Fatigue symptoms associated with COVID-19 in convalescent or recovered COVID-19 patients; a systematic review and meta-analysis

Abstract

BackgroundThe prevalence and prognosis of post-acute stage SARS-CoV-2 infection fatigue symptoms remain largely unknown.AimsWe performed a systematic review to evaluate the prevalence of fatigue in post-recovery from SARS-CoV-2 infection.MethodMedline, Embase, PsycINFO, CINAHL, Web of Science, Scopus, trial registries, Cochrane Central Register of Controlled Trials and Google Scholar were searched for studies on fatigue in samples that recovered from PCR diagnosed COVID-19. Meta-analyses were conducted separately for each recruitment setting.ResultsWe identified 39 studies with 8825 patients that recovered from COVID-19. Post-COVID-19 patients self-report of fatigue was higher compared to healthy controls (RR = 3.688, 95%CI [2.502, 5.436], p < 0.001). Over 50% of patients discharged from inpatient care reported symptoms of fatigue during the first (ER = 0.517, 95%CI [0.278, 0.749]) and second month following recovery (ER = 0.527, 95%CI [0.337, 0.709]). 10% of the community patients reported fatigue in the first month post-recovery. Patient setting moderated the association between COVID-19 recovery and fatigue symptoms (R2 = 0.12, p < 0.001). Female gender was associated with greater self-report of fatigue (OR =1.782, 95%CI [1.531, 2.870]). Patients recruited through social media had fatigue above 90% across multiple time points. Fatigue was highest in studies from Europe.ConclusionFatigue is a symptom associated with functional challenges which could have economic and social impacts. Developing long-term planning for fatigue management amongst patients beyond acute stages of SARS-CoV-2 infection is essential to optimizing patient care and public health outcomes.

Exploring the recovery curve for long-term post-COVID dyspnea and fatigue

“…Our prevalence rates of dyspnea and fatigue at the different follow-up periods are similar to those reported in current literature [ 3 , 4 ]; however, we recognized that collecting fatigue as an onset symptom at hospital admission during the first wave of the pandemic was difficult because several subjects confused it with generalized viral-induced myalgias (general tiredness painful sensation). In fact, dyspnea and fever are the most bothersome COVID-19 symptoms self-reported by the patients at hospital admission.…”

“…Further, according to a meta-analysis published in the Eur J Internal Medicine , fatigue and dyspnea are also the most prevalent post-COVID symptoms [2] . Another meta-analysis specifically evaluating post-COVID fatigue reported a prevalence rate of 42% the first six months after the infection [3] . The presence of post-COVID fatigue is associated with worse quality of life [4] .…”

“…Most studies investigating post-COVID fatigue and dyspnea are cross-sectional since they assessed the presence of these symptoms at one follow-up period [2] , [3] , [4] , [5] . Two longitudinally assessing symptoms during the first year after infection reported different results.…”

Serological Biomarkers at Hospital Admission Are Not Related to Long-Term Post-COVID Fatigue and Dyspnea in COVID-19 Survivors

“…Prevalence rates of post-COVID fatigue and dyspnea observed in our study agree with current meta-analyses on the topic [5, 6] suggesting that our sample is representative of long-COVID patients. Potential pathophysiologic mechanisms proposed for explaining post-COVID fatigue and dyspnea include a systemic immune response with prolonged inflammation and atypical response of the mast cells, persistent viral replication/toxicity, hypercoagulability, and the presence of residual lung injury [10-12].…”

“…Different meta-analyses had reported that the prevalence of post-COVID symptoms ranges from 35% to 60%, depending on the symptom and the follow-up [3, 4]. Fatigue and dyspnea seem to be the most prevalent post-COVID symptoms reaching up to 50% of COVID-19 survivors [5, 6]. The association between post-COVID symptoms and laboratory biomarkers is controversial.…”