Objective To evaluate longer term symptoms and health outcomes associated with post-covid-19 condition within a cohort of individuals with a SARS-CoV-2 infection. Design Population based, longitudinal cohort. Setting General population of canton of Zurich, Switzerland. Participants 1106 adults with a confirmed SARS-CoV-2 infection who were not vaccinated before infection and 628 adults who did not have an infection. Main outcome measures Trajectories of self-reported health status and covid-19 related symptoms between months six, 12, 18, and 24 after infection and excess risk of symptoms at six months after infection compared with individuals who had no infection. Results 22.9% (95% confidence interval 20.4% to 25.6%) of individuals infected with SARS-CoV-2 did not fully recover by six months. The proportion of individuals who had an infection who reported not having recovered decreased to 18.5% (16.2% to 21.1%) at 12 months and 17.2% (14.0% to 20.8%) at 24 months after infection. When assessing changes in self-reported health status, most participants had continued recovery (68.4% (63.8% to 72.6%)) or had an overall improvement (13.5% (10.6% to 17.2%)) over time. Yet, 5.2% (3.5% to 7.7%) had a worsening in health status and 4.4% (2.9% to 6.7%) had alternating periods of recovery and health impairment. The point prevalence and severity of covid-19 related symptoms also decreased over time, with 18.1% (14.8% to 21.9%) reporting symptoms at 24 months. 8.9% (6.5% to 11.2%) of participants reported symptoms at all four follow-up time points, while in 12.5% (9.8% to 15.9%) symptoms were alternatingly absent and present. Symptom prevalence was higher among individuals who were infected compared with those who were not at six months (adjusted risk difference 17.0% (11.5% to 22.4%)). Excess risk (adjusted risk difference) for individual symptoms among those infected ranged from 2% to 10%, with the highest excess risks observed for altered taste or smell (9.8% (7.7% to 11.8%)), post-exertional malaise (9.4% (6.1% to 12.7%)), fatigue (5.4% (1.2% to 9.5%)), dyspnoea (7.8% (5.2% to 10.4%)), and reduced concentration (8.3% (6.0% to 10.7%)) and memory (5.7% (3.5% to 7.9%)). Conclusions Up to 18% of individuals who were not vaccinated before infection had post-covid-19 condition up to two years after infection, with evidence of excess symptom risk compared with controls. Effective interventions are needed to reduce the burden of post-covid-19 condition. Use of multiple outcome measures and consideration of the expected rates of recovery and heterogeneity in symptom trajectories are important in the design and interpretation of clinical trials. Study registration Current Controlled Trials [ISRCTN14990068][1] Current Controlled Trials [ISRCTN18181860][2] We are open to sharing de-identified individual participant data that underlie the results reported in this article. Requests can be made to the corresponding author at miloalan.puhan@uzh.ch. Data requestors will need to sign a data access agreement. [1]: /external-ref?link_type=ISRCTN&access_num=ISRCTN14990068 [2]: /external-ref?link_type=ISRCTN&access_num=ISRCTN18181860

中文翻译：

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SARS-CoV-2 感染后长达两年的恢复和症状轨迹：基于人群的纵向队列研究

目的 评估一组感染 SARS-CoV-2 的个体中与 covid-19 后状况相关的长期症状和健康结果。设计基于人群的纵向队列。设置瑞士苏黎世州的总人口。参与者包括 1106 名确诊感染 SARS-CoV-2 且在感染前未接种疫苗的成年人和 628 名未感染的成年人。主要结果衡量感染后第 6、12、18 和 24 个月之间自我报告的健康状况和 covid-19 相关症状的轨迹，以及与未感染者相比，感染后 6 个月出现症状的风险更高。结果 22.9%（95% 置信区间为 20.4% 至 25.6%）的感染 SARS-CoV-2 的个体在六个月内没有完全康复。报告未康复的感染者比例在感染后 12 个月下降至 18.5%（16.2% 至 21.1%），在感染后 24 个月下降至 17.2%（14.0% 至 20.8%）。在评估自我报告的健康状况的变化时，大多数参与者随着时间的推移持续恢复（68.4%（63.8% 至 72.6%））或整体改善（13.5%（10.6% 至 17.2%））。然而，5.2%（3.5% 至 7.7%）的健康状况恶化，4.4%（2.9% 至 6.7%）的人处于康复和健康受损的交替期。covid-19 相关症状的患病率和严重程度也随着时间的推移而下降，18.1%（14.8% 至 21.9%）在 24 个月时报告出现症状。8.9%（6.5% 至 11.2%）的参与者在所有四个随访时间点都报告了症状，而 12.5%（9.8% 至 15.9%）的参与者时隐时现。与六个月未感染者相比，感染者的症状流行率更高（调整后的风险差异为 17.0%（11.5% 至 22.4%））。感染者个体症状的超额风险（调整后的风险差异）范围为 2% 至 10%，观察到的最高超额风险为味觉或嗅觉改变（9.8%（7.7% 至 11.8%））、劳累后不适（9.4 %（6.1% 至 12.7%））、疲劳（5.4%（1.2% 至 9.5%））、呼吸困难（7.8%（5.2% 至 10.4%））和注意力下降（8.3%（6.0% 至 10.7%））和内存（5.7%（3.5% 至 7.9%））。结论 在感染前未接种疫苗的个体中，高达 18% 的人在感染后长达两年内患有 covid-19 后病症，有证据表明与对照组相比症状风险更高。需要采取有效的干预措施来减轻 covid-19 后状况的负担。在临床试验的设计和解释中，使用多种结果测量并考虑症状轨迹的预期恢复率和异质性很重要。研究注册 当前对照试验 [ISRCTN14990068][1] 当前对照试验 [ISRCTN18181860][2] 我们愿意共享作为本文报告结果基础的去识别化个人参与者数据。可以通过 miloalan.puhan@uzh.ch 向通讯作者提出请求。数据请求者需要签署数据访问协议。[1]: /external-ref?link_type=ISRCTN&access_num=ISRCTN14990068 [2]: /external-ref?link_type=ISRCTN&access_num=ISRCTN18181860 研究注册 当前对照试验 [ISRCTN14990068][1] 当前对照试验 [ISRCTN18181860][2] 我们愿意共享作为本文报告结果基础的去识别化个人参与者数据。可以通过 miloalan.puhan@uzh.ch 向通讯作者提出请求。数据请求者需要签署数据访问协议。[1]: /external-ref?link_type=ISRCTN&access_num=ISRCTN14990068 [2]: /external-ref?link_type=ISRCTN&access_num=ISRCTN18181860 研究注册 当前对照试验 [ISRCTN14990068][1] 当前对照试验 [ISRCTN18181860][2] 我们愿意共享作为本文报告结果基础的去识别化个人参与者数据。可以通过 miloalan.puhan@uzh.ch 向通讯作者提出请求。数据请求者需要签署数据访问协议。[1]: /external-ref?link_type=ISRCTN&access_num=ISRCTN14990068 [2]: /external-ref?link_type=ISRCTN&access_num=ISRCTN18181860