Bast, Elizabeth, Jester, Dylan J, Palacio, Ana et al. · Military medicine · 2026 · DOI
Gulf War Illness (GWI) is a chronic condition affecting 30-40% of veterans deployed during the 1990-1991 Gulf War, causing fatigue, pain, memory problems, digestive issues, and other symptoms similar to ME/CFS and long COVID. This review examines whether GWI might be caused by a viral infection, similar to how long COVID develops after SARS-CoV-2 infection. The authors suggest that veterans may have been exposed to a coronavirus related to MERS during their deployment, and they call for more research to explore this possibility.
This study is important because it proposes a testable mechanistic framework for understanding GWI by drawing parallels with long COVID and ME/CFS, potentially identifying shared pathogenic pathways across these debilitating post-infectious conditions. If GWI is indeed post-viral, lessons learned from investigating its cause could accelerate understanding of ME/CFS etiology. Furthermore, the hypothesis offers a specific research direction—examining MERS-related coronavirus exposure—that could unify understanding of multiple post-viral syndromes affecting millions of people globally.
This review does not establish that GWI is definitively caused by a viral infection; it presents a hypothesis requiring direct investigation. The paper does not provide serological or virological data proving MERS or MERS-related coronavirus exposure in Gulf War veterans. The symptomatologic similarities between GWI, ME/CFS, and long COVID suggest possible shared mechanisms but do not prove identical etiology across these conditions.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
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