A global systematic analysis of the occurrence, severity, and recovery pattern of long COVID in 2020 and 2021.
Journal: medRxiv : the preprint server for health sciences
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Affiliated Institutions:
Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Department of Juridical and Economic Studies, La Sapienza University, Rome, Italy.
Department of Pulmonary Medicine, Erasmus University Medical Center, Rotterdam, Netherlands.
John T. Milliken Department of Internal Medicine, Washington University in St. Louis, St. Louis, MO, USA.
Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zurich, Switzerland.
Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
Clinical Medicine (Pediatric profile), I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
EuroQol Research Foundation, Rotterdam, Netherlands.
Pirogov Russian National Research Medical University, Moscow, Russia.
Department of Woman and Child Health and Public Health, Agostino Gemelli University Polyclinic IRCCS, Rome, Italy.
I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
Department of Medicine, University of Washington, Seattle, WA, USA.
The Center for Policy Impact in Global Health, Duke University, Durham, NC, USA.
Uppsala University Hospital, Uppsala, Sweden.
Pediatric Dentistry and Dental Public Health Department, Alexandria University, Alexandria, Egypt.
Rector's Office, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden.
Clinical Medicine (General Medicine profile), I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
Administration Department, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands.
Applied Physiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
School of Nursing, Duke University, Durham, NC, USA.
Department of Rehabilitation Medicine, Erasmus University Medical Center, Rotterdam, Netherlands.
Department of Neurology, Medical University Innsbruck, Innsbruck, Austria.
Department of Infectious Diseases and Respiratory Medicine, Charité Medical University Berlin, Berlin, Germany.
Department of Respiratory Medicine, Erasmus University Medical Center, Rotterdam, Netherlands.
Department of Public Health Surveillance and Response, National Institute for Communicable Diseases, Johannesburg, South Africa.
Department of Infectious Diseases and Respiratory Medicine, Charité University Medical Center Berlin, Berlin, Germany.
Department of Epidemiology, Harvard University, Boston, MA, USA.
Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
Russian Medical Academy of Continuous Professional Education, Ministry of Healthcare of the Russian Federation, Moscow, Russia.
Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
Department of Paediatrics and Paediatric Infectious Diseases, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
Duke Global Health Institute, Duke University, Durham, NC, USA.
ZA Bashlyaeva Children's Municipal Clinical Hospital, Moscow, Russia.
Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
Department of Occupational Medicine and Public Health, The Faroese Hospital System, Torshavn, Faroe Islands.
Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zurich, Switzerland.
Department of Internal Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
epartment of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
(Princess University Hospital), Autonomous University of Madrid, Hospital Universitario de La Princesa, Madrid, Spain.
Department of Global Health and Social Medicine, Harvard University, Boston, MA, USA.
Department of Family Medicine and Community Health, Duke University, Durham, NC, USA.
Department of Political Science, University of Washington, Seattle, WA, USA.
Department of Applied Mathematics, University of Washington, Seattle, WA, USA.
Postgraduate Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
School of Public Health, The University of Queensland, Brisbane, QLD, Australia.
National Center for Disease Control and Public Health, Tbilisi, Georgia.
Munk School of Global Affairs and Public Policy, University of Toronto, Toronto, Ontario, Canada.
Department of Maternal and Child Nursing and Public Health, Federal University of Minas Gerais, Belo Horizonte, Brazil.
West Moreton Hospital Health Services, Queensland Centre for Mental Health Research, Wacol, QLD, Australia.
Clinical Epidemiology and Public Health Research Unit, Burlo Garofolo Institute for Maternal and Child Health, Trieste, Italy.
Department of Health Policy and Management, Keio University, Tokyo, Japan.
Department of Internal Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Wacol, QLD, Australia.
Evans School of Public Policy & Governance, University of Washington, Seattle, WA, USA.
Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.
Department of Orthopaedic Surgery, Duke University, Durham, NC, USA.
Abstract summary
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.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.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.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.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. What are the extent and nature of the most common long COVID symptoms by country in 2020 and 2021? 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. 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.
Authors & Co-authors:
Hanson Sarah Wulf SW
Abbafati Cristiana C
Aerts Joachim G JG
Al-Aly Ziyad Z
Ashbaugh Charlie C
Ballouz Tala T
Blyuss Oleg O
Bobkova Polina P
Bonsel Gouke G
Borzakova Svetlana S
Buonsenso Danilo D
Butnaru Denis D
Carter Austin A
Chu Helen H
De Rose Cristina C
Diab Mohamed Mustafa MM
Ekbom Emil E
El Tantawi Maha M
Fomin Victor V
Frithiof Robert R
Gamirova Aysylu A
Glybochko Petr V PV
Haagsma Juanita A JA
Javanmard Shaghayegh Haghjooy SH
Hamilton Erin B EB
Harris Gabrielle G
Heijenbrok-Kal Majanka H MH
Helbok Raimund R
Hellemons Merel E ME
Hillus David D
Huijts Susanne M SM
Hultström Michael M
Jassat Waasila W
Kurth Florian F
Larsson Ing-Marie IM
Lipcsey Miklós M
Liu Chelsea C
Loflin Callan D CD
Malinovschi Andrei A
Mao Wenhui W
Mazankova Lyudmila L
McCulloch Denise D
Menges Dominik D
Mohammadifard Noushin N
Munblit Daniel D
Nekliudov Nikita A NA
Ogbuoji Osondu O
Osmanov Ismail M IM
Peñalvo José L JL
Petersen Maria Skaalum MS
Puhan Milo A MA
Rahman Mujibur M
Rass Verena V
Reinig Nickolas N
Ribbers Gerard M GM
Ricchiuto Antonia A
Rubertsson Sten S
Samitova Elmira E
Sarrafzadegan Nizal N
Shikhaleva Anastasia A
Simpson Kyle E KE
Sinatti Dario D
Soriano Joan B JB
Spiridonova Ekaterina E
Steinbeis Fridolin F
Svistunov Andrey A AA
Valentini Piero P
van de Water Brittney J BJ
van den Berg-Emons Rita R
Wallin Ewa E
Witzenrath Martin M
Wu Yifan Y
Xu Hanzhang H
Zoller Thomas T
Adolph Christopher C
Albright James J
Amlag Joanne O JO
Aravkin Aleksandr Y AY
Bang-Jensen Bree L BL
Bisignano Catherine C
Castellano Rachel R
Castro Emma E
Chakrabarti Suman S
Collins James K JK
Dai Xiaochen X
Daoud Farah F
Dapper Carolyn C
Deen Amanda A
Duncan Bruce B BB
Erickson Megan M
Ewald Samuel B SB
Ferrari Alize J AJ
Flaxman Abraham D AD
Fullman Nancy N
Gamkrelidze Amiran A
Giles John R JR
Guo Gaorui G
Hay Simon I SI
He Jiawei J
Helak Monika M
Hulland Erin N EN
Kereselidze Maia M
Krohn Kris J KJ
Lazzar-Atwood Alice A
Lindstrom Akiaja A
Lozano Rafael R
Magistro Beatrice B
Malta Deborah Carvalho DC
Månsson Johan J
Herrera Ana M Mantilla AMM
Mokdad Ali H AH
Monasta Lorenzo L
Nomura Shuhei S
Pasovic Maja M
Pigott David M DM
Reiner Robert C RC
Reinke Grace G
Ribeiro Antonio Luiz P ALP
Santomauro Damian Francesco DF
Sholokhov Aleksei A
Spurlock Emma Elizabeth EE
Walcott Rebecca R
Walker Ally A
Wiysonge Charles Shey CS
Zheng Peng P
Bettger Janet Prvu JP
Murray Christopher Jl CJ
Vos Theo T
Study Outcome
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