Coronavirus Resource Centre.
However, in the wake of the pandemic, post-acute sequelae of COVID-19, or long COVID, has emerged: a chronic illness in people who have ongoing multidimensional symptomatology and disability weeks to years after the initial infection.
COVID-19 rapid guideline: managing the long-term effects of COVID-19.
Early reports of long COVID prevalence, summarised in a systematic review examining the frequency and variety of persistent symptoms after COVID-19, found that the median proportion of people who had at least one persistent symptom 60 days or more after diagnosis or at least 30 days after recovery from COVID-19 infection was 73%.
- Nasserie T
- Hittle M
- Goodman SN
However, the estimated prevalence depends on the duration, population, and symptoms used to define long COVID. More recently, community-based studies have suggested a lower prevalence of persistent symptoms;
- Whitaker M
- Elliott J
- Chadeau-Hyam M
- et al.
whereas among people who were hospitalised following COVID-19 infection, a high proportion do not fully recover (50–70%).
- Evans RA
- McAuley H
- Harrison EM
- et al.
,
Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study.
,
Coronavirus Resource Centre.
Consequently, the number of people with long COVID is similarly increasing. Indeed, the UK Office for National Statistics (ONS) survey up to May, 2022 estimated that 2 million people in the UK had self-reported long COVID.
Prevalence of ongoing symptoms following coronavirus (COVID-19) infection in the UK.
Of these people, 72% reported having long COVID for at least 12 weeks, 42% for at least 1 year, and 19% for at least 2 years. Consistent with other studies, fatigue was the most common symptom in the ONS survey, followed by breathlessness, cough, and muscle ache.
- Whitaker M
- Elliott J
- Chadeau-Hyam M
- et al.
,
- Evans RA
- McAuley H
- Harrison EM
- et al.
,
Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study.
,
,
Prevalence of ongoing symptoms following coronavirus (COVID-19) infection in the UK.
Risk factors for long COVID are female sex, obesity, middle age (35–65 years), living in areas of greater socioeconomic deprivation, and the presence of another activity-limiting health condition.
Coronavirus Resource Centre.
,
- Evans RA
- McAuley H
- Harrison EM
- et al.
,
Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study.
Importantly, health-care use is increased in those with long COVID, with increased general practitioner consultation rates.
- Whittaker HR
- Gulea C
- Koteci A
- et al.
- Ballering AV
- van Zon SKR
- olde Hartman TC
- Rosmalen JGM
Persistence of somatic symptoms after COVID-19 in the Netherlands: an observational cohort study.
report the findings of a longitudinal cohort study conducted in the north of the Netherlands between April, 2020, and August, 2021, where 23 somatic symptoms were assessed using 24 repeated measurements in digital COVID-19 questionnaires. The study was embedded within the large, population-based Lifelines COVID-19 cohort. The main strengths of this study were that participants were their own control, with the pattern and severity of symptoms assessed before and 3–5 months after SARS-CoV-2 infection, and were also compared with a matched control group of COVID-19-negative participants. Of the 76 422 participants, 4231 (5·5%) had COVID-19 and were compared with 8462 matched controls. Participants had a mean age of 53·7 years (SD 12·9), 46 329 (60·8%) were female, and nearly all were of White ethnicity. The proportion of participants who had at least one core symptom of substantially increased severity to at least moderate was 21·4% (381 of 1782) in COVID-19-positive participants versus 8·7% (361 of 4130) in COVID-19-negative controls. Thus, this study found that core symptoms were attributed to COVID-19 in 12·7% of participants, or approximately one in eight. This is a major advance on previous long COVID prevalence estimates, as it includes a matched control group without SARS-CoV-2 infection and accounts for symptoms that were present before infection.
- Ballering AV
- van Zon SKR
- olde Hartman TC
- Rosmalen JGM
Persistence of somatic symptoms after COVID-19 in the Netherlands: an observational cohort study.
was similar to previous reports, with fatigue and breathlessness among the most common symptoms, but other symptoms such as chest pain were more common in people who had COVID-19 than in COVID-19-negative controls. Ballering and colleagues
- Ballering AV
- van Zon SKR
- olde Hartman TC
- Rosmalen JGM
Persistence of somatic symptoms after COVID-19 in the Netherlands: an observational cohort study.
propose a core symptom set to be considered as part of the case definition for long COVID. Although an agreed diagnostic core symptom set would inform clinical pathways and research, the study by Ballering and colleagues
- Ballering AV
- van Zon SKR
- olde Hartman TC
- Rosmalen JGM
Persistence of somatic symptoms after COVID-19 in the Netherlands: an observational cohort study.
did not fully consider the impact on mental health, it was conducted in one region in the Netherlands, and it did not include an ethnically diverse population; thus the concept of a core symptom set will require further validation.
- Ballering AV
- van Zon SKR
- olde Hartman TC
- Rosmalen JGM
Persistence of somatic symptoms after COVID-19 in the Netherlands: an observational cohort study.
does not provide new mechanistic insights, which are key to uncovering new therapeutic targets. In other studies, clustering of patient-reported outcomes has identified different severity groups of long COVID and identified increased systemic inflammation in people with very severe long COVID.
- Evans RA
- McAuley H
- Harrison EM
- et al.
,
Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study.
How patient-centred outcomes, together with biomarkers, can further refine long COVID diagnosis and inform precision medicine approaches warrants further consideration.
- Antonelli M
- Penfold RS
- Merino J
- et al.
and might be lower in people infected with the omicron variant than those infected with earlier variants.
- Antonelli M
- Pujol JC
- Spector TD
- Ourselin S
- Steves CJ
Findings from the ONS survey suggested that vaccination following infection might reduce the symptom burden of long COVID after the first dose, with sustained improvement after a second dose.
- Ayoubkhani D
- Bermingham C
- Pouwels KB
- et al.
Whether acute treatments for COVID-19 affect the likelihood of developing long COVID or its severity is unknown.
Current evidence supports the view that long COVID is common and can persist for at least 2 years after SARS-CoV-2 infection, although severe debilitating disease is present in a minority. The long COVID case definition needs to be further improved, potentially to describe different types of long COVID, of which better mechanistic understanding is crucial. This will lead to personalised multimodality treatments that can be implemented to manage the increasingly high number of people with long COVID.
CEB has received consultancy and or grants paid to his institution from GlaxoSmithKline, AstraZeneca, Boehringer Ingelheim, Novartis, Chiesi, Genentech, Roche, Sanofi, Regeneron, Mologic, and 4DPharma for asthma and chronic obstructive pulmonary disease research. RAE has received consultancy fees from AstraZeneca on the topic of long COVID and from GlaxoSmithKline on digital health, and speaker’s fees from Boehringer Ingelheim on long COVID. RAE holds a National Institute for Health and Care Research (NIHR) clinician scientist award CS-2016-16-020.
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Article Info
Publication History
Published: 06 August 2022
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DOI: https://doi.org/10.1016/S0140-6736(22)01385-X
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© 2022 Elsevier Ltd. All rights reserved.
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