One of the most frustrating times of being a physician, and perhaps of being any human who deals with the problems of another, is when you are unable to figure out why that person is feeling poorly and unable to give them any options that can help them feel better. You feel powerless and useless and in those times often people will look for any lifeline or last ditch effort to give hope to either person that they have some power to make a change, meaningful change that will help them both feel better about their role in the relationship.
I think one such issue that happens in medicine is related to chronic fatigue syndrome, now also known as myalgic encephalomyelitis. This is a condition that is very poorly understood and for a long time, and even now, is under diagnosed and misdiagnosed, oftentimes because we as physicians have a fear of saying that we do not know why someone is sick and have very limited training on or education about.
A brief look around online will find that people are routinely going through many doctors for months to years before getting a diagnosis. The primary symptom is, as you would expect, fatigue, so profound that people can no longer function in their normal fashion. This can also be misclassified as an issue related to somebody's thyroid or a "hormonal imbalance" or depression or sometimes malingering, the idea that somebody is faking their symptoms in order for a secondary gain, oftentimes considered to be being on Worker's Compensation in this case.
Our vague understanding of this condition is that typically there is some inciting factor that causes some sort of immune response and subsequent inflammation in the brain which translates to this fatigue. It is this fatigue that is not relieved with sleeping or resting, can cause trouble with thinking and memory often called a "brain fog" and sometimes also including unexplainable muscle and joint aches and headaches as well as a host of other symptoms. It is a grab bag of symptoms that can be explained by any number of other conditions but testing shows the absence of any explainable medical issues.
As with any condition, especially ones for which there is no clear beneficial treatment, there have been numerous medication trials to try to improve the symptoms of chronic fatigue syndrome, including but not limited to antivirals, antibiotics, inflammation inhibitors, Alzheimer's medications, steroids, immunoglobulin, ADHD medications, and even some treatments reserved for cancer or other severe autoimmune diseases. To date there has been no effective medical intervention for chronic fatigue syndrome. The cornerstone has still been cognitive behavioral therapy and graded exercise therapy in order to improve people's energy tolerance. The best way I have heard of explained is that people need to identify how much energy they have in their bucket and try to make sure they do not dump it all out because its going to take a long time to refill which can lead to a relapse and worsening of symptoms.
Why I bring this up now is because we are seeing a large number of people who have had COVID-19 have these lingering sensations of fatigue that are often seen with chronic fatigue syndrome. Technically one must have this fatigue for more than 6 months in order to meet the diagnostic criteria for chronic fatigue syndrome, but with the way things have been going we are expecting to see this much more in the future especially as this syndrome has a predilection to the Caucasian population which makes up a large chunk of this country where we are having this horrible viral spread right now. It is too early to know what this will mean of course but I think the most important things that will come from this is the idea that more healthcare providers are going to be seeing people with chronic fatigue syndrome and need to understand the condition, know what other conditions can mimic it and how to assess for them, and be able to work with people in a compassionate relationship to try to aid in any recovery we can expect.
I am expecting that at some point we will see more accessible forms of cognitive behavioral therapy and graded exercise therapy programs as his condition becomes more prominent which will hopefully help normalize the whole situation.
Until then, I can leave you with some words of wisdom from the CDC regarding this conditions he can be aware of it amongst friends and family members and coworkers as we all move through this time together.