Nikhil Prasad Fact checked by:Thailand Medical News Team Sep 03, 2026 14 minutes ago
Post-exertional malaise (PEM), a potentially disabling worsening of symptoms following physical or mental activity, was reported by about one in five New York City adults with a history of COVID-19, according to a large population-representative survey.
A large NYC survey found post-exertional malaise in about one-fifth of adults with prior COVID, with strong associations with
disability
Researchers found that 20.9% of adults with prior COVID screened positive for PEM, corresponding to approximately 841,000 New Yorkers. However, the study does not establish that COVID-19 caused their PEM because researchers did not include a COVID-negative comparison group.
What Researchers Investigated
The analysis included 9,620 adults surveyed during May and June 2024, representing approximately 4.2 million adult NYC residents with at least one previous COVID-19 infection. Researchers used the DePaul Symptom Questionnaire–Post Exertional Malaise to identify PEM and examine symptom duration.
PEM can involve extreme fatigue, cognitive problems, pain, muscle weakness and flu-like symptoms following exertion. Unlike ordinary tiredness, the resulting “crash” can follow relatively mild activity, emerge hours later and persist for extended periods.
This Thailand
Medical News report notes that 4.0% of adults with prior COVID experienced PEM lasting at least 14 hours, representing approximately 160,000 New Yorkers. That duration represents one major diagnostic criterion for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), but researchers emphasized that their screening results cannot diagnose ME/CFS.
PEM Particularly Common with Long COVID
Among participants with a history of long COVID, 42.3% had PEM, compared with 12.4% among those without long COVID. Prolonged PEM affected 10.2% of those with long COVID versus 1.5% without it.
PEM prevalence was also 25.0% among cisgender women and 15.2% among cisgender men. Rates reached 29.1% among Latino participants and 24.0% among Black participants, compared with 15.2% among White, non-Latino adults.
Strong Links with Disability, Depression and Anxiety
The functional differences were substantial. Disability scores were 3.4 times higher with mild/moderate-duration PEM and 4.7 times higher with prolonged PEM compared with people reporting no PEM. Higher disability scores appeared across all six measured domains.
After adjustment for multiple potential confounders, mild/moderate PEM was associated with 3.46 times the risk of probable depression and 2.93 times the risk of probable anxiety. Prolonged PEM was associated with 4.14 times the risk of probable depression and 3.67 times the risk of probable anxiety.
The researchers were from the New York City Department of Health and Mental Hygiene and Myalgic Encephalomyelitis Action Network.
Conclusions
The findings indicate that PEM is common
among New Yorkers with prior COVID and strongly associated with disability and adverse mental health outcomes. Greater clinical recognition, appropriate evaluation, supportive services and improved awareness could help address its substantial functional and public health burden.
The study findings were published as a medRxiv preprint and have not been peer reviewed.
https://www.medrxiv.org/content/10.64898/2026.08.31.26356614v1
Read Also:
https://www.thailandmedical.news/articles/long-covid
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