Long COVID: 4 years of data from Saudi Arabia
A new prospective cohort followed 816 patients for up to 4 years after COVID-19.
Result?
29% developed Long COVID (per WHO definition).
That’s nearly 1 in 3 people.🧵
A new prospective cohort followed 816 patients for up to 4 years after COVID-19.
Result?
29% developed Long COVID (per WHO definition).
That’s nearly 1 in 3 people.🧵
The most common persistent symptoms were
fatigue (57%)
post-exertional malaise (46%)
cough (41%)
cognitive dysfunction/brain fog (31%)
shortness of breath (25%)
Fatigue & brain fog often lasted > 32 weeks.
fatigue (57%)
post-exertional malaise (46%)
cough (41%)
cognitive dysfunction/brain fog (31%)
shortness of breath (25%)
Fatigue & brain fog often lasted > 32 weeks.
Who was most at risk?
Women - 11× higher odds (aOR)
People with diabetes - 14× higher odds
These are striking numbers, pointing to strong biological mechanisms.
(This was a cohort with more comorbidities and severe cases - the effect sizes may overestimate risk compared to healthier populations.)
Women - 11× higher odds (aOR)
People with diabetes - 14× higher odds
These are striking numbers, pointing to strong biological mechanisms.
(This was a cohort with more comorbidities and severe cases - the effect sizes may overestimate risk compared to healthier populations.)
And what slowed recovery once Long COVID was established?
female sex (3.4× slower recovery)
diabetes (1.6×)
hospitalization (1.1×)
reinfection (1.9×)
female sex (3.4× slower recovery)
diabetes (1.6×)
hospitalization (1.1×)
reinfection (1.9×)
Reinfection matters
In Long COVID patients, reinfection was much more common than in those who recovered (34.9% vs 12.8%)!
Reinfection made recovery 1.9× slower.
In Long COVID patients, reinfection was much more common than in those who recovered (34.9% vs 12.8%)!
Reinfection made recovery 1.9× slower.
Reinfection did not emerge as an independent predictor of developing Long COVID after adjusting for stronger factors (like sex and diabetes).
But it clearly slowed recovery (aHR 1.86).
This suggests reinfections mainly act to sustain or worsen Long COVID, rather than trigger its very first onset.
But it clearly slowed recovery (aHR 1.86).
This suggests reinfections mainly act to sustain or worsen Long COVID, rather than trigger its very first onset.
If you already have Long COVID and catch SARS-CoV-2 again, your chances of getting better drop sharply.
Reinfections act as a trigger that sustains or restarts symptoms.
Reinfections act as a trigger that sustains or restarts symptoms.
In this Saudi cohort, reinfection didn’t stand out as an independent risk factor for developing Long COVID once sex and diabetes were accounted for.
But in larger population studies (UK/US), each additional infection clearly adds cumulative risk.
The common ground - once Long COVID is established, reinfections almost always worsen or prolong it.
But in larger population studies (UK/US), each additional infection clearly adds cumulative risk.
The common ground - once Long COVID is established, reinfections almost always worsen or prolong it.
Impact on life
Only 39% of Long COVID patients returned to work within 12 months.
In the recovered group, it was 82%.
Quality of life scores stayed significantly lower across all domains.
Only 39% of Long COVID patients returned to work within 12 months.
In the recovered group, it was 82%.
Quality of life scores stayed significantly lower across all domains.
Even with Omicron, prevalence of Long COVID stayed high (used time periods as a proxy)
2020–21 (Wuhan/Alpha): 35%
2021–22 (Delta): 30%
2022–23 (early Omicron): 27%
2023–24 (late Omicron): 23%
1 in 4 people still developed Long COVID during the Omicron era.
2020–21 (Wuhan/Alpha): 35%
2021–22 (Delta): 30%
2022–23 (early Omicron): 27%
2023–24 (late Omicron): 23%
1 in 4 people still developed Long COVID during the Omicron era.
Long COVID is not rare.
It’s a sustained burden - especially for women, people with diabetes, those hospitalized, and anyone facing reinfections.
Prevention (!) & structured post-COVID care are essential. @szupraha @ZdravkoOnline
It’s a sustained burden - especially for women, people with diabetes, those hospitalized, and anyone facing reinfections.
Prevention (!) & structured post-COVID care are essential. @szupraha @ZdravkoOnline
Kamal et al. 2025, BMC Infectious Diseases. Long COVID-19: a Four-Year prospective cohort study of risk factors, recovery, and quality of life. bmcinfectdis.biomedcentral.com/articles/10.11…
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