Long COVID symptoms may persist 3 years post-infection

One in five COVID-19 survivors experiences at least one unresolved symptom 3 years after the initial infection, a systematic review and meta-analysis reports.

“The key finding is that the pooled prevalence of survivors of COVID‐19 experiencing at least one unresolved symptom after 3 years of the initial SARS‐CoV‐2 infection is 20 percent (p=0.01),” the investigators said.

Moreover, the pooled prevalence of COVID‐19 survivors having at least one unresolved respiratory symptom 3 years post-infection was 35 percent. [J Med Virol 2025;97:e70429]

The most frequent significant symptom was dyspnoea (12 percent; p=0.0001), followed by fatigue (11 percent; p=0.001), smell disorder (7 percent; p=0.0006), cough (6 percent; p=0.018), and expectoration (4 percent; p=0.028).

Mortality risk

COVID‐19 patients who were not hospitalized during the acute phase of the disease were at an increased risk of death 3 years post-infection (incidence rate ratio [IRR], 1.01); this was higher among those who were hospitalized (IRR, 1.29).

Mortality rate was 7.84 percent among COVID‐19 patients without neurological signs post‐COVID‐19 hospitalization at 3 years. This nearly doubled among those with neurological signs (14.01 percent).

“[T]hese findings highlight the lasting impact of COVID‐19 on mortality and disability up to 3 years after infection, particularly among individuals who required hospitalization and those who experienced neurological complications,” the researchers said. This underlines the need for ongoing monitoring, support, and targeted interventions for affected individuals, particularly individuals who have severe or complex postacute presentations.

A multifaceted response

“Despite a decline in long COVID prevalence, its impact on health‐related quality of life, functional capacity, and socioeconomic consequences, along with the strain on public health systems, remains significant,” the investigators noted.

However, issues such as limited clinical guidance, inadequate diagnostic and treatment protocols, and fragmented care approaches hinder the management of long COVID, they said. “Additionally, delays in recognition and misattributions of symptoms to psychosomatic causes may compromise patient outcomes and trust.”

Addressing these challenges thus requires a multifaceted response. Multidisciplinary care teams should be established, and long COVID management must be integrated into routine healthcare protocols to enhance care delivery. Healthcare professionals should be trained and equipped with evidence‐based guidelines necessary to deliver tailored care, they added.

“Moreover, public health campaigns are vital to raise awareness, reduce stigma, and foster informed patient engagement. By improving knowledge among the public and in practitioners, we can build a more responsive and empathetic healthcare system,” the researchers said.

For instance, public health campaigns should focus on prevention, such as improving COVID vaccination effectiveness and advocating for early antiviral use during the acute phase. [J Med Virol 2023;95:e28833; Cell 2024;187:5500-5529; Lancet 2024;404:707-724]

“Ultimately, tackling long COVID must be recognized as a public health priority. Coordinated global action, informed by robust evidence and compassionate care, will be key to supporting the recovery and long‐term well‐being of those affected,” they concluded.

The analysis used data from 11 studies (n=142,171; >80 percent men) conducted across six countries (Bulgaria, China, Japan, Italy, Romania, the US).

The researchers noted that the findings may not be extrapolated to long COVID patients with mild symptoms during the initial infection, because the analysis primarily used data on long COVID patients who were hospitalized during the acute phase of the disease.