This is a preprint.

It has not yet been peer reviewed by a journal.

The National Library of Medicine is running a pilot to include preprints that result from research funded by NIH in PMC and PubMed.

[Preprint]. 2022 May 27:2022.05.26.22275532.

doi: 10.1101/2022.05.26.22275532.

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

Sarah Wulf Hanson¹, Cristiana Abbafati², Joachim G Aerts³, Ziyad Al-Aly^{4

5}, Charlie Ashbaugh¹, Tala Ballouz⁶, Oleg Blyuss^{7

8}, Polina Bobkova⁹, Gouke Bonsel¹⁰, Svetlana Borzakova^{11

12}, Danilo Buonsenso^{13

14}, Denis Butnaru¹⁵, Austin Carter¹, Helen Chu¹⁶, Cristina De Rose¹³, Mohamed Mustafa Diab^{17

18}, Emil Ekbom¹⁹, Maha El Tantawi²⁰, Victor Fomin²¹, Robert Frithiof²², Aysylu Gamirova²³, Petr V Glybochko²⁴, Juanita A Haagsma²⁵, Shaghayegh Haghjooy Javanmard²⁶, Erin B Hamilton¹, Gabrielle Harris²⁷, Majanka H Heijenbrok-Kal^{28

29}, Raimund Helbok³⁰, Merel E Hellemons³, David Hillus³¹, Susanne M Huijts³², Michael Hultström^{22

33}, Waasila Jassat³⁴, Florian Kurth^{35

36}, Ing-Marie Larsson²², Miklós Lipcsey²², Chelsea Liu³⁷, Callan D Loflin²⁷, Andrei Malinovschi³⁸, Wenhui Mao^{17

39}, Lyudmila Mazankova⁴⁰, Denise McCulloch¹⁶, Dominik Menges⁶, Noushin Mohammadifard⁴¹, Daniel Munblit^{42

43}, Nikita A Nekliudov²³, Osondu Ogbuoji³⁹, Ismail M Osmanov^{44

11}, José L Peñalvo^{45

46}, Maria Skaalum Petersen^{47

48}, Milo A Puhan^{49

50}, Mujibur Rahman⁵¹, Verena Rass³⁰, Nickolas Reinig¹, Gerard M Ribbers²⁸, Antonia Ricchiuto⁵², Sten Rubertsson^{22

53}, Elmira Samitova^{44

40}, Nizal Sarrafzadegan^{41

54}, Anastasia Shikhaleva⁹, Kyle E Simpson¹, Dario Sinatti¹³, Joan B Soriano^{55

56}, Ekaterina Spiridonova²³, Fridolin Steinbeis³¹, Andrey A Svistunov²⁴, Piero Valentini¹³, Brittney J van de Water^{57

58}, Rita van den Berg-Emons²⁸, Ewa Wallin²², Martin Witzenrath^{35

59}, Yifan Wu¹, Hanzhang Xu⁶⁰, Thomas Zoller³¹, Christopher Adolph^{61

62}, James Albright¹, Joanne O Amlag¹, Aleksandr Y Aravkin^{63

1

64}, Bree L Bang-Jensen¹, Catherine Bisignano¹, Rachel Castellano¹, Emma Castro¹, Suman Chakrabarti^{1

65}, James K Collins¹, Xiaochen Dai^{1

64}, Farah Daoud¹, Carolyn Dapper¹, Amanda Deen¹, Bruce B Duncan⁶⁶, Megan Erickson¹, Samuel B Ewald¹, Alize J Ferrari^{67

1}, Abraham D Flaxman^{1

64}, Nancy Fullman¹, Amiran Gamkrelidze⁶⁸, John R Giles¹, Gaorui Guo¹, Simon I Hay^{1

64}, Jiawei He¹, Monika Helak¹, Erin N Hulland^{1

65}, Maia Kereselidze⁶⁸, Kris J Krohn¹, Alice Lazzar-Atwood¹, Akiaja Lindstrom^{67

69}, Rafael Lozano^{1

64}, Beatrice Magistro⁷⁰, Deborah Carvalho Malta⁷¹, Johan Månsson¹, Ana M Mantilla Herrera^{72

67}, Ali H Mokdad^{1

64}, Lorenzo Monasta⁷³, Shuhei Nomura^{74

75}, Maja Pasovic¹, David M Pigott^{1

64}, Robert C Reiner Jr^{1

64}, Grace Reinke¹, Antonio Luiz P Ribeiro^{76

77}, Damian Francesco Santomauro^{78

67

1}, Aleksei Sholokhov¹, Emma Elizabeth Spurlock^{1

79}, Rebecca Walcott⁸⁰, Ally Walker¹, Charles Shey Wiysonge^{81

82}, Peng Zheng^{1

64}, Janet Prvu Bettger⁸³, Christopher Jl Murray^{1

64}, Theo Vos^{1

64}

Affiliations

¹ Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
² Department of Juridical and Economic Studies, La Sapienza University, Rome, Italy.
³ Department of Pulmonary Medicine, Erasmus University Medical Center, Rotterdam, Netherlands.
⁴ John T. Milliken Department of Internal Medicine, Washington University in St. Louis, St. Louis, MO, USA.
⁵ Clinical Epidemiology Center, US Department of Veterans Affairs (VA), St. Louis, MO, USA.
⁶ Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zurich, Switzerland.
⁷ Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
⁸ Department of Pediatrics and Pediatric Infectious Diseases, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
⁹ Clinical Medicine (Pediatric profile), I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
¹⁰ EuroQol Research Foundation, Rotterdam, Netherlands.
¹¹ Pirogov Russian National Research Medical University, Moscow, Russia.
¹² Research Institute for Healthcare Organization and Medical Management, Moscow Healthcare Department, Moscow, Russia.
¹³ Department of Woman and Child Health and Public Health, Agostino Gemelli University Polyclinic IRCCS, Rome, Italy.
¹⁴ Global Health Research Institute, Catholic University of Sacred Heart, Rome, Italy.
¹⁵ I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
¹⁶ Department of Medicine, University of Washington, Seattle, WA, USA.
¹⁷ The Center for Policy Impact in Global Health, Duke University, Durham, NC, USA.
¹⁸ Department of Surgery, Duke University, Durham, NC, USA.
¹⁹ Uppsala University Hospital, Uppsala, Sweden.
²⁰ Pediatric Dentistry and Dental Public Health Department, Alexandria University, Alexandria, Egypt.
²¹ Rector's Office, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
²² Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden.
²³ Clinical Medicine (General Medicine profile), I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
²⁴ Administration Department, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
²⁵ Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands.
²⁶ Applied Physiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
²⁷ School of Nursing, Duke University, Durham, NC, USA.
²⁸ Department of Rehabilitation Medicine, Erasmus University Medical Center, Rotterdam, Netherlands.
²⁹ Neurorehabilitation, Rijndam Rehabilitation, Rotterdam, Netherlands.
³⁰ Department of Neurology, Medical University Innsbruck, Innsbruck, Austria.
³¹ Department of Infectious Diseases and Respiratory Medicine, Charité Medical University Berlin, Berlin, Germany.
³² Department of Respiratory Medicine, Erasmus University Medical Center, Rotterdam, Netherlands.
³³ Department of Medical Cell Biology, Uppsala University, Uppsala, Sweden.
³⁴ Department of Public Health Surveillance and Response, National Institute for Communicable Diseases, Johannesburg, South Africa.
³⁵ Department of Infectious Diseases and Respiratory Medicine, Charité University Medical Center Berlin, Berlin, Germany.
³⁶ Department of Clinical Research and Tropical Medicine, Bernhard-Nocht-Institute of Tropical Medicine, Hamburg, Germany.
³⁷ Department of Epidemiology, Harvard University, Boston, MA, USA.
³⁸ Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
³⁹ Duke Global Health Institute, Duke University, Durham, NC, USA.
⁴⁰ Russian Medical Academy of Continuous Professional Education, Ministry of Healthcare of the Russian Federation, Moscow, Russia.
⁴¹ Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
⁴² Department of Paediatrics and Paediatric Infectious Diseases, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
⁴³ National Heart & Lung Institute, Imperial College London, London, UK.
⁴⁴ ZA Bashlyaeva Children's Municipal Clinical Hospital, Moscow, Russia.
⁴⁵ Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
⁴⁶ Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.
⁴⁷ Department of Occupational Medicine and Public Health, The Faroese Hospital System, Torshavn, Faroe Islands.
⁴⁸ Centre of Health Science, University of Faroe Islands, Torshavn, Faroe Islands.
⁴⁹ Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zurich, Switzerland.
⁵⁰ Department of Epidemiology, Johns Hopkins University, Baltimore, USA.
⁵¹ Department of Internal Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
⁵² epartment of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
⁵³ Department of Surgical Sciences, Hedenstierna laboratory, Uppsala University, Uppsala, Sweden.
⁵⁴ School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
⁵⁵ (Princess University Hospital), Autonomous University of Madrid, Hospital Universitario de La Princesa, Madrid, Spain.
⁵⁶ Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), (Center for Biomedical Research in Respiratory Diseases Network), Madrid, Spain.
⁵⁷ Department of Global Health and Social Medicine, Harvard University, Boston, MA, USA.
⁵⁸ Nursing and Midwifery Department, Seed Global Health, Boston, USA.
⁵⁹ German Center for Lung Research, Berlin, Germany.
⁶⁰ Department of Family Medicine and Community Health, Duke University, Durham, NC, USA.
⁶¹ Department of Political Science, University of Washington, Seattle, WA, USA.
⁶² Center for Statistics and the Social Sciences, University of Washington, Seattle, WA, USA.
⁶³ Department of Applied Mathematics, University of Washington, Seattle, WA, USA.
⁶⁴ Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA.
⁶⁵ Department of Global Health, University of Washington, Seattle, WA, USA.
⁶⁶ Postgraduate Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
⁶⁷ School of Public Health, The University of Queensland, Brisbane, QLD, Australia.
⁶⁸ National Center for Disease Control and Public Health, Tbilisi, Georgia.
⁶⁹ School of Public Health, Queensland Centre for Mental Health Research, Wacol, QLD, Australia.
⁷⁰ Munk School of Global Affairs and Public Policy, University of Toronto, Toronto, Ontario, Canada.
⁷¹ Department of Maternal and Child Nursing and Public Health, Federal University of Minas Gerais, Belo Horizonte, Brazil.
⁷² West Moreton Hospital Health Services, Queensland Centre for Mental Health Research, Wacol, QLD, Australia.
⁷³ Clinical Epidemiology and Public Health Research Unit, Burlo Garofolo Institute for Maternal and Child Health, Trieste, Italy.
⁷⁴ Department of Health Policy and Management, Keio University, Tokyo, Japan.
⁷⁵ Department of Global Health Policy, University of Tokyo, Tokyo, Japan.
⁷⁶ Department of Internal Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.
⁷⁷ Centre of Telehealth, Federal University of Minas Gerais, Belo Horizonte, Brazil.
⁷⁸ Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Wacol, QLD, Australia.
⁷⁹ Yale School of Public Health - Social and Behavioral Sciences, Yale University, New Haven, CT, USA.
⁸⁰ Evans School of Public Policy & Governance, University of Washington, Seattle, WA, USA.
⁸¹ Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.
⁸² HIV and other Infectious Diseases Research Unit, South African Medical Research Council, Durban, South Africa.
⁸³ Department of Orthopaedic Surgery, Duke University, Durham, NC, USA.

PMID: 35664995
PMCID: PMC9164454
DOI: 10.1101/2022.05.26.22275532

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

Sarah Wulf Hanson et al. medRxiv. 2022.

[Preprint]. 2022 May 27:2022.05.26.22275532.

doi: 10.1101/2022.05.26.22275532.

Authors

Affiliations

¹ Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
² Department of Juridical and Economic Studies, La Sapienza University, Rome, Italy.
³ Department of Pulmonary Medicine, Erasmus University Medical Center, Rotterdam, Netherlands.
⁴ John T. Milliken Department of Internal Medicine, Washington University in St. Louis, St. Louis, MO, USA.
⁵ Clinical Epidemiology Center, US Department of Veterans Affairs (VA), St. Louis, MO, USA.
⁶ Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zurich, Switzerland.
⁷ Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
⁸ Department of Pediatrics and Pediatric Infectious Diseases, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
⁹ Clinical Medicine (Pediatric profile), I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
¹⁰ EuroQol Research Foundation, Rotterdam, Netherlands.
¹¹ Pirogov Russian National Research Medical University, Moscow, Russia.
¹² Research Institute for Healthcare Organization and Medical Management, Moscow Healthcare Department, Moscow, Russia.
¹³ Department of Woman and Child Health and Public Health, Agostino Gemelli University Polyclinic IRCCS, Rome, Italy.
¹⁴ Global Health Research Institute, Catholic University of Sacred Heart, Rome, Italy.
¹⁵ I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
¹⁶ Department of Medicine, University of Washington, Seattle, WA, USA.
¹⁷ The Center for Policy Impact in Global Health, Duke University, Durham, NC, USA.
¹⁸ Department of Surgery, Duke University, Durham, NC, USA.
¹⁹ Uppsala University Hospital, Uppsala, Sweden.
²⁰ Pediatric Dentistry and Dental Public Health Department, Alexandria University, Alexandria, Egypt.
²¹ Rector's Office, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
²² Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden.
²³ Clinical Medicine (General Medicine profile), I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
²⁴ Administration Department, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
²⁵ Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands.
²⁶ Applied Physiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
²⁷ School of Nursing, Duke University, Durham, NC, USA.
²⁸ Department of Rehabilitation Medicine, Erasmus University Medical Center, Rotterdam, Netherlands.
²⁹ Neurorehabilitation, Rijndam Rehabilitation, Rotterdam, Netherlands.
³⁰ Department of Neurology, Medical University Innsbruck, Innsbruck, Austria.
³¹ Department of Infectious Diseases and Respiratory Medicine, Charité Medical University Berlin, Berlin, Germany.
³² Department of Respiratory Medicine, Erasmus University Medical Center, Rotterdam, Netherlands.
³³ Department of Medical Cell Biology, Uppsala University, Uppsala, Sweden.
³⁴ Department of Public Health Surveillance and Response, National Institute for Communicable Diseases, Johannesburg, South Africa.
³⁵ Department of Infectious Diseases and Respiratory Medicine, Charité University Medical Center Berlin, Berlin, Germany.
³⁶ Department of Clinical Research and Tropical Medicine, Bernhard-Nocht-Institute of Tropical Medicine, Hamburg, Germany.
³⁷ Department of Epidemiology, Harvard University, Boston, MA, USA.
³⁸ Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
³⁹ Duke Global Health Institute, Duke University, Durham, NC, USA.
⁴⁰ Russian Medical Academy of Continuous Professional Education, Ministry of Healthcare of the Russian Federation, Moscow, Russia.
⁴¹ Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
⁴² Department of Paediatrics and Paediatric Infectious Diseases, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
⁴³ National Heart & Lung Institute, Imperial College London, London, UK.
⁴⁴ ZA Bashlyaeva Children's Municipal Clinical Hospital, Moscow, Russia.
⁴⁵ Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
⁴⁶ Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.
⁴⁷ Department of Occupational Medicine and Public Health, The Faroese Hospital System, Torshavn, Faroe Islands.
⁴⁸ Centre of Health Science, University of Faroe Islands, Torshavn, Faroe Islands.
⁴⁹ Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zurich, Switzerland.
⁵⁰ Department of Epidemiology, Johns Hopkins University, Baltimore, USA.
⁵¹ Department of Internal Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
⁵² epartment of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
⁵³ Department of Surgical Sciences, Hedenstierna laboratory, Uppsala University, Uppsala, Sweden.
⁵⁴ School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
⁵⁵ (Princess University Hospital), Autonomous University of Madrid, Hospital Universitario de La Princesa, Madrid, Spain.
⁵⁶ Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), (Center for Biomedical Research in Respiratory Diseases Network), Madrid, Spain.
⁵⁷ Department of Global Health and Social Medicine, Harvard University, Boston, MA, USA.
⁵⁸ Nursing and Midwifery Department, Seed Global Health, Boston, USA.
⁵⁹ German Center for Lung Research, Berlin, Germany.
⁶⁰ Department of Family Medicine and Community Health, Duke University, Durham, NC, USA.
⁶¹ Department of Political Science, University of Washington, Seattle, WA, USA.
⁶² Center for Statistics and the Social Sciences, University of Washington, Seattle, WA, USA.
⁶³ Department of Applied Mathematics, University of Washington, Seattle, WA, USA.
⁶⁴ Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA.
⁶⁵ Department of Global Health, University of Washington, Seattle, WA, USA.
⁶⁶ Postgraduate Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
⁶⁷ School of Public Health, The University of Queensland, Brisbane, QLD, Australia.
⁶⁸ National Center for Disease Control and Public Health, Tbilisi, Georgia.
⁶⁹ School of Public Health, Queensland Centre for Mental Health Research, Wacol, QLD, Australia.
⁷⁰ Munk School of Global Affairs and Public Policy, University of Toronto, Toronto, Ontario, Canada.
⁷¹ Department of Maternal and Child Nursing and Public Health, Federal University of Minas Gerais, Belo Horizonte, Brazil.
⁷² West Moreton Hospital Health Services, Queensland Centre for Mental Health Research, Wacol, QLD, Australia.
⁷³ Clinical Epidemiology and Public Health Research Unit, Burlo Garofolo Institute for Maternal and Child Health, Trieste, Italy.
⁷⁴ Department of Health Policy and Management, Keio University, Tokyo, Japan.
⁷⁵ Department of Global Health Policy, University of Tokyo, Tokyo, Japan.
⁷⁶ Department of Internal Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.
⁷⁷ Centre of Telehealth, Federal University of Minas Gerais, Belo Horizonte, Brazil.
⁷⁸ Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Wacol, QLD, Australia.
⁷⁹ Yale School of Public Health - Social and Behavioral Sciences, Yale University, New Haven, CT, USA.
⁸⁰ Evans School of Public Policy & Governance, University of Washington, Seattle, WA, USA.
⁸¹ Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.
⁸² HIV and other Infectious Diseases Research Unit, South African Medical Research Council, Durban, South Africa.
⁸³ Department of Orthopaedic Surgery, Duke University, Durham, NC, USA.

PMID: 35664995
PMCID: PMC9164454
DOI: 10.1101/2022.05.26.22275532

Update in

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; Wulf Hanson S, Abbafati C, Aerts JG, Al-Aly Z, Ashbaugh C, Ballouz T, Blyuss O, Bobkova P, Bonsel G, Borzakova S, Buonsenso D, Butnaru D, Carter A, Chu H, De Rose C, Diab MM, Ekbom E, El Tantawi M, Fomin V, Frithiof R, Gamirova A, Glybochko PV, Haagsma JA, Haghjooy Javanmard S, Hamilton EB, Harris G, Heijenbrok-Kal MH, Helbok R, Hellemons ME, Hillus D, Huijts SM, Hultström M, Jassat W, Kurth F, Larsson IM, Lipcsey M, Liu C, Loflin CD, Malinovschi A, Mao W, Mazankova L, McCulloch D, Menges D, Mohammadifard N, Munblit D, Nekliudov NA, Ogbuoji O, Osmanov IM, Peñalvo JL, Petersen MS, Puhan MA, Rahman M, Rass V, Reinig N, Ribbers GM, Ricchiuto A, Rubertsson S, Samitova E, Sarrafzadegan N, Shikhaleva A, Simpson KE, Sinatti D, Soriano JB, Spiridonova E, Steinbeis F, Svistunov AA, Valentini P, van de Water BJ, van den Berg-Emons R, Wallin E, Witzenrath M, Wu Y, Xu H, Zoller T, Adolph C, Albright J, Amlag JO, Aravkin AY, Bang-Jensen BL, Bisignano C, Castellano R, Castro E, Chakrabarti S, Collins JK, Dai X, Daoud F, Dapper C, Deen A, Duncan BB, Erickson M, Ewald SB, Ferrari AJ, Flaxman AD, Fullman N, Gamkrelidze A, Giles JR, Guo G, Hay SI, … See abstract for full author list ➔ Global Burden of Disease Long COVID Collaborators, et al. JAMA. 2022 Oct 25;328(16):1604-1615. doi: 10.1001/jama.2022.18931. JAMA. 2022. PMID: 36215063 Free PMC article.

Abstract

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.

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Figures

**Figure 1.**
Proportions of incident long COVID symptom clusters and their overlap in 2020 and 2021 globally

**Figure 2.**
Global incident cases, prevalent cases, and severity-weighted prevalence of long COVID by age, sex, symptom cluster, and overlap of symptom clusters in 2020 and 2021

See this image and copyright information in PMC

References

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This is a preprint.

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

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

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