Post-Covid-19 syndrome (PCS), also known as long Covid, is defined as symptoms and signs of Covid-19 that remain after 12 weeks of initial acute infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The growing number of diagnosed PCS patients is quickly becoming a public health concern due to the impact that morbidity associated with PCS symptoms has on daily life activities. An inability to work due to chronic or debilitating PCS symptoms such as fatigue is not only damaging to the individual’s physical and mental health, but it also reduces the pool of people of working age who would otherwise be in employment.
A recent nationwide study, published in March 2023 in BMJ Open, led by Walker and colleagues, looked at the impact of PCS symptoms on functional impairments and health-related quality of life (HRQoL). They found worryingly high levels of functional impairment and low HRQoL in treatment-seeking PCS patients, and fatigue was the greatest predictor of this and the cause of the inability to work and care for others.
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A total of 3,754 treatment-seeking PCS patients were identified from 31 specialised Covid-19 treatment centres in England and Wales; patients completed the Work and Social Adjustment Scale (WSAS) validated questionnaire, which measures the level of functional impairment, where a score of 20 or higher equates to experiencing moderately severe limitations. The HRQoL was measured based on EQ-5D scores, and other symptoms measured included fatigue, anxiety, depression, cognitive impairment, and breathlessness. The mean WSAS score was 20.6, with 53% of those in the moderately severe category scoring above 20. The highest rates of functional impairment seen in the WSAS domain were in the Social Leisure Activities and Ability to Work categories; the least affected category was Close Relationships. Regarding HRQoL, 96.2% of patients reported pain/discomfort, 95% reported anxiety/depression, and 36% reported no problems based on the evaluation of patient EQ-5D scores. A concerning 20.3% of patients reported losing 20 to 28 days from work in the past four weeks. Extreme fatigue was commonly experienced among PCS patients, with a mean Functional Assessment of Chronic Illness Therapy-Fatigue score of 19.6, which is well below the threshold value of 30. Patients experiencing fatigue were 16% more likely to score a high WSAS score; fatigue scores reported by PCS patients were worse than those reported by patients with stroke, anaemic cancer, and inflammatory bowel disease. This adds to the evidence showing how fatigue in the severe form can interfere with daily life. Mental health in PCS patients was also impacted; the mean score for depression in patients was also past the threshold for clinical depression.
PCS symptoms such as fatigue, depression, and cognitive impairment were significant predictors of functional impairment in patients; this vital data provided by the study is a valuable insight for clinicians and public health professionals to design appropriate services to reduce the burden of disease caused by PCS and alleviate the stresses felt by patients suffering from PCS.
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