Fatigue Symptoms Associated With COVID-19 in Convalescent or Recovered COVID-19 Patients; a Systematic Review and Meta-Analysis

  1. Sanjay Rao
  2. Tarek Benzouak
  3. Sasha Gunpat
  4. Rachel J Burns
  5. Tayyeb A Tahir
  6. Stephen Jolles
  7. Steve Kisely

Reviewed by

Read the full article See related articles

Listed in

Log in to save this article

Abstract

Background

The prevalence and prognosis of post-acute stage SARS-CoV-2 infection fatigue symptoms remain largely unknown.

Aims

We performed a systematic review to evaluate the prevalence of fatigue in post-recovery from SARS-CoV-2 infection.

Method

Medline, Embase, PsycINFO, CINAHL, Web of Science, Scopus, trial registries, Cochrane Central Register of Controlled Trials, and Google Scholar were searched for studies on fatigue in samples that recovered from polymerase chain reaction (PCR) diagnosed COVID-19. English, French, and Spanish studies were included. Meta-analyses were conducted separately for each recruitment setting.

Results

We identified 41 studies with 9,362 patients that recovered from COVID-19. Post-COVID-19 patients self-report of fatigue was higher compared to healthy controls (risk ratio (RR) = 3.688, 95%CI [2.502, 5.436], p < .001). Over 50% of patients discharged from inpatient care reported symptoms of fatigue during the first (event rate [ER] = 0.517, 95%CI [0.278, 0.749]) and second month following recovery (ER = 0.527, 95%CI [0.337, 0.709]). Ten percent of the community patients reported fatigue in the first-month post-recovery. Patient setting moderated the association between COVID-19 recovery and fatigue symptoms (R2 = 0.11, p < .001). Female patients recovering from COVID-19 had a greater self-report of fatigue (odds ratio [OR] = 1.782, 95%CI [1.531, 2.870]). Patients recruited through social media had fatigue above 90% across multiple time points. Fatigue was highest in studies from Europe.

Conclusion

Fatigue is a symptom associated with functional challenges which could have economic and social impacts. Developing long-term planning for fatigue management amongst patients beyond the acute stages of SARS-CoV-2 infection is essential to optimizing patient care and public health outcomes. Further studies should examine the impact of sociodemographic, pandemic-related restrictions and pre-existing conditions on fatigue.

Article activity feed

  1. Version published to 10.1093/abm/kaab081
  2. Version published to 10.1101/2021.04.23.21256006v3 on medRxiv
  3. ScreenIT

    SciScore for 10.1101/2021.04.23.21256006: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variableData from these were used to examine the effect of time since recovery, PCR negative test confirmed recovery, recruitment setting, average sample age, proportion of females, Diabetes Mellitus, COPD and hypertension.
    RandomizationAs post-viral effects related to COVID-19 is an evolving challenge, several study designs were considered for evaluation: cluster or non-cluster randomized controlled trials, controlled trials, and uncontrolled trials, cross-sectional, case-control and cohort studies.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Antibodies
    SentencesResources
    The exclusion criteria were: a) COVID-19 status was screened through antibody testing (i.e., IgG and IgM) only; b) absence of a post-infection follow-up; c) presence of medical or neurological complications (which could explain fatigue symptoms); d) the sample was comprised of participants below the age of 18; e) publication was in a language other than English, French or Spanish; or f) utilizing non-human methodology (i.e., lab simulation, in vitro or animal models).
    IgM
    suggested: None
    Software and Algorithms
    SentencesResources
    The study protocol and MEDLINE search strategy were pre-registered in the Open Science Framework (i.e., osf.io/zu25b) on the 14th of September, 2020 and underwent full registration in the International Prospective Register of Systematic Reviews on the 18th of September, 2020 (i.e., [CRD42020209411]).
    MEDLINE
    suggested: (MEDLINE, RRID:SCR_002185)
    Search strategy: We searched Medline, Embase, PsycINFO, CINAHL, Web of Science, Scopus, trial registries (i.e., NIH clinical trials registry, Cochrane Central Register of Controlled Trials and ISRCTN registry) and google scholar.
    Embase
    suggested: (EMBASE, RRID:SCR_001650)
    PsycINFO
    suggested: (PsycINFO, RRID:SCR_014799)
    A combined set of MeSH and keywords associated with COVID-19 and fatigue were used to identify publications on fatigue in individuals recovered from acute COVID-19 infection, diagnosed with appropriate testing.
    MeSH
    suggested: (MeSH, RRID:SCR_004750)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  4. Version published to 10.1101/2021.04.23.21256006v2 on medRxiv
  5. Version published to 10.1101/2021.04.23.21256006v1 on medRxiv