On day 16, Helene finally woke up with energy. “I did this long walk. I came back, and I was in the garden, lying in the sun. And then I felt I was getting a migraine.” At first she thought nothing of it, putting it down to spring pollen causing hay fever. But then it got worse. “I developed this sinus pain and then it turned into nausea, and my whole body ached. So I went to bed. I don’t think I was ever the same after that.”
Helene was recounting this story to me in August 2020, five months after contracting Covid-19. Her story is not unusual. Her description of feeling better and then getting even sicker after exercise has a medical name: post-exertional malaise. It is common in patients with post-viral fatigue and is a hallmark of chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME) and some other overlapping chronic pain conditions.
For the first few months of 2020, as the world was just beginning to comprehend what Covid-19 was, World Health Organization guidelines suggested people generally recovered from Covid-19 in two weeks.
By April, studies from Italy and China were documenting “a significant symptom burden in Covid-19 survivors including anxiety, sleep disorders, fatigue, limited exercise tolerance, and memory and executive function impairment”.