so difficult to look around at the laundry and the clutter without feeling even worse…it was very upsetting. 

Long-Hauler Fatigue

At times Melissa would feel much better - even full of energy. When that happened, she took advantage of the opportunity to get things done. However, she found herself even more fatigued - so much so that she’d have to lie down for hours at a time just to feel a little better. After a few days, she’d be back to where she started…and the cycle continued - something like this:

Although there is no cure for severe long COVID fatigue or post-exertional malaise (PEM), Melissa could have taken steps to help manage her symptoms and prevent extreme episodes of fatigue (crashing or feeling completely wiped out). 

What might Melissa have done differently? She could have conserved her energy by using the strategies described as the four Ps. She could have planned, paced, prioritized, and positioned. Like Melissa, you can use the same methods to conserve energy and work towards regaining your health.

But to better understand how to fight chronic fatigue, it may help to understand what chronic fatigue is.

What is Chronic Fatigue?

As you already read, fatigue is a very common part of long COVID. With long COVID, it may be severe and it may be worse after activity. Some people may refer to it as chronic fatigue, but what exactly is chronic fatigue?

In general, chronic fatigue means long-term tiredness or exhaustion. It makes sense that it could be used to describe fatigue in long COVD. After all, the fatigue may last for weeks or months. 

But chronic fatigue is also a symptom of other medical conditions. One of those conditions is chronic fatigue syndrome (CFS)

Here’s where it gets even more complicated: If you search the Internet for “chronic fatigue,” almost all of the results are actually information about chronic fatigue syndrome. The same is true if you use the words chronic fatigue in conversation. People are likely to think you’re referring to the condition chronic fatigue syndrome. In other words, chronic fatigue has become shorthand for chronic fatigue syndrome

So, let’s break that down to avoid any confusion.

Chronic Fatigue and Chronic Fatigue Syndrome

It may be helpful to know a little bit about chronic fatigue syndrome since fatigue (severe chronic fatigue and post-exertional malaise), other symptoms, and common treatments are similar to long COVID fatigue. 

People with chronic fatigue syndrome also called myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), have severe long-term fatigue, post-exertional malaise, and unrefreshed sleep. They have other symptoms as well, like pain, trouble thinking and concentrating, or lightheadedness and weakness upon standing. 

The cause isn’t fully understood, but it may be related to an infection with the Epstein–Barr virus (EBV), a very common herpesvirus that causes infectious mononucleosis (you probably know this as “mono”).

There isn’t a cure for CFS. Treatment focuses on lessening symptoms, and energy conservation is a significant part of managing the fatigue associated with CFS.

Fatigue and Energy Conservation

Doctors have learned about chronic fatigue and energy conservation based on research of other medical conditions with severe fatigue and post-exertional malaise (PEM), like rheumatoid arthritis (RA) and, of course, chronic fatigue syndrome (CFS).  

People with RA and CFS benefit from conserving their energy by planning, pacing, prioritizing, and positioning - so can those with long-haul COVID fatigue.

What are the Four Ps?

The four Ps represent the ways you can achieve energy conservation. Conserving your physical and mental energy helps to prevent episodes of severe fatigue and post-exertional malaise (PEM) while helping your body heal and recover. The Four Ps are adaptable based on your changing symptoms, daily activities, and life events.  

How Do I Plan?

The first P represents plan. You should plan your daily activities with scheduled rest throughout the day. 

There are various tools to help. You can use calendars or schedulers on your phone or computer, or go with a paper agenda or calendar. Goodpath has its own Activity Planner designed for those with long COVID.

How Do I Pace?

The second P stands for pace. Pacing is critical to managing and preventing worsening fatigue or post-exertional malaise. The idea is to strike a balance between easy and difficult tasks, as well as activities and rest throughout the day. 

How Do I Prioritize?

The third P represents prioritize. Think about what’s most important to you as you plan your daily activities. Be realistic about what you can accomplish. You can:

  • Simplify. You might make meals easier with healthy prepared or restaurant foods and use recyclable, dishes

  • Eliminate. For example, don’t make your bed (if that’s something you usually do) or don’t worry about returning phone calls (explain to friends, etc. ahead of time)

  • Delegate. Think about asking family members to do laundry, dust furniture, retrieve mail or packages, etc. Ask friends or neighbors for help, especially if they offer

How Do I Position?

The fourth P stands for position, and it covers both your body and the things around you.

Body Position

If you stay in one position too long your muscles become fatigued. Sitting on the sofa or standing at the kitchen counter can be tiring. So, change positions often - from lying down to rest or sleep, to sitting, to standing and walking around. 

Your posture matters, too. Good posture with your head upright, your shoulders back, and your spine straight helps prevent muscle tiredness.

Position or Placement of Items

Think about ways to organize your kitchen, desk, or workspace to make it easier to reach items and complete tasks. The idea here is to simplify. If you have to gather items before starting an activity, you’ll use more energy. Instead, for your morning coffee, have your mug, spoon, coffee, etc. near the coffee maker. And, in your workspace, keep your laptop, charger, earbuds, etc. together. 

Remembering the four Ps may be easy, but using them takes practice. Make some changes to get used to the techniques, then gradually add more. Using the four Ps now will allow you to do more later.

Back to Melissa’s Story

Now that you know some techniques for managing fatigue, what about Melissa? With long COVID fatigue, she was in a cycle of feeling good, overdoing it, feeling extreme fatigue, resting/sleeping for a few days, feeling better, then getting caught up and overdoing it again.

What could she do differently using the 4 Ps?

Plan. Melissa could plan activities, scheduling a few of them each day. She could use a planner to schedule the next day’s activities. 

Pace. She could pace herself, allowing for rest between activities. She could have washed one load of laundry (activity), listened to a meditation (rest), folded the laundry (activity).

Prioritize. Melissa could prioritize and then simplify, eliminate, or delegate tasks. She may have washed one load of the boy’s laundry and supervised the boys making cut-and-bake cookies from the grocery store (less effort for her and time together for everyone).

Position. She could have changed positions throughout the day. She may have sat comfortably to fold the clean laundry (instead of standing) and watched the boys prepare the cookies.

By using the four Ps and making changes, Melissa could have lessened the symptoms of her extreme fatigue - a much better way to move towards her recovery.

Goodpath’s Long COVID program

Goodpath’s long COVID program supports those who have long-haul COVID fatigue and post-exertional malaise (PEM). It focuses on integrative care and includes activity pacing, tailored exercise therapy, supplements, relaxation techniques, and one-on-one coach support. Take our assessment to get started today.