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This is a plain English summary of an original research article. The views expressed are those of the author(s) and reviewer(s) at the time of publication.

Long COVID can have a severe impact on everyday life. Symptoms vary, but a new study found that fatigue is the dominant symptom and most closely predicts poor everyday functioning. It could severely impact people’s work, home, social and private life, and close relationships. The authors call for services to prioritise the management of fatigue.

According to the National Institute for Health and Care Excellence (NICE), people have long COVID (post-COVID syndrome) if their symptoms continue for more than 12 weeks after the infection.

In this study, 3,700 people seeking treatment for long COVID completed a survey on their symptoms and the effect on their life. It showed that their quality of life was severely impacted, with 1 in 5 people unable to work because of long COVID. Their mental health was affected, and many people met the threshold for depression.

These findings will raise awareness among the public, employers and healthcare professionals of how this condition can affect people’s ability to live, work, and enjoy life. They call for more research on how to support people with long COVID, particularly those with fatigue.  

For more information on long COVID, visit the NHS website.

The issue: how does long COVID impact on everyday life?

In March 2023, 2 million people in the UK were living with long COVID. Symptoms include fatigue, breathlessness, loss of smell, mental health problems and brain fog (memory problems and/or poor concentration). Symptoms such as breathlessness are linked with an early death.

Some people with long COVID have minor symptoms for several months and then return to full health. Others have severe symptoms that last much longer and have a devastating impact on people’s work and social life.

To date, no medicines have been developed to cure long COVID. People are helped by clinicians to self-manage their condition but post-COVID clinics lack a clear pathway for rehabilitation as it is such a novel disease.

This study sought to improve our understanding of the symptoms of long COVID and how they affect people’s everyday lives.

What’s new?

The study included 3,700 people with long COVID, who were attending 31 post-COVID-19 clinics in the UK. Almost all (94%) were of working age (18 – 65 years). Between November 2020 and March 2022, participants completed questionnaires via an app, about their symptoms and the effect on their lives.

The study found that:

  • more than half (53%) the participants said their everyday functioning, including work, home, social and private life, and close relationships, was severely impacted
  • of all the symptoms of long COVID, fatigue was the strongest predictor of poor everyday functioning; depression and brain fog were also linked
  • half (51%) the participants had been unable to work at least one day in the previous month, with some (20%) unable to work at all in the previous month
  • almost all (96%) said pain, and anxiety or depression affected their quality of life.

Why is this important?

The study highlights the severe impact long COVID can have on people’s lives and productivity. Fatigue was closely linked with poor everyday functioning. The researchers suggest that clinical care and rehabilitation prioritise fatigue management. People with long COVID may need help to plan their day around times when their energy levels are higher; they may need to seek support from professionals or family and friends.

The study included people attending post-COVID clinics; most were white (87%) and university-educated (53%). The findings therefore may not represent all people with long COVID. Participants self-reported their symptoms. Some might have recorded fatigue when a doctor would have diagnosed weakness or low mood.

What’s next?

Long COVID is a relatively new condition and the support available may not be optimal. The researchers suggest that post-COVID clinics focus on assessing and treating fatigue. This could aid people’s recovery and help them return to work sooner.

The team calls for more research on long COVID, and on how to design services to support people with the condition. Interventions to address severe fatigue could help many, they say. They are now looking in more detail at how long people continue to report fatigue, and its impact on everyday functioning over the course of their disease.

You may be interested to read

This summary is based on: Walker S and others. Impact of fatigue as the primary determinant of functional limitations among patients with post-COVID-19 syndrome: a cross-sectional observational study. British Medical Journal Open 2023; 13: 1 – 11.

Information about long COVID from the British Heart Foundation.

Advice on managing long COVID-related fatigue from the Royal College of Occupational Therapists.

Obituary

One of the authors, Elizabeth Murray, Professor of eHealth and Primary Care, UCL, sadly died after this study was completed. The BMJ, the Guardian and UCL have published tributes.

Funding: this study was funded by the NIHR Health and Social Care Delivery Research programme.

Conflicts of Interest: John Hurst has received payments from several pharmaceutical companies. A full list of disclosures is available on the original paper.

Disclaimer: Summaries on NIHR Evidence are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that the views expressed are those of the author(s) and reviewer(s) at the time of publication. They do not necessarily reflect the views of the NHS, the NIHR or the Department of Health and Social Care.

NIHR Evidence is covered by the creative commons, CC-BY licence. Written content and infographics may be freely reproduced provided that suitable acknowledgement is made. Note, this license excludes comments and images made by third parties, audiovisual content, and linked content on other websites.

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