The fatigue spectrum in a community-based long haul COVID cohort 2026 Strohl et al

[Andy]

Abstract​

Introduction​

In a Long Haul COVID referral clinic we describe the primary presentations of fatigue according to the CDC 2015 criteria for myalgic encephalitis/chronic fatigue syndrome (ME/CFS).

Methods​

Between September 2021 and April 2022, 277 patients (61% women, 54 yrs: range 18–90 yrs) presented an average of 10 months after an acute COVID-19 infection (22% hospitalized). The clinical data were analyzed to conpare those with or without a primary or co-primary complaint of fatigue, subdivided as meeting ME/CFS criteria or not.

Results​

209 (73.5%) people (64% women) presented with fatigue. The Fatigue Severity Score was 5.33 (out 7) in those with 5.31 (SD1.54) vs. without 4.43 (SD1.65) a primary fatigue complaint (p > 0.001). Anxiety (58% vs. 38%, p < 0.02) and any psychiatric diagnosis (66% vs. 44%%, p < 0.01), but not depression itself, were overrepresented in those with Fatigue and ME/CFS. Those with prior managed sleep conditions did not increase risk for fatigue presentation. Of those with fatigue and an elevated FSS, 45/209 (21.9%) met criteria for ME/CFS. In those not meeting these criteria, associated ME/CFS symptoms were less consistent. Physical functioning by ECOG (1.88 (0.78) and 26% >2) did correlate with fatigue status. Depression was present (PHQ9 12.34 (5.95) with 63% >10) to a moderate or higher degree and was different with fatigue complaints. Brain fog (51.9%) was similar among the three categories, and correlated with FSS > 4, ECOG, and depression.

Conclusions​

The fatigue phenotype in those presenting with it as a primary complaint comprises 21% meeting ME/CFS criteria and 79% which do not. In all the Long Haul COVID presentations. brain fog had separate, distinguishing features. Post-COVID fatigue is a spectrum which will confound clinical trials.

Open access

 

[Andy]

Not sure how much trust we can put in to the authors understanding of ME/CFS criteria.

"At its start in 2019, the group focused on the complaint of fatigue, and used as a template the Myalgic Encephalitis/Chronic Fatigue Syndrome (ME/CFS), defined by the CDC in 2015 [4]. This classification had limitations but a proposed alternative syndrome, “systemic exertion intolerance disease”, did not provide criteria [5]. A recent repeat 2024 effort by the IOM on post-COVID presentations resulted in acknowledging that diagnostic importance of persistence of symptoms, collection of features, and diagnostic categories including that of ME/CFS were relevant, emphasizing that long COVID is not a diagnosis of exclusion [1]."

Ref 4 is to a "viewpoint" article on the IOM criteria, and ref 5 is an opinion piece by Frank Twisk on perceived shortcomings of the IOM report - he specifically notes the criteria for SEID, which the authors here claim doesn't have criteria.....

And here we see the authors assessment of ME/CFS caseness

"Intake questionnaires

The initial evaluation consisted of intake questionnaires on fatigue (Fatigue Severity Scale), depression (PHQ9), anxiety (GAD-7), physical functioning (ECOG), and cognitive impairment (MOCA). Scores were recorded from the initial visit note and verified in the uploaded files.

A determination of Myalgic Encephalitis/Chronic Fatigue Syndrome (ME/CFS) was based on the 2015 CDC definition [4] consisting of: the three core symptoms of fatigue lasting months after the acute infection- post-exertional exacerbation and malaise, and unrefreshing sleep- as well as either impaired memory/concentration and/or orthostatic intolerance. The complaint of post-exertional increase in fatigue was obtained from question 2 in the FSS scale as a score of >4."