“Take it seriously, investigate the causes and provide information” - The current strategy for fatigue and long COVID
Long COVID, fatigue and chronic fatigue syndrome - the group of patients with these diagnoses is growing. Prof. Dr. Christian Dettmers from Constance is a specialist for Long COVID. He will speak at the CON.THERA therapists' congress.
For those affected, life with long covid or fatigue is very stressful. The syndrome is also of great importance for society as a whole due to long periods of sick leave. Prof. Dr. Christian Dettmers is the head of the Multiple Sclerosis Department at the Schmieder Clinics in Constance and a proven specialist for Long COVID. In various studies with affected patients, he has conducted research on fatigue at the Schmieder Clinics, which specialise in Long COVID, and is familiar with the latest medical developments. He will be speaking at REHAB 2023 as part of the CON.THERA congress taking place there.
“Fatigue is a serious problem for the affected patients. The tiredness and exhaustion, as well as the long recovery period, make life very difficult. In terms of treatment, the first step is always to look for organic causes and determine whether there are any cognitive impairments, or whether psychosocial components intensify the syndrome.”
While fatigue is a subjectively experienced tiredness, the term fatigability refers to a potential organic cause of low physical performance and weariness. This complex of symptoms can be triggered by rheumatic diseases or even cancer.
Organic or non-organic causes
Long-lasting symptoms following an infection with SARS-CoV-2, also known as long COVID or post-COVID syndrome, have complicated the picture further. Research is still ongoing into the possible causes of this condition. Although patients report lower energy levels, this has proven difficult to measure and verify. They also suffer from a debilitating tiredness that makes everyday life almost impossible and sometimes leads to long periods off work. Recent studies have indicated that these cognitive impairments could be down to areas of the brain being affected and becoming inflamed due to COVID. There may therefore be a connection between organic causes and accompanying psychological or psychiatric symptoms.
“We must always take the symptoms of fatigue seriously, even if we cannot determine any organic causes in this patient group”, emphasises Dettmers. He believes that there could be many psychosocial causes for the exhaustion following an infection, which is also triggered by media coverage: “If the condition is down to organic causes, as is the case with MS, it is easy to speak to patients about the cognitive and psychological symptoms, and choose a course of therapy together. The situation is much more difficult if there is no organic cause, or in the case of long COVID. Here, it is hard to convince patients that the weariness they experience could be related to other factors aside from their previous COVID infection. This would make it easier to develop a way for them to deal with perceived crises and the accompanying tiredness.”
In a holistic socio-medical approach, differentiating between fatigue and fatigability allows doctors to consider both the subjective aspects and the objective findings. “When it comes to fatigue in MS patients, it is important to clarify to them that any early fatigability does not cause neurological damage. This stops the patients from developing preventative strategies and resting to avoid expected exhaustion”, says Prof. Dr Dettmers.
Interaction of all actors
He continues: “In many cases, resting can negatively affect the recovery process. All medical specialists involved, from GPs and psychologists to therapists, need to be made aware of this syndrome. We have to develop a standardised method of diagnosis, before moving on to a personalised approach to therapy, while also taking the patient’s psychosocial background into account.”
Resources in our healthcare system are tight at present, and fatigue and long COVID are proving a challenge: “We have to convince long COVID patients that they will most likely make a full recovery, so that this group of people does not remain permanently impaired in terms of their ability to work.” This is already happening successfully in the handful of specialised long COVID outpatient departments. The goal now is to spread the knowledge and experience gained here, in order to enable effective treatment of this growing phenomenon despite scarce resources.