Long COVID and Post-infective Fatigue Syndrome: A Review - Wyller, Moss-Morris, Crawley, Knoop, Lloyd et al, 2022

Kalliope

Kalliope

Senior Member (Voting Rights)
Abstract
Fatigue is a dominant feature of both acute and convalescent coronavirus disease 2019 (COVID-19) (sometimes termed “long-COVID”), with up to 46% of patients reporting fatigue that lasts from weeks to months. The investigators of the international Collaborative on Fatigue Following Infection (COFFI) conducted a systematic review of post-COVID fatigue and a narrative review on fatigue after other infections, and made recommendations for clinical and research approaches to assessing fatigue after COVID-19.

In the majority of COVID-19 cohort studies, persistent fatigue was reported by a significant minority of patients, ranging from 13% to 33% at 16–20 weeks post-symptom onset. Data from the prospective cohort studies in COFFI and others indicate that fatigue is also a prevalent outcome from many acute systemic infections, notably infectious mononucleosis, with a case rate for clinically significant Post-infective fatigue after exclusion of recognized medical and psychiatric causes, ranging from 10%–35% at 6 months.

To better characterize post-COVID fatigue, the COFFI investigators recommend the following: application of validated screening questionnaires for case detection; standardized interviews encompassing fatigue, mood, and other symptoms; and investigative approaches to identify end-organ damage and mental health conditions.

Journal: Open Forum Infectious Diseases

https://academic.oup.com/ofid/article/8/10/ofab440/6367589
 
Oh hooray, a BPS celebration of their great contribution to knowledge on 'fatigue'.

Well at least it provides us with a list of who to avoid. With Paul Garner as consumer advisor just to remind us they really really don't get it.

Unsurprisingly there is a lot of emphasis on psychiatric factors which they claim predispose and perpetuate post infectious fatigue.

They recommend the Chalder fatigue scale and SF36 Physical function along with a range of psychiatric questionnaires for assessment, and of course barely mention any negative effect of activity, and using all the old ideas of boom and bust and fear avoidance of activity.

Particularly noticeable is complete avoidance of the terms ME, CFS, PEM and PESE.
 
In the majority of COVID-19 cohort studies, persistent fatigue was reported by a significant minority of patients, ranging from 13% to 33% at 16–20 weeks post-symptom onset. Data from the prospective cohort studies in COFFI and others indicate that fatigue is also a prevalent outcome from many acute systemic infections, notably infectious mononucleosis, with a case rate for clinically significant Post-infective fatigue after exclusion of recognized medical and psychiatric causes, ranging from 10%–35% at 6 months.
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So both sets of data agree that a substantial fraction of patients have unexplained fatigue.

Which, presumably, includes being unexplained by the psycho-behavioural fear and deconditioning model so long promoted by the authors?
...investigative approaches to identify end-organ damage...
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Suspiciously specific. Would seem to rule out a lot of physiology. Are the immune and endocrine systems 'end-organs'?
 
They are revealing their complete ineptitude by continuing to obsess over making it all about a single symptom, and not even at that, since they have an alternative definition of fatigue. They still don't have a freaking clue about any of this.

It's been 2.5 years and the LC community is already sick of their crap, find those people to be completely mediocre and that's for the mediocre work they did before. But this pseudoscience is beloved in healthcare, even though it's ineffective BS. Brilliant work, folks. This is how to completely destroy the credibility of a profession, by making everything about themselves.
 
It's interesting see Ben Katz in that list. From memory, he co-authored a study with Lenny Jason on a prospective study of EBV infection in college students. There was a media article about the study in which he made it sound as though psychological measures were associated with going on to develop post-infection fatigue. But, and I'm uncertain about all of this, the paper later did not show this. My main recollection is that things did not seem to add up, and it was very odd to have Lenny Jason associating with someone with those views. I'd be interested to know about what was going on there.

Thanks for posting @Kalliope, the authors must have had quite the time, bolstering each others preconceptions. Here's the list of authors for completeness:
Carolina X Sandler, Vegard B B Wyller, Rona Moss-Morris, Dedra Buchwald, Esther Crawley, Jeannine Hautvast, Ben Z Katz, Hans Knoop, Paul Little, Renee Taylor, Knut-Arne Wensaas, Andrew R Lloyd

I note Paul Garner wasn't involved, which is odd given his background in infectious disease and evidence review and his obvious ongoing interest in Long Covid. Perhaps he is too tired to do academic work these days?
 
RedFox said:
Chalder and Sharpe still at it? Sigh.

Also, we need to stop treating ME as a diagnosis of exclusion.
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Agreed. If medicine just keeps testing around ME, and never tests for abnormalities or dysfunctions that have been found by ME experts, this will further help delay knowledge about what is going wrong.

Doc says: "You don't have this, and you don't have that, and you don't have something else, so you must have ME."

But what has been learned about ME in this scenario? Just what it's not!
 
Hutan said:
There was a media article about the study in which he made it sound as though psychological measures were associated with going on to develop post-infection fatigue.
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I didn't see that article. Do you remember where it was or have a link for it? I'd be curious to read it.

Katz is at Northwestern and it was a study of Northwestern students. Lenny is at DePaul University. Both are in Chicago. Katz has generally held the views expressed by COFFI, as far as I know, so I was surprised that they collaborated. In any event, the study found paper zero pre-morbid psychological differences but various differences in metabolites related to specific metabolic pathways. I thought it was a good paper and my infectious disease colleague at Berkeley, John Swartzberg, praised the study design and thought it pointed out some interesting biological areas for further investigation. (There was some understandable confusion at how the study defined "severe" disease. Severe was defined as meeting more than one definition of the illness--I think they used Fukuda, CCC and ICC.)

I'm interested to ask Lenny what he thinks of Katz' participation in COFFI and this new paper, which mentions the Northwestern findings but essentially ignores them in its conclusions.
 
A Validated Scale for Assessing the Severity of Acute Infectious Mononucleosis, 2019, Jason et al
There's that one where it's a bit oblique, but there is a suggestion that there is a useful treatment, and Jason undertook to query it with Katz. But I'm sure there was something else by Katz referring more directly to risk factors in the mononucleosis study.

edit, it was that same article, specifically the sentence before the point about treatments, that made it sound as though the study had strengthened the idea that 'psychologic factors' were a risk factor:
"It appears that chronic fatigue syndrome might involve a combination of immunologic and psychologic factors, but we still don't know the exact cause or causes," says Dr. Katz.
...
Multiple studies have identified two treatments that may be effective for chronic fatigue syndrome—graded exercise therapy (physical activity that starts out slowly and is gradually increased over time) and cognitive behavioral therapy.
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"Potential follow-up research will evaluate if treatment for chronic fatigue syndrome begun at the time severe mononucleosis is diagnosed can reduce the chances of developing this challenging condition six months later," says Dr. Katz.
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Hutan said:
it was that same article, specifically the sentence before the point about treatments, that made it sound as though the study had strengthened the idea that 'psychologic factors' were a risk factor
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Hm, I don't remember seeing that at the time. In any event, the results paper didn't find any psychological parameters, but apparently Katz doesn't believe their own findings, I guess. Or doesn't find them convincing enough to not put his name on COFFI's paper.
 
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