Long lasting impact of acute prolonged covid illness

The Charité study followed patients with pronounced fatigue over 20 months.

A new study has found that many people with post-Covid syndrome, who suffer from fatigue even six months after contracting the coronavirus, are still physically severely affected 20 months later. Most patients who develop myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) are acutely ill with no change. In contrast, patients with similar symptoms who do not meet the diagnostic criteria for ME/CFS experience a gradual improvement in their symptoms.

Patients with health problems after three months Sars-Cove-2 The infection, which continues with symptoms for at least two months and there is no other explanation for these complications, is said to have post-Covid syndrome (PCS), also known as “prolonged Covid”.

Symptoms vary widely. Many have breathing problems, trouble concentrating, or lack of stamina. Most people with PCS complain of fatigue, which rarely improves with normal rest and recovery. In many cases, these people struggle to cope with daily life, and even minor exertion worsens their condition, which is called exertional intolerance. This condition is more common in women than men.

Patients and others naturally wonder how long these symptoms last. Findings from several studies are now available for the first few months following infection. According to this research, the more severe the initial infection, the longer recovery usually takes. Many – but unfortunately not all – symptoms improve within a year. The long-term progression of the disease in these patients remains unclear.

Investigating post-Covid acute fatigue

The study, just published, focused on people who suffered from severe fatigue and exercise intolerance six months after being infected with SARS-CoV-2. In contrast to studies based solely on patients’ descriptions of symptoms, this study involved a comprehensive clinical examination of 106 participants — most of them women — at three time points several months apart.

“Unfortunately, our data show that people with post-Covid syndrome who have severe fatigue are still sick more than a year and a half after the initial infection,” says Dr. Judith Bellman-Strobl, the last author of the study and senior physician. Neuroimmunology Outpatient Clinic at the Experimental and Clinical Research Center (ECRC), a joint institution of Charide and the Max Delbrück Center. “Only about half of them — the half who don’t have the full range of symptoms of ME/CFS — experience gradual improvement in at least some symptoms.”

Distinguishing types of fatigue in PCS patients

Researchers observed last year Prolonged Covid sufferers with severe fatigue and exercise intolerance fall into two groups. Few patients meet the diagnostic criteria for ME/CFS, a complex neurological disease characterized by severe fatigue, work intolerance, and post-exacerbation of symptoms leading to physical disability. Patients in the second group experience similar symptoms, but their post-labor symptoms are usually mild and do not last long.

The new study showed that the latter group experienced some improvement over time, not only in terms of fatigue, but also in terms of general malaise, pain and concentration problems. The functional capacity of these individuals often improved, and some of those studied were even able to return to work. In contrast, post-Covid patients with ME/CFS saw no change in their symptoms. There were very few exceptions.

“Seven out of 55 patients with ME/CFS reported improvement in their physical impairments,” Bellman-Strobl explains. “But we still don’t have an explanation for this, and we can’t identify any clinical commonalities.”

Grip strength: a potential indicator?

Another observation made in the study may be useful for gauging how post-Covid syndrome will progress in people who meet diagnostic criteria for ME/CFS: Grip strength in these patients was stronger at the onset of the illness, less severe. Their symptoms persisted for up to 20 months.

“Seizure strength was not only a parameter of how severe the disease was, but also a predictor of how ME/CFS would progress,” explains Professor Carmen Schiebenbogen, Executive Director and Head of the Institute of Clinical Immunology at Charité. Charité Fatigue Center. She and Bellman-Stroble were the principal investigators on the study. “Before grip strength can be used as a prognostic factor, more studies are needed to confirm how meaningful it is,” points out Schiebenbogen.

“The WHO now puts the number of people living with prolonged Covid-19 in Europe at around 36 million. Most of them experience impairments in everyday life, and many can no longer lead normal lives,” he explains. “Before the pandemic, it was estimated that there were around three million people with ME/CFS in Europe. , and according to the data we currently have, that number is now more than double because of the pandemic. Our study shows that most people with ME/CFS are severely ill. In addition to increasing our efforts to find effective treatments, this means rapidly establishing health facilities where patients can receive multidisciplinary care based on current scientific findings and clinical experience.

In the absence of treatments to alleviate symptoms and instead address the root cause of post-Covid syndrome and ME/CFS, Bellman-Stroble’s main recommendation is for patients to pace themselves before depleting their energy reserves. Don’t overextend yourself. Tools that can help with this include fitness trackers or pedometers, heart rate monitors, activity journals, and relaxation exercises.

“Pace can prevent post-exercise malaise, which worsens the person’s condition. The best patients do with pacing, their symptoms are minimal. People need to be very careful about realizing their limits in terms of exertion. Professional guidance can help prevent overexertion.”

Note: “Long-Term Symptom Severity and Clinical Biomarkers Post-COVID-19/ Chronic Fatigue Syndrome: Franziska Lechler, Lille Mayer-Arnt, Lucas Motl, Claudia Gedor, Helma Freitag, Elisa Stein, Uta Hoppmann, Rebecca Rust, Kirsten Widrake, Niersten Vidrien, Kirsten Widrake, Frank Konietschke, Friedemann Paul, Carmen Scheibenbogen and Judith Bellmann-Strobl, 18 August 2023, Medical medicine.
DOI: 10.1016/j.eclinm.2023.102146