Long COVID Endures: 68% Struggle With Lingering Health Issues After a Year

Researchers tracking nearly 1,000 individuals with post-COVID-19 syndrome observed minimal changes in their symptoms during the second year of the illness.

A new study published in the open-access journal PLOS Medicine reveals that two-thirds of individuals with post-COVID-19 syndrome (PCS) continue to experience persistent, measurable symptoms—such as reduced physical exercise capacity and lower cognitive test performance—for a year or longer. Notably, the study, led by Winfried Kern of Freiburg University in Germany and colleagues, found no significant changes in symptom patterns during the second year of illness.

While self-reported health issues following SARS-CoV-2 infection are widely recognized and may persist for months, the long-term outlook for PCS remains uncertain.

In the new study, researchers studied 982 people aged 18 to 65 who had previously been identified as having PCS, as well as 576 controls. All participants visited one of several university health centers in southwestern Germany for comprehensive assessments, including neurocognitive, cardiopulmonary exercise, and laboratory testing.

Key Symptom Clusters in PCS

The predominant symptom clusters among people with PCS were fatigue/exhaustion, neurocognitive disturbances, chest symptoms/breathlessness, and anxiety/depression/sleep problems. Nearly 68% of people who originally reported PCS still struggled with symptoms in the second year. Exercise intolerance with post-exertional malaise was reported by 35.6% of people with persistent PCS, and these people had worse outcomes and more severe symptoms. People with lower educational attainment, obesity, or more severe illness during the initial COVID-19 infection were also at higher risk of prolonged symptoms.

When they looked at objective measures of health and cognition, the team found that people with persistent PCS had significant reductions in handgrip strength, maximal oxygen consumption, and ventilatory efficiency. Patients with persistent PCS and post-exertional malaise scored lower than control patients on cognitive tests measuring memory, attention, and processing speed; however, the researchers point out that they had no data on cognition before acute COVID-19 infection. The team was not able to identify differences in cardiac function or laboratory values, including tests of viral persistence.

“The results call for the inclusion of cognitive and exercise testing in the clinical evaluation and monitoring of patients with suspected PCS,” the authors say. “Observational studies with longer follow-up are urgently needed to evaluate factors for improvement and non-recovery from PCS.”

The authors add, “Grave symptoms with mental and physical exercise dysfunction, but no laboratory markers in Long Covid/post-Covid syndrome.”

Reference: “Persistent symptoms and clinical findings in adults with post-acute sequelae of COVID-19/post-COVID-19 syndrome in the second year after acute infection: A population-based, nested case-control study” by Raphael S. Peter, Alexandra Nieters, Siri Göpel, Uta Merle, Jürgen M. Steinacker, Peter Deibert, Birgit Friedmann-Bette, Andreas Nieß, Barbara Müller, Claudia Schilling, Gunnar Erz, Roland Giesen, Veronika Götz, Karsten Keller, Philipp Maier, Lynn Matits, Sylvia Parthé, Martin Rehm, Jana Schellenberg, Ulrike Schempf, Mengyu Zhu, Hans-Georg Kräusslich, Dietrich Rothenbacher, Winfried V. Kern and on behalf of the EPILOC Phase 2 Study Group, 23 January 2025, PLOS Medicine.
DOI: 10.1371/journal.pmed.1004511

This work was funded by a Baden-Württemberg Federal State Ministry of Science and Art grant (number MR/S028188/1) to WVK, HGK, UM, DR, SG and JS. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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