Insights from ME/CFS May Help Unravel the Pathogenesis of Post-Acute COVID-19 Syndrome

New paper by:

Anthony L. Komaroff 1 and W. Ian Lipkin 2

1 Division of General Medicine, Department of Medicine, Brigham and Women’s
Hospital, Harvard Medical School, Boston, MA
2 Center for Infection and Immunity, Mailman School of Public Health, Columbia
University, New York, NY

Available here from 7 June 2021

Journal Pre-proof

Citation: A.L. Komaroff and W.I. Lipkin, Insights from Myalgic
Encephalomyelitis/Chronic Fatigue Syndrome May Help Unravel the Pathogenesis of
Post-Acute COVID-19 Syndrome, Trends in Molecular Medicine (2021),

Keywords: myalgic encephalomyelitis/chronic fatigue syndrome, SARS-CoV-2, COVID19, post-acute sequelae of SARS-CoV-2, post-COVID-19 syndrome, long COVID


SARS-CoV-2 can cause chronic and acute disease. Post-Acute Sequelae of SARSCoV-2 infection (PASC) include injury to the lungs, heart, kidneys and brain, that may produce a variety of symptoms. PASC also includes a post-COVID-19 syndrome (“long COVID”) with features that can follow other acute infectious diseases as well as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Here we summarize what is known about the pathogenesis of ME/CFS and of acute COVID-19, and speculate that
the pathogenesis of post-COVID-19 syndrome in some people may be similar to that of
ME/CFS. We propose molecular mechanisms that might explain the fatigue and related
symptoms in both illnesses, and suggest a research agenda for both ME/CFS and postCOVID-19 syndrome.


In some people, the aftermath of acute COVID-19 is a lingering illness with fatigue and cognitive defects, known as post-COVID-19 syndrome or “long COVID”.

Post-COVID-19 syndrome is similar to post-infectious fatigue syndromes triggered by other infectious agents, and to myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), a condition that patients often report is preceded by an infectious-like illness.

ME/CFS is associated with underlying abnormalities of the central and autonomic nervous system, immune dysregulation, disordered energy metabolism and redox imbalance. It is currently unclear if the same abnormalities will be identified in post-COVID-19 syndrome.

The US and other developed nations have committed considerable support for research on post-COVID illnesses.

A.L. Komaroff and W.I. Lipkin, (2021)

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