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A recent study found that more than 35% of individuals with persistent long Covid (also known as post Covid syndrome) reported experiencing post-exertional malaise or exercise intolerance even in the second year of experiencing other major symptoms. The study also revealed that 68% of individuals diagnosed with long Covid were dealing with fatigue, cognitive issues, breathlessness, and mental health problems such as anxiety, depression, and sleep disturbances.
The researchers noted that symptoms such as pain syndromes, confusion, and dizziness were more frequently reported by patients with post-exertional malaise, in addition to fatigue and exhaustion. Post-exertional malaise was prevalent among patients with persistent post-Covid syndrome who reported symptoms from all three dominant clusters – fatigue, neurocognitive disturbances, and chest symptoms.
In a study published in PLoS Medicine on January 23, 2025.
The study focused on adults with long COVID-19 in southwestern Germany aged 18-65, alongside 576 participants without long COVID-19. All 982 participants underwent assessments of cardiopulmonary and cognitive abilities as well as detailed laboratory testing. Among those with long COVID-19, 65% were female.
The authors of the study noted that most working-age patients with post-Covid syndrome did not recover in the second year of their illness. The reported symptoms remained similar, non-specific, and were dominated by fatigue, exercise intolerance, and cognitive complaints. Despite cognitive deficits and reduced exercise capacity, there was no major pathology found in laboratory investigations, indicating no viral persistence.
The authors highlighted that a history of post-exertional malaise was linked to more severe symptoms and objective signs of disease, aiding in stratifying cases for disease severity. Fatigue, neurocognitive disturbance, and chest symptoms were among the predominant symptom clusters in persistent post-Covid syndrome.
The researchers observed a significant overlap of these three clusters, with a substantial proportion of patients reporting moderate or severe symptoms in all three main clusters. They also found that obesity was a major risk factor in the study group, with a higher percentage of participants with persistent long Covid compared to the control group.
According to the Centers for Disease Control and Prevention, post-exertional malaise refers to an increasing severity of symptoms after physical or mental effort that the patient could previously tolerate without issues. This symptom tends to worsen around 12 to 48 hours after activity and can last for days or weeks.
Since late 2019, there have been over 750 million cases of Covid-19 and 6.8 million Covid-related deaths globally. Approximately 14% of individuals in the United States who tested positive for Covid-19 have experienced or are still experiencing long Covid symptoms.
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