18.7: Future Directions- Coronavirus Disease 2019 (COVID-19)

At the time of writing, more than one year since the first outbreak, the coronavirus disease 2019 (COVID-19) pandemic continues worldwide. This contagious and multi-system illness is caused by a novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). To date(February 2021), more than 100 million cases have been confirmed worldwide. Alongside fever, cough and shortness of breath, fatigue is one of the acute clinical features of SARS-CoV-2 infection. Clinicians and researchers have focused on the acute phase of COVID-19, but there is now a growing awareness that some patients experience an unexpectedly long and challenging recovery, with ongoing symptoms and complications that can last for months after infection. Researchers, patient groups and those affected by the condition are collectively calling this phenomenon long COVID (Brown et al.,2021). Long COVID does not seem to be an issue that is only affecting the minority of people who require hospitalization due to severe respiratory problems. Young and otherwise healthy people who had a mild presentation of symptoms can also experience prolonged symptoms. Patient-led initiatives, such as the Patient-Led Research Team, were the first to conduct surveys to explore health problems after confirmed or suspected SARS-CoV-2 infection (McCorkell et al., 2020). Fatigue, shortness of breath, brain and fog/concentration challenges are just some of the common symptoms, and many respondents who had been physically active before symptom onset had become largely sedentary. Furthermore, reports of fluctuating symptoms that can flair up unpredictably or in response to over-exertion reveal the potential similarities between long COVID and ME/CFS (Komaroff et al., 2021).

The development of chronic fatigue has been observed in survivors of other epidemics (Islam et al., 2020). In earlier coronavirus outbreaks, approximately one-third of survivors of hospitalization or intensive care unit admission had fatigue, reduced quality of life, reduced exercise capacity, and psychological issues including post-traumatic stress disorder, depression and anxiety, even beyond six months after the illness (Ahmed et al., 2020). Although the long-term impact of the SARS-CoV-2 infection is not yet well understood, similar findings are emerging (Halpin et al., 2021). Because COVID-19 is a new disease and research is evolving rapidly, little is known about the mechanisms leading to lingering symptoms or what rehabilitation support is needed. As we have seen in this chapter, exercise can be therapy for conditions where chronic fatigue, inactivity, deconditioning, and mental health concerns are major problems. Looking to the future, helping people manage fatigue, gradually increase activity, regain lost quality of life and return to normal function should be a priority. Improvements in energy levels and breathlessness may be aided by careful tailoring, pacing, prioritization, and modest goal setting (Greenhalgh et al., 2020). There is a potential role for exercise scientists with knowledge of chronic fatigue, working alongside clinicians in the development of such exercise and rehabilitation recommendations for COVID-19 long haulers (Barker-Davies et al., 2020). However, as we have seen in the case of ME/CFS, given the potential for post-exertional malaise, a great deal of caution is required. Future research on responses to exertion and the efficacy of exercise as an intervention must be transparently reported and co-created with the patients (and patient doctors [Alwan et al., 2020]) who have survived not only a global pandemic but one of the major public health crises of our lifetimes.