The Burden of Long COVID on Quality of Life and Daily Functioning

OBJECTIVES: Long COVID symptoms and conditions may persist after an acute COVID-19 infection in patients with mild to severe disease. There is limited evidence on the impact of long COVID on patients’ health-related quality of life (HRQoL) and daily functioning. A structured targeted literature review was conducted to characterize the humanistic burden in adults with long COVID.

METHODS: Searches were conducted via Embase and MEDLINE between March 2020 and May 2024. Inclusion criteria comprised observational studies evaluating the impact of long COVID on HRQoL, disabilities and daily functioning using validated measures in >100 participants.

RESULTS: We included 37 studies, representing >570,000 patients with history of COVID-19 in 17 countries. Overall, 23 studies used the EQ-5D and 8 used the SF-36/SF-8 measures of HRQoL. Studies identified patients with COVID-19 who had been treated as inpatients (46%), outpatients (22%) and mixed/unspecified settings (32%) mainly for pre-Omicron infections. Duration of follow-up varied substantially across studies (6 weeks to 2 years after acute illness) and included the acute infection period in 8/37 studies. After having acute COVID-19, patients reported new or worsened fatigue and disabilities/limitations on activities of daily life, with worse functional impairment, more cognitive slowing, and greater risk of incident psychiatric disorders than healthy controls. Among patients who had acute COVID-19, post-COVID HRQoL was worse than pre-COVID (5/5 studies) and healthy controls/general population norms (9/10 studies). Aspects of HRQoL at 3-12 months post-COVID were more impaired in patients who had indicators of more severe acute disease (mechanical ventilation, oxygen therapy, hospitalization). Two studies assessed the impact of vaccination on HRQoL and found those with ≥2 vaccinations had less of a reduction in HRQoL after COVID-19 compared to those with fewer or no vaccines.

CONCLUSIONS: Long COVID has a negative impact on patient HRQoL and daily functioning. Further contemporaneous studies with recently circulating Omicron lineages are needed.