Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is common in post-acute sequelae of SARS-CoV-2 infection (PASC): Results from a post-COVID-19 multidisciplinary clinic

Abstract

Background The global prevalence of PASC is estimated to be present in 0.43 and based on the WHO estimation of 470 million worldwide COVID-19 infections, corresponds to around 200 million people experiencing long COVID symptoms. Despite this, its clinical features are not well defined. Methods We collected retrospective data from 140 patients with PASC in a post-COVID-19 clinic on demographics, risk factors, illness severity (graded as one-mild to five-severe), functional status, and 29 symptoms and principal component symptoms cluster analysis. The Institute of Medicine (IOM) 2015 criteria were used to determine the ME/CFS phenotype. Findings The median age was 47 years, 59.0% were female; 49.3% White, 17.2% Hispanic, 14.9% Asian, and 6.7% Black. Only 12.7% required hospitalization. Seventy-two (53.5%) patients had no known comorbid conditions. Forty-five (33.9%) were significantly debilitated. The median duration of symptoms was 285.5 days, and the number of symptoms was 12. The most common symptoms were fatigue (86.5%), post-exertional malaise (82.8%), brain fog (81.2%), unrefreshing sleep (76.7%), and lethargy (74.6%). Forty-three percent fit the criteria for ME/CFS. Interpretations Most PASC patients evaluated at our clinic had no comorbid condition and were not hospitalized for acute COVID-19. One-third of patients experienced a severe decline in their functional status. About 43% had the ME/CFS subtype.

ME/CFS and Post-Exertional Malaise among Patients with Long COVID

“…This study confirms prior research showing that a substantial percentage of people who contract COVID-19 develop a condition that meets the criteria for a CCC diagnosis of ME/CFS. This percentage is comparable to earlier studies [ 16 , 17 , 18 , 20 ], except that of González-Hermosillo et al [ 21 ]. It is apparent that many who have been infected with SARS-CoV-2 and have persisting symptoms will meet a ME/CFS case definition.…”

“…For example, in the study by Jason and Islam [ 16 ] of 359 patients with Long COVID, 49% met ME/CFS criteria. In another study of 140 participants with Long-COVID, Bonilla et al [ 17 ] found that 43% met the criterial for ME/CFS; Twomey, et al [ 18 ] found that 58.7% of those infected with COVID-19 meet ME/CFS criteria. Similarly, Mancini et al [ 19 ] studied patients with unexplained dyspnea among those who had Long COVID for a mean of 8 months and found that 46% met the criteria for ME/CFS.…”

An Exploratory Factor Analysis of Long Covid

“…Recent research has found that from 43% to 46% of patients with COVID-19 symptoms meet one or more Myalgia Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) case definitions [18,19,20,21]. Research of ME/CFS might suggest ways to measure Long COVID symptoms.…”

“…In the ME/CFS field, using statistical methods to classify patients has helped identify latent factors [23], and similar methods are beginning to be employed to identify critical domains of COVID-19 and Long COVID symptoms. For example, Guo et al [24] [18] PCA resulted in the following five components: fatigue, post-exertional malaise, daytime sleepiness (lethargy), brain fog, and unrefreshing sleep.…”

“…the second factor labeled PEM/Fatigue/Cognitive Dysfunction, four of the eight prior studies found one or more of these symptom clusters (See Table 5). The latent factor also makes conceptual sense because fatigue and post-exertional malaise cause cognitive impairment, and these types of symptoms are common among those with ME/CFS, which is present in approximately 50% of patients with COVID-19 symptoms [18][19][20][21]. For this factor, those who are severely impaired by Long COVID appear to have more difficulties than those who are only moderately/mildly affected.…”