Methodology:
This prospective cohort study was conducted among patients admitted at COVID-19 wards at Dhaka Medical College Hospital between July and August, 2020. During their hospital stay patients were evaluated for complications such as fatigue, sleep disturbances, dyspnea etc. A total of 373 patients were diagnosed to be suffering from some form of fatigue using the validated bi-modal Chalder Fatigue Score, as described previously (Townsend et al., 2020). We then approached patients diagnosed as “fatigued” during hospital stay and asked them to participate in a follow-up telephone interview regarding their disease condition after two-months of their hospital discharge. All patients agreed to participate in the interview and gave informed written consent. Ethical permission was obtained from institutional review board at Dhaka Medical College. After two months, patients were contacted over phone. A total of 36 patients could not be reached even after repeated attempts and five patients died during these two months. Hence, a total of 332 patients participated in our study. Due to complexity associated with conducting telephone interview and considering the socio-economic background of most participants, they were asked to categorize their fatigue symptoms into one of the following groups – “deteriorated,” “same as acute phase infection,” “improved but persistent,” and “completely recovered.” This approach of data collection and follow-up of a heterogeneous group of COVID-19 patients through telephone conversation was recorded in previous studies (Tenforde et al., 2020).
In addition to their responses, patient demographic data, epidemiological, clinical and on- admission laboratory data (e.g. Hb%, neutrophil, lymphocyte, C-reactive protein, d-dimer, and serum ferritin) were obtained from hospital records. All the statistical analyses were conducted using software package SPSS version 25. Categorical values were presented as frequency and percentage. Continuous values were presented as median and inter-quartile range (IQR). For the purpose of statistical analysis, patients were either grouped as “fatigued” or “not-fatigued” based on their responses. Wilcoxon Rank Sum Test and Chi-square test were primarily used to test association between variables. P-values less than 0.05 were considered significant for all statistical testing.