Mental Morbidities and Chronic Fatigue in Severe Acute Respiratory Syndrome Survivors

PsychiatryInternal Medicine
Written By Brianne Drury

Marco Ho-Bun Lam, FHKAM(Psych); Yun-Kwok Wing, FRCPsych; Mandy Wai-Man Yu, MPH; Chi-Ming Leung, FHKAM(Psych); Ronald C. W. Ma, FRCP, FHKAM(Medicine); Alice P. S. Kong, FRCP, FHKAM(Medicine); W.Y. So, FRCP, FHKAM(Medicine); Samson Yat-Yuk Fong, FHKAM(Psych); Siu-Ping Lam, FHKAM(Psych)

JAMA Internal Medicine

Published: December 2009

doi:10.1001/archinternmed.2009.384

Summary:

This article investigates long-term sequelae in 233 individuals who had recovered from SARS in Hong Kong (mean time after SARS was 3.44 years). Data was collected form 2005-2007 via a set of psychometric questionnaires and a clinical interview by a trained clinician. The main results found 40% with active psychiatric illness, 40.3% with chronic fatigue, and 27.1% with chronic fatigue syndrome as classified by the 1994 modified CDC criteria. Additionally, those who were healthcare workers during the epidemic, unemployed, have perception of social stigmatization, or applicants of the SARS survivors' fund, showed increased risk for psychiatric morbidities. Morbidities associated with SARS remained clinically significant at 4-year follow-up. These findings are alarming and highlight the need for further research on this topic as well as support following a SARS recovery. 

Live Discussion Summary:

  • Covid-19 is a public health catastrophe of unprecedented magnitude and comes with unique challenges that are difficult to predict, most importantly, unforeseen long-term sequelae of infection. 

  • A potential long-term complication is post viral myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Imagine a tremendous number of Americans living with an exacerbated level of chronic fatigue syndrome? 

  • If similar figures are seen with this novel coronavirus, which epidemiologists warn may affect 50-70% of all Americans, we will see a wave of millions of patients with chronic post-viral illnesses, notably psychiatric sequelae. If this happens, our system is not equipped to handle these cases. 

  • If these sequelae are affecting those who contract Covid-19 and not those who do not get it, then it stands to reason that it is not just psychological in its origins, but biochemical. We need more data to better understand these interactions, as the fact remains that there is a fear-based psychological component. Most agree that this is likely a combination of psychological and neurobiological etiology. 

  • These are also purported sequelae of the 1918 Spanish Influenza. 

Brianne Drury