When recovering from COVID-19, many people notice they have less energy than before. Sometimes, people feel exhausted and have trouble thinking or doing light activities after a small amount of physical, cognitive or emotional effort. This is called Post-Exertional Malaise (PEM).

Symptoms of fatigue and exhaustion can become severe and cause people to spend all day in bed. If you get to this point, speak to a health care professional experienced in Post-COVID (also known as Long COVID) to rule out any other condition that could be causing your symptoms and to discuss management strategies.

The most common lethargy symptoms of Post-COVID are Fatigue and PEM.

Possible Causes

Fatigue is a normal part of the body’s response to fighting a viral infection such as COVID-19. Fatigue is very common after a viral illness and typically resolves after two or three weeks.

Some people’s fatigue may last for weeks or months due to the body’s continued response to the COVID-19 virus even though the acute phase is over. Additionally, people who experience any severe illness are expected to have fatigue for up to six months after.

What does fatigue look like in everyday life?

You are likely to find that your energy levels fluctuate from day to day. You may sleep more, feel unsteady on your feet, or find standing for long periods difficult. Additionally, fatigue may affect your memory and your ability to concentrate. Walking around your home might be difficult, including walking the stairs, using the bathroom, and managing your daily routine. You may need to adapt your activities to conserve your energy.

Management

Various strategies you can use at home to help manage fatigue include:

    Old male teacher yawning at desk in the school classroom
    • Living on a single level of your home to avoid stairs while you recover
    • Using special equipment to help you with common tasks
    • Pacing and creating a plan to save energy while performing activities
    • Practicing relaxation techniques and therapies
    • Getting adequate sleep
    • Maintaining a healthy diet and staying hydrated

    Speak with a member of our healthcare team about specific strategies to help you manage your fatigue or PEM.

    Post Exertional Malaise (PEM)

    Some people recovering from COVID-19 experience exhaustion and have difficulty thinking, muscle aches, headaches, and increased fatigue after a minimal amount of activity. This can be brought on by a physical, mental, or emotional effort. This is known as Post-Exertional Malaise (PEM), an abnormal, disproportionate response to effort. This extreme exhaustion can occur 24 to 72 hours after activity and can last for days or weeks. PEM is not dangerous itself but it can affect your quality of life.

    Possible Causes of PEM

    The exact causes of PEM are not fully understood.

    The fact that pacing helps people with PEM suggests that symptoms are not random, but rather due to overdoing activity. If you do more than your body can handle, your symptoms will worsen. On the other hand, if you stay within your limits (what we call the “energy envelope”), you can gain some control.

    What does PEM look like in everyday life?

    People with PEM become caught up in a cycle of “push and crash” (periods of overactivity followed by forced rest). When their symptoms are mild, they push to get as much done as they can, which triggers extreme exhaustion. This makes their symptoms worse, which in turn leads to forced rest or a crash. The push-crash cycle leads to discouragement and frustration in these people, who feel like they have no control over their situation.

    The opposite of push and crash is “pacing.” Pacing means that you spread out your activities into smaller tasks with rest periods in between. You need to break the push-crash cycle by resting and not pushing your limits. To help with your recovery, do light activities for a while.

    Management of PEM

    Pacing is a way to approach activity so that you reduce the big ups and downs in your symptoms. Pacing is being smart about how you use your energy.
    It’s very important that you not wait until you feel tired before resting. By applying these strategies, you can decrease the frequency and severity of episodes of PEM.

    Man lying in bed turning off an alarm clock in the morning at 7am

    The benefits of a plan based on pacing strategies include:

    • Less frequent and intense symptoms
    • Less forced rest time
    • Less mental and physical suffering
    • More time for doing what you enjoy
    • More stable and predictable life
    • Better chance for improvement
    • Greater sense of control

    When should I speak to a
    healthcare professional?

    Fatigue can be debilitating. Speak to a healthcare professional experienced in Post-COVID to rule out any other condition that could be causing your fatigue. This is especially important if your fatigue is getting worse, or if it is unchanged after four weeks.