Estimated Global Proportions of Individuals With Persistent Fatigue, Cognitive, and Respiratory Symptom Clusters Following Symptomatic COVID-19 in 2020 and 2021
Authors:   Global Burden of Disease Long COVID Collaborators, Wulf Hanson Sarah , Abbafati Cristiana , Aerts Joachim G. , Al-Aly Ziyad , Ashbaugh Charlie , Ballouz Tala , Blyuss Oleg , Bobkova Polina , Bonsel Gouke , Borzakova Svetlana , Buonsenso Danilo , Butnaru Denis , Carter Austin , Chu Helen , De Rose Cristina , Diab Mohamed Mustafa , Ekbom Emil , El Tantawi Maha , Fomin Victor , Frithiof Robert , Gamirova Aysylu , Glybochko Petr V. , Haagsma Juanita A. , Haghjooy Javanmard Shaghayegh , Hamilton Erin B. , Harris Gabrielle , Heijenbrok-Kal Majanka H. , Helbok Raimund , Hellemons Merel E. , Hillus David , Huijts Susanne M. , Hultström Michael , Jassat Waasila , Kurth Florian , Larsson Ing-Marie , Lipcsey Miklós , Liu Chelsea , Loflin Callan D. , Malinovschi Andrei , Mao Wenhui , Mazankova Lyudmila , McCulloch Denise , Menges Dominik , Mohammadifard Noushin , Munblit Daniel , Nekliudov Nikita A. , Ogbuoji Osondu , Osmanov Ismail M. , Peñalvo José L. , Petersen Maria Skaalum , Puhan Milo A. , Rahman Mujibur , Rass Verena , Reinig Nickolas , Ribbers Gerard M. , Ricchiuto Antonia , Rubertsson Sten , Samitova Elmira , Sarrafzadegan Nizal , Shikhaleva Anastasia , Simpson Kyle E. , Sinatti Dario , Soriano Joan B. , Spiridonova Ekaterina , Steinbeis Fridolin , Svistunov Andrey A. , Valentini Piero , van de Water Brittney J. , van den Berg-Emons Rita , Wallin Ewa , Witzenrath Martin , Wu Yifan , Xu Hanzhang , Zoller Thomas , Adolph Christopher , Albright James , Amlag Joanne O. , Aravkin Aleksandr Y. , Bang-Jensen Bree L. , Bisignano Catherine , Castellano Rachel , Castro Emma , Chakrabarti Suman , Collins James K. , Dai Xiaochen , Daoud Farah , Dapper Carolyn , Deen Amanda , Duncan Bruce B. , Erickson Megan , Ewald Samuel B. , Ferrari Alize J. , Flaxman Abraham D. , Fullman Nancy , Gamkrelidze Amiran , Giles John R. , Guo Gaorui , Hay Simon I. , He Jiawei , Helak Monika , Hulland Erin N. , Kereselidze Maia , Krohn Kris J. , Lazzar-Atwood Alice , Lindstrom Akiaja , Lozano Rafael , Malta Deborah Carvalho , Månsson Johan , Mantilla Herrera Ana M. , Mokdad Ali H. , Monasta Lorenzo , Nomura Shuhei , Pasovic Maja , Pigott David M. , Reiner Robert C. , Reinke Grace , Ribeiro Antonio Luiz P. , Santomauro Damian Francesco , Sholokhov Aleksei , Spurlock Emma Elizabeth , Walcott Rebecca , Walker Ally , Wiysonge Charles Shey , Zheng Peng , Bettger Janet Prvu , Murray Christopher J. L. , Vos Theo 
Published: October 2022

Importance

Some individuals experience persistent symptoms after initial symptomatic SARS-CoV-2 infection (often referred to as Long COVID).

Objective

To estimate the proportion of males and females with COVID-19, younger or older than 20 years of age, who had Long COVID symptoms in 2020 and 2021 and their Long COVID symptom duration.

Design, Setting, and Participants

Bayesian meta-regression and pooling of 54 studies and 2 medical record databases with data for 1.2 million individuals (from 22 countries) who had symptomatic SARS-CoV-2 infection. Of the 54 studies, 44 were published and 10 were collaborating cohorts (conducted in Austria, the Faroe Islands, Germany, Iran, Italy, the Netherlands, Russia, Sweden, Switzerland, and the US). The participant data were derived from the 44 published studies (10 501 hospitalized individuals and 42 891 nonhospitalized individuals), the 10 collaborating cohort studies (10 526 and 1906), and the 2 US electronic medical record databases (250 928 and 846 046). Data collection spanned March 2020 to January 2022.

Exposures

Symptomatic SARS-CoV-2 infection.

Main Outcomes and Measures

Proportion of individuals with at least 1 of the 3 self-reported Long COVID symptom clusters (persistent fatigue with bodily pain or mood swings; cognitive problems; or ongoing respiratory problems) 3 months after SARS-CoV-2 infection in 2020 and 2021, estimated separately for hospitalized and nonhospitalized individuals aged 20 years or older by sex and for both sexes of nonhospitalized individuals younger than 20 years of age.

Results

A total of 1.2 million individuals who had symptomatic SARS-CoV-2 infection were included (mean age, 4-66 years; males, 26%-88%). In the modeled estimates, 6.2% (95% uncertainty interval [UI], 2.4%-13.3%) of individuals who had symptomatic SARS-CoV-2 infection experienced at least 1 of the 3 Long COVID symptom clusters in 2020 and 2021, including 3.2% (95% UI, 0.6%-10.0%) for persistent fatigue with bodily pain or mood swings, 3.7% (95% UI, 0.9%-9.6%) for ongoing respiratory problems, and 2.2% (95% UI, 0.3%-7.6%) for cognitive problems after adjusting for health status before COVID-19, comprising an estimated 51.0% (95% UI, 16.9%-92.4%), 60.4% (95% UI, 18.9%-89.1%), and 35.4% (95% UI, 9.4%-75.1%), respectively, of Long COVID cases. The Long COVID symptom clusters were more common in women aged 20 years or older (10.6% [95% UI, 4.3%-22.2%]) 3 months after symptomatic SARS-CoV-2 infection than in men aged 20 years or older (5.4% [95% UI, 2.2%-11.7%]). Both sexes younger than 20 years of age were estimated to be affected in 2.8% (95% UI, 0.9%-7.0%) of symptomatic SARS-CoV-2 infections. The estimated mean Long COVID symptom cluster duration was 9.0 months (95% UI, 7.0-12.0 months) among hospitalized individuals and 4.0 months (95% UI, 3.6-4.6 months) among nonhospitalized individuals. Among individuals with Long COVID symptoms 3 months after symptomatic SARS-CoV-2 infection, an estimated 15.1% (95% UI, 10.3%-21.1%) continued to experience symptoms at 12 months.

Conclusions and Relevance

This study presents modeled estimates of the proportion of individuals with at least 1 of 3 self-reported Long COVID symptom clusters (persistent fatigue with bodily pain or mood swings; cognitive problems; or ongoing respiratory problems) 3 months after symptomatic SARS-CoV-2 infection.