Fatigue as a result of Long Covid can have devastating effect on quality of life of patients

The University of Exeter researchers showed substantial impacts on the ability to work and activities of daily living in people with post-COVID-19 syndrome.

Post-COVID-19 syndrome, or 'long COVID', is defined by WHO and the National Institute for Health and Care Research as the signs and symptoms of the disease that persist for more than 12 weeks following the initial acute COVID-19 infection. It is causing increasing concern due to the associated morbidity caused by the symptoms and the potential number of patients infected.

Sarah Walker, University of Exeter, Exeter, UK, and colleagues described self-reported characteristics and symptoms of treatment-seeking patients with post-COVID-19 syndrome. They also assessed the impact of symptoms on health-related quality of life (HRQoL) and patients' ability to work and undertake activities of daily living.

The researchers studied self-reported long-COVID symptoms and quality of life in 3,754 adults registered to complete questionnaires on the Living with Covid Recovery app from 2020 to 2022. The participants were 18 to 65 years old, 71% were women, and all had COVID-19 symptoms at least three months after diagnosis. All were patients at 1 of 31 long-COVID clinics in Wales and England.

The primary outcome was the baseline WSAS (Work and Social Adjustment Scale), a measure of the patient's functional limitations (a score of ≥20 indicates moderately severe limitations). Other symptoms explored included depression, fatigue, anxiety, breathlessness, cognitive impairment, and health-related quality of life (HRQoL).

The study revealed the following findings:

• 94% of patients were of working age (18-65); the mean age was 48 years; 71% were female.
• 51% reported losing ≥1 day from work in the previous four weeks; 20% reported being unable to work.
• The mean WSAS score at baseline was 21 (SD 10), with 53% scoring ≥20.
• Factors associated with WSAS scores of ≥20 were high fatigue levels, depression and cognitive impairment.
• Fatigue was the main symptom contributing to a high WSAS score.
• Many long-COVID patients were seriously ill, and their average fatigue scores were similar to or worse than those of people with cancer-related anaemia (low counts of oxygen-carrying red blood cells) or severe kidney disease.
• Their health-related quality of life scores were also lower than those of people with advanced metastatic cancers, such as stage 4 lung cancer.

"Our findings revealed that long Covid can have a devastating effect on the lives of patients—with fatigue having the biggest impact on everything from social activities to chores, work, and maintaining close relationships," co-lead author Henry Goodfellow, PhD, of University College London (UCL), said in a UCL news release.

"Clinical care and rehabilitation should address fatigue management as the dominant symptom explaining variation in functionality," the researchers concluded.

Reference:

Walker S, Goodfellow H, Pookarnjanamorakot P, et al impact of fatigue as the primary determinant of functional limitations among patients with post-COVID-19 syndrome: a cross-sectional observational studyBMJ Open 2023;13:e069217. doi: 10.1136/bmjopen-2022-069217