Persistent fatigue following SARS-CoV-2 infection is common and independent of severity of initial infection

• Published in: PloS one Vol. 15; no. 11; p. e0240784
• Main Authors: Townsend, Liam, Dyer, Adam H, Jones, Karen, Dunne, Jean, Mooney, Aoife, Gaffney, Fiona, O'Connor, Laura, Leavy, Deirdre, O'Brien, Kate, Dowds, Joanne, Sugrue, Jamie A, Hopkins, David, Martin-Loeches, Ignacio, Ni Cheallaigh, Cliona, Nadarajan, Parthiban, McLaughlin, Anne Marie, Bourke, Nollaig M, Bergin, Colm, O'Farrelly, Cliona, Bannan, Ciaran, Conlon, Niall
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 09-11-2020; Public Library of Science (PLoS)
• Subjects: Adult; Aged; Bacterial infections; Betacoronavirus - isolation & purification; Biochemistry; Biology and life sciences; C-reactive protein; Chronic fatigue syndrome; Clinical medicine; Complications and side effects; Coronavirus Infections - complications; Coronavirus Infections - pathology; Coronavirus Infections - virology; Coronaviruses; COVID-19; Cytokines; Epidemics; Fatigue; Fatigue - epidemiology; Fatigue - etiology; Female; Gerontology; Hospitals; Humans; Illnesses; Immune response; Immune system; Immunology; Infections; Infectious diseases; Inflammation; Interleukin 6; Interleukin-2 Receptor alpha Subunit - blood; Interleukin-6 - blood; L-Lactate dehydrogenase; Lactate dehydrogenase; Lactic acid; Leukocytes; Lymphocytes; Male; Markers; Medicine; Medicine and Health Sciences; Middle Aged; Outpatient care facilities; Oxygen; Pandemics; Pneumonia, Viral - complications; Pneumonia, Viral - pathology; Pneumonia, Viral - virology; Prevalence; Risk factors; SARS-CoV-2; Severe acute respiratory syndrome; Severe acute respiratory syndrome coronavirus 2; Severity of Illness Index; Supervision; Townsend, Adam; Viral diseases; Ireland
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0240784

Fatigue is a common symptom in those presenting with symptomatic COVID-19 infection. However, it is unknown if COVID-19 results in persistent fatigue in those recovered from acute infection. We examined the prevalence of fatigue in individuals recovered from the acute phase of COVID-19 illness using the Chalder Fatigue Score (CFQ-11). We further examined potential predictors of fatigue following COVID-19 infection, evaluating indicators of COVID-19 severity, markers of peripheral immune activation and circulating pro-inflammatory cytokines. Of 128 participants (49.5 ± 15 years; 54% female), more than half reported persistent fatigue (67/128; 52.3%) at median of 10 weeks after initial COVID-19 symptoms. There was no association between COVID-19 severity (need for inpatient admission, supplemental oxygen or critical care) and fatigue following COVID-19. Additionally, there was no association between routine laboratory markers of inflammation and cell turnover (leukocyte, neutrophil or lymphocyte counts, neutrophil-to-lymphocyte ratio, lactate dehydrogenase, C-reactive protein) or pro-inflammatory molecules (IL-6 or sCD25) and fatigue post COVID-19. Female gender and those with a pre-existing diagnosis of depression/anxiety were over-represented in those with fatigue. Our findings demonstrate a significant burden of post-viral fatigue in individuals with previous SARS-CoV-2 infection after the acute phase of COVID-19 illness. This study highlights the importance of assessing those recovering from COVID-19 for symptoms of severe fatigue, irrespective of severity of initial illness, and may identify a group worthy of further study and early intervention.