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A previous study showed that although it is common in patients with other viral infections (such as influenza), the symptoms of long COVID appear more frequently after novel coronavirus virus infection [28]. Several systematic reviews showed that the most common symptoms are fatigue, shortness of breath, muscle pain, joint pain, headache, cough, chest pain, change of smell, change of taste, and diarrhea in hospitalized adults [7, 15, 29-33]. Due to the lack of standardized research methods in various studies, the prevalence and duration of individual symptoms are still difficult to determine.
The population-based COVID-19 infection survey carried out by the British National Bureau of Statistics estimated that as of November 6, 2022, 2.2 million people living in private homes in the UK (3.4% of the population) were experiencing self-reported long COVID lasting for more than 4 weeks after the first confirmed or suspected COVID-19 infection that were not explained by something else, and 1.6 million people’s (75% of them) day-to-day activities affected adversely. Fatigue, difficulty in concentration, shortness of breath, and muscle ache were the main symptoms reported. The prevalence of self-reported long COVID was greatest in people aged 35 to 69 years, females, those working in social care, and those with another activity-limiting health condition or disability[34].
Several studies were performed to investigate the prevalence of long COVID-19[3, 4, 6, 10-12, 35-37] (Table 1). One systematic review and meta-analysis identified 57 studies with 250,351 survivors of COVID-19 from December 2019 to March 2021, and 79% were hospitalized during acute COVID-19, more than half of these survivors experienced PASC 6 months after recovery. The most common PASC involved functional mobility impairments, prevalent pulmonary sequelae, and mental health disorders. Among them, constitutional symptoms were chest imaging abnormalities (median [IQR], 62.2% [45.8%−76.5%]), difficulty concentrating (median [IQR], 23.8% [20.4%−25.9%]), generalized anxiety disorder (median [IQR], 29.6% [14.0%−44.0%]), general functional impairments (median [IQR], 44.0% [23.4%−62.6%]), and fatigue or muscle weakness (median [IQR], 37.5% [25.4%−54.5%]). Other frequently reported symptoms included cardiac, dermatologic, digestive, and ear, nose, and throat disorders[29].
Table 1. Prevalence and duration in patients with long COVID symptoms
System Involved symptom (s) Prevalence and duration* Suggestion Central and peripheral nervous system[15,17,70-75] Fatigue, headache, stroke, Cognitive, mental health disorders, anosmia, ageusia, neuropathy 30%–80%,
6 months or morePrompt diagnosis and intervention of any neuropsychiatric care is recommended for all patients recovering from COVID-19. An increase in mental health attention models in hospitals and communities is needed during and after the COVID-19 pandemic. Respiratory[29,76,77] Dyspnea, chest pain,
cough, lung fibrosis10%–70%,
6 months or moreIn addition to symptomatic treatment, regular follow-up is needed. Smell and taste[2,35,78-80] Altered sense of smell, altered taste 10%–60%,
7 months or moreEarly prevention,this must be seen as a frequent symptom of post-COVID-19 condition and might be partly due to a decreased central nervous amplification. Gastrointestinal tract symptoms[15,33,81] Disorders of GI tract motility 6%,
3 months or moreIn addition to symptomatic treatment, regular follow-up is needed, specific focus directed to the GI tract need to be done. Immune system[12,82] Multisystem symptoms 3%–50%,
12 months or moreRegular monitoring of blood results and evaluation of the individualized thrombotic risk based on comorbidities and coagulation profile are essential for both post‐acute and chronic COVID‐19. Note. *Prevalence is the intersection of all included studies, and the duration was the longest in all included studies. In one persistent neurological manifestation in long COVID systematic review analyses, 36 studies with 9,944 participants from January 2020 to October 2021 were included, and most of the included studies had a mean duration of follow-up after COVID-19 onset of less than 6 months. Before the wave of the Omicron variant, fatigue was the most common (52.8%) symptom of long COVID, followed by cognitive disorder (35.4%), paranesthesia (33.3%), sleep disorder (32.9%), musculoskeletal pain (27.8%), and dizziness (26.4%) [38]. Another systematic review and meta-analysis on gastrointestinal (GI) manifestations of long COVID included 50 studies,and the frequencies of GI symptoms were 0.12 and 0.22 in patients with COVID-19 and those with long COVID, respectively. Loss of appetite, dyspepsia, irritable bowel syndrome, loss of taste, and abdominal pain were the five most common GI symptoms of long COVID [39].
A study led by the WHO and Global Burden of Disease Long COVID Collaborators included 1.2 million COVID-19 patients from 22 countries in 2020 and 2021 showed that, 6.2% of COVID-19 patients reported at least one symptom clusters of long COVID3 months after acute infection onset, the risk of long COVID was greater in females and in those who needed hospitalization for the initial SARS-CoV-2 infection, particularly among those needing ICU care. The symptoms of sequela were not unique to COVID-19, similar symptoms were also occurred after other viral disease and bacteria disease [40]. One large-scale study performed between March 2020 and August 2021 described long COVID symptoms after correcting the preinfectional symptoms of SARS-CoV-2 and distributed questionnaires to more than 75,000 adults in the Netherlands, with the aim of evaluating 23 physical symptoms. Researchers matched the respondents (5.5%) suffering from COVID-19 with the COVID-19 negative control group in age, sex and time period [41]. 90 to 150 days after the diagnosis of COVID-19, the persistent symptoms (compared with those before diagnosis and those of the control group) included chest pain, dyspnea and pain, myalgia, loss of taste or smell, numbness of limbs, feeling hot and cold, and fatigue [41]. Approximately 13% of these symptoms can be attributed to COVID-19, which suggests that 1/8 of COVID-19 patients have post-COVID-19 symptoms [41].
These analyses accounted for symptomatic SARS-CoV-2 infections through the end of 2021 and therefore did not cover the Omicron variant wave. One case-control observational study between December 2021 and March 2022 reported that among omicron cases, 4.5% of people (2,501/56,003) experienced long COVID, and among delta cases, 10.8% of people (4,469/41,361) experienced long COVID. Omicron cases were less likely to experience long COVID for all vaccine timings, with an odds ratio ranging from 0.24 to 0.50 [42]. Another cross-sectional study with a cohort of 16,091 adults found that, between February 2021 and July 2022 in the US, 14.7% individuals reported long COVID-19 symptoms more than 2 months after acute illness, and compared with ancestral COVID-19, infection during periods when the Omicron variant (OR, 0.77; 95% CI, 0.64−0.92) predominated in the US was associated with diminished likelihood of long COVID, completion of the primary vaccine series prior to acute illness was associated with diminished risk for long COVID (OR, 0.72; 95% CI, 0.60−0.86)[43]. The same result was also found in a retrospective cohort study from Eastern India[14]. These researches were mainly conducted in adult subjects, and the evidence of COVID-19 in children was very limited. The current proportion of long COVID among children was lower, and older age was not an independent predictor [26, 27, 44, 45]. Unfortunately, the variability in long COVID prevalence was heterogeneous, and there was a lack of standardization among the different long COVID studies, mainly for the different definitions of long COVID and different populations and settings that have been studied.
doi: 10.3967/bes2022.143
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The authors declare that they have no conflicts of interest.
注释:1) CONFLICT OF INTEREST: -
Table 1. Prevalence and duration in patients with long COVID symptoms
System Involved symptom (s) Prevalence and duration* Suggestion Central and peripheral nervous system[15,17,70-75] Fatigue, headache, stroke, Cognitive, mental health disorders, anosmia, ageusia, neuropathy 30%–80%,
6 months or morePrompt diagnosis and intervention of any neuropsychiatric care is recommended for all patients recovering from COVID-19. An increase in mental health attention models in hospitals and communities is needed during and after the COVID-19 pandemic. Respiratory[29,76,77] Dyspnea, chest pain,
cough, lung fibrosis10%–70%,
6 months or moreIn addition to symptomatic treatment, regular follow-up is needed. Smell and taste[2,35,78-80] Altered sense of smell, altered taste 10%–60%,
7 months or moreEarly prevention,this must be seen as a frequent symptom of post-COVID-19 condition and might be partly due to a decreased central nervous amplification. Gastrointestinal tract symptoms[15,33,81] Disorders of GI tract motility 6%,
3 months or moreIn addition to symptomatic treatment, regular follow-up is needed, specific focus directed to the GI tract need to be done. Immune system[12,82] Multisystem symptoms 3%–50%,
12 months or moreRegular monitoring of blood results and evaluation of the individualized thrombotic risk based on comorbidities and coagulation profile are essential for both post‐acute and chronic COVID‐19. Note. *Prevalence is the intersection of all included studies, and the duration was the longest in all included studies. -
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