Neurology of COVID-19 Fatigue - M.A.Aleem BMJ 2021;373:n1610

BMJ British Medical Journal 

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How can we manage covid fatigue?

BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n1610 (Published 24 June 2021)

Cite this as: BMJ 2021;373:n1610

Re: How can we manage covid fatigue?

Dear Editor

Neurology of COVID-19 Fatigue

With COVID-19 infection, fatigue can present in the mild early stages, during the severe clinical condition and in the post COVID-19 period.

Fatigue is one of the most common (38% to 55%) symptoms in the early stage and it is most persistent and debilitating in many people with COVID-19 infection.

Fatigue can be due to central, psychological, and/or peripheral mechanisms due to the COVID-19.

Many factors can contribute to fatigue with Covid-19 infection, which include changes in neurotransmitter levels, inflammation, psychological disorders, stress levels, cognitive dysfunction, impaired oxygen delivery to the brain, and skeletal muscle involvment.

The central factors influencing COVID-19 fatigue may be a result of the virus invading the central nervous system directly. Other central factors which may also contribute to COVID-19 fatigue include changes in neurotransmitter levels (e.g., dopamine and serotonin), intrinsic neuronal excitability, demyelination (resulting in changes in axonal conduction velocity), and many others.

The recent functional neuroimaging studies in COVID-19 patients have also demonstrated frontal hypometabolism and cerebellar hypermetabolism, which may also have an impact on fatigue.

In the periphery, COVID-19 may directly impact the skeletal muscle and, therefore, contribute to fatigue.

Various skeletal muscle cell types may independently and/or collectively show vulnerability to COVID-19 via angiotensin-converting enzyme 2 (ACE2). COVID-19 in the lungs activates various leukocytes to release a cascade of cytokines, including interleukin-6 (IL-6). Notably, systemic elevations of IL-6 can also disrupt the muscle metabolic homeostasis and exacerbate the muscle loss and can cause fatigue.

Competing interests: No competing interests

26 June 2021

M.A. Aleem

Emeritus Professor of Neurology * Visiting Specialist in Neurology ** Consultant Neurologist ***

The Tamilnadu Dr.M.G.R. Medical University * Dhanalakshami Srinivasan Medical College ** ABC Hospital ***

Chennai 600032* Perambalure 621212** Trichy 620018*** Tamilnadu India

@drmaaleem