COVID-19: Fatigue common after recovery regardless of disease severity

More than half of the patients who recovered from COVID-19 experienced persistent fatigue regardless of their disease severity, shows a study presented at ECCVID 2020.

“Fatigue is a common symptom in those presenting with symptomatic COVID-19 infection. In particular, concern has been raised that SARS-CoV-2 has the potential to cause persistent fatigue, even after those infected have recovered from COVID-19,” said presenting author Dr Liam Townsend from St James’s Hospital & Trinity College, Dublin, Ireland.

Townsend and team set out to understand whether patients remained fatigued after physical recovery from COVID-19. For this study, the researchers consecutively recruited 128 patients (mean age 49.5 years, 54 percent female) who were recovering from the acute phase of COVID-19, at a median of 10 weeks after SARS-CoV-2 infection. [ECCVID 2020, abstract 00024]

The prevalence of fatigue was assessed using the Chalder Fatigue Score (CFQ-11). The correlation between fatigue and patient-dependent variables such as disease severity, immune markers, and pre-existing conditions were also examined to look for potential predictors.

Over half of the patients (52.3 percent) reported having persistent fatigue, based on CFQ-11.

“Our findings demonstrate a significant burden of post-viral fatigue in individuals with previous SARS-CoV-2 infection after the acute phase of COVID-19 illness,” Townsend pointed out.

When the analysis was stratified according to disease severity (categorized based on need for hospital admission, supplemental oxygen, or critical/intensive care), the researchers did not find any significant association between post-COVID-19 fatigue and severity of illness.  

“Fatigue was found to occur independent of admission to hospital, affecting both groups equally,” reported Townsend.

In addition, none of the routine biomarkers for inflammation and cell turnover, such as C-reactive protein, neutrophil, lymphocyte or leukocyte counts, and neutrophil-to-lymphocyte ratio, were associated with fatigue following COVID-19.

The levels of both IL-6 and sCD25 pro-inflammatory molecules also did not correlate with fatigue following recovery from COVID-19.

On the other hand, women were more likely than men to report feeling fatigue after COVID-19 illness (p=0.002). Despite constituting just 54 percent of the study population, women were over-represented in those with persistent fatigue — of which two-thirds (67 percent) were women.  

Another predictor of persistent fatigue following recovery from COVID-19 was having a history of depression/anxiety (p=0.02). Of the 10 patients with a history of depression/anxiety, nine reported experiencing persistent fatigue. This finding, according to Townsend, “supports the use of non-pharmacological interventions for fatigue management.”

“The study highlights the importance of assessing those recovering from COVID-19 for symptoms of severe fatigue, irrespective of severity of initial illness, and may identify a group worthy of further study and early intervention,” he concluded.

“These interventions will need to be tailored to the individual needs of the patients, and may include lifestyle modification, cognitive behavioural therapy and self-pacing exercise, where tolerated.”