Prevalence of long-term effects in individuals diagnosed with COVID-19: an updated living systematic review

  1. Francesca Reyes Domingo
  2. Lisa A Waddell
  3. Angela M. Cheung
  4. Curtis L. Cooper
  5. Veronica J. Belcourt
  6. Alexandra M. E. Zuckermann
  7. Tricia Corrin
  8. Rukshanda Ahmad
  9. Laura Boland
  10. Claudie Laprise
  11. Leanne Idzerda
  12. Anam Khan
  13. Kate Morissette
  14. Alejandra Jaramillo Garcia

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Abstract

Objective

Post COVID-19 condition refers to persisting or recurring symptoms weeks after acute COVID-19 illness which can significantly impact quality of life and health systems. It is important to understand the manifestation and magnitude of this condition. The objective of this living systematic review is to summarize the prevalence of symptoms and sequelae reported by people ≥4 weeks after COVID-19 diagnosis.

Design

Systematic review, meta-analysis and narrative synthesis.

Data sources

Embase, Medline, PsychInfo, Cochrane Central and select grey literature up to April 14, 2021.

Methods

We adapted a previous search strategy used by the U.K. National Institute for Health and Care Excellence and updated it to search for new literature. Two reviewers screened references independently; one extracted data and assessed risk of bias and certainty of the evidence while another verified them. Prevalence data from laboratory-confirmed populations were meta-analyzed using a random effects model and synthesized separately in the short-term (4-12 weeks) and long-term (>12 weeks) periods after diagnosis. Data from clinically-diagnosed populations were synthesized narratively.

Results

Of the 4444 unique citations, 84 observational studies met our inclusion criteria. Over 100 post COVID-19 symptoms and sequelae were reported. Sixty-one percent (95% CI: 44-76%, low certainty ) and 53% (95% CI: 41-65%, low certainty ) of laboratory-confirmed individuals reported persistence or presence of one or more symptoms in the short- and long-term periods, respectively. The most prevalent symptoms in both periods included: fatigue, general pain or discomfort, shortness of breath, cognitive impairment and mental health symptoms.

Conclusions

A substantial proportion of individuals reported a variety of symptoms ≥4 weeks after COVID-19 diagnosis. Due to gaps in the research base, and the low certainty of the evidence currently available, further research is needed to determine the true burden of post COVID-19 condition in the general population and in specific subgroups.

PROSPERO registration number

CRD42021231476.

Article activity feed

  1. ScreenIT

    SciScore for 10.1101/2021.06.03.21258317: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    We adapted the NICE search strategy (which included a search of relevant literature published between January 1st to October 21st, 2020) and used it to search for new research published between October 22, 2020 to January 15, 2021 in the following databases: Embase, Medline, PsycINFO, and Cochrane Central.
    Embase
    suggested: (EMBASE, RRID:SCR_001650)
    Medline
    suggested: (MEDLINE, RRID:SCR_002185)
    PsycINFO
    suggested: (PsycINFO, RRID:SCR_014799)
    Cochrane Central
    suggested: (Cochrane Central Register of Controlled Trials, RRID:SCR_006576)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2021.06.03.21258317 on medRxiv