Mental Health Impact of Post-Infection Fatigue

*Mary Olamide Akinwola, Adesola Oyinkansola Abiodun and Yusuff Tunde Gbonjubola*

## **Abstract**

Post-infective fatigue is a major long-lasting complication of COVID-19. Among long COVID-19 survivors, the persistent fatigues experienced have had a significant impact on their physical health and mental health. Post-infective fatigue has been described as a loss of energy and a feeling of heaviness. Likewise, more evidence has highlighted the mental health component of fatigue triggered by subjectively minor physical and cognitive activities. These bouts of fatigue are commonly associated with mental health issues such as anxiety, depression, and sleep disorders. Ultimately, these mental health problems affect the quality of life of survivors. Although necessary public health efforts were directed at controlling the spread of COVID-19 and treating physical symptoms, it is crucial to backtrack, to develop inclusive mental health services for individuals plagued by post-COVID-19 fatigue.

**Keywords:** fatigue, long COVID-19, anxiety, depression, sleep disorders

### **1. Introduction**

Since the COVID-19 pandemic hit, we have continued to experience an aftershock beyond acute symptoms of the virus. In December 2019, an acute respiratory disease from Wuhan, China spread rapidly across the globe [1]. It was soon identified as the novel coronavirus which was named severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) [1]. On March 11, 2020, the disease was declared a pandemic by the World Health Organization [2]. The mode of transmission of this virus is usually from human to human commonly through air droplets, and this feature was responsible for its rapid and progressive outbreak [3]. As of May 1, 2022, 513 million people have been infected by the virus with 6.23 million deaths globally [3].

As a respiratory disease, the COVID-19 virus primarily affects the respiratory system [4]. Although other organs are involved, lower respiratory tract infection symptoms such as fever, dry cough, and dyspnea were commonly reported [4]. Other symptoms such as headache, dizziness, generalized weakness, vomiting, and diarrhea were also observed [4]. Like the virus, it was noted that the respiratory symptoms of COVID-19 could progress rapidly [5]. As such, the symptoms could vary from minimal to significant hypoxia with acute respiratory distress syndrome (ARDS) [5]. In addition to the progressive nature of the virus, the short duration for the onset of symptoms was an added

disadvantage to the nature of COVID-19. In earlier reports, the time of onset of symptoms to development of ARDS-related hypoxia may be as short as 9 days [6]. Typically, these symptoms can prove to be fatal. Although mechanisms have been placed to ensure acute response and control the spread of the virus, some survivors still experience distress long after management [7]. Therefore, the management of COVID-19 from the acute phase may be the beginning of a long path to full recovery. Months following hospitalization and acute care, some symptoms still persist in the post-COVID-19 phase [8].

Post-Covid-19, also known as, long COVID is used to describe the persistence of symptoms, weeks or months after an acute infection of Covid-19 irrespective of the viral status [8]. This state can be continuous, relapsing or remitting in nature. Post-COVID-19 can be divided into two stages depending on the duration of symptoms. The first is post-acute COVID-19 where symptoms are more than 3 weeks but less than 12 weeks and the other, chronic COVID-19 where symptoms continue beyond 12 weeks [8, 9]. The commonly reported symptoms include fatigue, dyspnea, joint pain, chest pain, cough, skin rashes, palpitations, headache, diarrhea, and paresthesia [8]. Of these symptoms, post-infective fatigue is the most persistent and debilitating [10].

Post-infective fatigue syndrome (PIFS) is a persistent, severe fatigue after an infection that cannot be explained by other medical or psychiatric conditions, which has been present for at least 6 months and significantly affects daily functioning [11]. After the onset of COVID-19, prevalence rates of fatigue persisting for months ranged from 9% to 58% [11]. It is observed that an increasing number of previously fit young people continue to have persistent fatigue months after mild cases of COVID-19 [9, 12]. Although it is currently established in some post-COVID-19 individuals, PIFS is not unique to coronavirus [12]. According to Rudroff et al. [7], it is noticed that patients treated for viral infections may sustain functional limitations over long periods. Hence, in comparison to COVID-19, patients with severe acute respiratory syndrome (SARS) had similar symptoms and persistent fatigue that was observed months and years beyond the initial infection [7]. Following the SARS epidemic, the health outcomes of recovered patients were observed 3 months, 6 months, and 12 months after hospital discharge, the findings reported that 64% had fatigue at 3 months, 54% at 6 months, and 60% at 12 months [13]. It was also discovered that chronic fatigue was related to sleeping difficulties [13]. Other studies also reported that patients experienced myalgia, joint pain, and depressive symptoms in addition to their fatigue [14]. In addition to SARS, studies have reported a similar trend of persistent fatigue with influenza virus, Ebola virus, and West Nile virus months after they have recovered [11, 13]. There has also been a recognized link between viral symptoms and fatigue [15]. Anecdotal reports suggest that patients who do not recover fully from COVID-19 experience some lingering symptoms of fatigue. Likewise, studies suggest that COVID-19 has had an exacerbating effect among those with chronic fatigue syndrome [13].

Mental health symptoms such as depression and anxiety are identified to be related to post-COVID-19 [16, 17]. Studies support that there is an established link between fatigue and mental health problems [18]. Hence, among long-COVID patients or post-COVID-19 individuals, these symptoms were found present. Mental health disorders such as depression, anxiety, post-traumatic stress disorder, and sleep disorders were found to occur with the chronic and debilitating nature of the fatigue [19]. According to the DSM-V, these disorders are characteristically mental health disorders. Overall, these mental disorders, in addition to the physical impact of fatigue, result in a decline in the quality of life of individuals [20]. In COVID-19, since the public health focus was on safety and survival, the mental health issue has been widely overlooked [21]. A proper and proactive approach to the prevention and management of the mental disorders associated with post-COVID fatigue is necessary to improve the individual's quality of life long after the onset of the disease.
