Screening of a Small Number of Italian COVID-19 Syndrome Survivors by Means of the Fatigue Assessment Scale, 2021, Serafini

Discussion in 'Long Covid research' started by Dolphin, Nov 4, 2021.

  1. Dolphin

    Dolphin Senior Member (Voting Rights)


    Screening of a Small Number of Italian COVID-19 Syndrome Survivors by Means of the Fatigue Assessment Scale: Long COVID Prevalence and the Role of Gender

    Antonella Serafini
    Alberto Tagliaferro
    Francesco Balbi
    Alberto Bordo
    Stefano Bernardi
    Giorgio Berta
    Lorenzo Trucco
    Enrico Perretta
    Elisa Gualco
    Patrizia Zoccali
    1 and
    Claudio De Michelis

    S.C. Pneumologia—Ospedale Imperia, Via Sant’Agata 57, 18100 Imperia, Italy
    DISAT, Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129 Torino, Italy
    Consorzio Interuniversitario Nazionale per la Scienza e Tecnologia dei Materiali (INSTM), Via G. Giusti 9, 50121 Florence, Italy
    Authors to whom correspondence should be addressed.

    COVID 2021, 1(3), 518-527;
    Received: 24 September 2021 / Revised: 23 October 2021 / Accepted: 26 October 2021 / Published: 29 October 2021


    Months after healing, a number of COVID-19 syndrome survivors are affected by both psychological and physical limitations.

    They are mainly troubled with long-term fatigue, which is a crucial aspect of Long Covid syndrome.

    This paper aims to investigate the level and persistency of fatigue among COVID-19 survivors from the first wave of the pandemic in Western Liguria and to elucidate the role of gender, age, and lifestyle.

    It also provides data to the scientific community to help drawing a consistent picture of Long Covid syndrome.

    The patients were requested to fill a Fatigue Assessment Questionnaire twice:

    (i) a few weeks after discharge from hospital or home confinement
    (ii) a few months later. Statistical analysis was carried out on the global scores and on the score for every single item of the questionnaire.

    The outcome of the two questionnaires were analyzed separately and compared.

    Females are more affected by fatigue than males.

    This results holds for both physical and mental fatigue.

    All the males’ fatigue scores were reduced at the second control, while 40% of females worsened it.

    Home-confined patients showed a higher fatigue score at the first check.

    In the initial stages of the recovery, patients are more affected by physical, rather than mental, fatigue.

    This is worth of further investigation as well as the reasons leading to a higher initial fatigue score for home cared patients.

    Keywords: chronic fatigue; long-COVID; gender issue
  2. Arnie Pye

    Arnie Pye Senior Member (Voting Rights)

    Given that, during their fertile years, women lose blood during periods (and the amount can be substantial), and they can often end up low in iron, iron deficient, or actually anaemic, fatigue isn't very surprising. And given that women are rarely tested for low or deficient iron and ferritin, but are lucky if they get a Full Blood Count done and nothing else, and also given that when a woman is found to be low in ferritin she is lucky to get a prescription for iron supplements that will just about push their result into the lower reaches of the reference range (if she's lucky to get that far), this is another reason for fatigue.

    [I could make the same arguments about low vitamin B12 and folate.]

    Also, autoimmune diseases are far more common in women, sometimes take years to get diagnosed, and many of those will cause fatigue, it is not remotely surprising that people with Long Covid are more likely to be female. There is a chance that some of the subjects of this research were low in iron (and hence fatigued) before they ever got Covid. Similarly, the subjects may have been fatigued before getting Covid, whether or not they were low in iron.

    Another factor could be that society's expectations are that women should go back to work even before they are fully recovered, and they will be expected to do childcare, housework, as well as their normal occupation for which they are paid.

    Talking about being "unwilling" to carry on an activity, and having a distaste towards activity suggests that the authors of the paper are unfamiliar with ever being severely fatigued. They make it sound as if fatigue is a mental illness.
  3. rvallee

    rvallee Senior Member (Voting Rights)

    Off to a very rough start that makes many assumptions. And it doesn't get much better from there. It's so obvious how so much research out there is done just for the sake of putting their name to something, don't even bother giving it any effort.
    Hutan, Starlight, Milo and 2 others like this.
  4. Mithriel

    Mithriel Senior Member (Voting Rights)

    When reading the stories of people with longcovid, I was struck by the fact that a lot of them said that they would begin to feel fine again, try to go back to work, or exercise but then they would be unable to get out of bed a few days later.

    That is a classic description of ME. Ramsay referred to this variability as characteristic of ME and contrasted it with the chronic fatigue the likes of Wessely kept saying was the same.

    So here we are thirty odd years later where they are using a fatigue scale which is not fine enough to pick out variability so they are again constraining the description of the disease instead of looking at what is actually there.
    Amw66, Art Vandelay, Hutan and 4 others like this.
  5. Hutan

    Hutan Moderator Staff Member

    Aotearoa New Zealand
    I'm thinking there are quite a few translation problems in this paper, making the errors about Long Covid and ME/CFS worse.
    NelliePledge, Wyva and Peter Trewhitt like this.
  6. Hutan

    Hutan Moderator Staff Member

    Aotearoa New Zealand
    For those of you wondering what the 'small number' in the title of this paper actually means:
    So, yes, it is pretty small.

    My bolding. So, we can't be sure what percentage of people (i.e. percentage of the 23 people) have fatigue after a year.

    There are a lot of problems with this paper that make it mostly useless, but I did like that they presented the questions for the Fatigue Assessment Scale that they used, and reported results for each of the questions. This reveals the shortcomings of the Fatigue Assessment Scale - which apparently has been used in a range of illnesses. For example, there were changes in Q1 "I am bothered by fatigue", but no changes in 8. "I feel no desire to do anything".

    So, it's possible to look at the responses to Question 1 on its own.
    Q1. I am bothered by fatigue
    The scoring is 1 to 5: 1. never; 2. sometimes; 3. regularly; 4. often; 5. always

    Straight after the illness
    males averaged about 2.8 - regularly; females averaged 4 - often
    (more females than males were 'home confined' rather than admitted to hospital)

    Approximately - either after the resolution of fatigue or after something like a year
    males averaged 1, - never; females averaged about 2.6 - regularly
    Looking at the SD bars, there isn't a lot of variation between people in a gender group. I am a bit doubtful that anyone in this small sample actually has Long Covid - as I think the level of fatigue would be more likely to be scored at least a 4 (often).

    The thing I'll take away from this study is @Arnie Pye's point. The authors give us no idea what answers healthy people would give to these questions. I suspect most healthy women would also answer that they are regularly bothered by fatigue. The range of activities that many women do is so great, and it's often the case that men aren't carrying an equivalent workload. It's easy to assume that a sample of women have levels of fatigue suggestive of Long Covid, when in fact the problem they have is more a societal one - trying to do all of the things society expects of them, and they expect of themselves. Or hey have another medical reason such as low iron. Perhaps too, it is less acceptable for men to report fatigue.

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