Unmasking the Long-Term Effects of COVID-19 With a Focus on Chronic Fatigue Syndrome: A Community-Based Study From India 2025 Gupta et al

Abstract

Background
The COVID-19 pandemic has highlighted the enduring health burden of long COVID, scientifically termed the postacute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection or PASC. Long COVID manifests as diverse symptoms affecting multiple organ systems, significantly impacting individuals globally, and especially underrepresented rural populations.

Objective
This study aimed to evaluate the prevalence of chronic fatigue syndrome (CFS) among laboratory-confirmed COVID-19 patients in rural India, focusing on identifying its predictors and the implications for healthcare systems in resource-limited settings.

Methodology
Retrospective data analysis was conducted on the follow-up visits of post-COVID-19 patients in the field practice area of AIIMS Mangalagiri, Nuthakki, Andhra Pradesh, India. The study involved 500 COVID-19 survivors diagnosed via reverse transcription polymerase chain reaction (RT-PCR) between 2023 and 2024. Data was collected via a semi-structured questionnaire to retrieve socio-demographic and clinical parameters, while CFS severity was assessed using a validated scoring system. Multivariable logistic regression and path analysis were used to examine the associations between the predictors of CFS.

Results
The prevalence of CFS was seen in 107 patients (21.4%; 95% CI: 18.01-25.22). Risk factors included older age (adjusted odds ratio or aOR: 15.90 for ≥60 years), female gender (aOR: 1.90), and comorbidities (aOR: 3.92). Common symptoms observed were fatigue in 180 (36%), joint pain in 185 (37%), and muscle pain in 182 (36.4%) patients. There was no significant association between vaccination and CFS.

Conclusion
The study underscores the substantial burden of post-COVID fatigue in rural populations, with female patients, older adults, and those with comorbidities being at greater risk. Tailored healthcare interventions and proactive post-COVID monitoring are critical to address this challenge. Future research should explore the underlying mechanisms and assess the role of vaccination in mitigating the post-COVID sequelae.

Open access

 

"Study tools
A semi-structured questionnaire was used to collect data on socio-demographic characteristics, comorbidities, history of the COVID-19 illness, vaccination status, and newly-emerging symptoms. The severity of the post-COVID-19 symptoms and fatigue was evaluated using a validated CFS score [12]. Participants rated fatigue severity and eight additional criteria over the past six months using an anchored ordinal scale (0 = no symptom, 1 = trivial, 2 = mild, 3 = moderate, 4 = severe). Fatigue ratings of three or four were used to classify participants as “Fatigued,” while lower scores categorized them as “Not fatigued.”"

Ref 12 is to A Chronic Fatigue Syndrome (CFS) severity score based on case designation criteria 2013 Baraniuk et al

 

So no controls or baseline measurements?

I suspect that older people experience more fatigue in general, so it’s not surprising that fatigue was associated with age.

I believe this is based on Fukuda.