Two-Year Longitudinal Study Reveals That Long COVID Symptoms Peak and Quality of Life Nadirs at 6–12 Months Postinfection

• Published in: Open forum infectious diseases 2024-03, Vol.11 (3), p.ofae027
• Main Authors: Demko, Zoe O, Yu, Tong, Mullapudi, Sarika K, Varela Heslin, M Gabriela, Dorsey, Chamia A, Payton, Christine B, Tornheim, Jeffrey A, Blair, Paul W, Mehta, Shruti H, Thomas, David L, Manabe, Yukari C, Antar, Annukka A R
• Format: Article
• Language: English
• Subjects: Microbiology and Pathogenesis
• ISSN: 2328-8957; 2328-8957
• DOI: 10.1093/ofid/ofae027

Abstract Background Few longitudinal studies available characterize long COVID outcomes out to 24 months, especially in people with nonsevere acute coronavirus disease 2019 (COVID-19). This study sought to prospectively characterize incidence and duration of long COVID symptoms and their association with quality of life (QoL) from 1–24 months after mild-to-moderate COVID-19 using validated tools in a diverse cohort of unvaccinated people infected with SARS-CoV-2 in 2020. Methods At 1–3, 6, 12, 18, and 24 months post-COVID-19, 70 participants had orthostatic vital signs measured, provided blood, and completed surveys characterizing symptoms, QoL, and return to pre-COVID-19 health and activities using validated tools (FLU-PRO+, Fatigue Severity Scale, Insomnia Severity Index, General Practitioner Assessment of Cognition, Patient Health Questionnaire Depression 8-Item, Generalized Anxiety Disorder 7-Item, 36-Item Short-Form Health Survey, EuroQol EQ-5D-5L). Results During the study period, 33% of participants experienced long COVID (had not returned to pre-COVID-19 health status and reported at least 1 symptom >90 days postinfection); 8% had not returned to their pre-COVID-19 health status 24 months postinfection. Long COVID symptoms peaked 6 months post-COVID-19, frequently causing activity limitations. Having long COVID was significantly associated with decreased QoL in multiple domains. Frequencies of orthostatic hypotension and tachycardia reflected levels reported in the general population. Within-person weight increased significantly between months 1 and 6. Long COVID was associated with pre-COVID-19 obesity and hyperlipidemia, but not with high-sensitivity C-reactive protein levels 1–3 months postinfection. Conclusions Long COVID occurs in a significant proportion of unvaccinated people, even if the acute illness was not severe. Long COVID prevalence peaked 6–12 months post-COVID-19, and a small proportion of participants still reported not returning to their pre-COVID-19 health status 24 months post-COVID-19. Thirty-three percent of unvaccinated adults with mild-to-moderate acute COVID-19 experienced long COVID symptoms; 8% still had not returned to their pre-COVID-19 health status 24 months postinfection. Long COVID symptoms peaked and quality of life nadired at 6–12 months postinfection.