Two years after infection, Covid symptoms – the most common being fatigue, cognitive issues, and pain – were still found in at least a third of numerous cases, report scientists, whose international meta-analysis of 12 studies also showed other problems like anxiety and depression.
For the study, published in the Journal of Infection, the team, led by a researcher from Universidad Rey Juan Carlos in Madrid, Spain, searched the literature for observational and case-control studies of long Covid 24 months after infection. The studies, which had been published up until 1 October 2023, were from Europe, China and the United States.
The sample included 7 912 hospitalised and non-hospitalised Covid-19 survivors; the average age was 59.5 years, and 50.7% were women. Up to 54% of patients had at least one underlying medical condition, with high blood pressure (34.0%) and obesity (22.4%) the most common. Long-Covid symptoms were evaluated at an average follow-up of 723 days.
Psychological problems also prevalent
The most common post-Covid symptoms two years’ post-infection were fatigue (28.0%), cognitive impairment (27.6%), and pain (8.4%). Psychological problems like anxiety (13.4%), depression (18.0%) and disturbed sleep (20.9%) were also prevalent.
The most common respiratory and general symptoms were fatigue (28.0%), runny nose (8.2%), and shortness of breath (5.7%). Prevalent neurologic and cognitive symptoms were dizziness and vertigo (6.7%) and impaired sense of smell (5.3%) and taste (4.9%).
This plethora of symptoms can be explained by several mechanisms attributed to SARS-CoV-2, such as viral persistence, long-lasting inflammation, autoimmunity, reactivation of latent infections, alteration in gut microbiota, microvascular thrombosis, or others.
Stomach pain was the most common gastrointestinal symptom (6.7%); headache (8.9%) and muscle pain (8.1%) were the most prevalent pain symptoms; and hair loss was the most common dermatologic symptom (7.4%).
“This plethora of post-Covid symptoms can be explained by several mechanisms attributed to SARS-CoV-2, like viral persistence, long-lasting inflammation, autoimmunity, reactivation of latent infections, alteration in gut microbiota, microvascular thrombosis, or others,” the study authors wrote.
They added that population-based studies using homogeneous data-collection procedures are needed to further refine estimates of the prevalence of long Covid.
Study details
Persistence of post-Covid symptoms in the general population two years after SARS-CoV-2 infection: A systematic review and meta-analysis
Cesar Fernandez-de-las-Peñas, Kin Israel Notarte, Raymart Macasaet, William Chung, Juan A. Valera-Calero, Marcos Navarro-Santana
Published in Journal of Infection on 13 December 2023
Highlights
• The prevalence of post-Covid symptoms is 30% two years after Covid-19.
• Fatigue, cognitive disorders, and pain are the most prevalent post-Covid symptoms two-years after.
• The prevalence of anxiety, depression and sleep problems reaches 20% two-years after Covid-19.
Objective
This meta-analysis investigated the prevalence of post-Covid symptoms two-years after SARS-CoV-2 infection.
Methods
Electronic literature searches on PubMed, MEDLINE, CINAHL, EMBASE, Web of Science databases, and on medRxiv/bioRxiv preprint servers were conducted up to 1 October 2023. Studies reporting data on post-Covid symptoms at two-years after infection were included. Methodological quality was assessed using the Newcastle-Ottawa Scale. Random-effects models were used for meta-analytical pooled prevalence of each symptom.
Results
From 742 studies identified, twelve met inclusion criteria. The sample included 7 912 Covid-19 survivors (50.7% female; age: 59.5, SD: 16.3). Post-Covid symptoms were assessed at a follow-up of 722.9 (SD: 51.5) days after. The overall methodological quality of studies was moderate (mean: 6/10, SD: 1.2 points). The most prevalent post-Covid symptoms two-years after SARS-CoV-2 infection were fatigue (28.0%, 95%CI 12.0–47.0), cognitive impairments (27.6%, 95%CI 12.6–45.8), and pain (8.4%, 95%CI 4.9–12.8). Psychological disturbances such as anxiety (13.4%, 95%CI 6.3–22.5) and depressive (18.0%, 95%CI 4.8–36.7) levels as well as sleep problems (20.9%, 95%CI 5.25–43.25) were also prevalent. Pooled data showed high heterogeneity (I2 ≥ 75%).
Conclusion
This meta-analysis shows the presence of post-Covid symptoms in 30% of patients two-years after Covid-19. Fatigue, cognitive disorders, and pain were the most prevalent post-Covid symptoms. Psychological disturbances as well as sleep problems were still present two-years after Covid-19.
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