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Michelen M, Manoharan L, Elkheir N, Cheng V, Dagens A, Hastie C, O'Hara M, Suett J, Dahmash D, Bugaeva P, Rigby I, Munblit D, Harriss E, Burls A, Foote C, Scott J, Carson G, Olliaro P, Sigfrid L, Stavropoulou C. Characterising long COVID: a living systematic review. BMJ Glob Health 2021; 6:e005427. [PMID: 34580069 PMCID: PMC8478580 DOI: 10.1136/bmjgh-2021-005427] [Citation(s) in RCA: 407] [Impact Index Per Article: 135.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 08/19/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND While it is now apparent clinical sequelae (long COVID) may persist after acute COVID-19, their nature, frequency and aetiology are poorly characterised. This study aims to regularly synthesise evidence on long COVID characteristics, to help inform clinical management, rehabilitation strategies and interventional studies to improve long-term outcomes. METHODS A living systematic review. Medline, CINAHL (EBSCO), Global Health (Ovid), WHO Global Research on COVID-19 database, LitCovid and Google Scholar were searched till 17 March 2021. Studies including at least 100 people with confirmed or clinically suspected COVID-19 at 12 weeks or more post onset were included. Risk of bias was assessed using the tool produced by Hoy et al. Results were analysed using descriptive statistics and meta-analyses to estimate prevalence. RESULTS A total of 39 studies were included: 32 cohort, 6 cross-sectional and 1 case-control. Most showed high or moderate risk of bias. None were set in low-income countries and few included children. Studies reported on 10 951 people (48% female) in 12 countries. Most included previously hospitalised people (78%, 8520/10 951). The longest mean follow-up time was 221.7 (SD: 10.9) days post COVID-19 onset. Over 60 physical and psychological signs and symptoms with wide prevalence were reported, most commonly weakness (41%; 95% CI 25% to 59%), general malaise (33%; 95% CI 15% to 57%), fatigue (31%; 95% CI 24% to 39%), concentration impairment (26%; 95% CI 21% to 32%) and breathlessness (25%; 95% CI 18% to 34%). 37% (95% CI 18% to 60%) of patients reported reduced quality of life; 26% (10/39) of studies presented evidence of reduced pulmonary function. CONCLUSION Long COVID is a complex condition with prolonged heterogeneous symptoms. The nature of studies precludes a precise case definition or risk evaluation. There is an urgent need for prospective, robust, standardised, controlled studies into aetiology, risk factors and biomarkers to characterise long COVID in different at-risk populations and settings. PROSPERO REGISTRATION NUMBER CRD42020211131.
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Affiliation(s)
- Melina Michelen
- School of Health Sciences, City University of London, London, UK
- ISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Lakshmi Manoharan
- ISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Natalie Elkheir
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Vincent Cheng
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Andrew Dagens
- ISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | | | | | - Jake Suett
- Anaesthetic Department, Queen Elizabeth Hospital, Kings Lynn, UK
| | - Dania Dahmash
- ISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Polina Bugaeva
- Julius-Maximilians-Universität Würzburg, Würzburg, Bayern, Germany
| | - Ishmeala Rigby
- ISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Daniel Munblit
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- Inflammation, Repair and Development Section, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
- Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - Eli Harriss
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Amanda Burls
- School of Health Sciences, City University of London, London, UK
| | | | - Janet Scott
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | - Gail Carson
- ISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Piero Olliaro
- ISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Louise Sigfrid
- ISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
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Alwan NA, Attree E, Blair JM, Bogaert D, Bowen MA, Boyle J, Bradman M, Briggs TA, Burns S, Campion D, Cushing K, Delaney B, Dixon C, Dolman GE, Dynan C, Frayling IM, Freeman-Romilly N, Hammond I, Judge J, Järte L, Lokugamage A, MacDermott N, MacKinnon M, Majithia V, Northridge T, Powell L, Rayner C, Read G, Sahu E, Shand C, Small A, Strachan C, Suett J, Sykes B, Taylor S, Thomas K, Thomson M, Wiltshire A, Woods V. From doctors as patients: a manifesto for tackling persisting symptoms of covid-19. BMJ 2020; 370:m3565. [PMID: 32933949 DOI: 10.1136/bmj.m3565] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
| | | | | | - Debby Bogaert
- Centre for Inflammation Research, University of Edinburgh, Edinburgh
| | | | | | | | | | | | | | | | | | | | | | | | - Ian M Frayling
- St Mark's Hospital, Harrow
- St Vincent's Hospital, Dublin
- Association of Clinical Pathologists
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Amy Small
- Prestonpans Group Practice
- BMA Scottish Council
- BMA Scottish GP Committee
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