Preprint Post-Viral Frailty in Long COVID: A Distinct Phenotype within Veterans, 2025, Bradley et al

Post-Viral Frailty in Long COVID: A Distinct Phenotype within Veterans

Jerry Bradley, Elizabeth Bast, ha M. Resendes, Fei Tang, Victor D. Cevallos, Dominique M. Tosi, Leonardo Tamariz, Ana Palacio, Iriana S. Hammel

Background
Long COVID is characterized by persistent symptoms affecting one or more organ systems for at least 3 months following a SARS-CoV-2 infection. The pathophysiologic mechanisms of this complex disease are poorly understood. Beyond the described symptoms of fatigue, dyspnea, myalgias, among others, Long COVID can affect the patient’s ability to work and function in society compared to their baseline. Frailty is defined as the decline of physiologic reserve that leads to increased vulnerability to stressors and poor health outcomes. Our study aimed to examine the characteristics of frailty seen in patients with Long COVID compared to the frailty seen in aging patients with multimorbidity.

Methods
This is a retrospective cohort study conducted in the Miami Veterans Affairs Medical Center (VAMC). The data used to calculate the Fried phenotype through the Johns Hopkins frailty calculator was collected from two separate clinics, a Long COVID clinic and a Geriatric Frailty clinic. We obtained the VA Frailty Index from VA CDW (Corporate Data Warehouse).

Results
We included 106 patients from the Long COVID clinic and 97 from the frailty clinic. Patients from the Long COVID clinic were significantly younger than those from the frailty clinic (60±12.6 vs.. 79.8±5.8, p<0.01). In the standard frailty group, weakness and slowness were the predominant features present in both the frail and pre-frail groups, with increasing exhaustion and lower activity in the frail group. Patients with frailty in the Long COVID group experienced exhaustion and low activity at a higher rate than those in the Geriatric frailty clinic.

Conclusions
Long COVID may predispose patients to develop a subtype of frailty (“post-viral frailty”) that presents with a higher frequency of exhaustion and low activity. This frailty appears phenotypically different from the frailty encountered in geriatric patients with multimorbidity, which presents more often with slowness and weakness as the initial drivers.

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A different type of frailty called PEM perhaps? Which isn’t actually frailty.