Prolonged COVID brain fog and fatigue negatively affects all aspects of daily life

In a recent study published in International Journal of Environmental and Public Health Researchresearchers examined the experiences of people with post-acute complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (PASC) to understand the impact of symptoms such as fatigue and brain fog on different aspects of life, including employment, daily activities and interpersonal relationships.

Study: Brain fog and fatigue after COVID-19 infection: an exploratory study of patients’ experiences with long-term COVID. Image credit: DOERS / Shutterstock

Background

Prolonged COVID or PASC is a multisystem complication of coronavirus disease 19 (COVID-19) that manifests in a wide range of symptoms such as dyspnea, debilitating fatigue, cough, dizziness, chest pain, headache, dysgeusia, anosmia, cognitive and cardiovascular difficulties.

Various studies and surveys attempting to understand the experiences of patients with PASC report common themes such as stigma, an isolated approach to health care, fear of permanently impaired cognitive and physical abilities, and variability of symptoms. The two predominant symptoms are fatigue and “brain fog,” commonly used to describe cognitive impairment. Understanding the impact of these PASC symptoms on a patient’s life can help manage the disease.

About the research

In the current study, researchers recruited elderly participants who had long-term health complications three months after recovering from SARS-CoV-2 infections. Participants were patients at the post-COVID-19 clinic, part of the University of Iowa Hospitals and Clinics.

Participants were included based on purposive sampling conducted to select information-rich cases. A total of 15 patients agreed to be interviewed. The interview guide included questions about symptoms experienced since the onset of SARS-CoV-2 infection, symptoms after COVID-19, the impact of long-term COVID symptoms on daily activities, interpersonal relationships, social support and their experience with health care facilities, methods of treatment and recovery.

Interviews were audio recorded and de-identified during transcription. The team conducted a thematic analysis and coded the transcripts using a deductive-inductive approach.

Results

The results showed that brain fog and fatigue affected all aspects of the patient’s life, including daily activities, interpersonal relationships, and employment. Patients report difficulty with household chores, personal tasks such as exercise, and recreational activities such as reading and gardening. These hardships made regular household management more difficult.

Most of the participants reported having more energy to complete tasks in the morning, with fatigue and brain fog worsening as the day progressed. In addition, flare-ups and remissions of symptoms make it difficult for patients to plan their day or anticipate periods of activity. The unpredictable nature of the disease also led to increased anxiety, sadness, fear and depression.

The synergistic relationship between fatigue and brain fog is a common observation, with increasing fatigue leading to worsening brain fog, and brain fog making daily tasks more challenging despite high energy levels. Many participants also reported that the symptoms affected their comfort and decision-making while driving, further limiting their mobility and forcing them to rely on others.

While 40% of participants were unemployed due to PASC symptoms, employed participants reported that employers were accommodating and emotionally supportive. However, the impact of PASC symptoms on work ability altered their self-perceptions of abilities and skills. A reduced ability to multitask makes them feel less productive and efficient at work.

Additionally, having to rely on co-workers for help led to additional anxiety about co-workers’ perceptions of them. Most patients report feeling stigmatized in the workplace because colleagues do not understand relapses and remissions of PASC symptoms. The inability to adequately cope with their work has also caused financial stress to patients and their families.

On the interpersonal front, most patients report that PASC symptoms cause loss or change in family roles, leading to feelings of isolation and inadequacy. Although many patients report feeling supported by their romantic partners, they express concerns about the speed of recovery, the burden on their partners, the inability to enjoy activities with their partners, and the future. Some patients report that their partners feel stressed, anxious, exhausted and require medication. Most patients who were parents report not being able to care for or communicate with their children as they used to.

Conclusions

Overall, PASC symptoms have a negative impact on all areas of the patient’s life, including the ability to perform simple tasks and care for themselves, their roles in the family, relationships with their partners, children and friends, and their perceptions of skills and opportunities at work. In addition, feelings of anxiety, depression, inadequacy and isolation stem from reduced physical capacity and financial stress.

Most patients emphasized the need for long-term support and the need to recognize PASC as a medical condition requiring disability benefits. The results highlight the need for a timely and sensitive approach to supporting patients with PASC.