Estimates of Incidence and Predictors of Fatiguing Illness after SARS-CoV-2 Infection
Quan M Vu, Annette L Fitzpatrick, Jennifer R Cope, Jeanne Bertolli, Nona Sotoodehnia, T Eoin West, Nikki Gentile, Elizabeth R Unger
Emerging Infectious Diseases, doi:10.3201/eid3003.231194
A ccording to the Household Pulse Survey con- ducted by the US Centers for Disease Control and Prevention in January 2023, up to 15% of all US adults had experienced >1 symptoms of post-COVID-19 conditions (PCC), also known as long COVID or postacute sequelae of SARS-CoV-2 infection (PASC) (1). Among persons with PCC, fatigue is frequently reported in both hospitalized and nonhospitalized patients (2,3). A recent prospective cohort study reported 85% of patients who met its PASC definition had fatigue (4). A substantial percentage of patients with fatigue remain ill for many months with an illness similar to myalgic encephalomyelitis/ chronic fatigue syndrome (ME/CFS) ( 5 ), an unexplained syndrome sometimes seen after infections that is characterized by functional limitations that impair patients' ability to maintain daily activities and is associated with profound fatigue (6). The burden, distribution, and trend of PCC can theoretically be measured by using prevalence and incidence. The prevalence of PCC is a useful measure of overall disease burden at a specific time but is dependent on recovery, deaths, and incidence. The incidence of PCC measures the rate of new cases over a certain period and can be valuable for informing public health actions to reduce new illnesses. Numerous studies have estimated PCC prevalence, but very few have attempted to estimate PCC incidence because the incidence estimate requires information on timing of incident event and a well-defined population at risk that does not include prevalent cases (7). Both requirements are challenging in the context of PCC because they consist of a range of conditions and symptoms, most of which are not specific to PCC. To date, no diagnostic biomarkers are available, and recognition of PCC requires integrating medical history and clinical findings. Recent studies also emphasize the importance of an equivalent, concurrent, non-COVID-19 comparison group so that the effects of COVID-19 will not be overestimated (8). Given the central role of fatigue in PCC and the lack of data on incidence of fatigue among patients who have had COVID-19, we conducted a study of incident fatigue diagnoses among patients with and without COVID-19. Our objectives were to estimate the incidence rates of fatigue and chronic fatigue; quantify the additional incident fatigue caused by COVID-19; assess factors associated with incident fatigue; and describe deaths and hospitalizations among patients with incident fatigue after SARS-CoV-2 infection.
S crapie is a fatal neurodegenerative disease of sheep and goats that was the first of a group of spongiform encephalopathies to be reported (1732 in England) and the first whose transmissibility was demonstrated by Cuille and Chelle in 1936. The name resulted because most affected sheep develop pruritis and compulsively scratch their hides against fixed objects. Like other transmissible spongiform encephalopathies, scrapie is associated with an alteration in conformation of a normal neural cell glycoprotein, the prion protein. The scrapie agent was first described as a prion (and the term coined) by Stanley Prusiner in 1982, work for which he received the Nobel Prize in 1997.
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