Severe, Persistent, Disruptive Fatigue Post-SARS-CoV-2 Disproportionately Affects Young Women

Abstract

Introduction

Post-acute SARS-CoV-2 (PASC) symptoms are often persistent, disruptive, and difficult to treat effectively. Fatigue is often among the most frequently reported symptoms and may indicate a more challenging road to recovery.

Purpose

To describe the natural history, symptomology, and risk profile of long-term post-acute SARS-CoV-2.

Patients and Methods

Participants treated for SARS-CoV-2 within a large, community health system in the US were enrolled prospectively in a longitudinal, observational PASC study examining participants at enrollment and 6 months. Medical history, symptom reporting, validated measures of cognition, and patient-reported outcomes (PROs), were performed for all participants and repeated during study follow-up visits.

Results

A total of 323 participants completed baseline evaluations. Sixty one participants indicated clinically significant fatigue (23.1% at baseline); a representative sample of 141 enrollees also completed a baseline Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) in-depth fatigue reporting questionnaire, 37 had severe fatigue. The severely fatigued (FACIT-F ≤29.7) were significantly younger, female, had more anxiety and depression, had a higher resting heart rate, reported more sick days, and were less physically active post-COVID. They were more likely to have a diagnosis of chronic kidney disease (13.5% vs 2.9%) but less likely to have a history of cancer (8.1% vs 23.1). Participants who were severely fatigued reported health, diet, weight, and sleep were worse than those not severely fatigued post-COVID (p = 0.02 to 0.0002). Fatigue was significantly correlated with impairment of all PROs administered after COVID-19 infection.

Conclusion

Fatigue is a common symptom post-COVID-19 infection and is associated with lower reported well-being and function. Those with severe fatigue tended to be younger and female and have a past medical history of anxiety, depression, kidney disease, and more sedentary lifestyles.

Keywords:

• symptom severity
• functional assessment of chronic illness therapy-fatigue
• FACIT-F
• SARS-CoV-2
• COVID-19
• recovery

Acknowledgments

The research team would like to acknowledge the support of our organization Inova Health System, through the Betty & Guy Beatty Center for Integrated Research and the Department of Medicine, and for internal URAP support granted to the primary investigator for conduct of this study. The authors would also like to gratefully acknowledge our colleagues and their support for our research efforts: James Michael Estep, Pegah Golabi, Manisha Verma, Patrick Austin, Kathy Terra, Carey Escheik, Manirath Srishord, Mariam Afendy, Fatema Nader, Sean Felix, and Rebecca Cable.

Disclosure

In addition to the internal funding received for this study reported in acknowledgements, some authors have received funding for other research endeavors. Specifically, AAW cites institutional payments by the Health Resources and Services Administration (HRSA), and ZMY has consulted for Bristol Myers Squibb, Gilead, Intercept, Novo Nordisk, Novartis, Terns, Merck, Quest, and Siemens, and Madrigal. The authors declare that they have no other competing interests in this work.