Post-COVID-19 syndrome patients experience fatigue, mood disorders

Patients who recover from the novel coronavirus (COVID-19) and are later diagnosed with post-COVID-19 syndrome (PCS), also known as COVID-19 long-haul syndrome, experience symptoms such as mood disorders, fatigue and perceived cognitive impairment that can negatively affect returning to work and resuming normal activities, according to a new study published in the journal Mayo Clinic Proceedings.

The study reports on the first 100 patients to participate in Mayo Clinic's COVID-19 Activity Rehabilitation program (CARP), a multidisciplinary program established to evaluate and treat patients with post-COVID-19 syndrome. The patients were evaluated and treated between June 1 and December 31, 2020. They had a mean age of 45, and 68 percent were female. They were evaluated a mean of 93 days after infection.

The most common symptom of patients seeking evaluation for post-COVID-19 syndrome was fatigue. Of the patients in the study, 80 percent reported unusual fatigue, while 59 percent had respiratory complaints and a similar percentage had neurologic complaints. More than one-third of patients reported difficulties performing basic activities of daily living, and only 1 in 3 patients had returned to unrestricted work activity.

"Most patients in the study had no preexisting comorbidities prior to COVID-19 infection, and many did not experience symptoms related to COVID-19 that were severe enough to require hospitalization," said Greg Vanichkachorn, MD, first author of the study and medical director of Mayo Clinic's COVID-19 Activity Rehabilitation program in a statement. "Most of the patients had normal or nondiagnostic lab and imaging results, despite having debilitating symptoms. That's among the challenges of diagnosing PCS in a timely way and then responding effectively."

The symptoms often resulted in significant negative effects as patients tried to return to normal daily activities, including work, Vanichkachorn said.  

"Most patients with whom we worked required physical therapy, occupational therapy or brain rehabilitation to address the perceived cognitive impairment," he said. "While many patients had fatigue, more than half also reported troubles with thinking, commonly known as brain fog. And more than one-third of patients had trouble with basic activities of life. Many could not resume their normal work life for at least several months."

In June 2020, the Mayo Clinic developed the COVID-19 Activity Rehabilitation program at Mayo Clinic in Rochester to care for patients experiencing persistent symptoms after COVID-19 infection. Among services provided are psychosocial support for patients who frequently report feelings of abandonment, guilt, and frustration during initial evaluation.

Mayo Clinic researchers continue to study post-COVID-19 syndrome, in part to better define how the condition presents across different socioeconomic groups and ethnicities. Prolonged symptoms, such as those experienced with post-COVID-19 syndrome, have been reported in prior epidemics, according to Vanichkachorn. Patients who have recovered from acute infection shouldn't wait to be evaluated if they are experiencing prolonged symptoms, though providers should be judicious in recommending expensive diagnostic tests, which often aren't covered by insurance and don't reveal significant information, he said.

"As the pandemic continues,” said Vanichkachorn, “we expect to see more patients who experience symptoms long after infection, and health care providers need to prepare for this, know what to look for, and know how to best provide for their patients' needs.”

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