Introduction
Long COVID, describing the long-term sequelae after SARS-CoV-2 infection, remains a poorly
defined syndrome. There is uncertainty about its predisposing factors and the extent of the
resultant public health burden, with estimates of prevalence and duration varying widely.
Methods
Within rounds 3–5 of the REACT-2 study, 508,707 people in the community in England were
asked about a prior history of COVID-19 and the presence and duration of 29 different
symptoms. We used uni- and multivariable models to identify predictors of persistence of
symptoms (12 weeks or more). We estimated the prevalence of symptom persistence at 12
weeks, and used unsupervised learning to cluster individuals by symptoms experienced.
Results
Among the 508,707 participants, the weighted prevalence of self-reported COVID-19 was 19.2%
(95% CI: 19.1,19.3). 37.7% of 76,155 symptomatic people post COVID-19 experienced at least
one symptom, while 14.8% experienced three or more symptoms, lasting 12 weeks or more. This
gives a weighted population prevalence of persistent symptoms of 5.75% (5.68, 5.81) for one and
2.22% (2.1, 2.26) for three or more symptoms. Almost a third of people 8,771/28,713 (30.5%)
with at least one symptom lasting 12 weeks or more reported having had severe COVID-19
symptoms (“significant effect on my daily life”) at the time of their illness, giving a weighted
prevalence overall for this group of 1.72% (1.69,1.76). The prevalence of persistent symptoms
was higher in women than men (OR: 1.51 [1.46,1.55]) and, conditional on reporting symptoms,
risk of persistent symptoms increased linearly with age by 3.5 percentage points per decade of
life. Obesity, smoking or vaping, hospitalisation , and deprivation were also associated with a
higher probability of persistent symptoms, while Asian ethnicity was associated with a lower
probability. Two stable clusters were identified based on symptoms that persisted for 12 weeks or
more: in the largest cluster, tiredness predominated, while in the second there was a high
prevalence of respiratory and related symptoms.
Interpretation
A substantial proportion of people with symptomatic COVID-19 go on to have persistent
symptoms for 12 weeks or more, which is age-dependent. Clinicians need to be aware of the
differing manifestations of Long COVID which may require tailored therapeutic approaches.
Managing the long-term sequelae of SARS-CoV-2 infection in the population will remain a
major challenge for health services in the next stage of the pandemic.