Prevalence and Determinants of Fatigue after COVID-19 in Non-Hospitalized Subjects: A Population-Based Study

Abstract

This study assessed the prevalence and determinants of fatigue in a population-based cohort of non-hospitalized subjects 1.5–6 months after COVID-19. It was a mixed postal/web survey of all non-hospitalized patients ≥18 years with a positive PCR for SARS-CoV-2 until 1 June 2020 in a geographically defined area. In total, 938 subjects received a questionnaire including the Chalder fatigue scale (CFQ-11) and the energy/fatigue scale of the RAND-36 questionnaire. We estimated z scores for comparison with general population norms. Determinants were analyzed using multivariable logistic and linear regression analysis. In total, 458 subjects (49%) responded to the survey at median 117.5 days after COVID-19 onset, and 46% reported fatigue. The mean z scores of the CFQ-11 total was 0.70 (95% CI 0.58 to 0.82), CFQ-11 physical 0.66 (0.55 to 0.78), CFQ-11 mental 0.47 (0.35 to 0.59) and RAND-36 energy/fatigue −0.20 (−0.31 to −0.1); all CFQ-11 scores differed from those of the norm population (p < 0.001). Female sex, single/divorced/widowed, short time since symptom debut, high symptom load, and confusion during acute COVID-19 were associated with higher multivariable odds of fatigue. In conclusion, the burden of post-viral fatigue following COVID-19 was high, and higher than in a general norm population. Symptoms of fatigue were most prevalent among women, those having a high symptom load, or confusion during the acute phase.

Characteristics and predictors of acute and chronic post-COVID syndrome: A systematic review and meta-analysis

“…Furthermore, a multivariable analysis adjusting for gender, ethnicity, age, BMI, and hospitalisation status reported that only the presence of fatigue accounted for long-term activity impairment (OR 6¢0, 95% CI 1¢0À34¢9) [29]. Similarly, those with a higher symptom load during the initial infection had greater odds of persistent fatigue [30].…”

Epidemiology and organ specific sequelae of post-acute COVID19: A narrative review

“…Similarly, it is unknown if SARS-COV-2 infection exacerbates preexisting neuropathies (e.g., diabetic neuropathy) Long-lasting and disabling fatigue is another frequently reported symptom under the umbrella of long COVID (Table 2, Appendix Table 2) [162,163]. Based on recent cohort studies, the frequency of fatigue and/or muscular weakness at 6 months post-symptom onset can reach 60% [162,164,165]. Intensity can fluctuate, it is typically exacerbated by physical or mental effort, it seems to affect mostly young women although exact frequency is hard to ascertain due to reporting bias.…”

Short-term Effects of a Three-week Inpatient Post-COVID-19 Pulmonary Rehabilitation Program - a Prospective Observational Study

“…The three-week inpatient PR program was performed in accordance with the recommendations of the German Respiratory Society (Deutsche Gesellschaft für Pneumologie) for PR in patients with COVID-19 [13]. The program was tailored to each patient's individual needs and included the following rehabilitative therapy components (O = obligatory for all participants, except those with individual contraindications, F = facultative if needed):…”

“…Particularly after severe or critical courses, i.e., after hospitalization, clinical manifestations often (up to 76% [6-9]) do not regress after the acute phase of the disease, so many patients still suffer both physically and psychologically from persistent impairments after an acute infection [6-8, 10]. In addition, although it is less common, even after initially milder courses that could be treated on an outpatient basis, symptoms can persist over time [11][12][13][14]. The term postacute COVID-19 syndrome (PACS) has been proposed to describe the presence of persistent signs and symptoms beyond 4 weeks after the onset of symptoms in patients with current negative polymerase chain reaction (PCR) test results [10].…”