Jan. 18, 2023 — On March 18, 2020, Megan Fitzgerald lay on the floor of her Philadelphia home after COVID-19 hit her like a pelvis of bricks. She had a fever, severe digestive problems, and she couldn’t stand on her own. And yet, there she is, arms outstretched in the bathroom, between answering work emails and entertaining her 3-year-old son, who is trying to entice her by passing a toy through the door.
She and her husband, both medical researchers, were working from home early in the pandemic and had no children to care for their children. Her husband has a grant application due, so even when she’s sick, the couple is going all out.
“My husband would help me up and down the stairs because I couldn’t stand,” Fitzgerald said.
So she put on a mask and tried to take care of her son, telling him: “Mom is sleeping on the floor again.” She regretted trying so hard because she later found out that there might be consequences. She often wondered: If she had taken more rest during that time, could she have avoided the years of decline and disability that followed?
Accumulating evidence suggests that overexertion and insufficient rest during the acute phase of COVID-19 infection can worsen long-term symptoms.
“The idea that I would be too sick to work was very foreign to me,” Fitzgerald said. “I didn’t expect illness and acute viruses to be long-term debilitating.”
Her story is common among long-term COVID-19 patients, not only for those who are severely ill, but also for those with only moderate symptoms.That’s why many medical experts and researchers who specialize in long-term COVID recovery recommend what’s called a complete rest — a term popularized by journalists and long-term COVID Advocate Fiona Lowenstein – taken immediately after an infection, and as a way to cope with the debilitating fatigue and energy breakdown that many people experience weeks, months, and years after becoming ill.
These constant rests and “rhythms”— Strategies to regulate and balance activities – Long advocated by people with post-viral illnesses such as myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS), which share many of the same symptoms as long-term COVID.
That’s why researchers and healthcare providers have been trying to help ME/CFS patients for years, and more recently chronic COVID patients, by advising them to take as much rest as possible after a viral infection for at least 2 weeks to help their immune system. They also recommend spreading out activities to avoid post-exercise malaise (PEM), a phenomenon in which even mild physical or mental exertion can trigger a flare-up of symptoms, including severe fatigue, headaches and brain fog.
One international studycompleted with the help of US Patient-Led Research Collaborative and published in Lancet In 2021, it was found that of nearly 1,800 long-term COVID patients who tried pacing, more than 40% said it helped them manage their symptoms.
burden on women and mothers
in another survey published last yearU.K. researchers asked 2,550 long-term COVID patients about their symptoms and found that not getting enough rest in the first 2 weeks of illness, along with other factors such as lower income, younger age and female gender, were associated with worse long-term COVID symptoms .
Nor do many researchers and patients forget that COVID symptoms are disproportionately prolonged affect women – many of them have no disability benefits and no choice about whether or not they can afford to take time off after sickness.
“I don’t think it’s a coincidence, especially in the U.S., where women of childbearing age have been hit the hardest by prolonged COVID,” Fitzgerald said. “We’re working outside the home, and we’re also doing a lot of unpaid labor at home.”
How does lack of rest affect COVID patients?
Experts are still trying to understand the many symptoms and mechanisms behind long-term COVID. But until the science is certain, both rest and pacing are the two most reliable pieces of advice they can offer, said Dr. David Putrino, a neuroscientist and physical therapist who has treated thousands of long-term COVID-19 patients at Mount Sinai Hospital in New York state. patient. York. “These things are currently our best defense against uncontrolled disease progression,” he said.
Putrino said there are many recommended guidelines for rest and pacing for chronic COVID patients, but ultimately, patients need to carefully craft an individual strategy that works for them. He called for research to better understand what went wrong with each patient and why they might respond differently to similar strategies.
There are several theories How Long Does a COVID Infection Cause Fatigue?One is that inflammatory molecules called cytokines, which are higher in long-term COVID patients, may damage the mitochondria that fuel the body’s cells, making it harder for them to use oxygen.
“When a virus infects your body, it starts hijacking your mitochondria and stealing energy from your own cells,” Putrino said. He explained that trying to exercise this way dramatically increases the body’s energy demands, which damages the mitochondria and also creates waste products from burning fuel, sort of like exhaust fumes. It drives oxidative stress, which damages the body.
“The more objectively we look, the more we see physiological changes associated with long-term COVID,” he said. “There is a distinct organic pathology leading to fatigue and post-exertion discomfort.”
To better understand what goes on in infections associated with complex chronic diseases such as long-term COVID and ME/CFS, Putrino’s lab is studying such mitochondrial dysfunction and blood biomarkers Such as Micro clot.
He also pointed to research by pulmonologist David Systrom, director of the Advanced Cardiopulmonary Exercise Testing Program at Brigham and Women’s Hospital and Harvard Medical School. Systrom has done invasive exercise testing experiments that show that people with long-term COVID have different physiology than people who have had COVID and recovered. His research showed that the problem wasn’t with the functioning of the heart or lungs, but rather with blood vessels not supplying the heart, brain and muscles with enough blood and oxygen.
Why are these blood vessel problems occurrence is unclear, but a study Research led by Systrom’s colleague, neurologist Peter Novak, MD, has shown that small nerve fibers in long-COVID patients are missing or damaged. As a result, the fibers cannot properly squeeze the large veins leading to the heart and brain (such as the legs and abdomen), leading to symptoms such as fatigue, PEM, and brain fog. Systrom has found evidence of similar neurological dysfunction or absence in people with other chronic conditions such as ME/CFS, fibromyalgia and postural orthostatic tachycardia syndrome (POTS).
“It’s very beneficial to help patients understand what’s making them uncomfortable, that it’s not in their head, or simply going to train or go to an indication,” Systrom said, referring to the erroneous advice some doctors have told Patients only need to exercise to get rid of constant fatigue.
The findings could also help develop specialized rehabilitation centers for patients with long-term COVID-19 infections at places like Mount Sinai Hospital and Brigham and Women’s Hospital, where programs include increased fluids and electrolytes, tight garments and dietary changes, among other things.Although different types of exercise therapy have long be shown To the serious detriment of someone with ME/CFS symptoms, both Putrino and Systrom say that skilled rehabilitation can still involve small amounts of movement when prescribed carefully and paired with rest to avoid pushing the patient to a breaking point. In some cases, exercise can be used in conjunction with medication.
in a small clinical trial Publishing in November, Systrom and his research team found that patients with ME/CFS and long-term COVID were able to boost their motor thresholds with the help of the POTS drug Mestinon (commonly known as pyridostigmine).
Like many people with long-term COVID infections, Fitzgerald’s recovery has had its ups and downs. Now, she’s getting more help with child care and doing research at the disability-friendly Patient-Led Research Collaborative. While she hasn’t joined a long-term COVID recovery group, she’s been teaching herself rhythm and breathing. In fact, the only treatment referral she got from her doctor was cognitive-behavioral therapy, which helped cushion the emotional toll the situation took. “But it doesn’t help with any physical symptoms,” Fitzgerald said.
She’s not the only one to spot this problem.
“We need to continue to appeal to those who are trying to mentalize disease rather than understand the physiology that drives these symptoms,” Putrino said. “We need to make sure patients are actually being cared for and not gaslighted.”