Titles, abstracts, and full texts of articles were independently screened by two authors (SLL and TWO). All types of studies, including randomized controlled trials, cohorts, and cross-sectional studies, were analyzed only when the cases (numerator) were part of a COVID-19 cohort (denominator). Given that LitCOVID includes all articles from MedLine, in the search in Embase we excluded the articles from MedLine and those not related to COVID-19. The search terms used for both searches were: COVID long* OR haulers OR post OR chronic OR term OR complications OR recurrent OR lingering OR convalescent OR convalescence. ![]() Studies were included if they were published before January 1st 2021. The databases used to identify the studies were LitCOVID ( 6) (PubMed and Medline) and Embase. Only studies with a minimum of 100 patients were included. The search’s objective was to identify peer-reviewed human studies in English that reported symptoms, signs, or laboratory parameters of patients at a post-COVID-19 stage (assessed two weeks or more after initial symptoms) in cohorts of COVID-19 patients. ![]() The aim of our study was to perform a systematic review and meta-analysis of peer-reviewed studies to estimate the incidence of all the symptoms, signs, or abnormal laboratory parameters extending beyond the acute phase of COVID-19 reported to date. However, a broad overview of all the possible longstanding effects of COVID-19 is still needed. In parallel, hundreds of scientific publications, including cohorts studying specific effects of the disease and lists of case reports, have been described ( 5). Since first reported, there has been a vast amount of social media patient groups, polls, comments, and scientific articles aiming to describe the chronicity of COVID-19. It has not yet been established if sex, gender, age, ethnicity, underlying health conditions, viral dose, or progression of COVID-19 significantly affect the risk of developing long-term effects of COVID-19( 4). Although such alteration is mostly reported in severe and critical disease survivors, the lasting effects also occur in individuals with a mild infection who did not require hospitalization( 3). ![]() Symptoms, signs, or abnormal clinical parameters persisting two or more weeks after COVID-19 onset that do not return to a healthy baseline can potentially be considered long-term effects of the disease( 2). In the absence of an agreed definition, we convened for this review to refer to “Long-term effects of COVID-19”. Different authors have used the terms “Long-COVID-19”, “Long Haulers”, “Post-acute COVID-19”, “Persistent COVID-19 Symptoms”, “Post COVID-19 manifestations”, “Long-term COVID-19 effects”, “Post COVID-19 syndrome”, among others. To date, there is no established term to coin the slow and persistent condition in individuals with lasting sequelae of COVID-19. Although unprecedented efforts from the scientific and medical community have been directed to sequence, diagnose, treat, and prevent COVID-19, individuals’ lasting effects after the acute phase of the disease are yet to be revealed. Since then, more than 90 million people worldwide have been infected after a year, and over 2 million people have died from the coronavirus disease 2019 (COVID-19)( 1). The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was detected in China in December 2019.
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