How To Deal With Fatigue After COVID

How to deal with fatigue after COVID

What is Fatigue?

Persistent fatigue is very common after COVID-19 and may seem to have a greater effect than it would after other viral illnesses. There is (so far) no evidence to suggest that COVID-19 infection persists long-term, although fatigue may continue past the ‘infective’ period.

Causes of fatigue

The exact causes of fatigue after any viral infection are unclear, but possible contributing factors are:

The production of chemicals called cytokines by the body’s immune system
Muscle weakness caused by immobility, particularly after an intensive care (ICU) stay
Sleep deprivation, especially after being in hospital
Anxiety, depression, cognitive difficulties, post-traumatic stress disorder

Levels of fatigue will vary for each person due to factors including:

Treatment received
Length of any hospital stay
Other existing illness / medication

Fatigue is likely to continue for some time after the infection has cleared. The person may experience good and bad days.

Effects of Fatigue

Fatigue is experienced differently from person to person, with some effects being more common than others.

Physical

The person may have an overwhelming feeling of tiredness, reduced energy levels, feeling like they’ve slowed down or are sluggish.

Sensory

The person may feel more aches or pains in their body and may be less active due to feeling unwell.

Cognitive

The person may have difficulty in concentrating or difficulty remembering things.

Behavior

The person may avoid engaging in their usual activities due to the worry of feeling even more fatigued.

Emotions

Emotions may cause the person to feel frustrated or irritated. Some people may feel that no-one else understands what they are going through.

Different effects can be more prevalent on different days. It is important to support people to identify what might be triggering their increased fatigue and use coping mechanisms to try and reduce it.

Managing Fatigue

The Early Days

In the early days of COVID-19 while being acutely ill, fatigue can be severe and it can be difficult to manage. There are a number of methods/practices that can help with this.

Rest

Rest is important to help the person to use their energy to recover from COVID-19. This means resting physically and mentally (body and mind). It is good to advise people to listen to their body and stop when the following signs of fatigue appear, for example heavy eyes, being clumsy or a bit more forgetful, or aching body. Encourage the person to give their body time to recover. Do different activities little and often rather than all in one go, such as limiting screen time, TV, social media or talking on the phone.

Sleep

Good sleep hygiene can be established by having a sleep routine (going to bed and getting up at similar times):

Have a good sleep environment. Ensure the bedroom is completely dark and has a comfortable temperature, with comfortable mattress and pillows
Follow a night-time routine prior to going to bed. Go to bed at the same time each night, have a hot bath, listen to music or meditate
Avoid things that can disturb sleep. Do not consume caffeine or alcohol in the few hours before going to bed. Stop screen time at least 30 minutes before sleeping. The blue light emitted by screens on mobile phones, computers, tablets and TVs limits the production of melatonin, the hormone that controls your sleep/wake cycle. A reduction in melatonin makes it harder to fall and stay asleep.

Gentle activity

Start moving around little and often
Encourage small walks and getting fresh air
Encourage normal activities that are not too strenuous, for example, washing and dressing
Reminders set on a phone could help

Plan a routine

Support the person to think about what they can manage in a day and notice when they get fatigued. Encourage planning ahead each day.

Anxiety and stress

Support the person to identify triggers. Encourage them to talk about it with you, family or someone they are comfortable with.

Actively encourage ‘worry time’ and promote relaxation techniques. This could be listening to relaxing music or using guided relaxation techniques.

Nutrition

Good nutrition is essential to optimize recovery from COVID-19. A varied and well balanced diet can have a positive impact on energy levels. Fatigue can lead to a reduced appetite and ability to prepare well balanced meals. Where possible, encourage the person’s normal eating and drinking routine.

If the person is less active because of fatigue, they will use fewer calories, so encourage them to choose healthier foods rather than those high in added sugars and fats.

Later Management of Fatigue

As you recover, managing fatigue will require you to take steps to gradually increase your activity and energy levels, which may include getting some help around the house, such as hiring a cleaner (if permitted by government guidance).

How to manage fatigue at home.

Fatigue can make the person feel less motivated, which may lead them to avoiding activities. Ask the person to reflect on good and bad days and aim for a balance of activity, rest and sleep.

How can you work to break the cycle of avoidance?

Work to break the cycle of avoidance. Encourage individuals to try activities and modify them, if necessary.

For instance:

Sitting to prepare meals
Doing housework one room at a time
Doing smaller regular food shopping/online home delivery

Energy Conservation: The 3 P’s

Conserving energy uses the 3 Ps principles (Plan, Prioritize, Pace) to support people to conserve their energy as they go about their daily tasks, so they have more energy throughout the day. Learning to pace, plan and prioritize their daily activities will help them to manage fatigue during their recovery. Encourage people to do tiring activities at the part of the day when they feel their best or spread activities across a longer period of time, rather than trying to complete them in one go. Having a plan for the week can help someone to commit to their plan and can give them a sense of accomplishment to ‘tick them off’ when completed.

The 3 P’s:

Plan

Planning activities can help reduce the feeling of stress or anxiety by reducing the number of unexpected events the person may need to cope with.

Prioritize

Support the person to identify what tasks are important to them and what it is that they want to spend their energy on. At this point, it is also important to consider what needs doing and whether or not there is anyone who can help. Research suggests that engaging in enjoyable activities can help break the cycle of fatigue. Getting outside in the fresh air can also help.

Pace

Finding the balance between exercise and activity but also including regular rests is important. Make sure people give themselves plenty of time, even extra time if necessary, to complete tasks.

Doing something too quickly and then being exhausted for the rest of the day can be disheartening and affect motivation.

Ensure the person builds rests between activities for at least 30-40 minutes to ‘recharge’. Where possible, sit to do activities and rest when they need to.

Example of the 3 P’s

Gardening

Don’t try to do this all in one go, encourage regular breaks and encourage the person to plan the day so this is the only strenuous task that day.

Laundry

Keep the washing basket near the washing machine, so that the person does not need to carry the washing up and down the stairs frequently.

Ironing

Encourage the person to only iron what is necessary or only what is needed for that day.

Meeting with friends or family

Make sure the arrangements and meeting place makes the person feel comfortable. This could be in their garden to begin with.

Advise them to not commit to doing any ‘big’ tasks, like making dinner. Maybe tea or coffee would be enough at first.

Climbing the stairs

Climb five steps, have a short rest and climb five more. This will reduce the recovery time at the top of the stairs and reduce tiredness for the rest of the day.

Balance

It is important to balance tasks that must be done, with more pleasurable activities. Encourage the individual to add in activities they enjoy, initially this may include reading or watching TV. When the person is feeling like they have more energy this could include, taking their dog for a short walk, socializing with family or friends, playing a sport or doing an activity (with children/grandchildren), following government guidance.

Long-term Fatigue

If someone’s fatigue symptoms persist for more than 2 to 3 months and are continuing to cause a significant functional impact that is preventing someone returning to work, education or every day activities, a diagnosis of Myalgic Encephalomyelitis (ME) or Chronic Fatigue Syndrome (CFS) may be considered.