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 Table of Contents  
Year : 2022  |  Volume : 2  |  Issue : 2  |  Page : 45-46

Long COVID and beyond: Persistence of symptoms 1 year after COVID-19 infection

Baby Memorial Hospital, Kozhikode, Kerala, India

Date of Submission12-Mar-2022
Date of Acceptance27-Mar-2022
Date of Web Publication17-May-2022

Correspondence Address:
Dr. Ravindran Chetambath
Baby Memorial Hospital, Kozhikode, Kerala
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jalh.jalh_11_22

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How to cite this article:
Chetambath R. Long COVID and beyond: Persistence of symptoms 1 year after COVID-19 infection. J Adv Lung Health 2022;2:45-6

How to cite this URL:
Chetambath R. Long COVID and beyond: Persistence of symptoms 1 year after COVID-19 infection. J Adv Lung Health [serial online] 2022 [cited 2023 Jun 11];2:45-6. Available from: https://www.jalh.org//text.asp?2022/2/2/45/345371

Long COVID is defined as the persistence of symptoms beyond 3 months after SARS-CoV-2 infection. In a true clinical scenario, patients report to the outpatient department with vague generalized symptoms or respiratory symptoms even after 1 year of COVID-19 infection. Few studies have reported persistent symptoms in patients up to a year after infection. One large study from the UK found one in three COVID-19 patients presenting with at least one symptom 6 months after recovery.[1] Another study from China detected symptoms among half of their hospitalized COVID-19 patients, up to a year after discharge.[2]

Observations from one study reported that only 22.9% of patients were completely free of symptoms at 12 months, and the most frequent symptoms were reduced exercise capacity in 56.3%, fatigue in 53.1%, dyspnea in 37.5%, concentration problems in 39.6%, and sleeping problems in 26.0%. Females showed significantly more neurocognitive symptoms than males. Compared to patients without symptoms, patients with at least one long COVID symptom at 12 months did not differ significantly with respect to their SARS-CoV-2-antibody levels, but had a significantly reduced quality of life, both physically and mentally compared to patients without symptoms.

In a new study published in JAMA Network Open, a team of Chinese researchers assessed 2,433 recovered COVID-19 patients, around 1 year after they had been discharged from the hospital.[2] The study found 45% of patients report at least one symptom persisting 12 months later. Fatigue, sweating, chest tightness, anxiety, and myalgia were the most common long-term symptoms cited by the cohort. Around a quarter of all hospitalized patients reported persistent fatigue 1 year later.

Old age and severe illness were linked to a higher risk of experiencing at least three long-term symptoms. In the respiratory outpatient clinic, the frequently reported long COVID symptoms are chest tightness and exercise intolerance. Between 3 and 6 months, most of the patients have persistent dry cough, vague chest pain, and exercise intolerance. These symptoms are less during 1-year follow-up pointing to the fact that symptoms of long COVID may decrease over time. Patients with preexisting lung diseases such as asthma, chronic obstructive pulmonary disease, and bronchiectasis with COVID-19 infection reported more symptoms in the post COVID period. They have persistent cough, breathlessness, wheeze, and fatigue even after 1 year. They also experience poor symptom control with existing medications.

Another important observation is exercise limitation in these patients. Those who get back to their routine activities after COVID-19 negativity, experience shortness of breath and had to interrupt their activities. Some patients with COVID-19 who have recovered from the acute infection after experiencing only mild symptoms continue to exhibit persistent exertional limitation. Majority of patients with lower respiratory symptoms during acute infection reported this symptom. Patients who have recovered from COVID-19 without cardiopulmonary disease demonstrate a marked reduction in peak oxygen consumption along with an exaggerated hyperventilatory response during exercise.[3] Cardiopulmonary exercise testing, which is the gold standard for the evaluation of exercise capacity, is included in the list of examinations of the European Respiratory Society/the American Thoracic Society task force for the follow-up of COVID-19 patients.[4] Patients with a reduced exercise capacity showed an early anaerobic threshold, indicating a higher degree of deconditioning; they reached lower levels of performance and earlier termination.[5] They were advised to involve in graded exercises and to have gradual exercise tolerance to get back to normal activities. These patients may benefit from rehabilitation[6] or yoga therapy.

Another study, by researchers from the University of Oxford, evaluated a cohort of 273,618 recovered.[1] Nearly 37% of all those who recovered from COVID-19 reported at least one long-term symptom lasting between 3 and 6 months beyond the acute infection. The most commonly cited long COVID symptom in this massive cohort was anxiety or depression reported by 15%. Other persistent symptoms present 3 to 6 months later include abnormal breathing in 8%, abdominal symptoms in 8%, chest/throat pain in 6%, cognitive problems in 4%, fatigue in 6%, and headache in 5% of subjects. The results confirm that a significant proportion of people, of all ages, can be affected by a range of symptoms even after 1 year of COVID-19 infection.

Research of different kinds is urgently needed to understand why not everyone recovers rapidly and fully from COVID-19. We need to identify the mechanisms underlying the diverse symptoms that can affect survivors. This information will be essential if the long-term health consequences of COVID-19 are to be prevented or treated effectively. The US government recently awarded nearly half a billion dollars to a variety of long COVID research projects.

Editorial Team

Journal of Adv Lung Health

  References Top

Taquet M, Dercon Q, Luciano S, Geddes JR, Husain M, Harrison PJ. Incidence, co-occurrence, and evolution of long-COVID features: A 6-month retrospective cohort study of 273,618 survivors of COVID-19. PLoS Med 2021;18:e1003773.  Back to cited text no. 1
Zhang X, Wang F, Shen Y, Zhang X, Cen Y, Wang B, et al. Symptoms and health outcomes among survivors of COVID-19 infection 1 year after discharge from hospitals in Wuhan, China. JAMA Netw Open 2021;4:e2127403.  Back to cited text no. 2
Xiong Q, Xu M, Li J, Liu Y, Zhang J, Xu Y, et al. Clinical sequelae of COVID-19 survivors in Wuhan, China: A single-centre longitudinal study. Clin Microbiol Infect 2021;27:89-95.  Back to cited text no. 3
Weisman IM, Marciniuk D, Martinez FJ, Sciurba F, Sue D, Myers J. ATS/ACCP statement on cardiopulmonary exercise testing. Am J Respir Crit Care Med 2003;167:211-77.  Back to cited text no. 4
Bai C, Chotirmall SH, Rello J, Alba GA, Ginns LC, Krishnan JA, et al. Updated guidance on the management of COVID-19: From an American Thoracic Society/European Respiratory Society coordinated International Task Force (29 July 2020). Eur Respir Rev 2020;29:200287.  Back to cited text no. 5
Halpin SJ, McIvor C, Whyatt G, Adams A, Harvey O, McLean L, et al. Postdischarge symptoms and rehabilitation needs in survivors of COVID-19 infection: A cross-sectional evaluation. J Med Virol 2021;93:1013-22.  Back to cited text no. 6


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