The Prevalence, Severity, and Impact of Post-COVID Persistent Fatigue, Post-Exertional Malaise, and Chronic Fatigue Syndrome 2022 Nehme et al

BACKGROUND

Fatigue is common after viral infections, including SARS-CoV-2.1 Our purpose was to report the prevalence and impact of persistent fatigue 6 months after SARS-CoV-2 infection, considering post-exertional malaise2 and criteria for chronic fatigue syndrome.3

METHODS
Since March 2020, individuals tested for SARS-CoV-2 at the Geneva University Hospitals outpatient testing center benefit from remote ambulatory follow-up (COVICARE).1 This study included all individuals tested between March 2020 and December 2020 and whose follow-up was at 6 months or more after their test date.

Follow-up included questions about the prevalence of symptoms (yes/no) and their severity using a Likert scale (mild, moderate, or severe). Fatigue was assessed using the Eastern Cooperative Oncology Group (ECOG) scale and the Chalder fatigue scale.4 The Chalder fatigue scale was scored using the 4-item Likert and the bimodal scoring schemes. A score of ≥ 4 on bimodal scoring indicated severe fatigue. The DePaul brief questionnaire5 was used to identify post-exertional malaise and criteria for chronic fatigue syndrome. The Sheehan Disability Scale was used to assess functional impairment. Reduced work capacity was defined as missing days off work or having a reduced productivity on the Sheehan disability scale. Comorbidities were considered present if pre-existing prior to SARS-CoV-2 infection. Statistical analysis included descriptive comparisons of percentages using chi-square tests and Student’s t test.

RESULTS
Overall, 5515 individuals participated in this study (response rate 70.7%), with 5406 participants at 6 months or more after their test date. A total of 1497 (27.7%) participants had a documented positive SARS-CoV-2 test and were ultimately included in the study. The median time for follow-up was 225 days (interquartile range 207–398). Respectively, fatigue was reported by 17.2%, post-exertional malaise by 8.2%, and the presence of criteria for chronic fatigue syndrome by 1.1% of SARS-CoV-2-positive individuals, compared to 8.9%, 3.5%, and 0.5% of SARS-CoV-2-negative individuals.

Open access, https://link.springer.com/article/10.1007/s11606-022-07882-x

 

"The DePaul brief questionnaire evaluated the frequency and severity of symptoms characterizing post-exertional malaise including heaviness or drowsiness after exercise, pain, fatigue, and exhaustion after minimal effort, as well as the time required for recovery. Using a Likert scale, a score of 2 or more on the frequency (5 questions) and severity (5 questions) of symptoms indicated post-exertional malaise. If recovery required more than 14 h after minimal physical or mental activity, the questionnaire was positive for chronic fatigue syndrome."

 

The DePaul PEM questionnaire has its flaws but it is interesting to see that, overall, twice as many test-positive participants met the IOM criteria (1.1% vs 0.5%) considering that the incidence of CFS up to two years after the swine flu pandemic was doubled in non-vaccinated vs vaccinated Norwegians.