Some physical symptoms can persist up to two years post-diagnosis

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In a recently published study, Dr Lancet Regional Health-EuropeResearchers investigated the prevalence of physical-type symptoms by severity of acute coronavirus disease 2019 (COVID-19) over two years after diagnosis.

Study: 2-year prevalence of COVID-19 illness severity and physical symptoms: an observational study in Iceland, Sweden, Norway and Denmark.  Image Credit: Meeko Media/
Study: 2-Year Prevalence of COVID-19 Illness Severity and Physical Symptoms: An Observational Study in Iceland, Sweden, Norway, and Denmark. Image Credit: Meeko Media/


Long Covid, or post-Covid-19, is a significant public health concern due to the persistence of physical symptoms after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

However, evidence is not available from extensive observational studies beyond one year of COVID-19 diagnosis because most studies have small samples of specific populations for less than one year of COVID-19 diagnosis. The lack of comparison with populations without confirmed SARS-CoV-2 infection limits the interpretability of the results.

About the study

In the current observational study, the researchers comprehensively assessed chronic Covid symptoms two years after the diagnosis of Covid-19.

In total, 64,880 adults from the four Nordic groups of the Covidment Consortium were included. [the Omtanke2020 study (18,190 Swedish individuals), the COVID-19 National Resilience Cohort (C-19 Resilience, 14,358 Icelandic individuals), the COVID-19, Mental Health and Adherence Project (MAP-19, 3,310 Norwegian individuals), and the Danish Blood Donor Study (DBDS, 29,958 individuals)] Including data on self-reported COVID-19 symptoms between April 2020 and August 2022.

Prevalence of physical symptoms, measured using the Patient Health Questionnaire (PHQ-15), among participants with reverse transcription-polymerase chain reaction (RT-PCR)-confirmed SARS-CoV-2 infection and those without compared infection severity and time. Since the diagnosis of infection. In addition, the researchers assessed changes in symptomatology in a subgroup of adult Swedish individuals, before and after infection with SARS-CoV-2.

Time since acute COVID-19 diagnosis was the reported date of diagnosis and the period of data collection on physical symptoms and C-19 resistance ranged from 16 months, 22 months, 27 months, and 27 = 4 months, Omtanke2020, DBDS, and MAP-19. groups respectively. Severity of acute COVID-19 was determined based on self-reported duration of hospitalization and hospitalization.

The team performed Poisson regression modeling to determine the prevalence ratio (PR). Covariates included in the analysis were age, sex, body mass index (BMI), average monthly household income, residential relationship status, smoking status, depression, anxiety, distress symptoms related to COVID-19, prior history of psychiatric disorders, and pre-existing somatic Comorbidities.

To assess the impact of the COVID-19 vaccine on the prevalence of physical symptoms, the team limited the analysis to one- or two-dose COVID-19 vaccine and determined PR values ​​for the Omtanke2020 and C-19 cohorts. Individuals with incomplete data on the diagnosis of COVID-19 and 25% missing PHQ-15 data were excluded from the study.


Individuals diagnosed with SARS-CoV-2 infection were younger, had a lower body mass index, and had lower percentages of somatic comorbidity and psychiatric disorders than individuals not diagnosed with Covid-19. Within cohorts, MAP-19 participants were younger and more likely to be single than other cohorts.

Among people with SARS-CoV-2 infection, 28% were confined to bed during acute COVID-19 (18% for one to six days, and 10% for at least seven days), and one percent were hospitalized.

The prevalence of severe symptoms was higher among those diagnosed with Covid-19 than those who were not in all cohorts: 16% vs. 10% in the C-19 cohort, eight percent vs. six percent in the Omtanke2020 study cohort, nine percent vs. eight percent in the MAP-19 cohort, and Two percent versus one percent in the DBDS cohort, the DBDS and MAP-19 cohorts had higher percentages of individuals with SARS-CoV-2 Omicron variant infection.

During follow-up, 35% of individuals (22,382 of 64,880) received a COVID-19 diagnosis, and had a 37% higher prevalence of physical symptoms than those who did not. [PHQ-15 scores of 15 or higher, adjusted PR of 1.4]. Symptom prevalence was associated with the severity of acute SARS-CoV-2 infection: those who had been bedridden for at least one week (10%) showed the highest symptom prevalence (PR 2.3), whereas those who had never been bedridden showed[aprevalencesimilartothatofthosewithundiagnosedSARS-CoV-2infection(PR09)[prevalencesimilartothosewhodidnotreceiveaSARS-CoV-2infectiondiagnosis(PR09)[একটিপ্রাদুর্ভাবঅনুরূপযারাSARS-CoV-2সংক্রমণনির্ণয়পাননি(PR09)।[aprevalencesimilartothosewhodidnotreceiveaSARS-CoV-2infectiondiagnosis(PR09)

Moreover, the prevalence was significantly higher among people diagnosed with SARS-CoV-2 infection for eight symptoms such as shortness of breath, dizziness, chest pain, headache, fatigue, difficulty sleeping, back pain, and racing heart. Because most individuals received one or two COVID-19 vaccines, the researchers similarly limited the analysis of the COVID-19 vaccine to increased prevalence.

Additionally, increased prevalence was higher among non-anxious and depressed individuals. A pairwise evaluation of 398 Omtanke2020 participants with measurements of physical COVID-19 symptoms before and after SARS-CoV-2 infection (mean three-month interval) confirmed the results of the study.


Overall, the study results showed an increased prevalence of some physical COVID-19 symptoms two years after acute infection, especially among people with severe acute SARS-CoV-2 infection. Findings highlight long-term health effects after long-term covid constitution and recovery from acute infection for the general population.

The association of long-term severe physical symptoms with the severity of acute Covid-19 emphasizes the importance of SARS-COV-2 surveillance and Covid-19 surveillance efforts in persons with severe acute Covid-19.

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