Abstract
Fatigue is a common symptom in those presenting with symptomatic COVID-19 infection. However, it is unknown if COVID-19 results in persistent fatigue in those recovered from acute infection. We examined the prevalence of fatigue in individuals recovered from the acute phase of COVID-19 illness using the Chalder Fatigue Score (CFQ-11). We further examined potential predictors of fatigue following COVID-19 infection, evaluating indicators of COVID-19 severity, markers of peripheral immune activation and circulating pro-inflammatory cytokines. Of 128 participants (49.5 ± 15 years; 54% female), more than half reported persistent fatigue (67/128; 52.3%) at median of 10 weeks after initial COVID-19 symptoms. There was no association between COVID-19 severity (need for inpatient admission, supplemental oxygen or critical care) and fatigue following COVID-19. Additionally, there was no association between routine laboratory markers of inflammation and cell turnover (leukocyte, neutrophil or lymphocyte counts, neutrophil-to-lymphocyte ratio, lactate dehydrogenase, C-reactive protein) or pro-inflammatory molecules (IL-6 or sCD25) and fatigue post COVID-19. Female gender and those with a pre-existing diagnosis of depression/anxiety were over-represented in those with fatigue. 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. This 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.
Highlights
Fatigue is recognised as one of the most common presenting complaints in individuals infected with severe acute respiratory syndrome (SARS)-CoV-2, the cause of the current COVID-19 pandemic
We present the first report, to our knowledge, of post-viral fatigue in those recovered from the acute phase of COVID-19 illness
In a similar fashion to previous coronavirus pandemics, COVID-19 appears to result in symptoms of severe fatigue that outlast the initial acute illness
Summary
Fatigue is recognised as one of the most common presenting complaints in individuals infected with SARS-CoV-2, the cause of the current COVID-19 pandemic. Patients acutely infected with SARS-CoV-2 demonstrate decreased lymphocyte counts, higher leukocyte counts with an elevated neutrophil-to-lymphocyte ratio (NLR) in addition to decreased percentages of monocytes, eosinophils and basophils. Whether or not the immunological alterations seen in SARS-CoV-2 have any relationship to the potential development of medium and long-term symptoms following infection is an area which has not been researched to date. The persistence of these changes following resolution of initial infection have not been examined
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