Fatigue in the COVID-19 pandemic

Fatigue, Internet Addiction and Symptoms of Long COVID-A Cross-Sectional Study of Polish Students

Introduction: Fatigue is the most persistent symptom in patients with long COVID. Moreover, Internet addiction itself has become a pandemic long-term effect. The aim of this study was to investigate the degree of fatigue and Internet addiction in a group of students with COVID-19 and to determine the relationship between fatigue and addiction in students with and without long COVID symptoms. Material and methods: A cross-sectional study was conducted among 402 Polish students aged 19-26. The 183 students who had COVID-19 signaled the presence of long COVID symptoms, which corresponded to 45.5% of the surveyed group. The Modified Fatigue Impact Scale was used to assess the level of fatigue, and the Kimberly Young questionnaire was used to assess the level of Internet addiction. Results: 19.7% (95% c.i.: 15.9-23.9%) of the students surveyed had a moderate level of Internet dependence (Internet addiction measure value of 50 points or more). Most of them did not complain of high levels of fatigue. Higher levels of dependence and fatigue were observed in subjects with long COVID symptoms (MFIS mean value was 26.5 in this group vs. 17.7 in the others; p = 0.0000 ***). The higher the respondents' level of dependence, the more they tended to feel tired (correlations were stronger in those with long COVID symptoms: rS = 0.23; p = 0.0017 **). Conclusions: In view of the results obtained, the study presented here has the potential to contribute to the international debate on the long-term health consequences of the COVID-19 pandemic and strategies to address them. The study provides data that may be useful in the development of educational and health policies that target the psychophysical well-being of patients with long COVID symptoms. This process should be considered as a long-term endeavor.

Long COVID-associated symptoms prevalent in both SARS-CoV-2 positive and negative individuals: A prospective follow-up study

Background

Research into persistent symptoms among SARS-CoV-2-positive i.e. CoV(+) patients mostly focuses on hospitalized individuals. Our prospective follow-up study compares long COVID-associated symptoms among laboratory-confirmed CoV(+) and SARS-CoV-2 negative [CoV(-)] individuals.

Methods

SARS-CoV-2 RT-PCR-tested volunteers were recruited into four cohorts: 1) CoV(+) outpatients, 2) CoV(-) outpatients, 3) CoV(+) intensive care unit (ICU) inpatients, and 4) CoV(+) non-ICU inpatients. Neutralizing antibodies were assessed and questionnaires filled in at enrolment and days 90-120, 121-180, 181-270, 271-365, and 365-533.

Results

Of the 1326 participants, 1191 were CoV(+): 46 ICU, 123 non-ICU, and 1022 outpatients; 135 were CoV(-) outpatient controls. Both CoV(+) outpatients and CoV(-) controls showed high overall symptom rates at all time points. More prevalent among CoV(+) than CoV(-) outpatients were only impaired olfaction and taste; many others proved more frequent for CoV(-) participants. At ≥181 days, fatigue, dyspnoea, various neuropsychological symptoms and several others were recorded more often for CoV(+) inpatients than outpatients.

Conclusions

Long COVID-associated symptoms were more frequent among hospitalized than non-hospitalized CoV(+) participants. As for outpatients, only impaired olfaction and taste showed higher rates in the CoV(+) group; some symptoms proved even more common among those CoV(-). Besides suggesting low long COVID prevalences for outpatients, our results highlight the weight of negative controls.

Fatigue and physical activity levels in poles living in Poland and the United Kingdom in the further year of the COVID-19 pandemic: a pilot study

OBJECTIVES

The aim of this study was to conduct a preliminary assessment of the prevalence of fatigue and level of physical activity, as well as the relationship between fatigue and physical activity among Poles living in Poland and the United Kingdom (UK) in the further year in the COVID-19 pandemic.

METHODS

A web-based online survey was conducted among Poles living permanently in Poland and the UK in January 2023. Responses were obtained from 200 respondents aged 18-69 years. The level of fatigue was assessed by the Modified Fatigue Impact Scale (MFIS). The level of physical activity was measured by the International Physical Activity Questionnaire (IPAQ).

RESULTS

The median for the total fatigue score was equal to 17 points out of a possible 105. 13.5% of the subjects had a low level of physical activity, the average MET for high-intensity activity was 1294.55 METs, for moderate activity 714.44 METs, and for walking 631 METs. As age and number of COVID-19 cases increased, scores on the MFIS questionnaire scale also increased. With an increase in the number of COVID-19 cases, high-intensity MET scores decreased.

CONCLUSIONS

The level of fatigue, in contrast to the level of physical activity, was low in the study population. There were few statistically significant differences in fatigue between people living in Poland and the UK. Further experimental studies on the physiological mechanism of differences in fatigue and physical activity are needed.

Longitudinal analysis and treatment of neuropsychiatric symptoms in post-acute sequelae of COVID-19

BACKGROUND

Persistent neuropsychiatric symptoms following acute COVID-19 infection are frequently reported. These include anxiety, depression, difficulty concentrating, fatigue, and insomnia. The longitudinal evolution of this neuropsychiatric burden is poorly understood and clinical guidelines concerning treatment are lacking.

OBJECTIVE

We sought to describe the longitudinal evolution of neuropsychiatric symptoms in the post-acute sequelae of COVID-19 (PASC) syndrome and examine symptom treatment at a single center.

METHODS

Consecutive participants experiencing persistent neurologic symptoms after acute COVID-19 infection were recruited from October 2020 to July 2022. Data collected included COVID-19 infection history, neurological exam and review of systems, Montreal Cognitive Assessment (MoCA), and self-reported surveys concerning neuropsychiatric symptoms and treatment. Data were collected at baseline and at 1-year follow-up.

RESULTS

A total of 106 participants (mean age 48.6, females 67%) were included in the study. At 1-year follow-up, 72.5% of participants reported at least one neuropsychiatric symptom. Over half (52.5%) of participants reported persistent fatigue. At baseline, 38.8% of all participants had met the established MoCA cut-off score of < 26 for mild cognitive impairment; this decreased to 20.0% at 1 year. COVID-19 infection severity was associated with neuro-PASC symptoms (including fatigue and anxiety) at 1 year. Overall, 29% of participants started at least one new medication for COVID-19-associated neuropsychiatric symptoms. Of the participants who started new medications, fatigue was the most common indication (44.8%) followed by insomnia (27.6%).

CONCLUSIONS

Neuropsychiatric symptoms related to neuro-PASC improve over time but can persist for over a year post-recovery. Most treatment modalities targeted neuro-PASC fatigue.

Long COVID, the Brain, Nerves, and Cognitive Function

SARS-CoV-2, a single-stranded RNA coronavirus, causes an illness known as coronavirus disease 2019 (COVID-19). Long-term complications are an increasing issue in patients who have been infected with COVID-19 and may be a result of viral-associated systemic and central nervous system inflammation or may arise from a virus-induced hypercoagulable state. COVID-19 may incite changes in brain function with a wide range of lingering symptoms. Patients often experience fatigue and may note brain fog, sensorimotor symptoms, and sleep disturbances. Prolonged neurological and neuropsychiatric symptoms are prevalent and can interfere substantially in everyday life, leading to a massive public health concern. The mechanistic pathways by which SARS-CoV-2 infection causes neurological sequelae are an important subject of ongoing research. Inflammation- induced blood-brain barrier permeability or viral neuro-invasion and direct nerve damage may be involved. Though the mechanisms are uncertain, the resulting symptoms have been documented from numerous patient reports and studies. This review examines the constellation and spectrum of nervous system symptoms seen in long COVID and incorporates information on the prevalence of these symptoms, contributing factors, and typical course. Although treatment options are generally lacking, potential therapeutic approaches for alleviating symptoms and improving quality of life are explored.

Long-term central nervous system (CNS) consequences of COVID-19 in children

INTRODUCTION

Neurological/neuropsychiatric symptoms are commonly reported by children/young people with long COVID, especially headache, fatigue, cognitive deficits, anosmia and ageusia, dizziness, mood symptoms, and sleep problems. However, reported prevalence estimates are highly variable due to study heterogeneity and often small sample size; most studies only considered short-term follow-ups; and, apart from mood and sleep problems, neuropsychiatric conditions have received less attention. Considering the potential debilitating effects of neurological/neuropsychiatric conditions, a comprehensive review of the topic is timely, and needed to support clinical recognition as well as to set the direction for future research.

AREAS COVERED

The authors discuss neurological/neuropsychiatric manifestations of long COVID in pediatric populations, with a focus on prevalence, associated demographic characteristics, and potential pathogenetic mechanisms.

EXPERT OPINION

Children/young people may develop persistent neurological/neuropsychiatric symptoms following acute SARS-CoV-2 infection, which may affect daily functioning and well-being. Studies in larger samples with longer follow-ups are needed to clarify prevalence and symptom duration; as well as less investigated risk factors, including genetic predisposition, ethnicity, and comorbidities. Controlled studies may help separate infection-related direct effects from pandemic-related psychosocial stressors. Clarifying pathogenetic mechanisms is paramount to develop more targeted and effective treatments; whilst screening programs and psychoeducation may enhance early recognition.

The Longitudinal Features of Depressive Symptoms During the COVID-19 Pandemic Among Chinese College Students: A Network Perspective

There is substantial evidence that the Corona Virus Disease 2019 (COVID-19) pandemic increased the risk of depressive symptoms among college students, but the long-term features of depressive symptoms on a symptom level have been poorly described. The current study investigated interaction patterns between depressive symptoms via network analysis. In this longitudinal study, participants included 860 Chinese college students (65.8% female; M_age = 20.6, SD_age = 1.8, range: 17-27) who completed a questionnaire at three-time points three months apart. Results demonstrated that fatigue was the most influential symptom, and the occurrence of fatigue could give rise to other depressive symptoms. In addition to predicting other symptoms, fatigue could be predicted by other symptoms in the measurement. The network structures were similar across time, suggesting that the overall interaction pattern of depressive symptoms was stable over the longitudinal course. These findings suggest that depressive symptoms during the COVID-19 period are associated with the presence of fatigue.

Exercise and COVID-19: exercise intensity reassures immunological benefits of post-COVID-19 condition

Any form of physical activity, including exercise, has various benefits at the physiological (improving cardiac and respiratory functions, increasing skeletal muscle mass, and maintaining homeostasis) and psychological levels (improving cognitive function, reducing anxiety and depression) which help to combat any type of infection. In contrast, the infectivity ratio could reduce the physical activity of an individual, such as performing a habitual exercise. Adaptation to different exercise strategies including intensity and duration may better increase physical performance and improve the symptoms. For example, low to moderate intensity perhaps fails to induce this adaptive process, while high-intensity of exercise compromises immune health. This can aggravate the infection rate (Open window theory). However, high intensity with a shorter time produces various morphological alterations in the primary organs including the lungs and heart, which facilitate life support in COVID-19 patients. However, less information about exercise protocols failed to assure the benefits of exercise to COVID-19 patients, particularly post-COVID-19 conditions. Therefore, this review will answer how exercise intensity is crucial to reassure the exercise benefits for promoting safe participation before infection and post-COVID-19 conditions.

Fatigue in older persons: the role of nutrition

Fatigue is defined as a symptom leading to the inability to continue functioning at the expected activity level. It is a highly prevalent symptom, challenging to frame into monodimensional pathophysiological mechanisms. As a result, fatigue is often underestimated in the clinical setting and is wrongly considered an unavoidable consequence of ageing. Several potential mechanisms responsible for fatigue have been proposed, including sleep patterns, autonomic nervous system abnormalities and biological complexity. Inflammation and mitochondrial dysfunction are among the most promising mechanisms through which malnutrition may cause fatigue. Not surprisingly, fatigue is highly prevalent in inflammatory conditions (e.g. COVID-19 infection). The nutritional status may also represent a critical factor in the development and presentation of fatigue, which may mimic the exhaustion of the individual's metabolic reserves. For example, the insufficient dietary intake of energy and proteins may determine the catabolism of body fat and muscles, disrupt the homeostatic balance and cause the onset of fatigue. It is necessary to conduct research on fatigue. By characterising its pathophysiological mechanisms, it will be possible to (1) support the design and development of targeted interventions, (2) improve the quality of life of many persons by acting on the symptom and (3) reduce the direct and indirect costs of a burdening condition typical of advancing age. In the present review, we provide an overview of the role that nutrition may play as a determinant of fatigue in older people, also in the context of the COVID-19 pandemic.

Relationships between Inflammatory Biomarkers and Fatigue among Patients with Moderate and Severe COVID-19

Background

Patients with moderate or severe COVID-19 infection suffer from varying levels of fatigue; however, there is a lack of understanding regarding the effect of inflammation on fatigue; and whether these relationships differ according to the severity of the infection.

Aim

To assess the relationships between selected inflammatory biomarkers and fatigue levels among hospitalized Jordanian patients with moderate or severe COVID-19 infection.

Methods

A quantitative cross-sectional design was used. A total of 352 participants were recruited for the study. Data regarding fatigue type and level were collected using the Chalder fatigue scale. Laboratory test results regarding several selected inflammatory biomarkers (e.g., ESR, CRP, IL-6, D-dimer, and others) were collected from patient records. The severity of the COVID-19 infection was determined using the criteria of the Ministry of Health in Jordan based on the results of O₂% (oxygen saturation).

Results

The mean scores of the total fatigue level significantly differed between the two levels of the severity of COVID-19 infection (moderate and severe levels) (t = -3.0, p < 0.05). Similar findings were observed with physiological fatigue (t = -3.50, p < 0.05), and no significant difference was observed in psychological fatigue. Out of the selected inflammatory markers, only neutrophil and lymphocyte count had a significant influence on total fatigue level.

Conclusion

The level and type of fatigue was affected by the severity of the disease. However, the disease process itself represented by the levels of the inflammatory markers showed little influence on fatigue. The implications such as continuous screening of fatigue, and monitoring of the levels of the inflammatory markers are important to assist in diagnosing and managing COVID-19 patients. Furthermore, the relationship between the inflammatory process and fatigue is complex and requires further exploration.

Dimensionality, psychometric properties, and population-based norms of the Turkish version of the Chalder Fatigue Scale among adults

BACKGROUND

Fatigue is emerging as a major public health problem that is highly associated with poor health-related quality of life and disability. Among adults, fatigue has become increasingly common because of workload or lifestyle changes. This study aimed to cross-culturally adapt the Chalder Fatigue Scale (CFS) into Turkish, to investigate its psychometric properties, and to establish normative data in healthy adults by age and gender.

METHODS

The validity of the CFS was tested with a total sample of 476 healthy adults aged 20-40 years (264 males and 212 females) and test-retest/measurement error analyses were performed with 161 participants (94 males and 67 females). The test-retest reliability was examined using the intraclass correlation coefficient (ICC), and internal consistency was determined using Cronbach's α-coefficient. Predictive validity was assessed using the Receiver Operating Characteristic to validate the cut-off value of the CFS for non-fatigued and fatigued participants. Factor analyses and hypothesis testing were conducted to assess construct validity. Hypothesis testing examined convergent and known-group validity by testing 14 predefined hypotheses.

RESULTS

The mean (SD) and median (25-75%) CFS scores were 10.7 (4.9) and 11 (7-14) for the total sample (n = 476). The cut-off point for CFS was set at ≥ 12 with a sensitivity of 65.8% and a specificity of 85.9%. The CFS provided evidence of excellent fit of the two-factor structure (CFI = 0.963, RMSEA = 0.06, SRMR = 0.02). There was evidence of strong internal consistency demonstrated by Cronbach's α = 0.863 and good test-retest reliability by ICC = 0.76. Thirteen out of 14 hypotheses (92.9%) were confirmed and the scale showed low to moderate correlation with other measurement instruments (r = 0.31-0.51).

CONCLUSIONS

The CFS has been shown to be a reliable and valid instrument that can be used in various populations for the assessment of fatigue.

LEVEL OF EVIDENCE

Level II.

Neurological Manifestations of SARS-CoV2 Infection: A Narrative Review

The COVID-19 virus frequently causes neurological complications. These have been described in various forms in adults and children. Headache, seizures, coma, and encephalitis are some of the manifestations of SARS-CoV-2-induced neurological impairment. Recent publications have revealed important aspects of viral pathophysiology and its involvement in nervous-system impairment in humans. We evaluated the latest literature describing the relationship between COVID-19 infection and the central nervous system. We searched three databases for observational and interventional studies in adults published between December 2019 and September 2022. We discussed in narrative form the neurological impairment associated with COVID-19, including clinical signs and symptoms, imaging abnormalities, and the pathophysiology of SARS-CoV2-induced neurological damage.

Clinical characteristics and analysis of risk factors for disease progression of patients with SARS-CoV-2 Omicron variant infection: A retrospective study of 25207 cases in a Fangcang hospital

OBJECTIVES

To summarize the clinical characteristics of patients infected by SARS-CoV-2 omicron variant and explore the risk factors affecting the progression in a Fangcang hospital, Shanghai, China.

METHODS

A total of 25,207 patients were retrospectively enrolled. We described the clinical characteristics and performed univariate and multivariate logistic regression analysis to identify the risk factors for non-severe to severe COVID-19 or death.

RESULTS

According to the outcomes, there were 39 severe patients (including 1 death) and 25,168 non-severe patients enrolled in this study. Among the 25,207 cases, the median age was 45 years (IQR 33-54), and 65% patients were male. Cough (44.5%) and expectoration (38.4%) were the most two common symptoms. Hypertension (10.4%) and diabetes (3.5%) were most two common comorbidities. Most patients (81.1%) were fully vaccinated. The unvaccinated and partially vaccinated patients were 15.1% and 3.9%, respectively. The length of viral shedding time was six days (IQR 4-9) in non-severe patients. Multivariate logistic regression analysis suggested that age (OR=1.062, 95%CI 1.034-1.090, p&lt;0.001), fever (OR=2.603, 95%CI 1.061-6.384, p=0.037), cough (OR=0.276, 95%CI 0.119-0.637, p=0.003), fatigue (OR=4.677, 95%CI 1.976-11.068, p&lt;0.001), taste disorders (OR=14.917, 95%CI 1.884-118.095, p=0.010), and comorbidity (OR=2.134, 95%CI 1.059-4.302, p=0.034) were predictive factors for deterioration of SARS-CoV-2 omicron variant infection.

CONCLUSIONS

Non-critical patients have different clinical characteristics from critical patients. Age, fever, cough, fatigue, taste disorders, and comorbidity are predictors for the deterioration of SARS-CoV-2 omicron variant infection.

When the Pandemic Will Be Over: Lots of Hope and Some Concerns

The COVID-19 pandemic significantly threatened healthcare systems worldwide. The worst-hit population has been represented by older people with underlying chronic comorbidities, while children and adolescents developed mild or asymptomatic forms of the disease. However, certain medical conditions (i.e., obesity, respiratory, or neurological or immune disorders) may increase the risk for poor health outcomes even in young and middle-aged people. Beyond the direct negative effects of the infection, the pandemic posed several health challenges through an increase in psycho-social issues (i.e., anxiety, depression, fatigue, sleep alterations, loneliness, reduced assistance, and loss of income). Accordingly, the pandemic is negatively impacting the accumulation of the functional reserves of each individual, starting from early life. With the long-term effects of the pandemic to be seen in the coming years, clinicians must be prepared to manage such high clinical complexity of people they encounter, through the implementation of multidimensional and multidisciplinary interventions.

Long-term effect of SARS-CoV-2 infection on cardiovascular outcomes and all-cause mortality

Since the very beginning of the coronavirus disease 2019 (COVID-19) pandemic in early 2020, it was evident that patients with cardiovascular disease (CVD) were at an increased risk of developing severe illness, and complications spanning cerebrovascular disorders, dysrhythmias, acute coronary syndrome, ischemic and non-ischemic heart disease, pericarditis, myocarditis, heart failure, thromboembolic disease, stroke, and death. Underlying these was excessive systemic inflammation and coagulopathy due to SARS-COV-2 infection, the effects of which also continued long-term as evidenced by post-COVID-19 cardiovascular complications.

The acute and chronic cardiovascular effects of COVID-19 occurred even among those who were not hospitalized and had no previous CVD or those with mild symptoms.

This comprehensive review summarizes the current understanding of molecular mechanisms triggered by the SARS-CoV-2 virus on various cells that express the angiotensin-converting enzyme 2, leading to endothelial dysfunction, inflammation, myocarditis, impaired coagulation, myocardial infarction, arrhythmia and a multisystem inflammatory syndrome in children or Kawasaki-like disease.

Making waves: Wastewater surveillance of SARS-CoV-2 in an endemic future

Wastewater-based surveillance (WBS) has been widely used as a public health tool to monitor the emergence and spread of SARS-CoV-2 infections in populations during the COVID-19 pandemic. Coincident with the global vaccination efforts, the world is also enduring new waves of SARS-CoV-2 variants. Reinfections and vaccine breakthroughs suggest an endemic future where SARS-CoV-2 continues to persist in the general population. In this treatise, we aim to explore the future roles of wastewater surveillance. Practically, WBS serves as a relatively affordable and non-invasive tool for mass surveillance of SARS-CoV-2 infection while minimizing privacy concerns, attributes that make it extremely suited for its long-term usage. In an endemic future, the utility of WBS will include 1) monitoring the trend of viral loads of targets in wastewater for quantitative estimate of changes in disease incidence; 2) sampling upstream for pinpointing infections in neighborhoods and at the building level; 3) integrating wastewater and clinical surveillance for cost-efficient population surveillance; and 4) genome sequencing wastewater samples to track circulating and emerging variants in the population. We further discuss the challenges and future developments of WBS to reduce inconsistencies in wastewater data worldwide, improve its epidemiological inference, and advance viral tracking and discovery as a preparation for the next viral pandemic.