Long COVID and Post-infective Fatigue Syndrome: A Review

Carolina X Sandler; Vegard B B Wyller; Rona Moss-Morris; Dedra Buchwald; Esther Crawley; Jeannine Hautvast; Ben Z Katz; Hans Knoop; Paul Little; Renee Taylor; Knut-Arne Wensaas; Andrew R Lloyd

doi:10.1093/ofid/ofab440

Long COVID and Post-infective Fatigue Syndrome: A Review

Open Forum Infect Dis. 2021 Sep 9;8(10):ofab440. doi: 10.1093/ofid/ofab440. eCollection 2021 Oct.

Authors

Carolina X Sandler¹, Vegard B B Wyller^{2

3}, Rona Moss-Morris⁴, Dedra Buchwald⁵, Esther Crawley⁶, Jeannine Hautvast⁷, Ben Z Katz^{8

9}, Hans Knoop¹⁰, Paul Little¹¹, Renee Taylor¹², Knut-Arne Wensaas¹³, Andrew R Lloyd¹

Affiliations

¹ The Kirby Institute, UNSW Sydney, New South Wales, Australia.
² Department of Pediatrics and Adolescent Medicine, Akershus University Hospital, Lørenskog, Norway.
³ Institute of Clinical Medicine, University of Oslo, Blindern, Oslo, Norway.
⁴ Health Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
⁵ Institute for Research and Education to Advance Community Health, Washington State University, Seattle, Washington, USA.
⁶ Bristol Medical School, University of Bristol. Bristol. Centre for Academic Child Health, Bristol, United Kingdom.
⁷ Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, Nijmegen, Netherlands.
⁸ Northwestern University Feinberg School of Medicine, Chicago, Department of Pediatrics, Chicago, Illinois, USA.
⁹ Ann & Robert H Lurie Children's Hospital of Chicago, Division of Infectious Diseases, Chicago, Illinois, USA.
¹⁰ Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, Netherlands.
¹¹ Primary Care Research Centre, Primary Care Public Health and Medical Education Unit, Faculty of Medicine, University of Southampton, United Kingdom.
¹² College of Applied Health Sciences, University of Illinois at Chicago, Chicago, Illinois, USA.
¹³ Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway.

Abstract

Fatigue is a dominant feature of both acute and convalescent coronavirus disease 2019 (COVID-19) (sometimes termed "long-COVID"), with up to 46% of patients reporting fatigue that lasts from weeks to months. The investigators of the international Collaborative on Fatigue Following Infection (COFFI) conducted a systematic review of post-COVID fatigue and a narrative review on fatigue after other infections, and made recommendations for clinical and research approaches to assessing fatigue after COVID-19. In the majority of COVID-19 cohort studies, persistent fatigue was reported by a significant minority of patients, ranging from 13% to 33% at 16-20 weeks post-symptom onset. Data from the prospective cohort studies in COFFI and others indicate that fatigue is also a prevalent outcome from many acute systemic infections, notably infectious mononucleosis, with a case rate for clinically significant Post-infective fatigue after exclusion of recognized medical and psychiatric causes, ranging from 10%-35% at 6 months. To better characterize post-COVID fatigue, the COFFI investigators recommend the following: application of validated screening questionnaires for case detection; standardized interviews encompassing fatigue, mood, and other symptoms; and investigative approaches to identify end-organ damage and mental health conditions.

Keywords: COVID-19; assessment; cohorts; fatigue; post-viral.

Publication types

Review