Fatigue after COVID-19 in occupationally exposed workers: prevalence, severity and associated risk factors in a cross-sectional analysis of a multicentre registry study.

OBJECTIVES

As fatigue is among the most frequent manifestations of post-COVID syndrome (PCS), this study aimed to assess the prevalence and severity of cognitive and physical fatigue after occupational SARS-CoV-2 infection and to identify sociodemographic, clinical and occupational predictors of fatigue severity.

DESIGN

Cross-sectional analysis of a multicentre prospective registry.

SETTING

Six German Social Accident Insurance hospitals distributed across Germany, providing standardised post-COVID assessments for individuals with persistent symptoms following occupational SARS-CoV-2 infection.

PARTICIPANTS

Workers with confirmed SARS-CoV-2 infection recognised as an occupational disease or work-related accident who presented with persistent symptoms and were enrolled in a multicentre post-COVID registry.

PRIMARY AND SECONDARY OUTCOME MEASURES: Cognitive and physical fatigue severity assessed using validated self-administered questionnaires (Fatigue Scale for Motor and Cognitive Functions, Modified Fatigue Impact Scale and Würzburg Fatigue Inventory for Multiple Sclerosis). Clinical relevance was determined based on established cut-offs reported in the literature. Fatigue severity was operationalised using median splits of the respective subscales to identify factors associated with higher fatigue levels.

RESULTS

Among 1511 registry cases, 628 participants had complete fatigue data. Median age was 54 years, 77% were female and most worked in nursing (43%) or educational/care professions (19%). Clinically relevant fatigue was highly prevalent: cognitive fatigue affected 78%-93% and physical fatigue 87%-98%. Both fatigue dimensions were positively correlated with older age, work incapacity and persistent symptom burden. In multivariate analyses, a higher number of acute symptoms was associated with lower odds of cognitive fatigue (adjusted OR 0.39, 95% CI 0.19 to 0.81), while physical fatigue remained associated with profession (adjusted OR 2.04, 95% CI 1.17 to 3.59). Sex, pre-existing conditions, hospitalisation and variant wave were not significant predictors in either model.

CONCLUSIONS

Fatigue is a prevalent and disabling PCS-symptom among occupationally exposed workers. Distinct determinants of cognitive and physical fatigue emphasise the need for early recognition, targeted management and rehabilitation strategies to support recovery and work reintegration.