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COVID Impacts

Detailed information and resources on the long-term health consequences of COVID-19 infection and the broad social impacts of the COVID-19 pandemic


Autonomic dysfunction (dysautonomia) is a condition in which the autonomic nervous system (ANS) does not work properly. This can affect the functioning of many organs and systems in the body. Dysautonomia is form of neuropathy, which is damage or disease that affects the peripheral nerves and nervous system, as it damages the nerves of the autonomic nervous system.

The autonomic nervous system (also referred to as the "vegetative nervous system", since it controls the body functions in a vegetative state) is a division of the nervous system that controls the internal organs, smooth muscles and glands. Within the autonomic nervous system, there are two main divisions:

  • Sympathetic Nervous System (SNS)
  • Parasympathetic Nervous System (PSNS)

Sympathetic and parasympathetic divisions typically function complementary (opposite) to each other. The sympathetic nervous system is the body's "fight or flight system", whereas the parasympathetic nervous system has been described as the "rest and digest system".

In the sympathetic nervous system (SNS), primary dysautonomia is common with other sympathetic nervous system dysfunctions, including:
  • Fibromyalgia
  • Chronic Fatigue Syndrome (CFS)
  • Irritable Bowel Syndrome (IBS)
  • Interstitial Cystitis

The association between dysautonomia and these comorbid conditions suggest that dysautonomia is the common underlying pathogenesis of these other conditions, and that they are simply distinct clusters or manifestations of dysautonomia, as opposed to separate diseases.

Dysautonomia can also be considered a symptom or manifestation of a variety of disorders, including:
  • Parkinson's Disease
  • Ehlers–Danlos Syndromes (EDS)
  • Postural Orthostatic Tachycardia Syndrome (POTS)
  • Multiple Sclerosis (MS)
  • Guillain–Barré Syndrome (GBS)
  • Long COVID

Postural Orthostatic Tachycardia Syndrome (POTS)

Postural Orthostatic Tachycardia Syndrome (POTS) is one of a group of autonomic disorders that have orthostatic intolerance (OI) as their primary symptom. OI is a condition in which an excessively reduced volume of blood returns to the heart after an individual stands up from a lying down position. The primary symptom of OI is lightheadedness or fainting. In POTS, the lightheadedness or fainting is also accompanied by a rapid increase in heartbeat of more than 30 beats per minute, or a heart rate that exceeds 120 beats per minute, within 10 minutes of rising. The faintness or lightheadedness of POTS is relieved by lying down again.

Anyone at any age can develop POTS, but it mainly affects women between the ages of 15 to 50 years of age. Some women report an increase in episodes of POTS right before their menstrual periods. POTS often begins after a pregnancy, major surgery, trauma, or a viral illness, including COVID-19.

Treating POTS

Treatment is targeted at relieving low blood volume or regulating circulatory problems that may cause the disorder. Simple interventions such as adding extra salt to the diet and attention to adequate fluid intake are often effective at raising blood pressure or increasing blood volume. Other drugs that have been found beneficial for treating POTS symptoms are fludrocortisone (for those on high salt diets), midodrine, and beta blockers. Drinking 16 ounces of water (two glasses) before getting has also been shown to help raise blood pressure in POTS patients.

POTS Prognosis

While the prognosis for POTS is generally good, despite sometimes severely impacting daily life. POTS may follow a relapsing-remitting course, in which symptoms come and go, for years.

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

Myalgic Encephalomyelitis/Chronic Ftigue Syndrome (ME/CFS) is a serious, long-term illness that affects many body systems. People with ME/CFS are often not able to do their usual activities. At times, ME/CFS may confine them to bed. People with ME/CFS have severe fatigue and sleep problems. ME/CFS may get worse after people with the illness try to do as much as they want or need to do. This symptom is called post-exertional malaise (PEM). Other symptoms can include problems with thinking and concentrating, pain, and dizziness.

Symptoms of ME/CFS may appear similar to many other illnesses and there is no test to confirm ME/CFS. This makes ME/CFS difficult to diagnose. The illness can be unpredictable. Symptoms may come and go, or there may be changes in how bad they are over time.

The primary "core" symptoms required for a diagnosis of ME/CSF:
  • Significant decrease in ability to perform activities that were common before illness
    • Must be present along with fatigue
    • Must be present for at least 6 months
  • Worsening symptoms after physical or mental activity that would not have occurred before illness (known as post-exertional malaise or PEM)
  • Sleep problems, including not feeling rested even after a full night's sleep, and insomnia (falling asleep or staying asleep)

In addition to all three (3) core symptoms, individuals must have at least one of the following symptoms:

  • Cognitive problems -- issues with memory and thinking
  • Orthostatic intolerance -- worsening of symptoms (dizziness, weakness, blurry vision) when standing or sitting upright


ME/CSF Fatigue

People with ME/CFS have fatigue that is very different from just being tired. The fatigue of ME/CFS:

  • Can be severe
  • Is not a result of unusually difficult activity
  • Is not relieved by sleep or rest
  • Was not a problem before becoming ill (not life-long)


Other Common Symptoms seen in ME/CSF patients

Pain is one of the most commonly observed symptoms in people with ME/CFS, though the type and severity can vary significantly, including: muscle aches and pain, joint pain (without swelling or redness), and headaches (new or worsening).

Some people with ME/CSF also may have:

  • swollen or tender lymph nodes
  • frequent sore throat
  • digestive issues such as IBS
  • chills and/or night sweats
  • allergies (new or worsening)
  • sensitivities (such as to food, light, noise, odors)
  • shortness of breath
  • irregular heartbeat
Treating ME/CSF

There is no cure or approved treatment for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). However, some symptoms can be treated or managed. Treating these symptoms might provide relief for some patients with ME/CFS but not others. Other strategies, like learning new ways to manage activity, can also be helpful.

Symptoms that can be managed or treated:
  • Post-Exertional Malaise (PEM)
  • Sleep issues
  • Pain
  • Psychological distress (depression, anxiety)
  • Orthostatic intolerance (dizziness, fainting)
  • Cognitive difficulties


ME/CSF Prognosis

Doctors report that most people with ME/CFS feel worse at first, improve and then plateau and remain at limited functionality. A significant subset of patients, however, regress or remain severely ill. Full recovery can occur but is rare. Studies have shown that, on average, 5% of individuals suffering from CFS make a full recovery and almost 40% improve over time. Around 8% to 30% of sufferers find their condition improves enough for them to be able to return to the workplace. However, 5% to 20% find their symptoms become worse over time.