Excess risk and clusters of symptoms after COVID-19 in a large Norwegian cohort

Eur J Epidemiol. 2022 May;37(5):539-548. doi: 10.1007/s10654-022-00847-8. Epub 2022 Feb 25.


Physical, psychological and cognitive symptoms have been reported as post-acute sequelae for COVID-19 patients but are also common in the general uninfected population. We aimed to calculate the excess risk and identify patterns of 22 symptoms up to 12 months after COVID-19. We followed more than 70,000 adult participants in an ongoing cohort study, the Norwegian Mother, Father and Child Cohort Study (MoBa) during the COVID-19 pandemic. Infected and non-infected participants registered presence of 22 different symptoms in March 2021. One year after infection, 13 of 22 symptoms were associated with SARS-CoV-2 infection, based on relative risks between infected and uninfected subjects. For instance, 17.4% of SARS-CoV-2 infected cohort participants reported fatigue that persist 12 months after infection, compared to new occurrence of fatigue that had lasted less than 12 months in 3.8% of non-infected subjects (excess risk 13.6%). The adjusted relative risk for fatigue was 4.8 (95% CI 3.5-6.7). Two main underlying factors explained 50% of the variance in the 13 symptoms. Brain fog, poor memory, dizziness, heart palpitations, and fatigue had high loadings on the first factor, while shortness-of breath and cough had high loadings on the second factor. Lack of taste and smell showed low to moderate correlation to other symptoms. Anxiety, depression and mood swings were not strongly related to COVID-19. Our results suggest that there are clusters of symptoms after COVID-19 due to different mechanisms and question whether it is meaningful to describe long COVID as one syndrome.

Keywords: COVID-19; MoBa; Post-acute sequelae; SARS-CoV-2; The Norwegian Mother, Father and Child Cohort Study.

MeSH terms

  • Adult
  • COVID-19* / complications
  • COVID-19* / epidemiology
  • Child
  • Cohort Studies
  • Fatigue / epidemiology
  • Humans
  • Pandemics
  • Post-Acute COVID-19 Syndrome
  • SARS-CoV-2