Prevalence of Chronic Fatigue in Post COVID-19 Patients in Twin Cities

acute


I N T R O D U C T I O N
COVID-19 is linked to clinically severe symptoms despite the initial infection has subsided. The acute symptoms and recovery from coronavirus disease 2019  are mainly in the headlines. However, many people who have recovered deal with ongoing physical, mental, and psychological issues long beyond the acute stage. The most persistent and debilitating of these symptoms is fatigue. Objective: To determine the prevalence of chronic fatigue in post COVID-19 patients living in Twin cities (Rawalpindi and Islamabad). Methods: A descriptive crosssectional survey was conducted and the data were collected from the population living in Islamabad and Rawalpindi using a non-probability convenient sampling technique. The study was completed within 6 months after the approval from the ethical committee. Data were collected through a self-structured questionnaire containing demographics and a fatigue severity scale was used to assess chronic fatigue. Results: There were 382 participants enrolled in total. Out of which 54.2% were females and 45.8% were males. According to the results of the fatigue severity scale 65.4% participants reported chronic fatigue. Out of the 207 female participants, 148 (71.5%) reported chronic Fatigue while 159 (28.5%) were non-fatigued. The results also showed that out of 175 males, 102 (58.3%) reported chronic fatigue and 59 (41.7%) were non-fatigued. Conclusions: The current study concluded that most of the population in the Twin cities (Rawalpindi and Islamabad) had a prevalence of chronic fatigue in post COVID-19 patients.
interferon-gamma and interleukins are released following the viral infection, passing through the blood-brain barrier and affecting the central nervous system organs such as the hypothalamus [7]. The autonomic alteration resulting from hypothalamus involvement may cause cognitive abnormality, imperfectly regulated sleep/wake cycle, and serious fatigue [8]. Many people survived but many lost their lives during this pandemic. Those who survived had acute and chronic effects on their health and chronic fatigue is one of them. It also referred as common complain seen in primary health cases [5]. Majority of individuals that have recovered present with the complain of weariness and exhaustion [9]. Due to this reason, it was necessary to estimate the generality of fatigue in post COVID-19 patients. Worldwide some researchers have been done on the prevalence of chronic fatigue but there was less literature available on this topic in Pakistan so there was a need to nd out the prevalence and effects of chronic fatigue. The current study makes an attempt to assess the prevalence of chronic fatigue in post COVID-19 patients in twin cities.
The current study was a cross-sectional survey. The data were collected from population living in Islamabad and Rawalpindi. After approval from the ethical committee, the study was completed within 6 months. The sample size calculated from Epitool was 382. A non-probability convenient sampling technique was used in this study. Patients with age 18 years or above, Post COVID-19 patients of 4 or more than 4 months, Patients infected with any COVID-19 variant (Delta, omicron etc.), Patients with at least one positive PCR were included. Patients with any Neuromuscular, Systemic and Musculoskeletal disorders, Patients with any Psychological or mental illness, and those who had any Disease associated with fatigue were excluded from the study. Demographic data were collected on a self-administered questionnaire that consists of (name, age, gender, marital status, height, weight, education and occupation). Data on COVID-19 related sy m p to m s we re c o l l e c te d o n a s e l f-s t r u c t u re d questionnaire. It includes the onset of symptoms, the kind of symptoms experienced by the patient during COVID-19 and post-COVID-19 and their current health status. The information regarding PCR and quarantine period was also collected. Fatigue was assessed using the Fatigue Severity Scale is a 9-item scale where responses were collected on a 7-point Likert scale where 1 represents "strongly disagree" and 7 represents "strongly agree". Its contents included nine statements for responding to fatigue e.g., how fatigue affects motivation, exercise, physical functioning, carrying out duties, interfering with work, family or social life. Score ranges 1-7. A higher score indicates more severe fatigue. According to the interpretation of fatigue severity scale, two categories were made based on the responses of Fatigue Severity Scale, non-fatigued category which scored less than 36 and fatigued category which scored 36 or greater than 36. SPSS version 21.0 (Statistical Procedure of Social Sciences) software was used to analyse the data. The data were analysed using descriptive statistical methods (mean, frequency, and percentage).

R E S U L T S
We approached 420 individuals for the current study. The study disquali ed 38 participants who failed to meet the inclusion criteria for participation. Out of 38 participants, 20 participants were those whose PCRs were negative, 10 were under the age of 18, and 8 had neuromuscular and other illnesses so 382 participants who met our inclusion criteria were included. Participants demographics and characteristics have been shown in Table 1.  (1) 31 (8) 53 (14) 195 (51) 99(26)
3. On the basis of these categories fatigue was prevalent in 65.4% of the participants.
According to the Fatigue Severity Scale ndings, out of 207 female participants 148(71.5%) female participants reported fatigued while 59(28.5%) were non-fatigued. Fatigue Severity Scale also nds out that out of 175 male participants 102(58.3%) male participants reported fatigued while 59(41.7%) were non-fatigued as shown in Figure 1.

Variables
The acute COVID-19 disease and the post-COVID condition have both been linked to post-COVID fatigue, which has been reported to be one of the main complaints. The current research con rms that post- Participants in the current study were split into two groups. "Non-fatigued" was de ned as having a fatigue severity scale score of less than 36, and severe "Fatigued" was de ned as having a score higher than 36 as shown in Table [17][18][19][20]. A previous study evaluated 201 patients six months after hospitalisation who had Wuhan, Alpha and Delta variant infections. Similar post-COVID-19 fatigue was observed in all three SARS-CoV-2 genotypes (70%). The inclusion of elderly and middleaged persons in the study, whose mean age was 60.510.5, may be the cause of the disparity in the results [9]. Those subjects who had at least one positive PCR result were included in this study. While a prior study included people with 2 consecutive negative PCR results, other studies also included positive PCR veri ed post-COVID-19 individuals [21].