Long COVID Fatigue: Beyond “Just Tired”
This post is part of a new blog series focusing on long COVID. See parts 1, 2, 4, 5, and 6.
Chronic fatigue – a persistent sense of exhaustion or lack of energy – is just one of over 200 symptoms of long COVID.1 However, it is often one of the more serious symptoms impacting long-haulers. This is especially true when it comes to severe chronic fatigue, which affects a substantial proportion of individuals with long COVID.2 For this post, we will discuss severe chronic fatigue as it relates to long COVID, and how you can best support affected long-haulers.
Now, what do I mean by severe chronic fatigue?
The word “severe” should not be taken lightly, as this type of fatigue is often debilitating for long-haulers.2 Severe chronic fatigue significantly limits normal human functioning, with many affected individuals unable to work or properly care for themselves. This fatigue is also unrelenting; it does not substantially improve with sleep or rest. In some cases, long-haulers may be housebound or even bedridden due to the severity of their fatigue, making long COVID a disabling condition that greatly impacts quality of life.
Additionally, severe chronic fatigue is not something that can be pushed through – not without negative consequences. Long-haulers with this type of fatigue often experience post-exertional malaise (PEM), a significant and prolonged worsening of fatigue and other disease symptoms following overexertion.2,3 This includes both physical and mental overexertion, as the brain uses a large amount of energy. Episodes of PEM – also called “crashes” or “flares,” referring to crashing energy levels and flaring symptoms – can occur after virtually any activity, even those normally considered mild (washing the dishes, reading a book, talking on the phone, etc.). This is a serious issue, as PEM can result in worsened symptoms that persist beyond the episode.
And yet, long-haulers too often hear statements along the lines of “you just have to try harder.” Severe chronic fatigue due to long COVID is not like normal tiredness, but healthy individuals often assume that we are “just tired” and need some encouragement to push through our symptoms. Generally, I think this behavior is well-intentioned, as people earnestly want to help others address their struggles. However, there are right ways and wrong ways to address severe chronic fatigue. It is not helpful – and can even be harmful – to tell long-haulers to “just try harder” when doing so may result in even greater suffering, including potentially permanent health decline.
Instead, I have some alternative recommendations on how to support long-haulers with severe chronic fatigue. The first is to just listen. When we confide in you about our struggles, we often just need to vent and want compassion – not advice on how we need to try harder. We are already trying our best, and some days are better than others. With that said, please do not mistake a rare good day/week with overall condition improvement and the ability to do more. The fatigue experienced by long-haulers can be inconsistent and temporarily appear better, but as soon as overexertion occurs, we will crash again.
Additionally, please refrain from giving out unsolicited medical advice; it does not help. There are no FDA-approved treatments for long COVID, and there is no alternative practice that will cure PEM. There are limited medications that may help with long COVID and related fatigue, such as low-dose naltrexone4 and low-dose aripiprazole,5 but they are still experimental. For now, activity pacing is the most accessible strategy we have for managing severe chronic fatigue associated with long COVID.3
This leads me to my next recommendation: try to support long-haulers with activity pacing. This strategy involves carefully pacing out one’s daily activities, which helps conserve limited energy associated with long COVID.3 For long-haulers with severe chronic fatigue, pacing is critical for avoiding overexertion and PEM, and therefore improving quality of life. So, rather than telling long-haulers to push through their fatigue and leaving them alone to manage their daily activities, try assisting them with certain tasks. Simple acts, such as helping with chores or running errands, can make a world of difference in improving the lives of your loved ones with long COVID and severe chronic fatigue. Remember, we are not “just tired.”
Note: The author of this blog post has lived experience with both long COVID and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), a condition that is marked by severe chronic fatigue and PEM. They are two separate conditions, although COVID-19 is a known trigger for ME/CFS (as was the case for the author), and about half of long COVID cases meet diagnostic criteria for ME/CFS. Due to misconceptions of inappropriate conflation between the two conditions, however, ME/CFS was not specifically discussed in this post. To learn more about ME/CFS and its relation to long COVID, please see Reference 2 below.
References
1. National Academies of Sciences, Engineering, and Medicine. A long COVID definition: a chronic, systemic disease state with profound consequences. Published 2024. Accessed February 13, 2025. https://nap.nationalacademies.org/read/27768/chapter/2#2
2. Dehlia A, Guthridge MA. The persistence of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) after SARS-CoV-2 infection: a systematic review and meta-analysis. J Infect. 2024;89(6):106297. doi:10.1016/j.jinf.2024.106297
3. Ghali A, Lacombe V, Ravaiau C, et al. The relevance of pacing strategies in managing symptoms of post‑COVID‑19 syndrome. J Transl Med. 2023;21(1):1-12. doi:10.1186/s12967-023-04229-w
4. Bonilla H, Tian L, Marconi VC, et al. Low-dose naltrexone use for the management of post-acute sequelae of COVID-19. Int Immunopharmacol. 2023;124:1-12. doi:10.1016/j.intimp.2023.110966
5. Cui J, Kalaycioglu M, Mejia GCR, et al. P-1610. Low-dose aripiprazole is a promising drug for long COVID treatment: a retrospective observational study. Open Forum Infect Dis. 2026;13(1). doi:10.1093/ofid/ofaf695.1788
