Clinician handoff
Long COVID / ME/CFS
Designed for a 60-second scan in primary care. Use this to explain why this theory fits, what would weaken it, and which tests are most worth discussing.
Why this still fits
I've had persistent brain fog and fatigue since [viral illness] [DURATION] ago. The key feature is that I crash 12-72 hours AFTER exertion - this delayed worsening is called post-exertional malaise. I'd like to discuss ME/CFS criteria and appropriate investigation.
What would weaken it
- -How do you feel 24-72 hours AFTER exercise or exertion?
- -Is your fog worst in the morning and clearly improves through the day?
- -Do you have cold intolerance and weight changes without trying?
- -When symptoms flare, do they reliably occur 1-3 hours after meals and improve when meal composition changes?
Key points to communicate
- •Post-exertional malaise (PEM) distinguishes ME/CFS from other fatigue causes
- •NICE removed Graded Exercise Therapy from guidelines due to harm - I should NOT be told to gradually increase activity
- •A substantial subset of Long COVID patients meet ME/CFS criteria, so PEM-focused management matters even before the label is settled
- •I'd like screening for treatable comorbidities: POTS, sleep disorders, thyroid
- •Please separate metabolic, sleep, autonomic, and medication overlap before narrowing to one cause.
Tests and measurements to discuss
Need the fuller context? Use the test explainers for the measurement itself, or jump back to the tests section on the Long COVID / ME/CFS page to see how the tests fit the whole pattern.
NASA Lean Test / Tilt Table
What this helps clarify: At-home POTS screening — 10-minute standing test
Range context
HR rise <30 bpm
How to use the result
Save the result with date and symptoms from the same week.
EBV reactivation panel (VCA IgM, EA-D IgG)
What this helps clarify: This panel is not a routine answer for every Long COVID case, but it can help when the history suggests latent-virus reactivation may be adding to the fog pattern.
Range context
Serology context
How to use the result
Use it only when the clinical story supports it; a positive result still needs interpretation in context.
Full thyroid panel
What this helps clarify: This panel helps frame whether the story fits thyroid slowdown, conversion issues, or a closer competitor cause before you default to broad lifestyle explanations.
Range context
Panel context
How to use the result
Ask which thyroid number best fits the way your fog shows up day to day.
Sleep study
What this helps clarify: Overnight polysomnography explainer framed around the patient-facing 'sleep study' language most people actually search.
Range context
Sleep report
How to use the result
Ask whether the goal is to rule in sleep apnea, UARS, or another sleep-disruption pattern.
A1c + fasting glucose context review
What this helps clarify: This route is for the situation where HbA1c and fasting glucose do not fully explain a strong post-meal or fasting crash pattern.
Range context
Interpret with timing pattern
How to use the result
If the averages are normal but the crashes are repeatable, ask what test would better capture variability.
Baseline Cognitive Assessment
What this helps clarify: A baseline screen helps document that the problem is measurable, track change over time, and decide when formal neuropsychology is worth the extra effort.
Range context
Screening context
How to use the result
Bring examples of word-finding, memory slips, slowed processing, and work or school impact.
Peer-reviewed references