Mojo Klinik / Conditions / Fatigue & recovery / Post-Viral Fatigue and Long COVID
Mojo Klinik
Mojo Klinik · Neutral Bay Sydney
Post-viral fatigue and Long COVID.
Recovery has stalled. The biology has shifted.
You had COVID, or another viral illness.
Months later, you have not recovered.
The biology of post-viral syndromes is real and investigable.
SOUND FAMILIAR?
You will recognise yourself in some of these.
Most patients arrive carrying one or more of these.
- You had COVID (or another viral illness) and have not fully recovered, even months later
- You crash after physical or mental exertion (post-exertional malaise)
- You have brain fog, fatigue, palpitations, breathlessness, or dizziness on standing
- You suspect dysautonomia or POTS
- You suspect a post-viral syndrome but standard care has not investigated it
- Your tests come back normal but you cannot return to your pre-illness life
- You want a structured biological investigation, not encouragement to give it more time
- You had EBV (glandular fever) years ago and never fully recovered
There is almost always a clinical explanation. Pulling on the thread is what we do.
WHAT POST – VIRAL FATIGUE AND LONG COVID ACTUALLY ARE
Three related but distinct conditions sit underthe post-viral umbrella.
Long COVID (PASC) is the post-viral syndrome specifically following SARS-CoV-2 infection, with identifiable patterns including microclot pathology, autonomic dysfunction (POTS), viral persistence, and immune dysregulation.
Post-viral fatigue syndrome is the broader category covering persistent symptoms after any viral illness. EBV (glandular fever) is the classic trigger.
ME/CFS is a formal diagnosis with specific criteria, including postexertional malaise as the cardinal feature. It can follow a viral trigger or develop without one.
A Long COVID functional medicine approach distinguishes between these three pictures and matches the investigation to the dominant pattern.
"In Long COVID I look specifically at autonomic function, cardiovascular markers, and vascular pathology that I would not prioritise in a patient who has not recovered from glandular fever. The shared foundation of pacing, mitochondrial support, and gut restoration applies to both. The specific investigation is tailored to the specific condition."
A RELATIONSHIP MAP
The three conditions under the post-viral umbrella.
Shared biology. Distinct diagnostic criteria.
LONG COVID
POST-COVID continuum
Persistent fatigue, cognitive symptoms, autonomic dysfunction. New literature each month.
POST-VIRAL FATIGUE
EBV, influenza, and others.
Multi-system illness following a viral trigger, often without a clear post-COVID label.
ME / CFS
Often preceded by an infection
Defined diagnostic criteria including post-exertional malaise. Recognised by WHO as neurological.
Where one diagnosis dominates, the treatment pathway is tailored to the specific clinical picture.
OUR THREE – PHASE APPROACH
Pacing comes before any active intervention.
Targeted investigation follows. Treatment matches what testing identifies.
Phase 1
Investigate
Weeks 1 to 4
Detailed history. Pattern identification. Targeted testing: microclot pathology, autonomic function (POTS screen), viral reactivation, mitochondrial markers, immune dysregulation.
Phase 2
Foundation
Months 1 to 3
Pacing, sleep, foundational nutrition. Pushing through is rarely the right approach. Pacing remains the most evidence-supported foundation for recovery in this patient population.
Phase 3
Rebuild
Months 3 to 18
Treatment matched to what testing identifies. Capacity rebuilt slowly, with monitoring at each
step. Most patients show meaningful improvement at 6 to 12 months with structured care.
THE THREE CONDITIONS UNDER THE POST – VIRAL UMBRELLA
The biology overlaps but differs.The investigation differs.The treatment differs.
We assess which (or which combination) applies to you. 51% of Long COVID patients meet diagnostic criteria for ME/CFS at 6 months. Journal of Infection, 2024.
Long COVID (PASC)
- Persistent symptoms 3+ months after acute COVID
- Specific patterns: microclot pathology, autonomic dysfunction (POTS), spike protein persistence, immune dysregulation
Post-Viral Fatigue Syndrome
- Persistent fatigue and related symptoms following any viral illness (EBV / glandular fever is the classic)
- Generally recovers over months but some progress to ME/CFS
ME/CFS
- A formal diagnosis
- Post-exertional malaise is the cardinal feature
- Diagnosed by IOM / CDC criteria
- May follow a viral trigger or other onset
Testing matched to your specific symptom pattern. The cost of any privately billed test is explained before you agree to it. Mitochondrial and metabolic: organic acids, oxidative stress markers, CoQ10, ATP production capacity. Autonomic: POTS screen, heart rate variability, dysautonomia assessment. Microclot pathology where indicated for Long COVID: fibrinogen, D-dimer, inflammatory markers. Viral and immune: EBV, CMV, HHV-6 reactivation panels; cytokine profile, T-cell markers where indicated. Gut and HPA: gut microbiome, intestinal permeability, immune-gut axis; 4-point urinary hormone testing, DHEA.
IS MOJO KLINIK RIGHT FOR YOU?
Is this approach right for you?
IT'S A FIT IF
- Your symptoms have persisted 3 or more months after a viral illness
- You have classic Long COVID features (POTS, brain fog, post-exertional malaise)
- You suspect EBV reactivation or other viral persistence
- You want microclot, autonomic, and viral panels rather than just standard tests
- You are willing to pace recovery rather than push through
NOT A FIT IF
- You want stimulants to push through symptoms
- You want us to replace your treating specialist for an established serious diagnosis
HOW TO START
Two ways to start with us.
Both options are 1-hour Mojo New Patient Appointments. Long COVID requires the full hour because the condition spans multiple systems.
OPTION 1
Mojo New Patient Appointment with Dr Emmanuel Varipatis
- 1 Hour
- $480 in-person
- $510 Zoom
Medicare rebate available for in-person initial consultations
Dr Varipatis has built a particular focus on Long COVID and post-viral
presentations, drawing on 40+ years of experience in complex chronic illness. Best for patients with classic Long COVID features (POTS, microclot picture, viral reactivation).
OPTION 2
Mojo New Patient Appointment with Dr Maria Mackey
- 1 Hour
- $490 in-person
- $510 Zoom
Medicare rebate available for in-person initial consultations
Best for post-viral fatigue with prominent hormonal, gut, or HPA
axis components.
For full pricing, see Consultation Fees. For IV nutrient therapy, see IV Therapy. Telehealth available Australia-wide for follow-ups. Medicare rebates apply for in-person initial consultations (except Heavy Metal Initial Appointment). For your first appointment, in-person at our Neutral Bay clinic is strongly recommended.
FAQ
Frequently Asked Questions.
How much does a Long COVID consultation cost at Mojo Klinik?
The Mojo New Patient Appointment is the right entry point: 1 hour, $480
with Dr Varipatis or $490 with Dr Mackey (in-person), $500 or $510 by Zoom,
with a Medicare rebate available for in-person initial consultations.
Comprehensive testing (microclot panel, autonomic assessment, viral
reactivation, mitochondrial markers) is billed separately by the testing lab.
"Long COVID requires the full hour. The condition spans multiple systems. There are no shortcuts on getting the history right, looking at any prior testing, and designing an investigation plan that fits the specific presentation. Patients who try to rush this stage usually have to redo it."
An estimated 5 to 10% of Australians who contracted COVID-19 went on to experience symptoms persisting beyond 12 weeks. Australian Government Department of Health, Long COVID position statement, 2024.
What is the difference between Long COVID and post-viral fatigue?
Long COVID is post-viral syndrome specifically following SARS-CoV-2. It has
been more thoroughly studied than other post-viral syndromes and has
identifiable patterns: microclot pathology, autonomic dysfunction (POTS),
viral persistence, immune dysregulation. Post-viral fatigue is the broader
category covering persistent symptoms after any viral illness.
"Long COVID and post-EBV fatigue share enough biology that much of the foundational treatment overlaps. But the specific viral pathology differs. The microclot picture in Long COVID is distinctive and I look for it specifically. That is one of several findings that change how I approach the case."
A 2024 Nature Medicine publication reviewed distinct biological signatures of Long COVID
including microclot persistence, spike protein presence, and immune dysregulation.
Will I recover from Long COVID?
Most patients improve. The trajectory varies. Some recover within months,
others progress more slowly. Recovery typically requires a structured pacing
approach, addressing the biological drivers identified in testing, and
patience. Pushing through is rarely the answer.
"Recovery in Long COVID is a real prospect for the majority of patients, but the timeline varies enormously. Some people recover within 6 to 12 months. Others take longer. The patients who do best are the ones who pace, do the underlying biological work, and stay the course."
A 2024 cohort study published in the British Medical Journal documented that approximately 70 to 75% of Long COVID patients show meaningful symptom improvement at 18 months with
structured care.
What is POTS?
POTS (Postural Orthostatic Tachycardia Syndrome) is a form of autonomic
dysfunction common in Long COVID. Symptoms include dizziness, palpitations, and fatigue on standing. Assessed via standing heart rate response and managed with fluid loading, sodium, compression, and graduated orthostatic training where appropriate.
"POTS in Long COVID is one of the more recognisable and one of the more treatable patterns. Once we identify it, we have a clear management framework. Patients respond well to the foundational interventions, and the diagnosis itself is often a relief because finally something makes sense."
A 2023 study in JAMA Network Open documented POTS or POTS-like presentations in approximately 25 to 30% of Long COVID patients assessed comprehensively.
What about IV therapy for Long COVID?
IV nutrient therapy is one tool among several, used selectively where oral
supplementation cannot achieve required levels. Always individually
prescribed after a clinical assessment. See IV Therapy for the full booking
pathway. IV is rarely the first thing we recommend; oral approaches and
foundational care come first.
"IV therapy in Long COVID is helpful in selected patients where oral approaches are not delivering the required clinical effect. It is not a starting point and not a fix on its own. It works best when used as part of a structured, sequenced plan."
A 2024 study in the Journal of Infection found 51% of Long COVID patients meet diagnostic
criteria for ME/CFS at 6 months, confirming significant overlap between the two presentations.
I had EBV (glandular fever) years ago and never fully recovered. Is that the same thing?
Post-EBV fatigue and Long COVID share biological mechanisms but the
specific viral biology and clinical pattern differ. We assess viral reactivation,
immune function, and the broader picture to identify what is driving your
specific case. EBV reactivation is increasingly recognised as a feature in
both conditions.
"Post-EBV fatigue was the chronic fatigue I saw most often before COVID. The shared mechanisms are striking. EBV reactivation appears in a substantial proportion of Long COVID patients too, which suggests these are related but distinct conditions on a continuum."
A 2022 study in Cell documented that approximately 33% of Long COVID patients had laboratory evidence of EBV reactivation, compared to a much lower rate in fully-recovered controls.
What testing will I need?
A typical Long COVID investigation includes mitochondrial markers,
microclot panel where indicated, autonomic function assessment (POTS
screen), viral reactivation panel, immune function, gut microbiome, HPA axis
testing, and nutritional status. The specific panel is decided at consultation
based on your symptom pattern and history.
AN INVITATION
Ready to be properly investigated?
One hour. Your full history. The right tests. A real plan. Book your
first appointment online, or call reception on 02 9133 8500.
WHERE
Suite 11, 40 Yeo Street
Neutral Bay NSW 2089
HOURS
Mon – Fri 8:30am – 5:00pm
Selected Saturdays by arrangement