Estimated Global Proportions of Individuals With Persistent Fatigue, Cognitive, and Respiratory Symptom Clusters Following Symptomatic COVID-19 in 2020 and 2021

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

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Abstract

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.
Original languageEnglish
Pages (from-to)1604-1615
Number of pages12
JournalJAMA
Volume328
Issue number16
DOIs
Publication statusPublished - 2022

Keywords

  • covid-19
  • COVID symptoms
  • persistent fatigue with bodily pain or mood swings
  • cognitive problems
  • ongoing respiratory problems
  • c SARS-CoV-2 infection

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