Trial Report Pattern of Post COVID Fatigue in Elderly Patients, 2023, Gaber (ME/CFS is also discussed)

[The author is or was "Clinical Lead for CFS/ME Service Wigan, Bolton & Bury (UK)"]

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https://journals.sagepub.com/doi/epub/10.1177/27536351231194561

Long COVID: Mechanisms, Treatments and Outcomes - Opinion

Pattern of Post COVID Fatigue in Elderly Patients

Tarek A Gaber

Abstract

The incidence of Long COVID (LC) increases with age but then drops sharply in over 70-year-olds.

The prevailing explanation is that different biases in data collection such as reluctance to report symptoms or attributing them to comorbidities may explain this pattern in this age group.

Our local data suggested a similar pattern confirming the rarity of LC symptoms especially fatigue in the over 70s.

Our data have also showed a different phenotype of post COVID fatigue which is not commonly associated with post exertional symptoms bringing into question the suggestion that bias in collecting data is the main cause.

We explore several immunological, metabolic and epigenetic factors associated with aging that may explain such phenomenon.

Keywords
Long COVID, elderly, post exertional malaise, post COVID syndrome

 

"Our data not only confirms the rarity of post COVID fatigue in subjects over 70 but also suggest that when fatigue occurs in that age group, it is not strongly associated with PEM or other post exertional symptoms."

"The metabolic effects of aging are equally complex but hypometabolism is a constant feature.14 We can hypothesise that such limited metabolic response to exercise and/or stress may protect the patient from the typical hypermetabolic phenomena and its subsequent symptoms of PEM."

The nature of immune response in ME/CFS is unknown with the limited studies available reporting inconsistent findings.15-17 This inconsistency may explain the wide variety of immunological symptoms ME/CFS patients experience ranging from impaired immunity leading to recurrent infections to an exaggerated immune response resulting in the classic symptoms of malaise, recurrent sore throats, lymphadenopathy and occasionally full blown autoimmune phenomena such as allergies."

From concluding paragraph:
If our findings could be replicated in a larger population, we feel that exploring the physiological changes associated with aging may not only explain such unique post COVID fatigue phenotype in the elderly (fatigue without PEM) but may also shed some light on the illusive ME/CFS and Long COVID pathogenesis.

 

If they exclude 'the one who had fibro and PEM symptoms before covid' then they are talking about 6 with PEM out of only 16 over 70yr olds referred to the service

That is still around 30%, and then there is the question of the level of severity because there is a chance that age group has more support for other conditions/their living situation which make it more possible to avoid the obvious and repetitive PEM-triggering events that would e.g. be associated with work, or energetic trips out (e.g. with kids or for birthdays) that allow people to identify PEM. Particularly when it is cumulative. How do you know it isn't something you caught until you realise it is the end of every week, or two days after you watch your kids soccer match each week that you are flat on your back with 'flu'.

And I have a horrible feeling that those who are more severe might end up in difference places e.g. residential care. Particularly if their symptoms are cognitive or interfere with e.g. eating, bathing etc.

So the how it is measured/tested but also the acknowledged possibility of missing part of the data due to referrals is still there.

On the other hand I don't understand and never have why this level of data was never collected nationally across ME/CFS

The only person that I think I know who ended up with LC is late 70s living alone with no support and was more active than most of that age spending their spare time walking and still doing bits of business and DIY. No idea to know if they have PEM. But if they are going to a clinic are all of the clinics asking whether they are gutted they can no longer go rambling without significant illness afterwards, or chop down trees, or is there presumption based on age - which I think is a reasonable question because I can imagine the 'coaching-communication' where someone is shaking their hand and the other person is forced to chuckle back about how maybe they've just reached the age where they need to get someone else in to chop the trees?