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Persistent fatigue following SARS-CoV-2 infection is common and independent of severity of initial infection
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Abstract
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.
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“Literature data are not equivocal about the association between females and long COVID: some preliminary studies have shown an increased prevalence of fatigue [24] or other symptoms among women [1,5,13,16], while in other studies no gender association was found [4,[18], [19], [20]].”
From Female gender is associated with long COVID syndrome: a prospective cohort study (2022) · cites this paper as [24]
In the citing paper
“Fatigue (58%) is the most common symptom of long and acute COVID-1923.”
From More than 50 long-term effects of COVID-19: a systematic review and meta-analysis (2021) · cites this paper as [23]
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“It is present even after 100 days of the first symptom of acute COVID-194,23.”
From More than 50 long-term effects of COVID-19: a systematic review and meta-analysis (2021) · cites this paper as [23]
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Metadata
- Authors
- Townsend, L., Dyer, A. H., Jones, K., Dunne, J., Mooney, A., Gaffney, F., O'Connor, L., Leavy, D., O'Brien, K., Dowds, J., Sugrue, J. A., Hopkins, D., Martin-Loeches, I., Ni Cheallaigh, C., Nadarajan, P., McLaughlin, A. M., Bourke, N. M., Bergin, C., O'Farrelly, C., Bannan, C., & Conlon, N.
- Affiliations
- Trinity College Dublin (IE)
- St. James's Hospital (IE)
- Corresponding author
- Townsend, Liam
- ORCID
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2020-11-09
- Volume
- 15
- Issue
- 11
- Pages
- e0240784
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC7652254
- OpenAlex
- W3102327145
- Cited by
- 911
- References
- 78
- Citations by year
- 2026: 25 · 2025: 69 · 2024: 124 · 2023: 190 · 2022: 242 · 2021: 244 · 2020: 14
- FWCI
- 74.27
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- medRxiv (acceptedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Wellcome Trust (203930/B/16/Z)
- Health Research Board (203930/B/16/Z)
- Topics
- Health Sciences › Medicine › Clinical Neurology › Long-Term Effects of COVID-19
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Keywords
- post-COVID-19 fatigue, persistent fatigue, COVID-19 pandemic, post-viral fatigue, Chalder Fatigue Questionnaire, COVID-19 severity, inflammatory cytokines, interleukin-6, soluble interleukin-2 receptor, peripheral immune activation, depression, anxiety, sex differences, C-reactive protein, lactate dehydrogenase
- MeSH terms
- Betacoronavirus, COVID-19, SARS-CoV-2, Adult, Aged, Fatigue, Female, Humans, Male, Middle Aged, Pneumonia, Viral, Severity of Illness Index, Interleukin-6, Prevalence, Coronavirus Infections, Interleukin-2 Receptor alpha Subunit, Pandemics
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