Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Dec 16;10(24):5913.
doi: 10.3390/jcm10245913.

A Systematic Review of Persistent Symptoms and Residual Abnormal Functioning following Acute COVID-19: Ongoing Symptomatic Phase vs. Post-COVID-19 Syndrome

Glenn Jennings  1   2 , Ann Monaghan  1   2 , Feng Xue  1   2 , David Mockler  3 , Román Romero-Ortuño  1   2   4   5
Affiliations
Review

A Systematic Review of Persistent Symptoms and Residual Abnormal Functioning following Acute COVID-19: Ongoing Symptomatic Phase vs. Post-COVID-19 Syndrome

Glenn Jennings et al. J Clin Med. .

Abstract

Objective: To compare the two phases of long COVID, namely ongoing symptomatic COVID-19 (OSC; signs and symptoms from 4 to 12 weeks from initial infection) and post-COVID-19 syndrome (PCS; signs and symptoms beyond 12 weeks) with respect to symptomatology, abnormal functioning, psychological burden, and quality of life.

Design: Systematic review.

Data sources: Electronic search of EMBASE, MEDLINE, ProQuest Coronavirus Research Database, LitCOVID, and Google Scholar between January and April 2021, and manual search for relevant citations from review articles. Eligibility Criteria: Cross-sectional studies, cohort studies, randomised control trials, and case-control studies with participant data concerning long COVID symptomatology or abnormal functioning.

Data extraction: Studies were screened and assessed for risk of bias by two independent reviewers, with conflicts resolved with a third reviewer. The AXIS tool was utilised to appraise the quality of the evidence. Data were extracted and collated using a data extraction tool in Microsoft Excel.

Results: Of the 1145 studies screened, 39 were included, all describing adult cohorts with long COVID and sample sizes ranging from 32 to 1733. Studies included data pertaining to symptomatology, pulmonary functioning, chest imaging, cognitive functioning, psychological disorder, and/or quality of life. Fatigue presented as the most prevalent symptom during both OSC and PCS at 43% and 44%, respectively. Sleep disorder (36%; 33%), dyspnoea (31%; 40%), and cough (26%; 22%) followed in prevalence. Abnormal spirometry (FEV1 < 80% predicted) was observed in 15% and 11%, and abnormal chest imaging was observed in 34% and 28%, respectively. Cognitive impairments were also evident (20%; 15%), as well as anxiety (28%; 34%) and depression (25%; 32%). Decreased quality of life was reported by 40% in those with OSC and 57% with PCS.

Conclusions: The prevalence of OSC and PCS were highly variable. Reported symptoms covered a wide range of body systems, with a general overlap in frequencies between the two phases. However, abnormalities in lung function and imaging seemed to be more common in OSC, whilst anxiety, depression, and poor quality of life seemed more frequent in PCS. In general, the quality of the evidence was moderate and further research is needed to understand longitudinal symptomatology trajectories in long COVID. Systematic Review Registration: Registered with PROSPERO with ID #CRD42021247846.

Keywords: COVID-19; fatigue; long COVID; ongoing symptomatic COVID-19; post-COVID-19 syndrome; symptomatology.

PubMed Disclaimer

Conflict of interest statement

The authors declare there is no conflicts of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram.
Figure 2
Figure 2
Bubble chart of the reported prevalences of the two long COVID phases (ongoing symptomatic COVID-19 in blue; post-COVID-19 syndrome in green), where the size of each bubble is proportional to the study sample size.
Figure 3
Figure 3
Body Chart of Long COVID Symptomatology.
See this image and copyright information in PMC

References

    1. Cucinotta D., Vanelli M. WHO Declares COVID-19 a Pandemic. Acta Biomed. 2020;91:157–160. doi: 10.23750/abm.v91i1.9397. - DOI - PMC - PubMed
    1. World Health Organisation WHO Coronavirus (COVID-19) Dashboard: World Health Organisation. 2021. [(accessed on 5 December 2021)]. Available online: https://covid19.who.int/
    1. Grant M.C., Geoghegan L., Arbyn M., Mohammed Z., McGuinness L., Clarke E.L., Wade R.G. The Prevalence of Symptoms in 24,410 Adults Infected by the Novel Coronavirus (SARS-CoV-2; COVID-19): A Systematic Review and Meta-Analysis of 148 Studies from 9 Countries. PLoS ONE. 2020;15:e0234765. doi: 10.1371/journal.pone.0234765. - DOI - PMC - PubMed
    1. Pijls B.G., Jolani S., Atherley A., Derckx R.T., Dijkstra J.I.R., Franssen G.H.L., Hendriks S., Richters A., Venemans-Jellema A., Zalpuri S., et al. Demographic Risk Factors for COVID-19 Infection, Severity, ICU Admission and Death: A Meta-Analysis of 59 Studies. BMJ Open. 2021;11:e044640. doi: 10.1136/bmjopen-2020-044640. - DOI - PMC - PubMed
    1. National Institute for Health and Care Excellence . COVID-19 Rapid Guideline: Managing COVID-19. NICE; London, UK: 2021. - PubMed

LinkOut - more resources