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

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

doi:10.1038/s41467-025-59012-w

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

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

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract

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.

Original language	English
Article number	4249
Number of pages	8
Journal	Nature Communications
Volume	16
DOIs	https://doi.org/10.1038/s41467-025-59012-w
Publication status	Published - 7 May 2025

Bibliographical note

Copyright © The Author(s) 2025. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/.

Data Access Statement

The dataset generated during and analysed during the current study are available in the Figshare repository (https://doi.org/10.6084/m9.figshare.28695185.v1).

Keywords

COVID-19/epidemiology
Humans
Post-Acute COVID-19 Syndrome/epidemiology
Risk Factors
SARS-CoV-2/pathogenicity

Access to Document

10.1038/s41467-025-59012-wLicence: CC BY 4.0

The risk of Long Covid symptoms
Copyright © The Author(s) 2025. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/.
Final published version, 834 KBLicence: CC BY 4.0

Cite this

O’Mahoney, L. L., Routen, A., Gillies, C., Jenkins, S. A., Almaqhawi, A., Ayoubkhani, D., Banerjee, A., Brightling, C., Calvert, M., Cassambai, S., Ekezie, W., Funnell, M. P., Welford, A., Peace, A., Evans, R. A., Jeffers, S., Kingsnorth, A. P., Pareek, M., Seidu, S., ... Khunti, K. (2025). The risk of Long Covid symptoms: a systematic review and meta-analysis of controlled studies. Nature Communications, 16, Article 4249. https://doi.org/10.1038/s41467-025-59012-w

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abstract = "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.",

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O’Mahoney, LL, Routen, A, Gillies, C, Jenkins, SA, Almaqhawi, A, Ayoubkhani, D, Banerjee, A, Brightling, C, Calvert, M, Cassambai, S, Ekezie, W, Funnell, MP, Welford, A, Peace, A, Evans, RA, Jeffers, S, Kingsnorth, AP, Pareek, M, Seidu, S, Wilkinson, TJ, Willis, A, Shafran, R, Stephenson, T, Sterne, J, Ward, H, Ward, T & Khunti, K 2025, 'The risk of Long Covid symptoms: a systematic review and meta-analysis of controlled studies', Nature Communications, vol. 16, 4249. https://doi.org/10.1038/s41467-025-59012-w

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AU - Almaqhawi, Abdullah

AU - Ayoubkhani, Daniel

AU - Banerjee, Amitava

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AU - Cassambai, Shabana

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AU - Jeffers, Shavez

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AU - Pareek, Manish

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AU - Willis, Andrew

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AU - Ward, Helen

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PY - 2025/5/7

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

Abstract

Bibliographical note

Data Access Statement

Keywords

Access to Document

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