Burden of post-COVID-19 syndrome and implications for healthcare service planning: A population-based cohort study

PLoS One. 2021 Jul 12;16(7):e0254523. doi: 10.1371/journal.pone.0254523. eCollection 2021.


Background: Longer-term consequences after SARS-CoV-2 infection are becoming an important burden to societies and healthcare systems. Data on post-COVID-19 syndrome in the general population are required for the timely planning of healthcare services and resources. The objective of this study was to assess the prevalence of impaired health status and physical and mental health symptoms among individuals at least six months after SARS-CoV-2 infection, and to characterize their healthcare utilization.

Methods: This population-based prospective cohort study (Zurich SARS-CoV-2 Cohort) enrolled 431 adults from the general population with polymerase chain reaction-confirmed SARS-CoV-2 infection reported to health authorities between 27 February 2020 and 05 August 2020 in the Canton of Zurich, Switzerland. We evaluated the proportion of individuals reporting not to have fully recovered since SARS-CoV-2 infection, and the proportion reporting fatigue (Fatigue Assessment Scale), dyspnea (mMRC dyspnea scale) or depression (DASS-21) at six to eight months after diagnosis. Furthermore, the proportion of individuals with at least one healthcare contact after their acute illness was evaluated. Multivariable logistic regression models were used to assess factors associated with these main outcomes.

Results: Symptoms were present in 385 (89%) participants at diagnosis and 81 (19%) were initially hospitalized. At six to eight months, 111 (26%) reported not having fully recovered. 233 (55%) participants reported symptoms of fatigue, 96 (25%) had at least grade 1 dyspnea, and 111 (26%) had DASS-21 scores indicating symptoms of depression. 170 (40%) participants reported at least one general practitioner visit related to COVID-19 after acute illness, and 10% (8/81) of initially hospitalized individuals were rehospitalized. Individuals that have not fully recovered or suffer from fatigue, dyspnea or depression were more likely to have further healthcare contacts. However, a third of individuals (37/111) that have not fully recovered did not seek further care.

Conclusions: In this population-based study, a relevant proportion of participants suffered from longer-term consequences after SARS-CoV-2 infection. With millions infected across the world, our findings emphasize the need for the timely planning of resources and patient-centered services for post-COVID-19 care.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • COVID-19 / complications*
  • COVID-19 / epidemiology
  • Cohort Studies
  • Cost of Illness
  • Depression / epidemiology
  • Dyspnea / epidemiology
  • Fatigue / epidemiology
  • Female
  • Health Services*
  • Humans
  • Male
  • Middle Aged
  • Post-Acute COVID-19 Syndrome
  • Quality of Life
  • Switzerland
  • Young Adult

Grant support

The Zurich SARS-CoV-2 Cohort study is part of the Corona Immunitas research program, coordinated by the Swiss School of Public Health (SSPH+) and funded through SSPH+ fundraising, including funding by the Swiss Federal Office of Public Health, the Cantons of Switzerland (Basel, Vaud and Zurich), private funders (ethical guidelines for funding stated by SSPH+ were respected) and institutional funds of the participating universities. Additional funding specific to this study was provided by the Department of Health of the Canton of Zurich and the University of Zurich Foundation. Study funders had no role in study design, data collection and analysis, interpretation, decision to publish or preparation of this manuscript.