After an infectious disease, fatigue is common. In the case of Covid-19, it can be severe and can last for several months. Some patients require exercise rehabilitation.

How to overcome fatigue after a Covid?

After the acute phase of Covid-19, fatigue is very common. It is common in patients discharged from hospital after a severe form of the disease, but also in some people who have only suffered mild symptoms. "Six weeks after infection, half of the patients have not recovered their full capacity," says Professor Pierre Tattevin, president of the French Society of Infectious Pathology. 

Why the post-Covid fatigue?

All infectious diseases can knock the body flat for several weeks; and this is especially true with Covid-19. "The disease puts a lot of strain on the immune system, which may explain why fatigue is so marked after infection, especially in young, initially healthy patients with highly responsive immune systems. This fatigue is not surprising in patients who have been ventilated (placed on respiratory support, editor's note) and are coming out of the ICU. It is more surprising in young people who have had a non-severe form of Covid. You don't see this after the flu," says the infectious disease specialist. 

Is this fatigue different?

The French National Authority for Health (HAS) delivered its recommendations on the management of Covid-longs in February 2021. In this practical document for physicians, it describes fatigue as "one of the most prevalent symptoms that may persist after the initial episode of Covid-19 or reappear abruptly after a phase of improvement."

The HAS urges that this seemingly trivial symptom not be overlooked and that the cause be sought as much as possible. "One should not blame everything on Covid-19," warns Professor Tattevin, who invites patients to talk to their doctor.

Fatigue on exertion and persistent shortness of breath are frequent. They can reveal a respiratory problem that has not been resolved, or a cardiac anomaly.

But other factors can trigger or aggravate this feeling of exhaustion: non-restorative sleep, stress, anxiety, even depression... 

Why do we need to fight this fatigue?

In consultation, patients tell their doctor that they "can't take it anymore". The risk, in this context, is to fall into a vicious circle. When we are exhausted, we sit or lie down, we limit our activities. The less you move, the more you lose your muscles and your respiratory capacities.

After a Covid, it is unquestionably necessary to rest; but without, for all that, remaining inactive. On the contrary, it is important to regain a good physical condition as soon as possible by strengthening your muscles and increasing your lung capacity. Another advantage is that by practicing physical activity, one regains self-confidence and the body secretes endorphins, anti-stress hormones, which help overcome the anxiety linked to the disease.

What physical activity should I do after a Covid?

This physical activity must be progressive and adapted to the capacities of each person, for example walking or cycling. You should train at your own pace, without trying to do too much.

It can be done at home or under the supervision of a professional. On its website, the Aprèsj20 association, which brings together patients suffering from Covid-long, advises a gentle Aprèsj20, to be done at home, developed by the Pitié Salpêtrière hospital (Paris).

On its side, the French Association of the chronic fatigue syndrome (a disease which presents many points in common with the Covid-long) proposes practical advice to recover better.

For people with particular respiratory problems, exercise rehabilitation sessions, supervised by a sports doctor or physiotherapist, are necessary. This is currently one of the rare treatments for Covid-long validated by the French National Health Authority. "These rehabilitation programs, which start in hospital but can then be continued at home, are offered to patients à la carte, after assessing their difficulties: mainly muscular fatigability or respiratory difficulties," explains Professor Tattevin.

Post-covid fatigue: getting out of the mental fog

Many patients come out of the Covid ordeal with a feeling of "mental fog". They complain of confusion, memory problems and lack of concentration. These various symptoms are often exacerbated by the stress and anxiety generated by the disease.

To overcome these difficulties, some people need real psychological support. But most people will get through it by following simple lifestyle rules: avoid stimulants such as tea or coffee, banish screens after 6 p.m. to fall asleep more easily, sleep in a cool room, relax or even meditate if possible...

Most patients who feel exhausted after a Covid will recover within a few weeks. For others, it will take longer. The evolution is often a rollercoaster ride, with ups and downs, at a different pace for each individual. In this respect, Professor Tattevin wishes to convey a message of optimism: "It takes a long time, but it always gets better in the end. Don't get discouraged!"