A global systematic analysis of the occurrence, severity, and recovery pattern of long COVID in 2020 and 2021

TY - JOUR

T1 - A global systematic analysis of the occurrence, severity, and recovery pattern of long COVID in 2020 and 2021

AU - Wulf Hanson, Sarah

AU - Abbafati, Cristiana

AU - Aerts, Joachim G

AU - Al-Aly, Ziyad

AU - Ashbaugh, Charlie

AU - Ballouz, Tala

AU - Blyuss, Oleg

AU - Bobkova, Polina

AU - Bonsel, Gouke

AU - Borzakova, Svetlana

AU - Buonsenso, Danilo

AU - Butnaru, Denis

AU - Carter, Austin

AU - Chu, Helen

AU - De Rose, Cristina

AU - Diab, Mohamed Mustafa

AU - Ekbom, Emil

AU - El Tantawi, Maha

AU - Fomin, Victor

AU - Frithiof, Robert

AU - Gamirova, Aysylu

AU - Glybochko, Petr V

AU - Haagsma, Juanita A

AU - Javanmard, Shaghayegh Haghjooy

AU - Hamilton, Erin B

AU - Harris, Gabrielle

AU - Heijenbrok-Kal, Majanka H

AU - Helbok, Raimund

AU - Hellemons, Merel E

AU - Hillus, David

AU - Huijts, Susanne M

AU - Hultström, Michael

AU - Jassat, Waasila

AU - Kurth, Florian

AU - Larsson, Ing-Marie

AU - Lipcsey, Miklós

AU - Liu, Chelsea

AU - Loflin, Callan D

AU - Malinovschi, Andrei

AU - Mao, Wenhui

AU - Mazankova, Lyudmila

AU - McCulloch, Denise

AU - Menges, Dominik

AU - Mohammadifard, Noushin

AU - Munblit, Daniel

AU - Nekliudov, Nikita A

AU - Ogbuoji, Osondu

AU - Osmanov, Ismail M

AU - Peñalvo, José L

AU - Petersen, Maria Skaalum

AU - Puhan, Milo A

AU - Rahman, Mujibur

AU - Rass, Verena

AU - Reinig, Nickolas

AU - Ribbers, Gerard M

AU - Ricchiuto, Antonia

AU - Rubertsson, Sten

AU - Samitova, Elmira

AU - Sarrafzadegan, Nizal

AU - Shikhaleva, Anastasia

AU - Simpson, Kyle E

AU - Sinatti, Dario

AU - Soriano, Joan B

AU - Spiridonova, Ekaterina

AU - Steinbeis, Fridolin

AU - Svistunov, Andrey A

AU - Valentini, Piero

AU - van de Water, Brittney J

AU - van den Berg-Emons, Rita

AU - Wallin, Ewa

AU - Witzenrath, Martin

AU - Wu, Yifan

AU - Xu, Hanzhang

AU - Zoller, Thomas

AU - Adolph, Christopher

AU - Albright, James

AU - Amlag, Joanne O

AU - Aravkin, Aleksandr Y

AU - Bang-Jensen, Bree L

AU - Bisignano, Catherine

AU - Castellano, Rachel

AU - Castro, Emma

AU - Chakrabarti, Suman

AU - Collins, James K

AU - Dai, Xiaochen

AU - Daoud, Farah

AU - Dapper, Carolyn

AU - Deen, Amanda

AU - Duncan, Bruce B

AU - Erickson, Megan

AU - Ewald, Samuel B

AU - Ferrari, Alize J

AU - Flaxman, Abraham D

AU - Fullman, Nancy

AU - Gamkrelidze, Amiran

AU - Giles, John R

AU - Guo, Gaorui

AU - Hay, Simon I

AU - He, Jiawei

AU - Helak, Monika

AU - Hulland, Erin N

AU - Kereselidze, Maia

AU - Krohn, Kris J

AU - Lazzar-Atwood, Alice

AU - Lindstrom, Akiaja

AU - Lozano, Rafael

AU - Magistro, Beatrice

AU - Malta, Deborah Carvalho

AU - Månsson, Johan

AU - Mantilla Herrera, Ana M

AU - Mokdad, Ali H

AU - Monasta, Lorenzo

AU - Nomura, Shuhei

AU - Pasovic, Maja

AU - Pigott, David M

AU - Reiner, Robert C

AU - Reinke, Grace

AU - Ribeiro, Antonio Luiz P

AU - Santomauro, Damian Francesco

AU - Sholokhov, Aleksei

AU - Spurlock, Emma Elizabeth

AU - Walcott, Rebecca

AU - Walker, Ally

AU - Wiysonge, Charles Shey

AU - Zheng, Peng

AU - Bettger, Janet Prvu

AU - Murray, Christopher Jl

AU - Vos, Theo

PY - 2022/5/27

Y1 - 2022/5/27

N2 - IMPORTANCE: While much of the attention on the COVID-19 pandemic was directed at the daily counts of cases and those with serious disease overwhelming health services, increasingly, reports have appeared of people who experience debilitating symptoms after the initial infection. This is popularly known as long COVID.OBJECTIVE: To estimate by country and territory of the number of patients affected by long COVID in 2020 and 2021, the severity of their symptoms and expected pattern of recovery.DESIGN: We jointly analyzed ten ongoing cohort studies in ten countries for the occurrence of three major symptom clusters of long COVID among representative COVID cases. The defining symptoms of the three clusters (fatigue, cognitive problems, and shortness of breath) are explicitly mentioned in the WHO clinical case definition. For incidence of long COVID, we adopted the minimum duration after infection of three months from the WHO case definition. We pooled data from the contributing studies, two large medical record databases in the United States, and findings from 44 published studies using a Bayesian meta-regression tool. We separately estimated occurrence and pattern of recovery in patients with milder acute infections and those hospitalized. We estimated the incidence and prevalence of long COVID globally and by country in 2020 and 2021 as well as the severity-weighted prevalence using disability weights from the Global Burden of Disease study.RESULTS: Analyses are based on detailed information for 1906 community infections and 10526 hospitalized patients from the ten collaborating cohorts, three of which included children. We added published data on 37262 community infections and 9540 hospitalized patients as well as ICD-coded medical record data concerning 1.3 million infections. Globally, in 2020 and 2021, 144.7 million (95% uncertainty interval [UI] 54.8-312.9) people suffered from any of the three symptom clusters of long COVID. This corresponds to 3.69% (1.38-7.96) of all infections. The fatigue, respiratory, and cognitive clusters occurred in 51.0% (16.9-92.4), 60.4% (18.9-89.1), and 35.4% (9.4-75.1) of long COVID cases, respectively. Those with milder acute COVID-19 cases had a quicker estimated recovery (median duration 3.99 months [IQR 3.84-4.20]) than those admitted for the acute infection (median duration 8.84 months [IQR 8.10-9.78]). At twelve months, 15.1% (10.3-21.1) continued to experience long COVID symptoms.CONCLUSIONS AND RELEVANCE: The occurrence of debilitating ongoing symptoms of COVID-19 is common. Knowing how many people are affected, and for how long, is important to plan for rehabilitative services and support to return to social activities, places of learning, and the workplace when symptoms start to wane.KEY POINTS: Question: What are the extent and nature of the most common long COVID symptoms by country in 2020 and 2021?Findings: Globally, 144.7 million people experienced one or more of three symptom clusters (fatigue; cognitive problems; and ongoing respiratory problems) of long COVID three months after infection, in 2020 and 2021. Most cases arose from milder infections. At 12 months after infection, 15.1% of these cases had not yet recovered.Meaning: The substantial number of people with long COVID are in need of rehabilitative care and support to transition back into the workplace or education when symptoms start to wane.

AB - IMPORTANCE: While much of the attention on the COVID-19 pandemic was directed at the daily counts of cases and those with serious disease overwhelming health services, increasingly, reports have appeared of people who experience debilitating symptoms after the initial infection. This is popularly known as long COVID.OBJECTIVE: To estimate by country and territory of the number of patients affected by long COVID in 2020 and 2021, the severity of their symptoms and expected pattern of recovery.DESIGN: We jointly analyzed ten ongoing cohort studies in ten countries for the occurrence of three major symptom clusters of long COVID among representative COVID cases. The defining symptoms of the three clusters (fatigue, cognitive problems, and shortness of breath) are explicitly mentioned in the WHO clinical case definition. For incidence of long COVID, we adopted the minimum duration after infection of three months from the WHO case definition. We pooled data from the contributing studies, two large medical record databases in the United States, and findings from 44 published studies using a Bayesian meta-regression tool. We separately estimated occurrence and pattern of recovery in patients with milder acute infections and those hospitalized. We estimated the incidence and prevalence of long COVID globally and by country in 2020 and 2021 as well as the severity-weighted prevalence using disability weights from the Global Burden of Disease study.RESULTS: Analyses are based on detailed information for 1906 community infections and 10526 hospitalized patients from the ten collaborating cohorts, three of which included children. We added published data on 37262 community infections and 9540 hospitalized patients as well as ICD-coded medical record data concerning 1.3 million infections. Globally, in 2020 and 2021, 144.7 million (95% uncertainty interval [UI] 54.8-312.9) people suffered from any of the three symptom clusters of long COVID. This corresponds to 3.69% (1.38-7.96) of all infections. The fatigue, respiratory, and cognitive clusters occurred in 51.0% (16.9-92.4), 60.4% (18.9-89.1), and 35.4% (9.4-75.1) of long COVID cases, respectively. Those with milder acute COVID-19 cases had a quicker estimated recovery (median duration 3.99 months [IQR 3.84-4.20]) than those admitted for the acute infection (median duration 8.84 months [IQR 8.10-9.78]). At twelve months, 15.1% (10.3-21.1) continued to experience long COVID symptoms.CONCLUSIONS AND RELEVANCE: The occurrence of debilitating ongoing symptoms of COVID-19 is common. Knowing how many people are affected, and for how long, is important to plan for rehabilitative services and support to return to social activities, places of learning, and the workplace when symptoms start to wane.KEY POINTS: Question: What are the extent and nature of the most common long COVID symptoms by country in 2020 and 2021?Findings: Globally, 144.7 million people experienced one or more of three symptom clusters (fatigue; cognitive problems; and ongoing respiratory problems) of long COVID three months after infection, in 2020 and 2021. Most cases arose from milder infections. At 12 months after infection, 15.1% of these cases had not yet recovered.Meaning: The substantial number of people with long COVID are in need of rehabilitative care and support to transition back into the workplace or education when symptoms start to wane.

U2 - 10.1101/2022.05.26.22275532

DO - 10.1101/2022.05.26.22275532

M3 - Other (editorial matter etc.)

C2 - 35664995

JO - medRxiv

JF - medRxiv

ER -