Journal Article

The risk of Long Covid symptoms: a systematic review and meta-analysis of controlled studies

Cassambai, Shabana, Seidu, Samuel, Evans, Rachael A., Gillies, Clare, Ward, Helen, Peace, Arron, Khunti, Kamlesh, Stephenson, Terence, Jenkins, Sian A., Almaqhawi, Abdullah, Funnell, Mark P., Willis, Andrew, Calvert, Melanie, Ward, Tom, Banerjee, Amitava, O’Mahoney, Lauren L., Jeffers, Shavez, Ayoubkhani, Daniel, Welford, Anneka, Shafran, Roz, Sterne, Jonathan, Wilkinson, Thomas J., Pareek, Manish, Brightling, Chris, Routen, Ash, Kingsnorth, Andrew P., Ekezie, Winifred

2025

Overview

The global evidence on the risk of symptoms of Long Covid in general populations infected with SARS-CoV-2 compared to uninfected comparator/control populations remains unknown. We conducted a systematic literature search using multiple electronic databases from January 1, 2022, to August 1, 2024. Included studies had ≥100 people with confirmed or self-reported COVID-19 at ≥28 days following infection onset, and an uninfected comparator/control group. Results were summarised descriptively and meta-analyses were conducted to derive pooled risk ratio estimates. 50 studies totaling 14,661,595 people were included. In all populations combined, there was an increased risk of a wide range of 39 out of 40 symptoms in those infected with SARS‑CoV‑2 compared to uninfected controls. The symptoms with the highest pooled relative risks were loss of smell (RR 4.31; 95% CI 2.66, 6.99), loss of taste (RR 3.71; 95% CI 2.22, 7.26), poor concentration (RR 2.68; 95% CI 1.66, 4.33), impaired memory (RR 2.53; 95% CI 1.82, 3.52), and hair loss/alopecia (RR 2.38; 95% CI 1.69, 3.33). This evidence synthesis, of 50 controlled studies with a cumulative participant count exceeding 14 million people, highlights a significant risk of diverse long-term symptoms in individuals infected with SARS-CoV-2, especially among those who were hospitalised. Estimating the risk of long COVID is challenging because many of its symptoms are associated with other conditions. Here, the authors conduct a systematic review and meta-analysis of studies that estimate long COVID risk while accounting for background symptoms using comparator control populations.

• Publisher: Nature Publishing Group UK,Nature Publishing Group,Nature Portfolio
• Subject: 631/326/596/4130 / 692/1807 / 692/699 / 692/700/478/174 / Alopecia / Comparators / COVID-19 / COVID-19 - complications / COVID-19 - epidemiology / COVID-19 - physiopathology / COVID-19 - virology / Humanities and Social Sciences / Humans / Literature reviews / Long COVID / Meta-analysis / multidisciplinary / Olfaction / Population control / Post-Acute COVID-19 Syndrome - epidemiology / Post-Acute COVID-19 Syndrome - physiopathology / Post-Acute COVID-19 Syndrome - virology / Risk / Risk assessment / Risk Factors / SARS-CoV-2 - pathogenicity / Science / Science (multidisciplinary) / Severe acute respiratory syndrome coronavirus 2 / Systematic review / Viral diseases