Fatigue, mood disorders associated with post-COVID-19 syndrome

The study reports on the first 100 patients to participate in Mayo Clinic's COVID-19 Activity Rehabilitation program (CARP), one of the first multidisciplinary programs established to evaluate and treat patients with post-COVID-19 syndrome. The patients were evaluated and treated between June 1 and Dec. 31, 2020. They had a mean age of 45, and 68% 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% reported unusual fatigue, while 59% 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," says Greg Vanichkachorn, M.D., medical director of Mayo Clinic's COVID-19 Activity Rehabilitation program and first author of the study. "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."

Nonetheless, the symptoms often resulted in significant negative effects as patients tried to return to normal daily activities, including work. "Most patients with whom we worked required physical therapy, occupational therapy or brain rehabilitation to address the perceived cognitive impairment," says Dr. Vanichkachorn. "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."

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

Mayo Clinic is conducting intensive research on 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.

"As the pandemic continues, 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," says Dr. Vanichkachorn.

Patients who have recovered from acute infection shouldn't wait to be evaluated if they are experiencing prolonged symptoms, though Dr. Vanichkachorn says providers should be judicious in recommending expensive diagnostic tests, which often aren't covered by insurance and don't reveal significant information.