Preprint Prevalence of CFS and its related factors in covid- 19 patients discharged from at northwest of Iran hospitals in 2022, 2024, Arman Alizadeh et al

This is a pre-print, with some issues with the English. I thought you might enjoy this typo that is probably the result of an over-zealous spell checker app.

There's an issue here with confusing the symptom of chronic fatigue with chronic fatigue syndrome. Reference 13 with the global prevalence is actually to Jason LA, Sunnquist M, Brown A, Reed J. Defining essential features of myalgic encephalomyelitis and chronic fatigue syndrome.
Reference 14 is Nacul LC, Lacerda EM, Pheby D, Campion P, Molokhia M, Fayyaz S, et al. Prevalence of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) in three regions of England: a repeated cross-sectional study in primary care. I don't know if that reference says there is a deficit of motivation in people with ME/CFS - I'd be surprised if it does. In any case, I don't believe there is any good evidence to support it.

I think it's a shame to refer to this problematic article suggesting associations they found are prognostic factors.

Reference 11 is Salari N, Khodayari Y, Hosseinian-Far A, Zarei H, Rasoulpoor S, Akbari H, et al. Global prevalence of chronic fatigue syndrome among long COVID-19 patients: A systematic review and meta-analysis. Biopsychosoc Med. 2022;16(1):21. Of course in Biopsychosocial Medicine. It's an odd statement that seems to be heading towards 'these people need to be got moving'.

and more:

There's an ongoing sloppiness with the naming of the syndrome, and a strange over concern about the adverse consequences of allowing "CFS/ME" to continue, rather than being concerned about the awfulness of the illness itself. And there seems to be a misplaced certainty that the factors causing the syndrome can be both known and fixed.

 

Methods

80% response rate; 340 patients

"Chalder Chronic Fatigue Questionnaire"
14 question, 0 to 3 Likart, range 0 to 42

Yeah right - check out commentary elsewhere on the forum if you aren't sure why I am so dismissive of the Chalder Fatigue Questionnaire.

 

Results

Not quite sure how George Monbiot and his ilk have managed to spread the meme of Long Covid to these people...

Although that easy jibe aside, surely most of these people don't have ME/CFS, or CFS/ME? Average age 60 years, 84% from an "unfavourable" economic situation, 81% with an existing chronic disease, and 100% had been hospitalised with the chronic infection. The collection of symptoms 3 months following hospitalisation does not seem to ask for new symptoms. For example over 99% of the sample had chronic pain, but what percentage of them had chronic pain before hospitalisation for Covid-19? And how many of them had obvious tissue damage as a result of their Covid illness (over 14% had mechanical ventilation)?

They report that 13% of the respondents scored below the cutoff score on the Chalder Fatigue Questionnaire. (This survey did ask if people were more fatigued than before). I'm surprised it was not more.

This finding, which was reported in the abstract, is what motivated me to read this paper. It's ridiculous to make a big deal of that difference. A P of 0.04 is barely significant, and 13% and 12.3% are really not very different.
What's worse, it's not even clear if the percentage was higher in men or women. Look at Table 5!



Table 5 suggests that the incidence of chronic fatigue was marginally higher in males, not females. Argh.

The abstract says '72% of the patients were female'. I have no idea how they got that figure or what 'patients' means here (respondents to the survey? respondents who met the CFQ criteria for chronic fatigue?). I haven't looked hard, but none of the numbers obviously result in 72% female.

 

Ok, the discussion

They say that this is different to another study that found fatigue was the most reported symptom. But, as I noted, this is ridiculous, because there was no accounting for pre-Covid symptoms, and no effort made to separate out people who had obviously been damaged by their severe Covid-19 infection.

But earlier in the paper they said

That makes no sense at all. And that's just the start of the problems with those sentences. CFS/ME is not the same as people scoring less than 22 on the Chalder Fatigue Questionnaire. The authors seem to have no understanding that ME/CFS or CFS/ME is not a synonym for chronic fatigue.

Well yes, but... Take smoking. 6 smokers had chronic fatigue, 27% of the smokers. 37 non-smokers had chronic fatigue, 12% of the non-smokers. And the P was barely significant. The sample is too small to say reliably. And this tells us nothing about risk factors for ME/CFS.

How muddled is that? The prevalence of chronic fatigue that they found was about the same in males and females. And yet they start out with a sentence suggesting that they found a higher prevalence in women. And then in the second sentence they say that their study had a different result to studies that found being female was a risk factor for CFS/ME. And in teh third sentence they say unequivocally and with no discussion of why they found otherwise, that CFS/ME is more common in women than men. and that is all they say about sex differences in the Discussion. But, in the abstract, they say

 

Conclusion

Heaven help the people of Northwest Iran if this paper is an indication of the quality of thinking that will go into the creation of programs to support long-term Covid-19 patients. I'm sorry to be so blunt, but the paper is terrible. I appreciate the concern for patients that does come through in this paper, but the authors desperately need more information about ME/CFS before they attempt to treat people with chronic fatigue.

 

I sincerely do not understand how people, who come across as well-meaning, can produce such a problematic paper with so many errors in internal inconsistencies.