In a recent interview with Alba Azola, MD lead author of the AAPM&R autonomic dysfunction guidance statement and a member of the Johns Hopkins Post-Acute COVID-19 Team, important insights were shared about the overlap between
Long COVID and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), two conditions that coincide with one another.
One of the key points discussed was how Long COVID can overlap with other conditions, such as ME/CFS. Long COVID, like ME/CFS, presents with a range of debilitating symptoms, including severe fatigue, post-exertional malaise (PEM), brain fog, and orthostatic intolerance. While these symptoms can mirror each other, the pathophysiology of Long COVID and ME/CFS remains an area of active investigation.
Azola explained that while both conditions share common symptoms, they are not necessarily the same. "I don't think that we are at a point where we can equate both things," she said. "I think that there are several, or there's a large group of Long COVID patients that do meet criteria for ME/CFS, and treating with symptom management that has been used in the past for pre-pandemic ME/CFS patients can be very effective for these patients as well."
She also noted that the definition of ME/CFS, according to the 2015 guidelines, includes the requirement of severe fatigue and loss of function lasting more than six months. Other diagnostic criteria include post-exertional malaise, brain fog, orthostatic intolerance, and unrefreshing sleep. These same symptoms are also commonly reported by individuals with Long COVID.
"The most recent definition was from June of 2024, by the National Academies of Medicine, and it defined it as symptoms that start after SARS-CoV-2 infection and last three months. And there is no particular kind of timing of the onset. It's not affected by the severity. So people with mild or asymptomatic illness can also develop Long COVID," Azola explained. "But Long COVID can also have other co-diagnoses. So it's not exclusive, right? So we have somebody who presents with new symptoms after Long COVID, and they may meet diagnostic criteria for ME, CFS."
According to the specific definition from the report defines
Long COVID is a chronic condition that occurs after a COVID-19 infection and lasts for at least three months. It can present as continuous, relapsing, or progressive and affect multiple organ systems.
Key aspects of the definition:
- Long COVID can follow any severity of SARS-CoV-2 infection, including asymptomatic cases. Symptoms may appear weeks or months after the initial infection.
- It includes a wide range of symptoms, such as fatigue, difficulty concentrating, shortness of breath, and post-exertional malaise, as well as conditions like POTS, ME/CFS, and autoimmune diseases.
- Long COVID can significantly impair daily activities, impacting work, school, and self-care. Its effects can range from mild to severe and may persist for months or years.
- Diagnosis is based on clinical assessment, as no biomarker currently exists for confirmation.
- The report highlights the need for continued research, particularly on biomarkers, risk factors, and equity, as socioeconomic factors and stigma can affect diagnosis and treatment.
The report recommends broad adoption of this new definition to improve diagnosis, care, and research.
