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Long Covid: a global health issue - a prospective, cohort study set in four continents

Pazukhina E 1 , Garcia-Gallo E 1 , Reyes LF 2 , Kildal AB 3 , Jassat W 4 , Dryden M 5 Show all authors , Holter JC 6 , Chatterjee A 7 , Gomez K 8 , Søraas A 9 , Puntoni M 10 , Latronico N 11 , Bozza FA 12 , Edelstein M 13 , Gonçalves BP 14 , Kartsonaki C 15 , Kruglova O 16 , Gaião S 17 , Chow YP 18 , Doshi Y 19 , Duque Vallejo SI 20 , Ibáñez-Prada ED 21 , Fuentes YV 21 , Hastie C 22 , O'Hara ME 22 , Balan V 1 , Menkir T 23 , Merson L 1 , Kelly S 24 , Citarella BW 1 , Semple MG 25 , Scott JT 26 , Munblit D 27 , Sigfrid L 28 , ISARIC Clinical Characterisation Group and ISARIC Global Covid-19 follow up working group

Affiliations 

  • 1 ISARIC Global Support Centre, Pandemic Sciences Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
  • 2 Unisabana Center for Translational Science, School of Medicine, Universidad de La Sabana, Chia, Colombia
  • 3 Department of Anesthesiology and Intensive Care, University Hospital of North Norway, Tromso, Troms, Norway
  • 4 Genesis Analytics Pty Ltd, Johannesburg, Gauteng, South Africa
  • 5 National Institute for Communicable Diseases, Johannesburg, South Africa
  • 6 Department of Microbiology, Oslo University Hospital, Oslo, Norway
  • 7 UK Health Security Agency, London, UK
  • 8 Gibraltar Health Authority, Gibraltar, Gibraltar
  • 9 The Norwegian Corona Cohort, Oslo, Norway
  • 10 Clinical & Epidemiological Research Unit, University Hospital of Parma, Parma, Italy
  • 11 Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
  • 12 National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
  • 13 Bar-Ilan University The Azrieli Faculty of Medicine, Safed, Northern District, Israel
  • 14 Department of Comparative Biomedical Sciences, University of Surrey, Guildford, UK
  • 15 Nuffield Department of Population Health, University of Oxford, Oxford, UK
  • 16 Department of Internal Medicine No 2, Lugansk State Medical University, Rivne, Ukraine
  • 17 São João Hospital Centre, Porto, Portugal
  • 18 Sunway Medical Centre, Bandar Sunway, Selangor, Malaysia
  • 19 Terna Specialty Hospital and Research Centre, Mumbai, India
  • 20 University of Oxford Nuffield Department of Medicine, Oxford, UK
  • 21 Universidad de La Sabana, Chia, Colombia
  • 22 Long COVID Support, London, UK
  • 23 The Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard TH Chan School of Public Health, Harvard University, Cambridge, Massachusetts, USA
  • 24 Pandemic Sciences Institute, University of Oxford, Oxford, UK
  • 25 NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary, and Ecological Sciences, University of Liverpool, Liverpool, UK
  • 26 MRC, University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
  • 27 Division of Care in Long Term Conditions, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
  • 28 ISARIC Global Support Centre, Pandemic Sciences Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK louise.sigfrid@ndm.ox.ac.uk
BMJ Glob Health, 2024 Oct 21;9(10).
PMID: 39433402 DOI: 10.1136/bmjgh-2024-015245

Abstract

INTRODUCTION: A proportion of people develop Long Covid after acute COVID-19, but with most studies concentrated in high-income countries (HICs), the global burden is largely unknown. Our study aims to characterise long-term COVID-19 sequelae in populations globally and compare the prevalence of reported symptoms in HICs and low-income and middle-income countries (LMICs).

METHODS: A prospective, observational study in 17 countries in Africa, Asia, Europe and South America, including adults with confirmed COVID-19 assessed at 2 to <6 and 6 to <12 months post-hospital discharge. A standardised case report form developed by International Severe Acute Respiratory and emerging Infection Consortium's Global COVID-19 Follow-up working group evaluated the frequency of fever, persistent symptoms, breathlessness (MRC dyspnoea scale), fatigue and impact on daily activities.

RESULTS: Of 11 860 participants (median age: 52 (IQR: 41-62) years; 52.1% females), 56.5% were from HICs and 43.5% were from LMICs. The proportion identified with Long Covid was significantly higher in HICs vs LMICs at both assessment time points (69.0% vs 45.3%, p<0.001; 69.7% vs 42.4%, p<0.001). Participants in HICs were more likely to report not feeling fully recovered (54.3% vs 18.0%, p<0.001; 56.8% vs 40.1%, p<0.001), fatigue (42.9% vs 27.9%, p<0.001; 41.6% vs 27.9%, p<0.001), new/persistent fever (19.6% vs 2.1%, p<0.001; 20.3% vs 2.0%, p<0.001) and have a higher prevalence of anxiety/depression and impact on usual activities compared with participants in LMICs at 2 to <6 and 6 to <12 months post-COVID-19 hospital discharge, respectively.

CONCLUSION: Our data show that Long Covid affects populations globally, manifesting similar symptomatology and impact on functioning in both HIC and LMICs. The prevalence was higher in HICs versus LMICs. Although we identified a lower prevalence, the impact of Long Covid may be greater in LMICs if there is a lack of support systems available in HICs. Further research into the aetiology of Long Covid and the burden in LMICs is critical to implement effective, accessible treatment and support strategies to improve COVID-19 outcomes for all.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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