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COVID-19 linked to higher fatigue rates, says study

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COVID-19 linked to higher fatigue rates, says study

Scientists on the US Centers for Disease Control and Prevention (CDC) and Washington University have conducted a study to estimate the incidence rate and predictors of fatigue after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

The study is published within the journal Emerging Infectious Diseases.

Study: Estimates of Incidence and Predictors of Fatiguing Illness after SARS-CoV-2 Infection. Image Credit: p.in poor health.i / Shutterstock

Background

Coronavirus disease 2019 (COVID-19) brought on by SARS-CoV-2 is a multifactorial disease characterised by a spread of mild-to-severe respiratory, cardiovascular, digestive, and neuropsychological symptoms. The disease can be related to long-term consequences, commonly referred to as long-COVID.

A CDC-conducted survey in January 2023 has shown that as much as 15% of US adults experience long-COVID symptoms and that fatigue is probably the most commonly reported symptom by each hospitalized and non-hospitalized patients. One other recent study has identified fatigue as a standard symptom amongst 85% of patients with long-COVID.

Post-COVID fatigue demonstrates many similarities with an illness called myalgic encephalomyelitis/chronic fatigue syndrome, which is an unexplained syndrome characterised by functional limitations that impair the each day life activities of patients.

On this study, scientists have estimated incidence rates of fatigue and chronic fatigue in patients with and without COVID-19 and determined the aspects associated incident fatigue.

Study design

The study was conducted on 4,589 adult patients with confirmed COVID-19 diagnoses between February 2020 and February 2021. A complete of 9,022 patients with no COVID-19 diagnosis in the course of the same period were included as controls.

Electronic health records of the patients were collected from three US hospitals and greater than 300 primary care and specialty clinics and analyzed to estimate the incidence rates of post–COVID-19 fatigue and chronic fatigue and to quantify the extra incident fatigue brought on by COVID-19.

The mean follow-up periods were 11.4 months for COVID-19 patients and 11.5 months for controls. The follow-up time was calculated because the duration between the primary COVID-19 diagnosis and the detection of the primary incident event (fatigue) for patients with an event. For patients without an event, the follow-up time referred to the duration between the primary COVID-19 diagnosis and the last follow-up date.

Incidence of fatigue

The study estimated that about 9.5% of COVID-19 patients included within the study had incident fatigue in the course of the study follow-up period. This gave rise to an incidence rate of 10.2/100 person-years.

Regarding aspects related to incident fatigue, the study found that the incidence rate increases with advancing age and is higher amongst women than men. A relatively lower incidence rate was also observed amongst patients without comorbidities and amongst patients who weren’t hospitalized for acute COVID-19.    

Considering patients without COVID-19 (controls), the incidence rate was estimated to be 6.0/100 person-years. This indicated that the chance of incident fatigue is 68% higher amongst COVID-19 patients in comparison with that amongst controls.

Incidence of chronic fatigue

In keeping with the study estimations, the incidence rates of chronic fatigue amongst COVID-19 patients and non-COVID-19 patients were 1.82/100 person-years and 0.42/100 person-years, respectively.

Much like fatigue, the chance of developing chronic fatigue was significantly higher amongst COVID-19 patients in comparison with that amongst non-COVID-19 patients. The difference in chronic fatigue incidence rate between COVID-19 patients and controls continued to extend even after 12 months of disease diagnosis.

Cumulative incidence of fatigue (A) and chronic fatigue (B) among 4,589 COVID-19 cases and 9,022 non–COVID-19 controls in study of fatiguing illness after SARS-CoV-2 infection, Washington, USA, February 2020–February 2021. Shading around data lines indicates 95% CIs.

Cumulative incidence of fatigue (A) and chronic fatigue (B) amongst 4,589 COVID-19 cases and 9,022 non–COVID-19 controls in study of fatiguing illness after SARS-CoV-2 infection, Washington, USA, February 2020–February 2021. Shading around data lines indicates 95% CIs.

Aspects related to incident fatigue

The evaluation conducted after adjusting for age and comorbidities revealed that ladies are 39% more more likely to develop incident fatigue than men. After adjusting for sex and comorbidities, a non-significantly higher risk of incident fatigue was observed for older adults in comparison with that for young adults (18 – 29 years).

Patients with comorbidities showed a significantly higher risk of incident fatigue than those without comorbidities. Amongst 36 diseases that were diagnosed 18 months before COVID-19, 21 showed significant associations with incident fatigue after adjusting for age, sex, and variety of comorbidities. Specifically, patients with hypertension, gastritis, and duodenitis showed 27% and 93% higher risks of incident fatigue, respectively.

Regarding clinical outcomes, the study found that about 25.6% of COVID-19 patients with incident fatigue were hospitalized greater than once in the course of the post-acute period. In contrast, only 13.6% of patients without incident fatigue were hospitalized in the course of the post-acute period. Furthermore, patients with fatigue showed a significantly higher risk of death in comparison with those without fatigue.

Study significance

The study finds that COVID-19 is related to a significantly higher risk of developing fatigue and that patients with incident fatigue have far worse clinical outcomes than those without fatigue.

The high incidence rate of post-COVID-19 fatigue observed within the study highlights the necessity for public health actions to manage SARS-CoV-2 infection and to develop effective treatments for post-COVID-19 fatigue.

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