Since first reported, there has been a vast amount of social media patient groups, polls, comments, and scientific articles aiming to describe the chronicity of COVID-19. It has not yet been established if sex, gender, age, ethnicity, underlying health conditions, viral dose, or progression of COVID-19 significantly affect the risk of developing long-term effects of COVID-19 4. Although such alteration is mostly reported in severe and critical disease survivors, the lasting effects also occur in individuals with a mild infection who did not require hospitalization 3. Symptoms, signs, or abnormal clinical parameters persisting two or more weeks after COVID-19 onset that do not return to a healthy baseline can potentially be considered long-term effects of the disease 2. In the absence of an agreed definition, we convened for this review to refer to “Long-term effects of COVID-19”. Different authors have used the terms “Long-COVID-19”, “Long Haulers”, “Post-acute COVID-19”, “Persistent COVID-19 Symptoms”, “Post COVID-19 manifestations”, “Long-term COVID-19 effects”, “Post COVID-19 syndrome”, among others. To date, there is no established term to coin the slow and persistent condition in individuals with lasting sequelae of COVID-19. Although unprecedented efforts from the scientific and medical community have been directed to sequence, diagnose, treat, and prevent COVID-19, individuals’ lasting effects after the acute phase of the disease are yet to be revealed. Since then, more than 90 million people worldwide have been infected after a year, and over 2 million people have died from the coronavirus disease 2019 (COVID-19) 1. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was detected in China in December 2019. From the clinical perspective, multi-disciplinary teams are crucial to developing preventive measures, rehabilitation techniques, and clinical management strategies with whole-patient perspectives designed to address long COVID-19 care. In order to have a better understanding, future studies need to stratify by sex, age, previous comorbidities, severity of COVID-19 (ranging from asymptomatic to severe), and duration of each symptom. All meta-analyses showed medium (n=2) to high heterogeneity (n=13). The five most common symptoms were fatigue (58%), headache (44%), attention disorder (27%), hair loss (25%), and dyspnea (24%). It was estimated that 80% (95% CI 65–92) of the patients that were infected with SARS-CoV-2 developed one or more long-term symptoms. The age of the study participants ranged between 17 and 87 years. The follow-up time ranged from 14 to 110 days post-viral infection. The prevalence of 55 long-term effects was estimated, 21 meta-analyses were performed, and 47,910 patients were included. A total of 18,251 publications were identified, of which 15 met the inclusion criteria. This systematic review followed Preferred Reporting Items for Systematic Reviewers and Meta-analysis (PRISMA) guidelines, although the study protocol was not registered. Heterogeneity was assessed using I 2 statistics. For effects reported in two or more studies, meta-analyses using a random-effects model were performed using the MetaXL software to estimate the pooled prevalence with 95% CI. All articles with original data for detecting long-term COVID-19 published before 1 st of January 2021 and with a minimum of 100 patients were included. LitCOVID (PubMed and Medline) and Embase were searched by two independent researchers. This systematic review and meta-analysis aims to identify studies assessing long-term effects of COVID-19 and estimates the prevalence of each symptom, sign, or laboratory parameter of patients at a post-COVID-19 stage. COVID-19, caused by SARS-CoV-2, can involve sequelae and other medical complications that last weeks to months after initial recovery, which has come to be called Long-COVID or COVID long-haulers.
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