Prevalence of severe fatigue after SARS-CoV-2 infection in Norway: a prospective 2-year follow-up study, 2026, Berg et al

[forestglip]

Prevalence of severe fatigue after SARS-CoV-2 infection in Norway: a prospective 2-year follow-up study

Spoiler: Authors

Berg, Kristine Karlsrud; Sarjomaa, Marjut; Tveten, Yngvar; Thilesen, Carina; Fell, Anne Kristin Moeller; Nordbø, Svein Arne; Reiso, Harald; Eikeland, Randi

Objectives
This study aims to estimate the prevalence of long-lasting severe fatigue and identify possible risk factors in a 2-year follow-up of patients with predominantly mild-to-moderate SARS-CoV-2 infection.

Design
Prospective cohort study. Setting A community-based cohort from Telemark and Agder Counties, Norway.

Participants
A total of 159 PCR-confirmed SARS-CoV-2 positive individuals in the period between 28 February and 17 December 2020 were included at 12 months after SARS-CoV-2 infection, and 93 responded at 24 months follow-up.

Outcome measures
Fatigue was assessed using the Fatigue Severity Scale (FSS), and health-related quality of life using the RAND version of health-related quality of life Short Form 36 (SF-36), developed by the RAND Corporation. SARS-CoV-2 antibodies were measured at 12 and 24 months.

Results
Severe fatigue (FSS ≥5) was reported by 36% at 12 months and 31% at 24 months. A higher proportion of women than men reported severe fatigue at 12 months (p=0.08). The number of acute-phase symptoms was associated with severe fatigue.

No association was found between severe fatigue and anti-SARS-CoV-2 antibody levels, demographic variables or reinfection status. The severe fatigue group scored significantly lower on all domains of SF-36.

Conclusion
In this cohort, severe fatigue was common, greatly impacted quality of life and persisted for up to 2 years following SARS-CoV-2 infection.

Fatigue severity was associated with symptom burden in the acute phase but not with antibody levels or other demographic variables. These findings underscore the need for long-term follow-up and support for affected individuals.

Web | DOI | PDF | BMJ Open | Open Access

 

[Utsikt]

The mechanisms underlying post-COVID-19 condition have been extensively studied but remain incompletely understood and are likely multifactorial and complex.10 Several therapeutic approaches have been investigated, including interventions focusing on physical activity11 12 and rehabilitation programmes based on cognitive and behavioural principles,13 with some evidence of effectiveness. Although physical activity interventions are generally considered safe, they should be individually tailored, as inappropriate exercise may worsen long covid symptoms, such as post-exertional malaise.11 12

11 is a meta analysis that seems to have the normal issues with quality assessment and using irrelevant objective outcomes.

12 is a meta analysis that botched the quality assessment by ignoring the lack of blinding.

13 is Nerli, which had a null result.

So there really is no reliable evidence of benefit.

Based on our data, we cannot assume that psychological and emotional stress, measured with HADS, is a risk factor for severe fatigue after SARS-CoV-2 infection. The association might also be due to long covid symptoms leading to increased anxiety and depression symptoms. It is also important to acknowledge that individuals with long covid who experience social vulnerabilities may be more likely to develop symptoms of anxiety and depression.35The causality of the association between anxiety and depression symptoms and long covid warrants further study.

The caveats are a good start, but it doesn’t seem like they are aware of the terrible construct validity of the HADS scale. It will flag sick people as anxious or depressed.