Doctor explains: Long COVID vs. ME/CFS: Why the NHS is Moving Toward a Joint Care Framework
- Dr Dmitry Pshezhetskiy
- Aug 3
- 4 min read
Long COVID vs ME/CFS
Since the COVID-19 pandemic, doctors have seen many people who continue to experience disabling symptoms long after the initial infection has resolved. At the same time, awareness of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) has increased significantly. One of the biggest questions patients ask is:
"Do I have Long COVID or ME/CFS?"
The answer is not always straightforward. Increasingly, research and clinical practice suggest that these conditions overlap considerably. This is why many NHS specialist services are moving towards a joint approach to diagnosing and managing both illnesses.
As an ME/CFS specialist and online ME/CFS doctor, I regularly assess patients with both conditions through remote consultations, helping determine the most likely diagnosis and developing an individual management plan.
Why are Long COVID and ME/CFS so similar?
Long COVID refers to symptoms that continue for more than 12 weeks after COVID-19 infection and cannot be explained by another condition.
ME/CFS can develop after many different infections, including:
COVID-19
Glandular fever (EBV)
Influenza
Gastrointestinal infections
Other viral illnesses
Other triggers such as severe stress or overwork
Although the trigger may differ, many patients experience remarkably similar symptoms.
Common symptoms include:
Severe fatigue
Brain fog
Poor concentration
Memory problems
Sleep disturbance
Muscle and joint pain
Dizziness on standing
Sensitivity to light and noise
Palpitations
Exercise intolerance
Perhaps most importantly, both illnesses commonly involve Post-Exertional Malaise (PEM).
Post-Exertional Malaise (PEM): The Symptom That Links Long COVID and ME/CFS
Post-Exertional Malaise (PEM) is now recognised as one of the defining features of ME/CFS and is increasingly recognised in Long COVID.
Unlike ordinary tiredness, Post-Exertional Malaise (PEM) is a worsening of symptoms after physical, mental or emotional activity.
Typical features of Post-Exertional Malaise (PEM) include:
Extreme exhaustion
Increased pain
Worse brain fog
Poor concentration
Flu-like symptoms
Sleep disturbance
Dizziness
Longer recovery after everyday tasks
Recovery may take:
24 hours
Several days
A week
Occasionally even longer
Recognising Post-Exertional Malaise (PEM) is one of the most important parts of making an accurate diagnosis.
Post-Exertional Malaise (PEM): Why It Changes Treatment
Because Post-Exertional Malaise (PEM) is triggered by exertion, traditional advice to simply "exercise more" can actually make patients worse.
This is reflected in the current NICE guideline for ME/CFS, which advises against graded exercise therapy (GET) as a treatment aimed at curing the condition.
Instead, modern management focuses on:
Understanding personal activity limits
Pacing daily activities
Avoiding repeated crashes
Managing symptoms individually
Improving quality of life
These principles are also increasingly being used in specialist Long COVID clinics.
Why the NHS is moving toward a joint care framework
Many NHS services that were originally established specifically for Long COVID are now working closely with existing ME/CFS services.
There are several reasons for this.
Shared symptoms
Both illnesses commonly involve:
Fatigue
Cognitive dysfunction
Post-Exertional Malaise (PEM)
Autonomic symptoms
Sleep disturbance
Chronic pain
Similar investigations
There is currently no single blood test that diagnoses either condition (although there are ongoing developments).
Doctors instead perform investigations to rule out other illnesses before making a clinical diagnosis.
Current ME/CFS testing often includes routine blood tests alongside careful assessment of symptom patterns, particularly Post-Exertional Malaise (PEM).
Similar management
Although individual treatments vary, both conditions often benefit from:
Energy management
Symptom control
Sleep optimisation
Pain management
Treatment of associated conditions
Psychological support where appropriate
Education about pacing
This shared approach explains why integrated services are becoming increasingly common.
Post-Exertional Malaise (PEM): Why an Accurate Diagnosis Matters
Not everyone with ongoing fatigue after COVID has ME/CFS.
Some people may have:
Lung disease
Heart disease
Anaemia
Thyroid disorders
Sleep disorders
Medication side effects
Other medical conditions
Equally, not everyone with Long COVID develops Post-Exertional Malaise (PEM).
A careful specialist assessment helps identify which symptoms fit ME/CFS, which relate to Long COVID, and whether another diagnosis should be considered.
This distinction helps patients receive the most appropriate advice and avoid treatments that may worsen symptoms.
What does current ME/CFS research show?
Recent ME/CFS research suggests there may be important biological similarities between Long COVID and ME/CFS.
Researchers are studying:
Immune system abnormalities
Persistent inflammation
Autonomic nervous system dysfunction
Abnormal energy production within cells
Changes in blood flow
Biomarkers that may improve future diagnosis
Although there is currently no definitive laboratory test, advances in ME/CFS testing are helping researchers better understand the condition and may eventually lead to more objective diagnostic tools.
This is an exciting area of ongoing research, but more studies are needed before new tests become part of routine clinical practice.
What about fibromyalgia?
Many patients diagnosed with Long COVID or ME/CFS also experience widespread pain that meets the criteria for fibromyalgia.
As a fibromyalgia specialist online, I frequently assess patients who have features of both conditions.
Fibromyalgia commonly overlaps with:
ME/CFS
Long COVID
Hypermobility
Irritable bowel syndrome
Migraine
Recognising these overlapping conditions allows treatment to be tailored to the individual rather than focusing on a single diagnosis.
Can online assessment help?
Yes.
Many people living with fatigue find travelling to hospital appointments extremely difficult, especially if they experience Post-Exertional Malaise (PEM).
An online consultation allows patients to discuss their symptoms from home, reducing unnecessary travel and minimising the risk of triggering symptom flare-ups. For individuals with moderate or severe ME/CFS, this can make specialist assessment much more accessible while still allowing a detailed clinical history and management plan to be developed.
As an online ME/CFS doctor, I provide comprehensive assessments for patients across the UK with suspected:
ME/CFS
Long COVID
Fibromyalgia
Other post-viral fatigue syndromes
If appropriate, I can also advise on further ME/CFS testing, discuss evidence-based ME/CFS therapy options, and explain the latest developments in ME/CFS research.
You can learn more about me on the About Doctor page:https://www.ukmecfsspecialist.co.uk/
To arrange an assessment, visit the Consultation page:https://www.ukmecfsspecialist.co.uk/book-online
You may also find additional information in our articles covering ME/CFS, Long COVID and related conditions:https://www.ukmecfsspecialist.co.uk/blog
Final thoughts
Long COVID and ME/CFS are increasingly recognised as closely related conditions that share many symptoms, particularly Post-Exertional Malaise (PEM). This growing understanding is one reason why the NHS is moving towards a more integrated model of care.
While the trigger may differ, accurate diagnosis remains essential. Careful assessment helps distinguish ME/CFS, Long COVID and other possible causes of persistent fatigue, ensuring patients receive appropriate advice and personalised management.
If you would like specialist assessment, learn more about our online consultations.
Prof. Dmitry Pshezhetskiy, MBBS, PhD, MRCGP
GMC 7494518 — Registered Medical Practitioner (GP)
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