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Epidemiology, clinical presentation, pathophysiology, and management of long COVID: an update

Molecular Psychiatry volume 28, pages 4056–4069 (2023)Cite this article

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Abstract

The increasing number of coronavirus disease 2019 (COVID-19) infections have highlighted the long-term consequences of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection called long COVID. Although the concept and definition of long COVID are described differently across countries and institutions, there is general agreement that it affects multiple systems, including the immune, respiratory, cardiovascular, gastrointestinal, neuropsychological, musculoskeletal, and other systems. This review aims to provide a synthesis of published epidemiology, symptoms, and risk factors of long COVID. We also summarize potential pathophysiological mechanisms and biomarkers for precise prevention, early diagnosis, and accurate treatment of long COVID. Furthermore, we suggest evidence-based guidelines for the comprehensive evaluation and management of long COVID, involving treatment, health systems, health finance, public attitudes, and international cooperation, which is proposed to improve the treatment strategies, preventive measures, and public health policy making of long COVID.

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Fig. 1: Multi system symptoms of long COVID.
Fig. 2: Potential biomarkers of multi system sequelae in long COVID.
Fig. 3: Overview of long COVID: potential pathogenesis, risk factors, treatments and broad public health management.

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Acknowledgements

This study was supported by a grant from the National Key Research and Development Program of China (2021YFC0863700, 2019YFA0706200), Natural Science Foundation of Beijing Municipality of China (M23013), National Programs for Brain Science and Brain-like Intelligence Technology of China (STI2030-Major Projects, 2021ZD0200800, 2021ZD0200700), and the National Natural Science Foundation of China (no. 82288101, 82171514). The authors declare that the research was conducted in the absence of any commercial or financial relationship that could be constructed as a potential conflict of interests.

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Authors and Affiliations

  1. Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China

    Sizhen Su, Xiaoxing Liu, Yi Zhong, Yimiao Gong, Zhibo Zhang, Kai Yuan, Wei Yan, Le Shi & Lin Lu

  2. National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China

    Yimiao Zhao, Na Zeng, Shuilin Wu, Shuyu Ni, Jie Shi, Yanping Bao & Lin Lu

  3. Scholl of Public Health, Peking University, Beijing, China

    Yimiao Zhao, Na Zeng, Shuilin Wu, Shuyu Ni & Yanping Bao

  4. Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China

    Yongbo Zheng, Yimiao Gong & Lin Lu

  5. Pain Medicine Center, Peking University Third Hospital, Beijing, China

    Jie Sun

  6. The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China

    Nan Gao

  7. Department of Psychiatry, University of Toronto, Toronto, Canada

    Arun V. Ravindran

  8. Department of Psychiatry, Baylor College of Medicine, Houston, TX, USA

    Thomas Kosten

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  1. Sizhen Su
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Contributions

LL and YB proposed the topic and main idea, SS was responsible for literature search, drafting the manuscript, and making the figures, and revising all versions. XL, NZ, YZ, YZ, SW, YZ, JS, and SN contributed to the first draft. YG, ZZ, NG, KY, WY, LS, AVR, TK, and JS revised the manuscript for intellectual content. YB and LL proposed the topic of the review and commented on and revised the manuscript.

Corresponding authors

Correspondence to Yanping Bao or Lin Lu.

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Su, S., Zhao, Y., Zeng, N. et al. Epidemiology, clinical presentation, pathophysiology, and management of long COVID: an update. Mol Psychiatry 28, 4056–4069 (2023). https://doi.org/10.1038/s41380-023-02171-3

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