Long-term persistence of post-COVID-19 symptoms: A two-year follow-up of a Primary Care cohort

Authors

  • Yolanda Barrera Martínez Servicio Andaluz de Salud. Atención Primaria de Salud. Centro de Salud El Palo. Málaga. España
  • Gerardo Andrés Boillat Oriani Servicio Andaluz de Salud. Atención Primaria de Salud. Centro de Salud Rincón de la Victoria. Rincón de la Victoria. Málaga. España https://orcid.org/0009-0002-2912-1917
  • Pedro Vega Montes Servicio Andaluz de Salud. Atención Primaria de Salud. Centro de Salud El Palo. Málaga. España
  • Elena Martínez Moreno Servicio Andaluz de Salud. Atención Primaria de Salud. Centro de Salud El Palo. Málaga. España
  • Alejandro Pérez Pérez Servicio Andaluz de Salud. Atención Primaria de Salud. Centro de Salud El Palo. Málaga. España
  • Ricardo José Casajuana Pérez Servicio Andaluz de Salud. Atención Primaria de Salud. Centro de Salud El Palo. Málaga. España
  • Francisca Muñoz Cobos Servicio Andaluz de Salud. Atención Primaria de Salud. Centro de Salud El Palo. Málaga. España

DOI:

https://doi.org/10.23938/ASSN.1101

Keywords:

Post-Acute COVID-19 Syndrome, Health-Related Quality of Life, Primary Care, Cohort Studies

Abstract

Background. This study aims to determine the prevalence of long COVID two years after initial infection, identify prognostic factors, and assess its impact on quality of life.

Methodology. An ambispective cohort study was conducted with patients aged ≥ 18 years from two health centers in Málaga, Spain, who tested positive for SARS-CoV-2 between October 2020 and May 2021. Systematic random sampling was performed in October 2022, with 5% precision, 5% alpha error, and 25% expected losses. The cohort was followed until May 2023. Dependent variables included long COVID (≥ 1 symptom lasting ≥8 weeks), symptom count, quality of life (EuroQol 5-D), and global health perception (EQ-EVA). Independent variables included age, sex, severity of initial infection severity, vaccination status, comorbidities, and reinfection.

Results. Of 914 eligible individuals, 173 patients were sampled (mean age 47 years, 58.4% female). Long COVID was observed in 32.36% of participants, with 23% affected two years after infection. Fatigue and anosmia/dysgeusia were the most frequent symptoms. Prognostic factors for long COVID included higher initial infection severity, younger age, and reinfection. For symptom count, factors were depression, initial infection severity, and reinfection. Health perception was eight points lower in long COVID patients (77.72: SD=17.10 vs 86.15; SD=16.25; p<0.001). Female sex, older age, fewer comorbidities, and more vaccine doses were associated with better quality of life.

Conclusions. Thirty-two percent of patients experienced long COVID, mainly fatigue and anosmia/dysgeusia. It associates with higher initial severity, younger age, and reinfection, negatively impacting quality of life.

 

Downloads

Download data is not yet available.

Author Biographies

Yolanda Barrera Martínez, Servicio Andaluz de Salud. Atención Primaria de Salud. Centro de Salud El Palo. Málaga. España

Servicio Andaluz de Salud. Atención Primaria de Salud. Centro de Salud El Palo. Málaga. España            https://ror.org/03q4c3e69

Gerardo Andrés Boillat Oriani, Servicio Andaluz de Salud. Atención Primaria de Salud. Centro de Salud Rincón de la Victoria. Rincón de la Victoria. Málaga. España

Servicio Andaluz de Salud. Atención Primaria de Salud. Centro de Salud Rincón de la Victoria. Rincón de la Victoria. Málaga. España       https://ror.org/03q4c3e69

Pedro Vega Montes, Servicio Andaluz de Salud. Atención Primaria de Salud. Centro de Salud El Palo. Málaga. España

Servicio Andaluz de Salud. Atención Primaria de Salud. Centro de Salud El Palo. Málaga. España            https://ror.org/03q4c3e69

Elena Martínez Moreno, Servicio Andaluz de Salud. Atención Primaria de Salud. Centro de Salud El Palo. Málaga. España

Servicio Andaluz de Salud. Atención Primaria de Salud. Centro de Salud El Palo. Málaga. España            https://ror.org/03q4c3e69

Alejandro Pérez Pérez, Servicio Andaluz de Salud. Atención Primaria de Salud. Centro de Salud El Palo. Málaga. España

Servicio Andaluz de Salud. Atención Primaria de Salud. Centro de Salud El Palo. Málaga. España            https://ror.org/03q4c3e69

Ricardo José Casajuana Pérez, Servicio Andaluz de Salud. Atención Primaria de Salud. Centro de Salud El Palo. Málaga. España

Servicio Andaluz de Salud. Atención Primaria de Salud. Centro de Salud El Palo. Málaga. España            https://ror.org/03q4c3e69

Francisca Muñoz Cobos, Servicio Andaluz de Salud. Atención Primaria de Salud. Centro de Salud El Palo. Málaga. España

Servicio Andaluz de Salud. Atención Primaria de Salud. Centro de Salud El Palo. Málaga. España            https://ror.org/03q4c3e69

References

World Health Organization. Report of the WHO-China Joint Mission on coronavirus disease 2019 (COVID-19). 2020. https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf

Gobierno de España. Ministerio de Sanidad, Consumo y Bienestar Social. Centro de Coordinación de Alertas y Emergencias Sanitarias (CCAES). Información científico-técnica. Enfermedad por coronavirus, COVID-19. https://www.mscbs.gob.es/profesionales/saludPublica/ccayes/alertasActual/nCov/documentos /ITCoronavirus.pdf

Cui J, Li F, Shi ZL. Origin and evolution of pathogenic coronaviruses. Nat Rev Microbiol 2019; 17(3): 181-192. http://dx.doi.org/10.1038/s41579-018-0118-9

National Institute for Health and Care Excellence. COVID-19 rapid guideline: managing the long-term effects of COVID-19. NICE uideline 188. 2020. https://www.nice.org.uk/guidance/ng188

Rajan S, Khunti K, Alwan N, Steves C, Greenhalgh T, MacDermott N et al. In the wake of the pandemic. Preparing for Long COVID. Health Systems and Policy Analysis: Policy Brief 39, 2020. https://apps.who.int/iris/bitstream/handle/10665/339629/Policy-brief-39-1997-8073-eng.pdf

Gobierno de España. Ministerio de Ciencia, Innovación y Universidades. Estudio Nacional de Sero-Epidemiología de la infección por SARS-CoV-2 en España (ENECOVID). 24 de marzo de 2022. https://portalcne.isciii.es/enecovid19/

Soriano JB, Murthy S, Marshall JC, Relan P, Diaz JV; WHO Clinical Case Definition Working Group on Post-COVID-19 Condition. A clinical case definition of post-COVID-19 condition by a Delphi consensus. Lancet Infect Dis 2021; 21(21): 00703-9. https://doi.org/10.1016/S1473-3099(21)00703-9.

Hanson SW, Abbafati C, Aerts JG, Al-Aly Z, Ashbaugh C, Ballouz T et al. A global systematic analysis of the occurrence, severity, and recovery pattern of long COVID in 2020 and 2021. medRxiv [Preprint] 2022. https://doi.org/10.1101/2022.05.26.22275532.

Rodriguez-Ledo P, Armenteros del Olmo L, Guerrero-Caballero S, Bilbao-Fernández S, en representación de Sociedad Española de Médicos Generales y de Familia (SEMG) y colectivo Long COVID ACTS. La persistencia de síntomas de la COVID-19 y su diagnóstico en la primera ola de la pandemia en España. Med Gen Fam 2021; 10(2): 53-59. https://doi.org/10.24038/mgyf.2021.009

Sociedad Española de Médicos Generales y de Familia. Guía clínica para la atención al paciente Long COVID/COVID persistente. 1 de mayo de 2021. https://www.semg.es/images/2021/Documentos/GUIA_CLINICA_COVID_Persistent_20210501_version_final.pdf

Davis HE, Assaf GS, Mccorkell L, Wei H, Low RJ, Re’em Y et al. Characterizing long COVID in an international cohort: 7 months of symptoms and their impact. medRxiv [Preprint] 2020. https://doi.org/10.1101/2020.12.24.20248802.

Lopez-Leon S, Wegman-Ostrosky T, Perelman C, Sepulveda R, Rebolledo PA, Cuapio A et al. More than 50 long-term effects of COVID-19: A systematic review and meta-analysis. Sci Rep 2021; 11(1): 16144. https://doi.org/10.1038/s41598-021-95565-8

Chen C, Haupert SR, Zimmermann L, Shi X, Fritsche LG, Mukherjee B. Global prevalence of post COVID-19 condition or long COVID: A meta-analysis and systematic review. J Infect Dis 2022; 226(9): 1593-1607. https://doi.org/10.1093/infdis/jiac136

Sociedad Española de Médicos Generales y de Familia. COVID-19 persistente. Encuesta. 11 de noviembre de 2020. https://semg.es/images/2020/Noticias/20201111_Resultados_Encuesta_COVID_Persistente.pdf

Romero-Duarte A, Rivera-Izquierdo M, Guerrero-Fernández de Alba I, Pérez Contreras M, Fernández-Martínez NF, Ruiz-Montero R et al. Sequelae, persistent symptomatology and outcomes after COVID-19 hospitalization: The ANCOHVID multicentre 6-month follow-up study. BMC Med 2021; 19(1): 129. https://doi.org/10.1186/s12916-021-02003-7

López-Sampalo A, Bernal-López MR, Gómez-Huelgas R. Síndrome de COVID-19 persistente. Una revisiónnarrativa. Rev Clin Esp 2022; 222(4): 241-250. https://doi.org/10.1016/j.rce.2021.10.003

British Society for Immunology. Long-term immunological health consequences of COVID-19. 13 August 2020. https://www.immunology.org/sites/default/files/BSI Briefing Note August 2020 FINAL.pdf

Boix V, Merino E. Post-COVID syndrome. The never-ending challenge. Med Clin (Barc) 2022; 158(4): 178-180. https://doi.org/10.1016/j.medcli.2021.10.002

Huang L, Yao Q, Gu X, Wang Q, Ren L, Wang Y et al. 1-year outcomes in hospital survivors with COVID-19: a longitudinal cohort study. Lancet 2021; 398(10302): 747-758. https://doi.org/10.1016/s0140-6736(21)01755-4

Al-Aly A, Xie Y, Bowe B. High-dimensional characterization of post-acute sequelae of COVID-19. Nature 2021;594(7862): 259-264. https://doi.org/10.1038/s41586-021-03553-9

Sudre CH, Murray B, Varsavsky T, Graham MS, Penfold RS, Bowyer RC et al. Attributes and predictors of long COVID. Nat Med 2021; 27(4): 626-631. https://doi.org/10.1038/s41591-021-01292-y

Rubio-Rivas M, Corbella X, Mora-Luján JM, Loureiro-Amigo J, López Sampalo A, Yera-Bergua C et al. Predicting clinical outcome with phenotypic clusters in COVID-19 pneumonia: An analysis of 12,066 hospitalized patients from the Spanish Registry SEMI-COVID-19. J Clin Med 2020; 9(11): 3488. https://doi.org/10.3390/jcm9113488

Daugherty SE, Guo Y, Heath K, Dasmariñas MC, Jubilo KG, Samranvedhya J et al. Risk of clinical sequelae after the acute phase of SARS-CoV-2 infection: Retrospective cohort study. BMJ 2021; 373: n1098. https://doi.org/10.1136/bmj.n1098

Bouza E, Cantón Moreno, de Lucas Ramos P, García-Botella A, García-Lledó A, Gómez-Pavón J et al. Síndrome post-COVID: Un documento de reflexión y opinión. Rev Esp Quimioter 2021; 34(4): 269-279.

Ayoubkhani D, Khunti K, Nafilyan V, Maddox T, Humberstone B, Diamond I et al. Post-COVID syndrome in individuals admitted to hospital with COVID-19: Retrospective cohort study. BMJ 2021; 372: n693. https://doi.org/10.1136/bmj.n693

Ayuso García B, Pérez López A, Besteiro Balado Y, Romay Lema E, García País MJ, Marchán-López et al. Calidad de vida relacionada con la salud en pacientes recuperados de COVID-19. J Healthc Qual Res 2022; 37(4): 208-215. https://doi.org/10.1016/j.jhqr.2022.01.001

Greenhalgh T, Knight M, A'Court C, Buxton M, Husain L. Management of post-acute covid-19 in primary care. BMJ 2020; 370: m3026. https://doi.org/10.1136/bmj.m3026

Moreno-Pérez O, Merino E, Leon-Ramirez JM, Andres A, Ramos JM, Arenas-Jiménez J. Post-acute COVID-19 syndrome. Incidence and risk factors: A Mediterranean cohort study. J Infect 2021; 82: 372-378.

Carrera Morodo M, Pérez Orcero A, Ruiz Moreno J, Altemir Vidal A, Larrañaga Cabrera A, Fernández San Martín MI. Prevalencia de la COVID persistente: seguimiento al año de una cohorte poblacional ambulatoria. Rev Clin Med Fam 2023; 16(2): 94-97. https://doi.org/10.55783/rcmf.160206

Rodríguez Onieva A, Vallejo Basurte C, Fernández Bersabé A, Camacho Cerro L, Valverde Bascón B, Muriel Sanjuan N et al. Clinical characterization of the persistent COVID-19 symptoms: A descriptive observational study in primary care. J Prim Care Community Health 2023; 14: 21501319231208283. https://doi.org/10.1177/21501319231208283

Centers for Disease Control and Prevention. COVID-19 The long haul: Forging a path through the lingering effects of COVID-19. April 28, 2021. https://www.cdc.gov/washington/testimony/2021/t20210428.htm

World Health organization. News. Post COVID-19 condition: WHO supports standardization of clinical data collection and reporting. August 12, 2021. https://www.who.int/news/item/12-08-2021-post-covid-19-condition-who-supports-standardization-of-clinical-data-collection-and-reporting

Pinzon RT, Wijaya VO, Jody AA, Nunsio PN, Buana RB. Persistent neurological manifestations in long COVID-19 syndrome: A systematic review and meta-analysis. J Infect Public Health 2022; 15(8): 856-869. https://doi.org/10.1016/j.jiph.2022.06.013

Al-Aly Z, Bowe B, Xie Y. COVID prolongado después de la infección irruptiva por SARS-CoV-2. Nat Med 2022; 28: 1461-1467. https://doi.org/10.1038/s41591-022-01840-0

Petersen MS, Kristiansen MF, Hanusson KD, Danielsen ME, Á Steig B, Gaini S et al. Long COVID in the Faroe Islands: a longitudinal study among nonhospitalized patients. Clin Infect Dis 2021; 73(11): e4058-e4063. https://doi.org/10.1093/cid/ciaa1792

Romero-Rodríguez E, Perula-de-Torres LÁ, González-Lama J, Castro-Jiménez RÁ, Jiménez-García C, Priego-Pérez C et al. Long COVID symptomatology and associated factors in primary care patients: the EPICOVID-AP21 study. Healthcare 2023; 11(2): 218. https://doi.org/10.3390/healthcare11020218

Al-Aly Z, Bowe B, Xie Y. Outcomes of SARS-CoV-2 reinfection. [Preprint]. Research Square 2022. https://doi.org/10.21203/rs.3.rs-1749502/v1

Owusu D, Kim L, O’Halloran A, Whitaker M, Piasecki AM, Reingold A et al. COVID-NET Surveillance Team. Characteristics of adults aged 18-49 years without underlying conditions hospitalized with laboratory-confirmed Coronavirus Disease 2019 in the United States: COVID-NET-March-August 2020. Clin Infect Dis 2021; 72(5): e162-e166. https://doi.org/10.1093/cid/ciaa1806

Ghosn J, Piroth L, Epaulard O, le Turnier P, Mentré F, Bachelet D et al. Persistent COVID-19 symptoms are highly prevalent 6 months after hospitalization: Results from a large prospective cohort. Clin Microbiol Infect 2021; 27(7): 1041.e1-1041.e4. https://doi.org/10.1016/j.cmi.2021.03.012

Vaes AW, Machado FVC, Meys R, Delbressine JM, Goertz YMJ, Van Herck M et al. Care dependency in non-hospitalized patients with COVID-19. J Clin Med 2020; 9(9): 2946. https://doi.org/10.3390/jcm9092946

Sociedad Española de Médicos Generales y de Familia. El 55% de afectados por Long COVID afirma que tras recibir la vacuna se sintió igual, el 26% mejor y un 18% peor. XXVII Congreso Nacional de Medicina General y de Familia; Mallorca 17-19 de junio de 2021. Nota de prensa. https://www.semg.es/index.php/noticias/item/673-noticia-20210618-1

Antonelli M, Penfold RS, Merino J, Sudre CH, Molteni E, Berry S et al. Risk factors and disease profile of post-vaccination SARS-CoV-2 infection in UK users of the COVID Symptom Study app: a prospective, community-based, nested, case-control study. Lancet Infect Dis 2022; 22(1):43-55. https://doi.org/10.1016/S1473-3099(21)00460-6

Published

2025-03-12

How to Cite

1.
Barrera Martínez Y, Boillat Oriani GA, Vega Montes P, Martínez Moreno E, Pérez Pérez A, Casajuana Pérez RJ, et al. Long-term persistence of post-COVID-19 symptoms: A two-year follow-up of a Primary Care cohort. An Sist Sanit Navar [Internet]. 2025 Mar. 12 [cited 2025 Dec. 21];48(1):e1101. Available from: https://recyt.fecyt.es/index.php/ASSN/article/view/108394

Issue

Section

Research articles

Similar Articles

1 2 3 4 5 6 7 8 9 10 > >> 

You may also start an advanced similarity search for this article.