Chapter 5 136 ABSTRACT Background Severe fatigue can persist months after coronavirus disease 2019 (COVID-19) onset. This longitudinal study describes fatigue severity and its determinants up to 12 months after illness onset, across the full spectrum of COVID-19 severity. Methods RECoVERED, a prospective cohort study in Amsterdam, the Netherlands, enrolled participants aged≥16 years after SARS-CoV-2 diagnosis. Fatigue was measured using the validated Short Fatigue Questionnaire (SFQ; range 4-28) at months 1, 3, 6, 9 and 12 of follow-up. Fatigue severity was modelled over time using mixed-effect linear regression. Determinants of severe fatigue (SFQ≥18) at six months since illness onset (i.e. persistent fatigue) were identified using logistic regression. Results Between May 2020-July 2021, 303 participants completed at least one fatigue questionnaire. Twelve months after illness onset, 17.4%[95%CI=6.7-38.3], 21.6%[95%CI=11.2-37.7]) and 44.8%[95%CI=28.0-62.9]) of participants with mild, moderate and severe/critical COVID-19 (WHO definition), respectively, experienced severe fatigue. When adjusting for age and sex, having ≥3 comorbidities (p=0.007), severe/critical COVID-19 (p=0.002), low mood (<0.001) and dyspnoea in the first two weeks of illness (p=0.001) were associated with more severe fatigue over time. Severe/critical COVID-19 (aOR 3.37[95%CI=1.28-8.93]) and low mood at enrolment (aOR 2.43[95%CI=1.11-5.29]) were associated with persistent fatigue. Recovery rarely occurred beyond 6 months after illness onset, regardless of COVID-19 severity. Conclusions The occurrence of severe fatigue in our cohort was high, especially among those with initially severe/critical COVID-19, with little recovery beyond 6 months after illness onset. Our findings highlight an urgent need for improved understanding of persistent severe fatigue following COVID-19 to help inform prevention and intervention.
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