Persistent fatigue in patients with COVID-19

Editor – We read with interest the review by Sullivan who described the long-term sequela of patients who acquired severe acute respiratory syndrome coronavirus infection and Middle East respiratory syndrome coronavirus infection.1 Based on the previous experiences with the two epidemics, the author suggested that patients who recovered from COVID-19 may also suffer from the similar long-term complications which include cardiopulmonary sequelae and fatigue.
We wish to discuss the condition of persistent fatigue following the recovery of COVID-19. In fact, available studies have reported fatigue as the most prevalent symptom that persists in patients who recovered from COVID-19, which has now been termed as ‘long COVID’. An Italian study of 179 patients reported that 87.4% of patients had persistence of at least one symptom in 60 days after their initial COVID-19 diagnosis, with fatigue being the most prevalent symptom (53.1%).2 Likewise, Townsend et al which evaluated 128 patients who recovered from the acute phase of COVID-19 reported persistent fatigue in 52.3% of patients at 10 weeks after initial symptoms.3 Moreover, an analysis of data from 4,182 incident cases of COVID-19 logged in the COVID Symptom Study app revealed that 13.3% of cases had symptoms lasting >28 days, with fatigue being the most commonly reported symptom (97.7%) among those who had long COVID.4
We agree with Sullivan that clinicians will need to monitor for long-term complications in patients who recover from COVID-19, especially persistence of fatigue.1 In patients who are particularly troubled with persistent fatigue, drug therapy including glucocorticoids and methylphenidate could be offered on a case-by-case basis after evaluating risks and benefits. A double-blind, randomised, placebo-controlled trial of 25–35 mg/day of oral hydrocortisone for 12 weeks in 70 patients with chronic fatigue syndrome (CFS) showed modest improvement at the expense of adrenal suppression.5 In another randomised crossover trial, improvement in fatigue level was observed in response to 5–10 mg/day of hydrocortisone among 32 CFS patients.6 A double-blind, randomised, placebo-controlled crossover study of 60 CFS patients evaluated treatment with methylphenidate (10 mg twice daily) compared with placebo and reported clinical improvement in 17% of patients.7
- © Royal College of Physicians 2021. All rights reserved.
References
- ↵
- O’Sullivan O
- ↵
- ↵
- Townsend L
- ↵
- Sudre CH
- ↵
- ↵
- ↵
Article Tools
Citation Manager Formats
Jump to section
Related Articles
- No related articles found.
Cited By...
- No citing articles found.