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
- -No post-viral onset and no delayed crash after physical, mental, or social exertion.
- -Pushing through doesn't worsen symptoms and there's no post-exertional malaise pattern.
- -Sleep apnea, anemia, thyroid disease, depression, or another overlap explains the reduced function more cleanly.
Key points to communicate
- •I want to know whether this truly fits Long COVID or ME/CFS versus another post-viral or sleep-related explanation.
- •Please separate delayed-crash PEM from simple deconditioning, depression, and ordinary tiredness.
- •If this pattern fits, I want to know what overlaps still need testing and what pacing guidance actually matters.
Bring this to the visit
- •A timeline from initial COVID infection to current symptoms with any fluctuations.
- •Prior COVID testing and vaccination dates.
- •A detailed description of post-exertional malaise (PEM) if present: cognitive and physical crashes.
- •All labs done since infection: CBC, CRP, ferritin, D-dimer, thyroid, ANA.
Useful screening structure
- -ME/CFS diagnostic criteria (Fukuda or Canadian Consensus) to assess if criteria are met.
- -DePaul Symptom Questionnaire for structured PEM documentation.
- -Orthostatic vitals (10-minute standing test) for co-occurring POTS.
Tests and measurements to discuss
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: Most doctors only order VCA IgG, which is positive in 90% of adults and tells you nothing about current viral activity.
Range context
Serology context
How to use the result
If EA is elevated: discuss immune support (sleep, stress reduction, pacing), potential antiviral therapy, and infectious disease referral.
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.
Questions to ask directly
- •Do I meet criteria for ME/CFS, or is this more likely a time-limited post-viral course?
- •Should we screen for co-occurring POTS, MCAS, or autoimmune activation?
- •What does the latest research say about treatment - are there trials I should know about?
- •How should I pace cognitive activity to avoid post-exertional cognitive crashes?
Functional impact snapshot
- -Track cognitive crash patterns: does mental exertion cause delayed fog 24-48 hours later?
- -Rate function against activity level - are you consistently pushing past your energy envelope?
- -Note whether any interventions (LDN, antihistamines, pacing) shift the baseline.
Escalate instead of self-managing if
- •New focal neurological deficits, seizures, or progressive weakness needing MRI.
- •Severe PEM causing complete functional collapse - may need aggressive pacing support.
- •Suicidal ideation from the severity and duration of symptoms.
Peer-reviewed references
- 1. Davis HE et al., Nat Rev Microbiol, 2023 - Long COVID: major findings, mechanisms and recommendations [DOI]
- 2. 10.1038/S41591-022-02171-0 [DOI]
- 3. HTTPS://WWW.CDC.GOV/ME-CFS/HCP/DIAGNOSIS/IOM-2015-DIAGNOSTIC-CRITERIA.HTML [DOI]
- 4. HTTPS://PUBMED.NCBI.NLM.NIH.GOV/36639608/ [DOI]
- 5. NICE NG206 2021; NICE NG188 2024; INSTITUTE OF MEDICINE DIAGNOSTIC CRITERIA 2015 [DOI]