Abstract

Background

Severe fatigue can persist for months after coronavirus disease 2019 (COVID-19) onset. This longitudinal study describes fatigue severity and its determinants up to 12 months after illness onset across the full spectrum of COVID-19 severity.

Methods

RECoVERED, a prospective cohort study in Amsterdam, the Netherlands, enrolled participants aged ≥16 years after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnosis. Fatigue was measured using the validated Short Fatigue Questionnaire (SFQ; range 4–28) at months 1, 3, 6, 9, and 12 of follow-up. Fatigue severity was modeled over time using mixed-effects linear regression. Determinants of severe fatigue (SFQ ≥18) at 6 months since illness onset (ie, persistent fatigue) were identified using logistic regression.

Results

Between May 2020 and July 2021, 303 participants completed at least 1 fatigue questionnaire. Twelve months after illness onset, 17.4% (95% CI, 6.7% to 38.3%), 21.6% (95% CI, 11.2% to 37.7%), and 44.8% (95% CI, 28.0% to 62.9%) of participants with mild, moderate, and severe/critical COVID-19 (World Health Organization definition), respectively, experienced severe fatigue. When adjusting for age and sex, having ≥3 comorbidities (P = .007), severe/critical COVID-19 (P = .002), low mood (P < .001), and dyspnea in the first 2 weeks of illness (P = .001) were associated with more severe fatigue over time. Severe/critical COVID-19 (adjusted odds ratio [aOR], 3.37; 95% CI, 1.28 to 8.93) and low mood at enrollment (aOR, 2.43; 95% CI, 1.11 to 5.29) were associated with persistent fatigue. Recovery rarely occurred beyond 6 months after illness onset, regardless of COVID-19 severity.

Conclusions

The occurrence of severe fatigue in our cohort was high, especially among those with initially severe/critical COVID-19, with little recovery beyond 6 months after illness onset. Our findings highlight an urgent need for improved understanding of persistent severe fatigue following COVID-19 to help inform prevention and intervention.

Details

Title
Severe Fatigue in the First Year Following SARS-CoV-2 Infection: A Prospective Cohort Study
Author
Verveen, Anouk 1 ; Wynberg, Elke 2   VIAFID ORCID Logo  ; Hugo D G van Willigen 3 ; Boyd, Anders 4 ; de Jong, Menno D 5 ; de Bree, Godelieve 6 ; Davidovich, Udi 7 ; Lok, Anja 8 ; Eric P Moll van Charante 9 ; Knoop, Hans 1 ; Prins, Maria 2 ; Pythia Nieuwkerk 1 ; Agard, Ivette; Ayal, Jane; Cavdar, Floor; Craanen, Marianne; Deuring, Annemarieke; Annelies van Dijk; Ertan Ersan; Laura del Grande; Hartman, Joost; Koedoot, Nelleke; Leenstra, Tjalling; Lebbink, Romy; Loomans, Dominique; Makowska, Agata; Tom du Maine; de Man, Ilja; Matser, Amy; Lizenka van der Meij; Marleen van Polanen; Oud, Maria; Clark, Reid; Storey, Leeann; Marc van Wijk; Joost van den Aardweg; Joyce van Assem; Marijne van Beek; Blankert, Thyra; Dijkstra, Maartje; Figaroa, Orlane; Frenkel, Leah; Marit van Gils; Jelle van Haga; Harskamp-Holwerda, Agnes; Hazenberg, Mette; Hidad, Soemeja; de Jong, Nina; Kootstra, Neeltje; Kuijt, Lara; Russell, Colin; Karlijn van der Straten; Annelou van der Veen; Verkaik, Bas; Visser, Gerben-Rienk

1  Department of Medical Psychology, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, the Netherlands 
2  Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands; Department of Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands 
3  Department of Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands; Department of Medical Microbiology & Infection Prevention, Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands 
4  Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands; Stichting HIV Monitoring, Amsterdam, the Netherlands 
5  Department of Medical Microbiology & Infection Prevention, Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands 
6  Department of Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands 
7  Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands; Department of Social Psychology, University of Amsterdam, Amsterdam, the Netherlands 
8  Department of Psychiatry, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, the Netherlands 
9  Department of Public & Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, the Netherlands; Department of General Practice, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, the Netherlands 
Publication year
2022
Publication date
May 2022
Publisher
Oxford University Press
e-ISSN
23288957
Source type
Scholarly Journal
Language of publication
English
DOI
https://doi.org/10.1093/ofid/ofac127
ProQuest document ID
3171174211
Copyright
© The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America. This work is published under https://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.