Long COVID and post-infective fatigue syndrome: A review

Carolina X. Sandler, Vegard B.B. Wyller, Rona Moss-Morris, Dedra Buchwald, Esther Crawley, Jeannine Hautvast, Ben Z. Katz, Hans Knoop, Paul Little, Renee Taylor, Knut Arne Wensaas, Andrew R. Lloyd*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

76 Scopus citations


Fatigue is a dominant feature of both acute and convalescent coronavirus disease 2019 (COVID-19) (sometimes termed "long-COVID"), with up to 46% of patients reporting fatigue that lasts from weeks to months. The investigators of the international Collaborative on Fatigue Following Infection (COFFI) conducted a systematic review of post-COVID fatigue and a narrative review on fatigue after other infections, and made recommendations for clinical and research approaches to assessing fatigue after COVID-19. In the majority of COVID-19 cohort studies, persistent fatigue was reported by a significant minority of patients, ranging from 13% to 33% at 16-20 weeks post-symptom onset. Data from the prospective cohort studies in COFFI and others indicate that fatigue is also a prevalent outcome from many acute systemic infections, notably infectious mononucleosis, with a case rate for clinically significant Post-infective fatigue after exclusion of recognized medical and psychiatric causes, ranging from 10%-35% at 6 months. To better characterize post-COVID fatigue, the COFFI investigators recommend the following: application of validated screening questionnaires for case detection; standardized interviews encompassing fatigue, mood, and other symptoms; and investigative approaches to identify end-organ damage and mental health conditions.

Original languageEnglish (US)
Article numberofab440
JournalOpen Forum Infectious Diseases
Issue number10
StatePublished - Oct 1 2021


  • Assessment
  • COVID-19
  • Cohorts
  • Fatigue
  • Post-viral

ASJC Scopus subject areas

  • Infectious Diseases
  • Oncology


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