Post-viral Fatigue: Implications for Long Covid

Main Article Content

A. P. Smith


There has been extensive research on post-viral fatigue, and the present mini-review and commentary provides an overview of the effects associated with different infecting agents. Fatigue is not only a subjective state, rather it has an impact on our ability to carry out everyday functions, and its effect can be demonstrated using performance tasks. It is not surprising, therefore, that persistent effects of COVID-19 are observed, and the key features of Long Covid are reviewed here, Suggestions for further research which will provide a better understanding of Long Covid and provide a basis for prevention and management are also discussed.

Common cold, influenza, epstein barr virus, chronic fatigue syndrome, Long Covid.

Article Details

How to Cite
Smith, A. P. (2021). Post-viral Fatigue: Implications for Long Covid. Asian Journal of Research in Infectious Diseases, 6(1), 17-23.
Review Article


Smith AP. Twenty-five years of research on the behavioural malaise associated with influenza and the common cold. Psychoneuroendocrinology. 2013;38:744-751. Available:

Smith AP, Tyrrell DAJ, Coyle K, Willman JS. Selective effects of minor illnesses on human performance. Brit J Psychol. 1987;78:183-188. DOI:10.1111/j.2044-8295.1987.tb02238.x

Smith AP, Tyrrell DAJ, Al-Nakib W, Coyle KB, Donovan CB, Higgins PG, Willman JS. Effects of experimentally-induced virus infections and illnesses on psychomotor performance. Neuropsychobiology. 1987; 18:144-148. DOI: 10.1159/000118408

Smith AP, Tyrrell DAJ, Al-Nakib W, Coyle KB, Donovan CB, Higgins PG, Willman JS. The effects of experimentally-induced respiratory virus infections on performance. Psychol Med. 1988;18:65-71. DOI: 10.1017/s0033291700001896

Smith AP, Tyrrell DAJ, Barrow GI, Coyle KB, Higgins PG, Trickett S, Willman JS. The effects of experimentally induced colds on aspects of memory. Percept Mot Skills. 1990;71:1207-1215. DOI: 10.2466/pms.1990.71.3f.1207

Smith AP, Tyrrell DAJ, Barrow GI, Higgins PG, Willman JS, Bull S, Coyle KB, Trickett S. Mood and experimentally-induced respiratory virus infections and illnesses. Psychol Health. 1992;6:205-212. DOI: 10.1080/08870449208403184

Smith A, Thomas M, Kent J, Nicholson K. Effects of the common cold on mood and performance. Psychoneuroendocrinology. 1998;23:733-739.

Smith A, Rich N, Sturgess W, Brice C, Collison C, Bailey J, Wilson S, Nutt D. Effects of the common cold on subjective alertness, simple and choice reaction time and eye movements. Journal of Psychophysiology. 1999;13:145-151

Smith AP, Thomas M, Whitney H. Effects of upper respiratory tract illnesses on mood and performance over the working day. Ergonomics. 2000;43:752-763.

Smith AP. Effects of the common cold on mood, psychomotor performance, the encoding of new information, speed of working memory and semantic processing. Brain, Behavior & Immunity. 2012;26:1072-1076. Available:

Smith AP, Tyrrell DAJ, Al-Nakib W, Barrow GI, Higgins PG, Leekam S, Trickett S, Effects and after-effects of the common cold and influenza on human performance. Neuropsychobiology. 1989;21:90-93. DOI: 10.1159/000118558

Hall SR, Smith AP. An investigation of the effects and after-effects of naturally-occurring upper respiratory tract illnesses on mood and performance. Physiology and Behavior. 1996;59:569-577.

Smith AP, Thomas M, Whitney, H. After-effects of the common cold on mood and performance. Ergonomics. 2000;43:1342-1349.

Tye J. The invisible factor: An inquiry into the relationship between influenza and accidents. London: British Safety Council; 1960.

Grant J. Post-influenzal judgement deflection among scientific personnel. Asian Journal of Medicine. 1972;8:535-539.

Smith AP. Chronic fatigue syndrome and performance. In: Handbook of Human Performance, Health and Performance. (eds) A. P. Smith & D.M. Jones. London: Academic Press. 1992;2:261-278.

Alluisi EA, Thurmond JB, Coates GD. Behavioral effects of infectious disease: respiratory Pasteurella tularensis in man. Perceptual and Motor Skills. 1971;32:647-688.

Alluisi EA, Beisel WR, Bartelloni PJ, Coates GD. Behavioral effects of tularensis and sandfly fever in man. Journal of Infectious Diseases. 1971;128:710-717.

Henle W, Henle G, Lennete ET. The Epstein Barr virus. Scientific American. 1979; 241: 49-59.

Isaacs R. Chronic infectious mononucleosis. Blood. 1948;3:858-861.

Masuci MG, Szigeti R, Ernberg I, et al. Cellular immune defects to Epstein Barr virus determined antigens in young males. Cancer Research. 1981;1:4284-4291.

Tobi M, Moag A, Ravid Z, et al. Prolonged atypical illness associated with serological evidence of persistent Epstein Barr virus infection. Lancet. 1982;I:61-64.

Hamblin TJ, Hussain J, Akbar AN, et al. Immunological reason for chronic ill-health after infectious mononucleosis. British Medical Journal. 1983;287: 85-88.

Dubois RE, Seeley JK, Bous I, et al. Chronic mononucleosis syndrome. South Medical Journal. 1984;77:1376-1382.

Jones JF, Ray G, Minnich LL, et al. Evidence for Active Epstein-Barr Virus Infection in Patients with Persistent, Unexplained Illnesses: Elevated Anti-Early Antigen Antibodies. Ann Intern Med. 1985;102:1-7.

Hall SR, Smith AP. Behavioural effects of infectious mononucleosis. Neuropsychobiology. 1996;33:202-209.

Smith AP, Behan PO, Bell W, Millar K, Bakheit M. Behavioural problems associated with the chronic fatigue syndrome. British Journal of Psychology. 1993;84:411-423.

Thomas MA, Smith AP. An investigation into the cognitive deficits associated with chronic fatigue syndrome. The Open Neurology Journal. 2009;3:13-23. DOI: 10.2174/1874205X009030010013

Holmes GP, Kaplan JE, Stewart JA, et al. A cluster of patients with chronic mononucleosis-like syndrome. Is Epstein-Barr virus the cause? JAMA. 1987;257: 2297-2302

Rasa S, Nora-Krukle Z, Henning N. et al. Chronic viral infections in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Journal of Translational Medicine. 2018;16:268. Available:

Selden SM, Cameron AS. Changing epidemiology of Ross River virus disease in South Australia. Med J Aust. 2016; 165:313–7.

Vollmer-Conna U, Fazou C, et al. Production of pro-inflammatory cytokines correlates with the symptoms of acute sickness behaviour in humans. Psychol Med. 2004;34:1289–97.

Filler K, Lyon D, Bennett J, et al. Association of mitochondrial dysfunction and fatigue: A review of the literature. BBA Clin. 2014;1:12–23.

Blomberg J, Gottfries CG, Elfaitouri A, et al. Infection elicited autoimmunity and myalgic encephalomyelitis/chronic fatigue syndrome: An explanatory model. Front Immunol. 2018;9:229.

Carfi A, Bernabel, R, Landi F. Persistent symptoms in patients after acute COVID-19. JAMA. 2020;603. DOI:10.1001/jama.2020.12603

NHS. After-care needs of inpatients recovering from COVID-19; 2020. Available:https://www.pcrs-uk,org/

Public Health England. COVID-19: long-term health effects; 2020. Available:

The Royal Society. Long Covid: what is it, and what is needed?; 2020. Available:

NIHR. Living with Covid19; 2020. Available:

Dennis, A. et al. Mulit-organ impairment in low-risk individuals with long COVID. MedRxiv; 2020. DOI: 10.1101/2020.10.14.2021255