A significant sub-set of Long COVIDpatients have symptoms that are consistent with a diagnosis of ME/CFS:

1. Reduction or impairment in ability to carry out normal daily activities, accompanied by profound fatigue;
2. Post-exertional malaise (worsening of symptoms after physical, cognitive, or emotional effort);
3. Unrefreshing sleep;
4. And either
   1. Cognitive impairment; or
   2. Orthostatic intolerance (symptoms that worsen when a person stands upright and improve when the person lies back down).

Other common manifestations of ME/CFS include pain, failure to recover from a prior infection, and abnormal immune function.

These symptoms may occur alone or along with other manifestations common to Long COVID.

Patients who have symptoms consistent with ME/CFS should be treated as ME/CFS patients, which includes guidance on energy management (e.g. pacing) and only a slow and carefully monitored re-introduction of exercise and resumption of normal activities.

Diagnosis

IOM 2015 Diagnostic Criteria for ME/CFS (CDC)

US ME/CFS Clinician Coalition Diagnostic Guidelines

 

ICD-10-CM Coding for the diagnosis

Effective October 1, 2022, updates to the US ICD-10-CM will enable tracking of people with ME/CFS, including those who develop the disease following COVID. These updates are specific to the ICD-10-CM, the US version of the International Classification of Diseases.

Updated Coding for ME/CFS and ME/CFS following Long COVID

Background information regarding this change

 

Clinical care

Clinical Care of Patients with ME/CFS (CDC)

US ME/CFS Clinicians Coalition Testing Recommendations

US ME/CFS Clinicians Coalition Treatment Recommendations

Mayo Clinic: ME/CFS Essentials Of Diagnosis and Management

AAPM&R consensus guidance statements

Multidisciplinary collaborative consensus guidance statement on the assessment and treatment of fatigue in postacute sequelae of SARS-CoV-2 infection (PASC) patients

Multi-disciplinary collaborative consensus guidance statement on the assessment and treatment of cognitive symptoms in patients with post-acute sequelae of SARS-CoV-2 infection (PASC)

Multi-disciplinary collaborative consensus guidance statement on the assessment and treatment of breathing discomfort and respiratory sequelae in patients with post-acute sequelae of SARS-CoV-2 infection (PASC)

Multi-Disciplinary Collaborative Consensus Guidance Statement on the Assessment and Treatment of Cardiovascular Complications in Patients with Post-Acute Sequelae of SARS-CoV-2 Infection (PASC) The full text of this article is currently available as a PDF.

 

Pathophysiology

Advances in Understanding the Pathophysiology of Chronic Fatigue Syndrome (2019)

Pathophysiology of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) — Dr. Anthony Komaroff, Dec 17, 2021. Grand Rounds presentation: 44 minute video. 

 

ME/CFS in Children

ME/CFS in Children (CDC)

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Diagnosis and Management in Young People: A Primer (2017)

 

Centers

The Ronald G. Tompkins Harvard ME/CFS Collaboration at the Harvard Affiliated Hospitals