. 2022 Dec 1:55:101762.

doi: 10.1016/j.eclinm.2022.101762. eCollection 2023 Jan.

The prevalence and long-term health effects of Long Covid among hospitalised and non-hospitalised populations: A systematic review and meta-analysis

Lauren L O'Mahoney¹, Ash Routen¹, Clare Gillies^{1

2}, Winifred Ekezie¹, Anneka Welford¹, Alexa Zhang³, Urvi Karamchandani⁴, Nikita Simms-Williams⁵, Shabana Cassambai¹, Ashkon Ardavani¹, Thomas J Wilkinson¹, Grace Hawthorne¹, Ffion Curtis¹, Andrew P Kingsnorth¹, Abdullah Almaqhawi⁶, Thomas Ward⁷, Daniel Ayoubkhani^{2

8}, Amitava Banerjee^{9

10}, Melanie Calvert^{5

11

12}, Roz Shafran³, Terence Stephenson³, Jonathan Sterne¹³, Helen Ward⁴, Rachael A Evans^{7

14}, Francesco Zaccardi^{1

2}, Shaney Wright¹⁵, Kamlesh Khunti¹

Affiliations

¹ Diabetes Research Centre, University of Leicester, Leicester, UK.
² Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK.
³ Great Ormond Street Institute of Child Health, University College London, London, UK.
⁴ Faculty of Medicine, School of Public Health, Imperial College London, London, UK.
⁵ Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
⁶ Department of Family and Community Medicine, College of Medicine, King Faisal University, Al Ahsa, Saudi Arabia.
⁷ Department of Respiratory Sciences, University of Leicester, Leicester, UK.
⁸ Office for National Statistics, Government Buildings, Newport, UK.
⁹ Faculty of Population Health Sciences, Institute of Health Informatics, University College London, London, UK.
¹⁰ Department of Population Science and Experimental Medicine, University College London, London, UK.
¹¹ NIHR Birmingham Biomedical Research Centre and NIHR Applied Research Collaboration West Midlands, University Hospital Birmingham and University of Birmingham, Birmingham, UK.
¹² Birmingham Health Partners Centre for Regulatory Science and Innovation and Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK.
¹³ Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
¹⁴ NIHR Leicester Biomedical Research Centre, Respiratory Department, University Hospitals of Leicester NHS Trust, Leicester, UK.
¹⁵ Patient Partner, UK.

PMID: 36474804
PMCID: PMC9714474
DOI: 10.1016/j.eclinm.2022.101762

The prevalence and long-term health effects of Long Covid among hospitalised and non-hospitalised populations: A systematic review and meta-analysis

Lauren L O'Mahoney et al. EClinicalMedicine. 2022.

. 2022 Dec 1:55:101762.

doi: 10.1016/j.eclinm.2022.101762. eCollection 2023 Jan.

Authors

Affiliations

¹ Diabetes Research Centre, University of Leicester, Leicester, UK.
² Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK.
³ Great Ormond Street Institute of Child Health, University College London, London, UK.
⁴ Faculty of Medicine, School of Public Health, Imperial College London, London, UK.
⁵ Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
⁶ Department of Family and Community Medicine, College of Medicine, King Faisal University, Al Ahsa, Saudi Arabia.
⁷ Department of Respiratory Sciences, University of Leicester, Leicester, UK.
⁸ Office for National Statistics, Government Buildings, Newport, UK.
⁹ Faculty of Population Health Sciences, Institute of Health Informatics, University College London, London, UK.
¹⁰ Department of Population Science and Experimental Medicine, University College London, London, UK.
¹¹ NIHR Birmingham Biomedical Research Centre and NIHR Applied Research Collaboration West Midlands, University Hospital Birmingham and University of Birmingham, Birmingham, UK.
¹² Birmingham Health Partners Centre for Regulatory Science and Innovation and Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK.
¹³ Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
¹⁴ NIHR Leicester Biomedical Research Centre, Respiratory Department, University Hospitals of Leicester NHS Trust, Leicester, UK.
¹⁵ Patient Partner, UK.

PMID: 36474804
PMCID: PMC9714474
DOI: 10.1016/j.eclinm.2022.101762

Erratum in

Corrigendum to "The prevalence and long-term health effects of long Covid among hospitalised and non-hospitalised populations: a systematic review and meta-analysis".
O'Mahoney LL, Routen A, Gillies C, Ekezie W, Welford A, Zhang A, Karamchandani U, Simms-Williams N, Cassambai S, Ardavani A, Wilkinson TJ, Hawthorne G, Curtis F, Kingsnorth AP, Almaqhawi A, Ward T, Ayoubkhani D, Banerjee A, Calvert M, Shafran R, Stephenson T, Sterne J, Ward H, Evans RA, Zaccardi F, Wright S, Khunti K. O'Mahoney LL, et al. EClinicalMedicine. 2023 May;59:101959. doi: 10.1016/j.eclinm.2023.101959. Epub 2023 Apr 19. EClinicalMedicine. 2023. PMID: 37096187 Free PMC article.

Abstract

Background: The aim of this study was to systematically synthesise the global evidence on the prevalence of persistent symptoms in a general post COVID-19 population.

Methods: A systematic literature search was conducted using multiple electronic databases (MEDLINE and The Cochrane Library, Scopus, CINAHL, and medRxiv) until January 2022. Studies with at least 100 people with confirmed or self-reported COVID-19 symptoms at ≥28 days following infection onset were included. Patient-reported outcome measures and clinical investigations were both assessed. Results were analysed descriptively, and meta-analyses were conducted to derive prevalence estimates. This study was pre-registered (PROSPERO-ID: CRD42021238247).

Findings: 194 studies totalling 735,006 participants were included, with five studies conducted in those <18 years of age. Most studies were conducted in Europe (n = 106) or Asia (n = 49), and the time to follow-up ranged from ≥28 days to 387 days. 122 studies reported data on hospitalised patients, 18 on non-hospitalised, and 54 on hospitalised and non-hospitalised combined (mixed). On average, at least 45% of COVID-19 survivors, regardless of hospitalisation status, went on to experience at least one unresolved symptom (mean follow-up 126 days). Fatigue was frequently reported across hospitalised (28.4%; 95% CI 24.7%-32.5%), non-hospitalised (34.8%; 95% CI 17.6%-57.2%), and mixed (25.2%; 95% CI 17.7%-34.6%) cohorts. Amongst the hospitalised cohort, abnormal CT patterns/x-rays were frequently reported (45.3%; 95% CI 35.3%-55.7%), alongside ground glass opacification (41.1%; 95% CI 25.7%-58.5%), and impaired diffusion capacity for carbon monoxide (31.7%; 95% CI 25.8%-3.2%).

Interpretation: Our work shows that 45% of COVID-19 survivors, regardless of hospitalisation status, were experiencing a range of unresolved symptoms at ∼ 4 months. Current understanding is limited by heterogeneous study design, follow-up durations, and measurement methods. Definition of subtypes of Long Covid is unclear, subsequently hampering effective treatment/management strategies.

Funding: No funding.

Keywords: COVID-19; Long Covid; Meta analyses.

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Conflict of interest statement

This work was supported by National Institute for Health Research (NIHR) ARC East Midlands. AB is PI of the NIHR funded STIMULATE-ICP study (COV-LT2-0043) and has also received other research funding from Astra Zeneca, NIHR, BMA, UK Research and Innovation (UKRI) and EU. MC is Director of the Birmingham Health Partners Centre for Regulatory Science and Innovation, Director of the Centre for the Centre for Patient Reported Outcomes Research and is a NIHR Senior Investigator. MC receives funding from the NIHR, UKRI, NIHR Birmingham Biomedical Research Centre, the NIHR Surgical Reconstruction and Microbiology Research Centre, NIHR ARC West Midlands, UK SPINE, European Regional Development Fund–Demand Hub and Health Data Research UK at the University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Innovate UK (part of UKRI), Macmillan Cancer Support, UCB Pharma, Janssen, GSK and Gilead. She is senior author of the Symptom Burden Questionnaire™ for Long COVID. MC has received personal fees from Aparito Ltd, CIS Oncology, Takeda, Merck, Daiichi Sankyo, Glaukos, GSK and the Patient-Centered Outcomes Research Institute (PCORI) outside the submitted work. In addition, a family member owns shares in GSK. TS and RS receive funding from the NIHR, and by the UKRI who have awarded funding grant number COVLT0022. All research at Great Ormond Street Hospital NHS Foundation Trust and UCL Great Ormond Street Institute of Child Health is made possible by the NIHR Great Ormond Street Hospital Biomedical Research Centre. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. HW is an NIHR Senior Investigator Award, and acknowledges support from the NIHR Imperial Biomedical Research Centre, Health Data Research UK, NIHR Applied Research Collaborative North West London, and the Wellcome Trust. KK is Chair of the Ethnicity Subgroup of the UK Scientific Advisory Group for Emergencies (SAGE) and Member of SAGE and also Chair of the National Long Covid working group which reports to the Chief Medical Officer. TW receives funding from the NIHR, the views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. JS receives funding from the NIHR and UKRI.

Figures

**Fig. 1**
PRISMA flow diagram. Delineation of study selection.

**Fig. 2**
Prevalence of symptoms (ranked) in the hospitalised population. In total 46 symptoms and 12 investigations were reported. PTSD, Post-traumatic stress disorder; FEV1:FVC, ratio of the forced expiratory volume in the first 1 s to the forced vital capacity of the lungs.

**Fig. 3**
Prevalence of symptoms (ranked) in the non-hospitalised population. In total 14 symptoms were reported.

**Fig. 4**
Prevalence of symptoms (ranked) in the mixed (hospitalised and non-hospitalised) population. In total 28 symptoms and 1 investigation were reported. CT, Computed tomography.

See this image and copyright information in PMC

References

1. WHO WHO Coronavirus (COVID-19) dashboard. 2021. https://covid19.who.int/
1. WHO . 2021. A clinical case definition of post COVID-19 condition by a Delphi consensus; p. 2021. - PMC - PubMed
1. Office for National Statistics Prevalence of ongoing symptoms following coronavirus (COVID-19) infection in the UK: 6 May 2022. 2022. https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/...
1. National Centre for Health Statistics Nearly one in five American adults who have had COVID-19 still have “Long COVID”. 2022. https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2022/20220622.htm
1. Michelen M., Manoharan L., Elkheir N., et al. Characterising long COVID: a living systematic review. BMJ Global Health. 2021;6(9) - PMC - PubMed

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The prevalence and long-term health effects of Long Covid among hospitalised and non-hospitalised populations: A systematic review and meta-analysis

Affiliations

The prevalence and long-term health effects of Long Covid among hospitalised and non-hospitalised populations: A systematic review and meta-analysis

Authors

Affiliations

Erratum in

Abstract

Conflict of interest statement

Figures

References

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