Chronic fatigue syndromes (ICD-10 code G93.3) are one of the major mysteries of current medical science. While myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is still a very much debated condition, a similar set of post-viral fatigue symptoms is now appearing in the aftermath of COVID-19. There is no known cause or effective treatment. Therefore, the need for understanding the etiology and pathophysiologic mechanisms of fatigue syndromes has never before been as timely and urgent as today. Depending on the area of expertise, several theories of pathogenesis and pathophysiology have been proposed. In addition to earlier psychological theories, chronic (viral) infections, systemic inflammation, autoimmune diseases, and disorders of the autonomic nervous system dysautonomia are the most commonly proposed ones. Despite intensive current research and promising initiatives, none of the approaches has so far managed to result in effective therapies to cure or even systematically control the debilitating symptoms.
Epidemic outbreaks of ME/CFS have been described before. However, there is a risk that COVID-19 becomes the first pandemic that is followed by post-viral fatigue of a global range. This would result in significant individual suffering, a burden on healthcare systems, and decreased productivity of economies. We absolutely need to share and combine all our efforts that could contribute to further understanding the disease mechanisms, to get control over the current and future chronic fatigue pandemics.
More research into fatigue syndromes is urgently needed. Significant research is possible only if we have innovative theories or a hypothesis to test. Every clinician who has solid knowledge around basic sciences, an observational eye, and the ability to pay careful attention to patients’ symptoms and responses to medical treatments and nonmedical interventions may develop their own understanding of ME/CFS or post-COVID syndrome. If you have a novel idea regarding this issue, as well as the resources to investigate it further and perhaps submit a patent application for a potential treatment, then I would encourage you to do just that. However, if you still think that you have a good understanding or an idea arising from your clinical observations but do not think you could take it further by yourself, perhaps because the diagnostic testing you are proposing does not even exist yet, then you should consider that sharing your experience and thoughts could inspire other clinicians or researchers to combine your idea with their experience or take it forward to scientific testing or methodological development, for the benefit of all.
