Text

Background: Post-COVID syndrome (PCS) is associated with persistent and often fluctuating symptoms as well as reduced quality of life. In primary care, patients and clinicians need realistic expectations about recovery. However, many studies report symptoms only at isolated time points, making it difficult to judge whether symptoms truly improve over time.

Aim/scientific question: To examine how the prevalence of common symptoms changes over time in people with PCS, focusing on fatigue, dyspnoea, depression, and sleep problems.

Material & Methods: We conducted a systematic review and meta-analysis of longitudinal studies in people with PCS. We included studies that reported symptom prevalence at baseline, defined as at or near PCS diagnosis, and at least one follow-up. Symptom-specific pooled odds ratios (ORs) were calculated from prevalences between baseline and predefined follow-up windows from early follow-up to >53 weeks. ORs <1 indicate declining prevalence over time.

Results: A total of 95 studies were included in the meta-analysis. Symptom prevalence generally declined over time, but the extent and timing of improvement varied by symptom. The most significant decrease in prevalence was observed between 14 and 26 weeks in fatigue (OR= 0,50, p = 0.006). Dyspnoea, depression, and sleep problems also decreased significantly at 14–26 weeks. Overall, in later follow-up time points, pooled effects were often not statistically significant due to substantial between-study heterogeneity and low study count, especially beyond 53 weeks.

Discussion: PCS symptom prevalence generally declines over time, particularly during the first 3 to 6 months, but recovery is incomplete and does not follow the same pattern for all symptoms. Interpretation of longer-term findings requires caution, as selective loss to follow-up may distort prevalence estimates if participants with different symptom burdens remain under observation at different rates.

Take Home Message: Clinicians and health services should not assume uniform recovery in PCS. Monitoring should be symptom-oriented and extend beyond the early recovery phase.

Competing interests: None