After an infectious disease, fatigue is common. In the case of Covid-19, it is sometimes intense and can last for several months. Some patients need to undergo exercise rehabilitation sessions.

After the acute phase of Covid-19, fatigue persists very frequently. It is logically found in patients who leave the hospital after having presented a severe form of the disease, but also in some people who have suffered only mild symptoms. "Six weeks after infection, half of the patients have not regained their full capacity," says Professor Pierre Tattevin, president of the French-language Society of Infectious Pathology.

Why this post-Covid fatigue?

All infectious diseases can put 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 could explain why fatigue is so marked after infection, especially in young and initially healthy patients, whose immune system is very reactive. This fatigue does not surprise us in patients who have been ventilated (placed on respiratory assistance, Editor's note) and who is released from resuscitation. It is more surprising in young people who have presented with a non-severe form of Covid. We do not see such a situation after the flu, "observes the infectiologist.

Is this fatigue different?

The High Health Authority (HAS) delivered its recommendations on the management of Covid-long in February 2021. In this practical document for doctors, she describes fatigue as "one of the most prevalent symptoms that can persist during the initial episode of Covid-19 or reappear abruptly after a phase of improvement".

The HAS encourages not to neglect this seemingly banal symptom and to look for its cause as much as possible. "We must not put everything on the account of Covid-19," warns Professor Tattevin who invites patients to talk to their doctor.

Fatigue during exertion, persistent shortness of breath are common. They may reveal a breathing problem that has not been resolved or a heart defect.

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 you are exhausted, you sit or lie down, you limit your activities. However, the less you move, the more you lose your muscles and respiratory abilities.

After a Covid it is undeniable necessary to rest; but without, however, remaining inactive. On the contrary, it is important to regain a good physical condition as quickly as possible by strengthening your muscles and increasing your lung capacity. Another advantage is that by practising physical activity, you regain self-confidence and the body secretes endorphins, anti-stress hormones, which help overcome anxiety related to the disease.

What physical activity after Covid?

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

It can be practised 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).

For its part, the French Association of Chronic Fatigue Syndrome (a disease that has many points in common with Covid-long) offers practical advice to better recover.

For people who are particularly embarrassed about their respiratory level, exercise rehabilitation sessions, supervised by a sports doctor or a physiotherapist, are necessary. It is, at present, one of the few treatments for Covid-long validated by the High Authority of Health. "These rehabilitation programs, which start in the hospital, but can then be continued at home, are offered to patients à la carte, after assessing their difficulties: mainly muscle fatigue or breathing 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 different 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 will get by respecting simple rules of lifestyle: avoid stimulants such as tea or coffee, ban screens after 6 pm to fall asleep more easily, sleep in a cool room, relax or even meditate if possible...

Most patients who feel exhausted after Covid will recover within a few weeks. For others, it will be longer. Evolution is often jagged, with ups and downs, at a different rate depending on the individual. As such, Professor Tattevin wants to convey a message of optimism: "It's long, but it always ends up getting better. Don't get discouraged! »