Persistent fatigue following SARS-CoV-2 infection is common and independent of severity of initial infection July 2020 Townsend et al

Snow Leopard said:
Depression/Anxiety was based on prior diagnoses or use of antidepressant medication.

The real problem is that caseness was based on the aforementioned crap questionnaire.

Notably, 86.6% of "Fatigued" participants did not have any prior depression/anxiety diagnoses, so this a weak predictor at most.
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It seems they might be open for input, so hopefully that leads to some changes :) Well done, @Trish
 
Trish said:
Oh dear. I think the next link to offer them is to Mark Vink's latest paper deconstructing Cochrane and focusing on return to work.
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Well, at least that explains the use of the CFQ, when they actually advise the thing that is most likely to harm and otherwise does absolutely nothing.

Can we not get people who know what they're doing? No? Is that too much to ask? That experts have, you know, EXPERTISE?! I repeat myself again but: ugh.
 
Participants were recruited from the post-COVID-19 outpatient clinic, which offers an outpatient appointment to all individuals with a positive SARS-CoV-2 nasopharyngeal swab PCR at our institution.
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Could be selection bias here - patients who visited a post-COVID-19 outpatient clinic, might be preselected for having post COVID-19 symptoms.
Prior to COVID-19 illness, the majority (82%;105/128) had been employed, of whom 33 (31%) had not returned to work at time of study participation.
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This probably says more than the Chalder Fatigue Scores.

It is interesting that none of the factors in their regression models was a significant predictor of their post-COVID-19 fatigue scores, not even factors related to the severity of the initial infection. They write: " There was no association between COVID-19 severity (need for inpatient admission, supplemental oxygen or critical care) and fatigue following COVID-19."
Female gender and those with a pre-existing diagnosis of depression/anxiety were over-represented in those with fatigue.
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But a pre-existing diagnosis of depression/anxiety was not included in the regression models. Also: couldn't simply be that these persons had fatigue for other reasons than COVID19?
 
Michiel Tack said:
But a pre-existing diagnosis of depression/anxiety was not included in the regression models. Also: couldn't simply be that these persons had fatigue for other reasons than COVID19?
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On the contrary to the authors claims, an unexpectedly low number (1.6% compared to population norms) of depression/anxiety was associated with an absence of caseness. In fact diagnoses in both groups were below Irish norms, agreeing with your hypothesis of participation bias.
https://www.cambridge.org/core/jour...e-in-ireland/1C2AFBEDFE53E7F21217172CAB62B0B2 (16% in primary care)

The absence depression/anxiety in the regression models is because the authors did not hypothesise that it would matter and thus didn't include it in t their model. It is possible that the association would disappear in a regression model.
 
Is it made clear what is meant by 33 had not returned to work at the time of study participation? Does this include, or not include, those who had returned to work but then discovered they were unable to continue and were taking further time off?
 
I've had a query from a friend's son who is a journalist in America if there are any figures on numbers of longhaulers? The only thing I could suggest was this paper, so I've referred him to the forum, as it's a public thread. Are there any others we are aware of? He wants figures, not just stories, but I've offered it's too soon really. Any suggestions are welcome, thanks!
 
chrisb said:
Is it made clear what is meant by 33 had not returned to work at the time of study participation? Does this include, or not include, those who had returned to work but then discovered they were unable to continue and were taking further time off?
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And does it include those who were able to work but had been furloughed?
 
I must say I find it very difficult to believe that 52% of covid patients have persistent fatigue 10 weeks after infection. Wouldn't it have been reported much more widely if that were the case?

There was a different study which found that like 10% of people had persistent symptoms (at I can't remember what time after infection), wasn't there?
 
It would be more interesting if they would specify the type of CBT which they consider appropriate, and its purpose
 
The more I read, the more I'm coming to the conclusion that the best way to estimate physical and mental fatigue levels in these studies might be to ask a short series of simple questions about general function before the illness, and then again afterwards. At least for adults, a picture of the extent to which 'normal life' (in the broadest sense) has been affected by the illness could reveal quite a lot.

This is the sort of thing I was thinking of. It would fail when someone has a specific issue that means they can't progress through it as intended – for instance, someone might have no energy impairment but be unable to leave the house because of agoraphobia – but if more skill and experience went into the compilation, it should be possible to put something together that will work for a good proportion of respondents.


Only answer Yes if you're confident you'd be able to repeat the activities reliably over a period of at least four weeks. It doesn't matter whether you're actually doing all of them at the moment, the questions is whether you'd have enough energy and wellness to do them.

(1) Could you meet basic needs such as eating, toileting, washing and dressing every day?

(2) In addition to (1), could you read, watch TV, use the internet, or do puzzles for at least half an hour every day?

(3) In addition to (1 and 2), could you cook a meal or do an hour's housework three times a week?

(4) In addition to (1 to 3), could you go out to fetch shopping or attend an appointment at least twice a week?

(5) In addition to (1 to 4), could you do your usual job, follow an apprenticeship, study for a qualification, or look after a child/an adult with care needs, for at least 18 hours a week?

(6) In addition to (1 to 5), could you walk or self-propel a wheelchair on level ground for at least 20 minutes every day?

(7) In addition to (1 to 6), could you do 45 minutes of moderate aerobic exercise at least twice a week, such as an exercise class, swimming, walking, riding a bike, or gardening?

(8) In addition to (1 to 7), could you do sustained exercise at least once a fortnight, such as running or propelling a sitting bike for 15 km, riding a standard bike for 40 km, or training for competition (at any level) in a sport?
 
As I found when I tried to do a series of descriptors that indicated increasing functional capacity, one person can do activity A but not activity B, and another person it is the reverse - especially if you mix together physical and cognitive activities, so on your list, @Kitty I can't do all the activities in the first category daily, but I can do the second.
 
Trish said:
I can't do all the activities in the first category daily, but I can do the second.
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That's why I added 'in addition to'. I think questionnaires need to put more emphasis on the accumulation of daily or weekly activities than they do on specific types of activity. Otherwise, it can appear that people are able to do more than they really can, due to the fact that they may routinely sacrifice one activity to enable another. It's probably a universal strategy among chronically ill people for managing energy, but it can so easily get obscured in long lists of questions.
 
I really have difficulty believing that "over half" of covid patients are left with ongoing fatigue. Is this really a valid study? Wouldn't we have already known if it was that common? My impression is that it is a minority of people. If it was half of all people who've had covid, it would have been huge in the news long before now, surely. And the King's College study said that 10% of people have ongoing symptoms (can't remember what time frame they were looking at).
 
Sarah94 said:
I really have difficulty believing that "over half" of covid patients are left with ongoing fatigue. Is this really a valid study? Wouldn't we have already known if it was that common? My impression is that it is a minority of people. If it was half of all people who've had covid, it would have been huge in the news long before now, surely. And the King's College study said that 10% of people have ongoing symptoms (can't remember what time frame they were looking at).
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The study that the news report cites has methodological limitations (such as poor quality operationalisation of "persistent fatigue" caseness using the Chalder Fatigue Questionnaire!) and is discussed here:
https://www.s4me.info/threads/persi...ial-infection-july-2020-townsend-et-al.16128/
 
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