Fatigue in children and young people up to 24 months after infection with SARS-CoV-2, 2025, Richards-Belle, Stephenson, Chalder+

SNT Gatchaman

SNT Gatchaman

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Fatigue in children and young people up to 24 months after infection with SARS-CoV-2
Richards-Belle, Alvin; Shafran, Roz; Rojas, Natalia K; Stephenson, Terence; Carr, Ewan; Chalder, Trudie; Dalrymple, Emma; McOwat, Kelsey; Simmons, Ruth; Pinto Pereira, Snehal M

Persistent fatigue is common following acute SARS-CoV-2 infection. Little is known about post-infection fatigue trajectories in children and young people (CYP). This paper reports on a longitudinal analysis of the Children and Young People with Long COVID study. SARS-CoV-2-positive participants, aged 11-to-17-years at enrolment, responding to follow-ups at 3-, 6-, 12-, and 24-months post-infection were included.

Fatigue was assessed via the Chalder Fatigue Scale (CFQ; score range: 0-11, with ≥4 indicating clinical case-ness) and by a single-item (no, mild, severe fatigue). Fatigue was described cross-sectionally and examined longitudinally using linear mixed-effects models.

Among 943 SARS-CoV-2-positive participants, 581 (61.6%) met CFQ case-ness at least once during follow-up. A higher proportion of ever-cases (vs. never-cases) were female (77.1% vs. 54.4%), older (mean age 15.0 vs. 13.9 years), and met Post-COVID Condition criteria 3-months post-infection (35.6% vs. 7.2%). The proportion of CFQ cases increased from 35.0% at 3-months to 40.2% at 24-months post-infection; 15.9% meet case-ness at all follow-ups. Single-item mild/severe responses showed sensitivity (≥0.728) and specificity (≥0.755) for CFQ case ascertainment. On average, CFQ scores increased by 0.448 points (95% CI, 0.252 to 0.645) over 24-months, but there were subgroup differences (e.g., fatigue increased faster in females than males and improved slightly in those meeting Post-COVID Condition criteria 3-months post-infection while worsening in those not meeting criteria).

Persistent fatigue was prominent in CYP up to 24 months after infection. Subgroup differences in scores and trajectories highlight the need for targeted interventions. Single-item assessment is a practical tool for screening significant severe fatigue.

Web | DOI | PDF | Nature Scientific Reports | Open Access
 
Fig. 1
figure 1
Prevalence of CFQ items over time up to 24 months post-infection among CFQ ever-cases. CFQ, Chalder Fatigue Scale. N=581.

Fig. 2
figure 2
Mean CFQ Trajectory over time: overall and for the mental and physical subscales (95% CI indicated via shading around trajectory).Scored using the Chalder Fatigue Scale (CFQ) bimodal scoring system. N=943.

Fig. 3
figure 3
Mean trajectories of CFQ total score, by sex, age at time of infection, EHCP and/or learning difficulties at school, and PCC at 3 m (95% CI indicated via shading around trajectory). CFQ, Chalder Fatigue Scale; PCC, Post-Covid Condition; EHCP, Education Health and Care Plan. N=943.
 
ME/CFS gets a mention:
Although distinct, the overlap between paediatric chronic fatigue syndrome and PCC in terms of fatigue and other symptoms is striking, with some authors tentatively suggesting that SARS-CoV-2 infection could trigger post-infectious fatigue syndrome: not dissimilar to outcomes following other serious viruses (including earlier coronaviruses and meningitis)29.

We reported mean CFQ scores ranging from 4.25 to 5.00 among CFQ cases across follow-ups – comparable to 4.38 reported from a cross-sectional sample of 36 CYP attending a specialist chronic fatigue syndrome clinic in South East England30.

Detailed studies characterising the phenotypic features of these two diagnoses will aid understanding of their similarities and differences.
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I struggle to see the relevance of this paper. There is no comparison group, no baseline, and lots of sources of bias.
 
Abstract said:
Little is known about post-infection fatigue trajectories in children and young people
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And we know who to blame for that, Ms Chalder.

Fatigue was assessed via the Chalder Fatigue Scale (CFQ; score range: 0-11, with ≥4 indicating clinical case-ness) and by a single-item (no, mild, severe fatigue).
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Useless.
What a waste of effort, time, money...
 
Trish said:
And we know who to blame for that, Ms Chalder.
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Yeah that is actually a small bit of accidental honesty. There have been easily hundreds of studies, trials and so on. Enough that lots of people consider it more than sufficient to go around making assertions about how to handle it. Including literally Chalder. What as the point of those studies, then, if we know next to nothing? Considering that all the past ones are pretty much copy-paste of one another, as are the current ones, and no doubt the future ones.

And yet, we don't know much. And people like Chalder know even less. Who is not a pediatrician, so whatever. But Crawley was (is?) and so is Shamez Ladhani, who advised the UK government that it's no problem, and was shortly after given funds to study pediatric LC, about which we still know almost nothing because, well, people like Chalder, Crawley and Ladhani keep wasting millions of life years to satisfy their egos.
 


November 25, 2025

Long Covid Advocacy​

@longcovidadvoc.com

#CLoCK Update
New paper released on #longcovid paediatric fatigue that demonstrates UK research culture has not made the vital steps needed to meet need or understand the disease.
Let's critically assess the issues:
/1

They found that 61.6% met the CFQ (Chalder Fatigue Scale ) case-ness .35% at 3 months 40% at 24 months Higher risk = female, older c.15yrs, reported learning difficulty
This demonstrates that #longcovid research predominantly risks misrepresentation for young women.
Why?
/2

The key issue is the persistent use of the term fatigue.
THERE IS NOT ONE MENTION OF PEM.
Fatigue as an umbrella term is misleading.
It is a heterogeneous term that enables other issues to be conflated into Long Covid.
/3

Yet, this is an advantage to the researchers as we know they have a biopsychosocial agenda to bring psychological factors into #longcovid.
We can see this as they 'question' if prepandemic health, school, EHCP status & demographics are factors.
/4

Papers that use only the word “fatigue” without distinguishing PEM or its fluctuating profile cannot identify the specific, disabling phenomenon that defines ME and many Long Covid patients.
Clinical ME guideline bodies emphasise PEM as a defining symptom.
/5

CLoCk have used the Chalder Fatigue Questionnaire & single-item tiredness measures, which are limited for detecting PEM.
The CFQ was designed to capture physical/cognitive fatigue but has recognised limitations in content validity for ME/CFS and poor correlation with PEM.
/6

CFQ conflates severity with causal interpretation and can mask important symptom-patterns.
The CFQ gives a summed fatigue score but does not record the hallmark PEM features (triggering by minimal exertion, delayed onset, prolonged recovery, symptom cluster)
/7

Omitting explicit assessment of PEM has direct dangerous clinical consequences for children and teens. If PEM is not recognised, guidance and services derived from the data may recommend activity-based rehabilitation (or pressure to “increase activity”), which risks harm.
/8

Including Trudie Chalder as author and using instruments she developed raises methodological and interpretative red flags because of known debates around CBT/GET-era measures, especially that they are all subjective.
/9

The CFQ was centrally used in trials that produced therapeutic recommendations now contested by patient groups and clinicians.
There is a substantial and well-documented debate about the CFQ’s sensitivity and the interpretation of changes on it in the context of trials ie PACE
/10

The epidemiological consequence is that large datasets risk conflating psychosocial correlates with causal pathology.When instruments are tuned to broad fatigue and mental-health correlates statistical models will show strong associations with adolescent psychosocial variables.
/11

This can be misinterpreted (or wilfully misused). Yet it gets worse. The paper states this is evidence needed to form interventions, service delivery & future pandemic preparation.
/12

This future proofing of #CLoCKS methods, failure to redress crucial methodologies, inability to listen to patients/orgs means children in this country are in trouble. We see the SAME mistakes made in ME, now it is Long Covid where they aim to perpetuate their flawed narrative
/13

At this point, 5 years into the pandemic this is culpably perverse & even malpractice? The cost paid is by children and families, as we are no closer to understanding the biology or to effective treatments
/14

The authors state this themselves - "little is known about fatigue" This could have been different if the million+ research funding scoured by #CLoCK had gone into pathophysiology. The same applies to the millions wasted in pre-pandemic MECFS research.
/15

The paper:www.nature.com
https://www.nature.com/articles/s41598-025-24868-x
Our previous investigation & formal complaint:t.co
https://t.co/uqKqrOpIqR
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Utsikt said:
I struggle to see the relevance of this paper.
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rvallee said:
Not just the relevance, but its validity. CFQ is an entirely useless assessment for anything. This is a total waste of resources. As usual.
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Actually, I think the abstract says that it's just as accurate to ask people if they have no, mild or severe fatigue as to fluff around with Chalder's very own fatigue scale. So, that is something.

abstract said:
Fatigue was assessed via the Chalder Fatigue Scale (CFQ; score range: 0-11, with ≥4 indicating clinical case-ness) and by a single-item (no, mild, severe fatigue).
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abstract said:
Single-item assessment is a practical tool for screening significant severe fatigue.
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It might be worth having a look at the paper to confirm if that is so, as it could be useful.
 
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