Myalgic Encephalomyelitis/Chronic Fatigue Syndrome is common in post-acute sequelae of SARS-CoV-2 infection (PASC): Results from a post-COVID-19 multidisciplinary clinic

Hector Bonilla; Tom C Quach; Anushri Tiwari; Andres E Bonilla; Mitchell Miglis; Phillip C Yang; Lauren E Eggert; Husham Sharifi; Audra Horomanski; Aruna Subramanian; Liza Smirnoff; Norah Simpson; Houssan Halawi; Oliver Sum-Ping; Agnieszka Kalinowski; Zara M Patel; Robert William Shafer; Linda N Geng

doi:10.3389/fneur.2023.1090747

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome is common in post-acute sequelae of SARS-CoV-2 infection (PASC): Results from a post-COVID-19 multidisciplinary clinic

Front Neurol. 2023 Feb 24:14:1090747. doi: 10.3389/fneur.2023.1090747. eCollection 2023.

Authors

Hector Bonilla¹, Tom C Quach¹, Anushri Tiwari¹, Andres E Bonilla², Mitchell Miglis¹, Phillip C Yang¹, Lauren E Eggert¹, Husham Sharifi¹, Audra Horomanski¹, Aruna Subramanian¹, Liza Smirnoff¹, Norah Simpson¹, Houssan Halawi¹, Oliver Sum-Ping¹, Agnieszka Kalinowski¹, Zara M Patel¹, Robert William Shafer¹, Linda N Geng¹

Affiliations

¹ Department of Medicine, Stanford University, Stanford, CA, United States.
² Department of Molecular, Cell and Developmental Biology, University of Michigan, Ann Arbor, MI, United States.

Abstract

Background: The global prevalence of PASC is estimated to be present in 0·43 and based on the WHO estimation of 470 million worldwide COVID-19 infections, corresponds to around 200 million people experiencing long COVID symptoms. Despite this, its clinical features are not well-defined.

Methods: We collected retrospective data from 140 patients with PASC in a post-COVID-19 clinic on demographics, risk factors, illness severity (graded as one-mild to five-severe), functional status, and 29 symptoms and principal component symptoms cluster analysis. The Institute of Medicine (IOM) 2015 criteria were used to determine the Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) phenotype.

Findings: The median age was 47 years, 59.0% were female; 49.3% White, 17.2% Hispanic, 14.9% Asian, and 6.7% Black. Only 12.7% required hospitalization. Seventy-two (53.5%) patients had no known comorbid conditions. Forty-five (33.9%) were significantly debilitated. The median duration of symptoms was 285.5 days, and the number of symptoms was 12. The most common symptoms were fatigue (86.5%), post-exertional malaise (82.8%), brain fog (81.2%), unrefreshing sleep (76.7%), and lethargy (74.6%). Forty-three percent fit the criteria for ME/CFS, majority were female, and obesity (BMI > 30 Kg/m²) (P = 0.00377895) and worse functional status (P = 0.0110474) were significantly associated with ME/CFS.

Interpretations: Most PASC patients evaluated at our clinic had no comorbid condition and were not hospitalized for acute COVID-19. One-third of patients experienced a severe decline in their functional status. About 43% had the ME/CFS subtype.

Keywords: ME/CFS; PASC; post-COVID-19 clinic; prevalence; symptoms.