ME/CFS and Long COVID share similar symptoms and biological abnormalities: road map to the literature

Summary & key facts

This review found that Long COVID and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) share many symptoms and similar biological changes. People with both conditions often have long-lasting fatigue, thinking problems, sleep disruption, pain, post-exertional worsening, and signs of problems in the brain, autonomic nervous system, heart, lungs, immune system, gut microbiome, and energy metabolism. The authors note many supporting studies but also some negative studies, so the strength of evidence varies and more research is needed.

Key facts:

• Long COVID and ME/CFS share many core symptoms, including persistent fatigue, cognitive problems, headaches, disrupted sleep, muscle and joint pain, post-exertional malaise, and orthostatic intolerance.
• The review summarizes biological abnormalities reported in both illnesses across multiple systems: central and autonomic nervous system, lungs, heart and vasculature, immune system, gut microbiome, and energy metabolism/redox balance.
• More than half of patients with Long COVID had impairments in executive function and memory about two months after acute infection, according to the studies cited in the review.
• Reduced cerebral blood flow has been reported in people with ME/CFS and in people with Long COVID, measured by methods such as SPECT, arterial-spin-labeling MRI, and transcranial Doppler.
• Brain hypometabolism (lowered brain energy use) has been found in both illnesses by PET and magnetic resonance spectroscopy, and in Long COVID it has been reported to last 10–12 months after acute infection in some studies.
• The review reports both positive and negative study results for many findings, and it highlights that the strength of evidence varies by abnormality and by condition.
• Estimates cited in the review say ME/CFS may affect up to 2.5 million people in the U.S. and generate about $17–24 billion in direct and indirect expenses per year in the U.S.
• The review states post-COVID conditions may affect about 65 million people worldwide, and that nearly 2% of the U.S. civilian labor force is unable to work because of these illnesses, with estimated foregone wages of $170–230 billion per ye
• A cited analysis projects combined medical care, lost productivity, and disability from post-COVID conditions could cost about $3.7 trillion in the next 5 years, and the NIH has committed over $1 billion to study post-COVID conditions.
• The review also distinguishes Long COVID from other post-COVID problems that involve clear organ injury, and it cites studies reporting increased incidence (150–400%) of new major diseases and a 160% higher risk of death in the first year a

Abstract

Some patients remain unwell for months after "recovering" from acute COVID-19. They develop persistent fatigue, cognitive problems, headaches, disrupted sleep, myalgias and arthralgias, post-exertional malaise, orthostatic intolerance and other symptoms that greatly interfere with their ability to function and that can leave some people housebound and disabled. The illness (Long COVID) is similar to myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) as well as to persisting illnesses that can follow a wide variety of other infectious agents and following major traumatic injury. Together, these illnesses are projected to cost the U.S. trillions of dollars. In this review, we first compare the symptoms of ME/CFS and Long COVID, noting the considerable similarities and the few differences. We then compare in extensive detail the underlying pathophysiology of these two conditions, focusing on abnormalities of the central and autonomic nervous system, lungs, heart, vasculature, immune system, gut microbiome, energy metabolism and redox balance. This comparison highlights how strong the evidence is for each abnormality, in each illness, and helps to set priorities for future investigation. The review provides a current road map to the extensive literature on the underlying biology of both illnesses.

Topics

Fibromyalgia and Chronic Fatigue Syndrome Research Long-Term Effects of COVID-19 Respiratory Support and Mechanisms

Categories

Health Sciences Medicine Neurology

Tags

2019-20 coronavirus outbreak Cartography Coronavirus disease 2019 (COVID-19) Disease Geography History Infectious disease (medical specialty) Internal medicine Medicine Outbreak Road map Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Virology