Muscle Changes - PEM Post-Exertional Malaise (PEM) - Disaster Management

Research on Long Covid and Its Impact on Muscle Tissue and the Increase of Post-Exertional Malaise (PEM)

Professor Dr. Rob Wüst (Vrije Universität Amsterdam, Netherlands) has investigated how Long Covid damages muscle tissue and contributes to post-exertional malaise (PEM). In 2022, Dr. Wüst received a Solve Ramsay Research Grant to study muscle dysregulation and PEM in patients with infection-associated chronic conditions. Recently, he published a review article (3) in the journal Trends in Endocrinology and Metabolism, explaining how changes in the muscle tissue of Long Covid patients are related to PEM. He has developed a comprehensive approach to researching the effects of Long Covid and ME/CFS on muscle tissue. (1)

Here are the key findings summarized (read in detail here)

Dysregulation of Muscle Tissue

Muscles of Long Covid patients show unusual mitochondria in size and position, as well as reduced cellular respiration.
Muscle atrophy and changes in muscle fiber composition, especially a decline in type 1 fibers that prevent fatigue.

Changes in Blood Vessels

Thickening, constriction or damage of blood vessels in the muscles, leading to inadequate oxygen and nutrient supply as well as insufficient removal of waste products.

Post-Exertional Malaise (PEM)

These changes worsen with PEM, further reducing the physical performance of patients.

Hypotheses on the Cause

Misguided immune reactions attacking important parts of muscle tissue or blood vessels.
Central fatigue, where the central nervous system improperly regulates muscle contractions.
Reduced physical activity of patients, although this does not explain all muscle changes.

Connection to ME/CFS

Many of the observed muscle changes and PEM also affect patients with ME/CFS.
PEM is typical for ME/CFS and is a diagnostic criterion.

Current and Planned Treatments

Currently, there are no FDA-approved medications to reduce PEM in Long Covid.
Various clinical studies are evaluating treatments such as immunoadsorption, dietary supplements, hyperbaric oxygen therapy, anti-inflammatory and antiviral medications.

Now you might be wondering, what does this have to do with our disaster management approaches?

In my eyes, unfortunately, quite a lot ...

Dr. Rob Wüst's research findings on Long Covid and post-exertional malaise (PEM) could have significant implications for disaster management. These findings provide valuable insights into the impacts of Long Covid and PEM on muscle tissue and demonstrate how profoundly these conditions can affect the lives of those impacted. This has implications for disaster management, as it highlights the need to integrate these chronic conditions into planning and strategies.

The importance of long-term, specialized care for those affected cannot be overstated. This could present a challenge in disaster areas, but also an opportunity to increasingly utilize innovative solutions such as telemedicine and AI. The training and preparation of emergency responders should be expanded to address the challenges posed by Long Covid, ME/CFS, MCS and PEM. Flexibility and additional resources are crucial here. These findings underscore the need to implement many preventive measures and to promote the physical health and resilience of the population, in order to reduce susceptibility to chronic illnesses.

Here are some possible scenarios I have thought about ...

Scenario 1: Disaster Relief and Emergency Responders

Impacts: Emergency responders who suffer from Long Covid and experience PEM may have their work capacity severely limited. This leads to a reduced availability of qualified personnel in critical situations. Responders suffering from PEM may be less resilient and more likely to fall ill, leading to shortages in disaster relief due to decreased personnel availability. It would be necessary to train responders on the symptoms and limitations of Long Covid and PEM. This includes recognizing signs and managing affected individuals. Development of specialized training programs for responders to detect and manage Long Covid and PEM early on. This encompasses both medical knowledge and self-management strategies.

Consequences: Disaster management teams would need to mobilize alternative resources and possibly deploy additional personnel to fill the gaps. Formation of supplementary teams composed of volunteers and reserves to bridge personnel shortages. These teams could consist of trained volunteers, retired responders or international aid organizations. Standby plans would need to be adjusted to ensure sufficient backup personnel are available. This could lead to higher costs and longer response times. Introduction of flexible working hours and shorter shifts to minimize the burden on affected responders. Job-sharing models could also be considered.

Scenario 2: Long-Term Healthcare

Impacts: The long-term healthcare of affected individuals could be complicated by PEM, particularly in disaster areas where medical resources are limited. It will be necessary to form specialized medical care teams that are focused on the treatment of Long Covid and PEM. Chronic conditions like PEM require long-term medical care. Optimizing resource management to ensure that sufficient medical supplies and medications are available. Establishing networks for psychosocial support to promote the mental health of affected individuals and help them manage chronic symptoms.

Consequences: Disaster management teams would need to ensure that sufficient medical care and support are available for affected individuals. This could require additional medical capacities and specialized treatments. Formation of teams specialized in the treatment of Long Covid and PEM. These teams could be mobilized in disaster areas to provide support. Implementation of telemedicine solutions to facilitate access to healthcare. Patients could be monitored and treated by specialists remotely. Development and implementation of rehabilitation programs specifically tailored to the needs of Long Covid and PEM patients. Establishing networks for psychosocial support to promote the mental health of affected individuals and help them manage chronic symptoms.

Scenario 3: Return to Normality

Impacts: Individuals experiencing PEM may struggle to return to their normal lifestyle, which could hinder recovery efforts in disaster areas. Providing additional support for affected individuals to help them return to their normal lives, e.g., through adjusted working conditions and support services. Adjusting infrastructure in disaster areas to ensure it is accessible for people with chronic conditions.

Consequences: Establishing programs for the long-term monitoring of the health progress of affected individuals to respond early to deteriorations. Disaster management teams would need to develop and implement programs to support the mental and physical health of affected individuals, helping them readjust to normal life. Providing financial support to affected individuals to address economic challenges arising from their limited ability to work.

Scenario 4: Prevention and Preparation

Impacts: Dr. Wüst's findings could help improve preventive measures and preparations for disasters by emphasizing the importance of physical health and exercise. Comprehensive preventive measures to reduce susceptibility to PEM are lacking. Disaster management teams are often not adequately prepared to treat and support patients with chronic conditions. Developing programs to promote the physical fitness and health of the population to reduce susceptibility to PEM and other health problems. Training for the population and emergency responders to prevent chronic illnesses and promote a healthy lifestyle.

Consequences: Establishing early intervention programs aimed at recognizing and treating early signs of Long Covid, ME/CFS and PEM. Disaster management teams could develop programs to promote the physical fitness and health of the population to reduce susceptibility to PEM and other health problems. Encouraging community engagement and mutual support to strengthen community resilience. This could be achieved through local initiatives and partnerships with non-governmental organizations.

Scenario 5: Research and Development

Impacts: The research findings could promote the development of new treatments and therapies to reduce PEM, improving the efficiency and effectiveness of disaster management. Currently, there are no FDA-approved medications to reduce PEM in Long Covid. Previous research findings are often not comprehensive enough to develop specific treatments. Encouraging collaboration between researchers, medical professionals and disaster management teams to develop innovative solutions. Research institutes could jointly initiate projects focused on the treatment of Long Covid and PEM. Supporting and funding clinical studies focused on the treatment of Long Covid, ME/CFS and PEM.

Consequences: Utilizing technological innovations to improve the diagnosis and treatment of Long Covid, ME/CFS and PEM. Disaster management teams could work in collaboration with researchers and medical professionals to develop and implement new treatment approaches to improve the health and well-being of affected individuals. Supporting and funding clinical studies focused on the treatment of Long Covid, ME/CFS and PEM. These studies could include various therapeutic approaches such as immunoadsorption, dietary supplements, hyperbaric oxygen therapy, anti-inflammatory and antiviral medications. Utilizing technological innovations to improve the diagnosis and treatment of Long Covid and PEM. This could include the use of AI and machine learning to analyze patient data and develop personalized treatment plans. Ensuring effective knowledge transfer between research institutions and practical emergency responders to implement the latest findings into practice. This could be achieved through regular continuing education and training.

These scenarios are intended to illustrate how Dr. Wüst's research findings could impact disaster management and what measures could be taken to mitigate the effects of Long Covid, ME/CFS and PEM. And we should not forget that there are plenty of similar cases where chronic illnesses can lead to post-exertional malaise (PEM), meaning the pool of affected individuals is significantly enlarged.

1. People with rare muscle diseases such as centronuclear myopathies (CNM).

2. PEM is a common symptom of CFS and leads to a significant worsening of symptoms after physical or mental exertion. (2)

3. Post-polio syndrome occurs in people who have survived polio and develop symptoms such as muscle weakness, pain, and fatigue years later. Similar to Long Covid and CFS, PPS can also cause PEM, severely limiting the ability of affected individuals to engage in physical activities. (2)

4. Chronic Lyme disease is a long-term infection caused by the bacterium Borrelia burgdorferi. PEM is also a common symptom and can significantly impair the quality of life of affected individuals.

5. Systemic lupus erythematosus is an autoimmune disease that can attack various organs and tissues in the body. Affected individuals can experience chronic fatigue and post-exertional malaise, which impairs their ability to participate in daily activities. (2)

(1) https://solvecfs.org/solve-funded-researcher-reviews-how-long-covid-changes-muscle-tissues-to-increase-post-exertional-malaise-pem/ (Abruf: 27.01.2025)

(2) https://link.springer.com/article/10.1007/s41906-023-2553-0 (Abruf: 27.01.2025)

(3) Skeletal muscle adaptations and post-exertional malaise in long COVID December 17, 2024, Open access (Braeden T. Charlton 1,2 ∙ Richie P. Goulding 1,2 ∙ Richard T. Jaspers 1,2 ∙ Brent Appelman 3,4 ∙ Michèle van Vugt 4,5 ∙ Rob C.I. Wüst 1,2)