Red flags for long covid fatigue

2 minute read

Risk factors include being single, having less education, higher neuroticism and being on multiple medications.

Covid patients who have a mild infection are four times more likely to suffer from persistent fatigue than those without covid, new data reveals.

“Psychosocially vulnerable” people appeared to be at an even greater risk of persistent fatigue after covid infection, but the findings meant GPs could adapt treatment plans accordingly, the Dutch authors wrote in the British Journal of General Practice.

The prospective matched cohort study compared the reported fatigue rates over time between 180 patients with suspected covid and 120 without suspected covid using online questionnaires. At three months, 56% of the covid patients had fatigue compared to 30% of the non-covid participants, at six months the proportions were 57% and 25%, and at 15 months the rates were 48% and 31%.

By the end of the 15-month period, 35% of the covid group and 13% of the non-covid group reported experiencing persistent fatigue.

There were several risk factors for persistent fatigue.

Patients with a lower education level were three times more likely to be diagnosed, as were those who were single and those who had higher frequencies of GP contact one year prior to their covid infection.

Polypharmacy, high neuroticism scores and number of adverse life events were also significantly associated with greater odds of persistent fatigue following infection.

“The effects partly overlap, and the effects of neuroticism and the number of medications were found to be independently related to persistent fatigue,” the researchers said.

“These prognostic factors have not been described in previous studies of long covid. However, some studies suggest that psychosocial vulnerability and low income are associated with symptoms of long covid, which is confirmed by the results of the current study.

“Smoking, alcohol use, comorbidities, earlier life events and perceived personalised GP care did not seem to be associated with persistent fatigue after covid-19.”

Unlike previous studies, there was no significant association found between female sex and obesity and the likelihood of severe and persistent symptoms post-covid.  

“Care should be taken before concluding that the prevalence of persistent fatigue in the suspected covid-19 group can be attributed completely to covid-19 infection,” the authors wrote.

Awareness of the risk of developing long covid and persistent fatigue could allow GPs to employ appropriate strategies and “prevent its development”, the authors concluded.

British Journal of General Practice 2023, online 7 February

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