Postcoronavirus Disease Chronic Fatigue Is Frequent and Not Only Restricted to Hospitalized Patients.

To the Editor:

We read with interest the study of Martillo et al (1) published in the recent issue of Critical Care Medicine, who report a high proportion of patients suffering from chronic fatigue 1 month after discharge from hospital for ICU-treated coronavirus disease 2019 (COVID-19). In the last month, physicians became more aware of the post-COVID syndrome, a new syndrome including more than 50 different conditions after a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (2), with fatigue, mental impairment, and dyspnea as the most frequent conditions. The reported frequency of symptoms ranges between 13.3% and 80% (3).

Martillo et al (1) only included patients that were treated on an ICU for at least 7 days in their analyses. However, the vast majority of SARS-CoV-2 patients receive only outpatient treatment. Further, most reports inclusive the study by Martillo et al (1) lack a control group.

Neuropsychiatric disorders are frequently described after other infections as well, for example, for Epstein-Barr virus infections and more broadly for sepsis. Until today, it is unclear whether the reported post-COVID symptoms are more frequent than those described after other infections. Thus, information on post-COVID symptoms in inpatients and outpatients is of special interest.

We reviewed all patients consecutively treated at the post-COVID outpatient clinic of the Jena University Hospital (n = 108) and compared them with patients after ICU-treated sepsis or septic shock (n = 290), who are a subsample of the “Mid-German Sepsis Cohort” (4).

Between August 2020 and March 2021, 108 patients (59 female, 49 male, median age 50 yr) were included after a median of 6 months after the primary infection with SARS-CoV-2. Forty-five patients (41.7%) had been hospitalized due to SARS-CoV-2 infection, including 19 patients (17.6%) on an ICU, and 63 patients (58.3%) were treated as outpatients, including 11 patients (10.2%) with initially asymptomatic infection.

All patients received a structured screening for neuropsychologic and cognitive disorders. Among them, chronic fatigue and depression occurred frequently in 87.0% and 74.1% of the patients. Interestingly, the severity of the initial infection as defined by the World Health Organization Ordinal Scale was comparable in outpatients (87.3%), inpatients (86.6%), and patients on the ICU (78.9%). Similarly, we observed no evidence for a correlation between the need for oxygen supply the occurrence of chronic fatigue (p = 0.725). Interestingly, when comparing the post-COVID patients to patients 6 months after sepsis, post-COVID patients seem to suffer more frequently from chronic fatigue (87.0% vs 35.2%; p < 0.001) and depression (74.1% vs 19.7%; p < 0.001).

In sum, our data suggest that neuropsychologic post-COVID symptoms like chronic fatigue and depression seem to be more frequently compared with other infections and are not only restricted to severe cases. Outpatients must be included into post-COVID care programs.