Post COVID Fatigue

Fatigue is a normal part of the body’s response to fighting a viral infection but can continue for a long time after the infection has cleared. The fatigue is often experienced as overwhelming and is very different from everyday tiredness. It can affect you physically and emotionally as well as your levels of concentration and memory.

Some people may recover quickly without additional support, while others need much more time and can benefit from learning strategies to help them improve.

The evidence for recovery from covid is only just becoming known, so the advice and guidance being offered to people is based on a wealth of experience in managing similar symptoms related to other illnesses.

This leaflet gives guidance to help you find ways to manage your fatigue symptoms when they are longer-lasting.

How to manage longer-term fatigue symptoms

Fatigue management techniques, as outlined below, can help you learn
different ways to use the limited energy you currently have to help you
gradually re-establish a sustainable routine.

• Identify the things you are actually able to do at this time. Try not to make comparisons with how you would usually have done things when you were well but see what you are able to do right now. It may help to use diary sheets like the ones at the end of this leaflet or a journal to record what you can do, or talk with family and friends. This can help with pacing techniques, which are described below.
• Avoid overdoing things on the days when you feel you have a bit more energy as this can lead to a ‘boom and bust’ pattern, as described below, which can make you feel much worse
• Ask other people to help with tasks when you can
• Adapt and try doing things differently so they are easier and take less energy
• Prioritise so you only do the most important things and ‘don’t sweat the small stuff’
• Take time and do things more slowly and less intensely
• Do things you enjoy It’s really important to include things that bring you pleasure in your daily routine
• Use pacing techniques to reorganise the things you are able to do, plan ahead and establish a more balanced level of activity across the days and weeks.

Is there anything else I can do to help myself?

‘Boom and bust’ pattern of activity

For many people with persistent fatigue symptoms, trying to increase their activity levels by even a small amount can cause their symptoms to ‘flare up’. Fatigue symptoms can vary and it can be easy to unintentionally overdo things on the days when you feel you have a bit more energy. Symptoms can flare up, you feel ‘wiped out’ and can then find you are unable to do very much for several days afterwards. This is often referred to as a ‘boom and bust’ pattern of activity which can feel very frustrating and disheartening.

Pacing

Pacing strategies aim to help you find a middle road to establish a routine which gives a steadier pattern of energy use and rest.

Try to avoid the ‘boom’ and ‘bust’ pattern of activity.

A, B, C and D represent different types of activity. Some activities will be physically demanding, some mentally demanding, and some emotionally demanding. In this example, each activity is done in a big chunk, one after the other, leading to the person having to rest for a long period afterwards.

Reorganise your day to become more balanced

• Divide A, B, C and D into smaller, and more manageable, chunks or ‘microtasks’
• Avoid taking any extended breaks but split the ‘rest’ time to create shorter breaks throughout the day.

Try to work towards this reorganised balance of varied activities throughout the day.

• Spread the smaller chunks across the day
• Take frequent planned breaks before you think you need them – before, during and after each chunk of activity
• Vary the activities throughout the day mixing and switching between thinking tasks, physical tasks and taking breaks.

Why use pacing?

Pacing is about doing things differently. Rearranging the things you want, and need to do to enable you to do more things in a more sustainable way over time.

Pacing is used to prevent symptoms getting worse. It is better to take a short break before you need one rather than wait until you already feel symptoms flaring up and then need to take a substantially longer break to recover.

You won’t feel the impact of rebalancing your energy levels straight away, it takes a few weeks to begin to see the benefits just as it would with taking any new medication. Talk to your family and friends about what you are doing so they can support you to maintain this new more balanced way of doing things.

Helpful tips for pacing activities

Start pacing activities that are easier. Leave the activities that are too hard for now and come back to them or note them as goals for the future. Set yourself up for success and try the less difficult tasks first.

For those activities that you cannot leave, it is most important that you try to pace yourself as much as possible. Take short breaks as often as possible. Incorporate all your pacing principles to get them accomplished.

Remember it is good to ask for help with specific tasks. Delegate those tasks that are too difficult to tackle right now, and offer to do the less difficult ones.

Keep to your steady plan as much as possible. This will mean that you, and not your fatigue, will decide how much you do.

• If you are having a difficult day, try to ‘turn the volume down’ on your plan so you do smaller chunks of activities, for shorter times, with more breaks
• If you are having an easier day, try not to be tempted to do more, to avoid overdoing things.

Setbacks or flare-ups will happen from time to time. It is important that you have a plan and use it at these times to avoid slipping back into unhelpful ways of coping. Cut back your activity and put in more rest breaks, then plan to return to your normal activity as soon as possible as the fatigue subsides.

Recovery can take time

It can be frustrating and difficult to understand that things you did easily when you were well have now become exhausting. Activities such as: talking, checking messages on your phone, watching TV, or feeling frustrated or worried, can all affect your energy levels and impact on what else you can manage each day.

People often say "but I’m not even doing anything" because they are comparing their activity levels to when they were well.

If you find that talking to people on the phone is unexpectedly tiring, it can help to try limiting conversations to 10 minutes. For example, using a timer or asking the person you are talking with to help end the conversation early. Stopping, when you feel you could easily carry on, this can feel very strange and disruptive to start with but gets easier with practice and can prevent you pushing yourself beyond your capacity.

Building up activity levels

You can experiment with very gradually increasing activity levels when you are able to maintain your routine without causing a flare-up in your symptoms. You will find you can start doing a little bit more over time. When you feel your energy levels are more stable you can try to introduce either a small amount of a new activity or a bit more of an activity you are already doing.

Recovery does take time and patience, but if you try to ensure your goals are small, achievable steps, you will see progress.

Diary sheets

Filling in diary sheets can help you identify what your patterns of activity are at the moment and help you plan and rearrange things so that your energy is more balanced across the days and weeks. However not everyone finds the diaries helpful and it can be more useful to practise the principals of pacing.

• Take planned breaks regularly throughout the day, in the middle of, and between everything you do, even if your body doesn’t seem to need a break
• Try not to do things to your energy limit – aim for doing a part and then stop and take a break
• If you’re having a difficult day, try to do some of the things you planned for the day but only in small amounts and for a shorter time
• Balance your day between easier and trickier tasks, and build in rest breaks
• If you have a heavy task to do, break it down into smaller chunks. Do it a bit at a time.

Who can I contact if I have any concerns or questions?

For advice on support for activities of daily living, for example, personal care, meals or shopping:

Sefton Social Services on 03451 400 845

For advice on equipment or aids around your home:

Sefton Community Equipment Service on 0151 288 6208
Equipment.service@sefton.gov.uk

For advice on employment issues:

Advisory Conciliation Arbitration Service (ACAS) on 03001 231 100
www.acas.org.uk

For advice on benefits or financial worries:

Citizens Advice Bureaux (CAB) on 0808 2787 841
Mail@seftoncab.org.uk
www.seftoncab.org.uk

General advice on health and wellbeing:

Sefton Social Prescribers
Sefton Community Volunteer Service (CVS) 0300 323 0181
www.seftoncvs.org.uk

Sefton Long Covid Service
0151 247 6417
SeftonLongCOVIDMDT@merseycare.nhs.uk

Where can I find more information?

• For further advice on energy conservation and COVID recovery:
  • Royal College of Occupational Therapy
• For advice on how to cope with other effects of COVID including anxiety, mood and concentration:
  • yourcovidrecovery.nhs.uk

Our patients matter

Mersey Care NHS Foundation Trust listens and responds to patients and their carers to help improve the services we deliver. If you have any comments, compliments or concerns you can speak with a member of staff or contact our Patient Advice and Liaison Service (PALS) and Complaints Team.

Phone: 0151 471 2377
Freephone: 0800 328 2941
Email: palsandcomplaints@merseycare.nhs.uk

Mersey Care NHS Foundation Trust
V7 Building
Kings Business Park
Prescot L34 1PJ

www.merseycare.nhs.uk

To request this leaflet in an alternative format or language, please speak to a member of staff.