Next Article in Journal
Explainable COVID-19 Detection Based on Chest X-rays Using an End-to-End RegNet Architecture
Next Article in Special Issue
Do COVID-19 Vaccinations Affect the Most Common Post-COVID Symptoms? Initial Data from the STOP-COVID Register–12-Month Follow-Up
Previous Article in Journal
Investigation of Potency and Safety of Live-Attenuated Peste des Petits Ruminant Virus Vaccine in Goats by Detection of Cellular and Humoral Immune Response
Previous Article in Special Issue
How Does Long-COVID Impact Prognosis and the Long-Term Sequelae?
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:

Post-COVID-19 Syndrome in Non-Hospitalized Individuals: Healthcare Situation 2 Years after SARS-CoV-2 Infection

Inge Kirchberger
Christine Meisinger
Tobias D. Warm
Alexander Hyhlik-Dürr
Jakob Linseisen
1,3 and
Yvonne Goßlau
Epidemiology, Faculty of Medicine, University of Augsburg, 86156 Augsburg, Germany
Vascular Surgery, Faculty of Medicine, University of Augsburg, 86156 Augsburg, Germany
Institute for Medical Information Processing, Biometry and Epidemiology–IBE, LMU Munich, 81377 Munich, Germany
Author to whom correspondence should be addressed.
Viruses 2023, 15(6), 1326;
Submission received: 16 May 2023 / Accepted: 31 May 2023 / Published: 5 June 2023
(This article belongs to the Special Issue COVID-19: Prognosis and Long-Term Sequelae)


Although “post-COVID-19 syndrome” (PCS) is reported to be common even in non-hospitalized individuals, long-term information on symptom burden, healthcare needs, utilization, and satisfaction with healthcare is scarce. The objectives of this study were to describe symptom burden, healthcare utilization and experiences with the healthcare offered for PCS in a German sample of non-hospitalized persons 2 years after SARS-CoV-2 infection. Individuals with past COVID-19 confirmed by positive polymerase chain reaction testing were examined at the University Hospital of Augsburg from 4 November 2020 to 26 May 2021 and completed a postal questionnaire between 14 June 2022 and 1 November 2022. Participants who self-reported the presence of fatigue, dyspnea on exertion, memory problems or concentration problems were classified as having PCS. Of the 304 non-hospitalized participants (58.2% female, median age 53.5), 210 (69.1%) had a PCS. Among these, 18.8% had slight to moderate functional limitations. Participants with PCS showed a significantly higher utilization of healthcare and a large proportion complained about lacking information on persistent COVID-19 symptoms and problems finding competent healthcare providers. The results indicate the need to optimize patient information on PCS, facilitate access to specialized healthcare providers, provide treatment options in the primary care setting and improve the education of healthcare providers.

1. Introduction

A considerable proportion of patients infected with the coronavirus SARS-CoV-2 experience symptoms such as fatigue, dyspnea, and cognitive problems that persist several weeks or months after the acute coronavirus disease 2019 (COVID-19) [1,2,3,4]. This long-term sequelae is commonly called “long COVID” or “post-COVID syndrome/condition” [5,6]. The proportion of persons affected with post-COVID syndrome (PCS), which includes persistence of symptoms for at least 12 weeks, varies depending on the specific definition of PCS, the study design and symptom assessment, and the severity of the acute COVID-19, and ranges between 6% and 46% in non-hospitalized persons [3,4,7,8,9]. From the healthcare system point of view, its prevalence in non-hospitalized persons is particularly important because this group makes up 80% [10] to 97% [8] of all COVID-19 cases. The large number of persons with PCS challenges the healthcare systems since many of them may require specific treatment and support [11].
So far, scientific investigations on the healthcare needs, utilization and the patients’ experiences have been scarce. Qualitative studies in different countries found difficulties in accessing healthcare services for PCS and showed that experiences with healthcare providers, services and systems as well as the challenges of obtaining appropriate information were a major concern of the affected persons [12,13,14,15,16,17]. An online survey of 2113 persons with long COVID in the Netherlands and Belgium identified various unmet specific information needs and a large number of persons who were dissatisfied with COVID-19 aftercare [18]. The only study from Germany consisted of an online survey of 126 persons with long COVID and a postal survey of 73 general practitioners [19]. Heterogenous ratings of satisfaction with medical care and attitudes towards patients and their disease were found, and patient and healthcare practitioners suggested a structured concept of care with competent contact points and good coordination of healthcare [19].
Furthermore, most studies having investigated PCS have a follow-up (FUP) time of less than 2 years. However, long-term information is needed to assure that healthcare services appropriately consider the specific short- and long-term needs of individuals with PCS.
Thus, the objectives of the present study were to characterize the symptom burden in a German sample of non-hospitalized persons 2 years after SARS-CoV-2 infection and to describe their healthcare utilization and experiences with the healthcare offered for persistent COVID-19 symptoms.

2. Materials and Methods

2.1. Design and Study Population

The present study is a follow-up assessment of the Corona Thrombosis Study (COVID-T), a prospective single-center observational study evaluating the consequences of COVID-19 for the vascular system [20,21,22]. The study sample was recruited from the population living in the city and the county of Augsburg. The public health departments identified eligible persons with past COVID-19 confirmed by positive polymerase chain reaction (PCR) testing and sent out a total of 1600 postal invitations for study participation between 21 October 2020 and 6 November 2020. The potential study participants were invited to clinical examinations and assessments that were performed at the University Hospital of Augsburg from 4 November 2020 to 26 May 2021. A total of 525 (32.8%) participants were enrolled in the study. A postal follow-up survey was conducted between 14 June 2022 and 1 November 2022. Of the 525 persons, 361 (69%) returned a completed questionnaire. The present analysis is based on 304 persons who were not hospitalized for their initial COVID-19 disease (see Supplementary Figure S1).
The study was approved by the ethics committee of the Ludwig-Maximilians Universität Munich and was performed in accordance with the Declaration of Helsinki. Written informed consent was obtained from all participants.

2.2. Measures

Data were collected using a self-reporting questionnaire which was administered on a tablet personal computer at the baseline examination and on paper in the postal follow-up survey. The questionnaire covered information on socio-demographics, disease history, comorbid conditions as well as symptoms during the acute COVID-19 infection and persisting symptoms. The participants were asked to complete a self-developed list of 42 symptoms, rating them for their occurrence in the acute COVID-19 phase as well as for the 14 days before the baseline examination and the follow-up survey.
In the follow-up postal survey, the participants were additionally asked about health care utilization in the past 4 weeks and 12 months, and responded to eight questions on experiences regarding PCS health care and nine questions on experiences endured with long-lasting fatigue. Moreover, functional limitations were assessed using the Post-COVID Functional Status Questionnaire (PCFS) [23].

2.3. Definition of PCS

In the present study, a definition of the PCS largely based on the World Health Organization (WHO) clinical case definition [5] was applied: Participants who self-reported the presence of fatigue, dyspnea on exertion, memory problems or concentration problems, either at the baseline assessment (median 9 months after acute infection) or in the follow-up (median 26 months after acute infection), were classified as having PCS.

2.4. Data Analysis

A Chi square test or Fisher’s exact test was used to determine differences between persons with or without PCS in nominal variables and a Mann–Whitney U-Test in ordinal variables, respectively. For statistical tests, an alpha level of 0.05 was defined. Statistical analyses were performed using SAS Version 9.4 (SAS Institute, Cary, NC, USA).

3. Results

3.1. Sample Characteristics

The study sample consisted of 177 (58.2%) women and 127 (41.8%) men with a median age of 53 years (IQR 41; 61). Further characteristics are detailed in Table 1.
Of the 304 participants, 183 (60.2%) agreed to having experienced COVID-19 related symptoms longer than 4 weeks, and 138 out of 303 (45.5%) longer than 3 months, respectively. Based on the report of COVID-19 symptoms, 210 (69.1%) were classified as having PCS. Among these, 63 (30.1%) perceived themselves as suffering from PCS, 60 (28.7%) were unsure, and 86 (41.2%) stated not having PCS.

3.2. COVID-19 Symptoms

At least one symptom was reported by 245 participants (80.6%) at the baseline and 262 persons (86.2%) at the FUP. Fatigue was the most common symptom at the baseline (33.9%) and the FUP (52.8%), followed by muscle or joint pain (22.0%, 42.1%), headache (25.1%, 37.6%), concentration problems (27.2%, 34.9%) and memory problems (23.4%, 33.6%). Dyspnea on exertion was reported by 24.4% of the participants at the baseline and 27.4% at the FUP (see Supplementary Table S1). With the exception of impairment of smell or taste functions and heartburn, all symptoms were more common at the FUP than at the baseline.
Participants with PCS had significantly higher prevalences in 33 out of 42 symptoms assessed at the FUP (see Table 2). In addition, the median number of symptoms at the baseline was 6 (IQR 3; 10) in persons with PCS and 1 (0; 2) in persons without PCS. At the FUP, persons with PCS had a median of 9 (5; 15) symptoms compared with persons without PCS who had a median of 1 (0; 3) symptom. Differences at both time points were significant (p < 0.0001).

3.3. Healthcare Utilization

Table 3 shows that general practitioners were most often attended in the past 4 weeks, followed by several medical specialists and physical therapists. Specialists in psychiatry/psychotherapy were significantly more often attended by persons with PCS. In the past year, most of the medical specialists as well as physical therapists, psychologists/psychotherapists and non-medical practitioners were significantly more often visited by persons with PCS.

3.4. Experiences with PCS Healthcare

Among all participants, 143 (48.5%) were dissatisfied with the information on PCS provided by the media, 118 (40.7%) with the information through physicians/therapists, and 162 (61.1%) with the information through health insurance companies and other healthcare providers.
Among those who confirmed having experienced COVID-19-related symptoms for at least 3 months after diagnosis (n = 138), 85/129 (64.8%) reported difficulties in finding an appropriate point of contact for their complaints, 89/129 (68.9%) in finding good information about long-lasting COVID-19 symptoms, and 57/130 (43.8%) reported that information about long-lasting complaints following COVID-19 was mostly unclear and difficult to understand (see Figure 1). Support and understanding from others, including health professionals, was considered less problematic.
Most of the 123 participants (40.5%) who reported having experienced fatigue for more than 3 months following the acute COVID-19 event confirmed that fatigue was specifically severe after vigorous exercise or mental strain (n = 96, 78.7%) and 64 (56.2%) perceived fatigue as the worst consequence of the COVID-19 disease (see Figure 2). In addition, almost one half of the persons reported helplessness regarding their fatigue and problems in receiving professional support.

4. Discussion

The present study found that even 2 years after SARS-CoV-2 infection, affected persons with a mild disease course had a number of persisting symptoms and 69.1% can be classified as having PCS. Among these, 18.8% had slight to moderate functional limitations. Study participants with PCS had a significantly higher utilization of healthcare and a large proportion complained about lacking information on long-lasting COVID-19 symptoms and problems in finding competent healthcare providers.
In general, the frequency of COVID-19 related symptoms was higher at 26 months after the onset of the disease than at 9 months after, with the exception of impairment to the sense of taste or smell, and heartburn. This is in line with another German study showing an increase in the prevalence of fatigue and dyspnea from 5 to 12 months post-COVID [24] and with studies reporting that olfactory dysfunction disappears in most patients over time [25]. However, the fact that most symptoms persisted over 2 years indicates the need to further investigate the long-term course of PCS and factors contributing to an improvement or deterioration in symptoms. Furthermore, the persistence of PCS in persons with mild COVID-19 courses in the present study suggests that a considerable proportion of the population may need medical care for their PCS-related health problems over a long period of time. Healthcare providers should be prepared to manage these challenges and the healthcare system should offer additional resources to support healthcare providers and affected persons.
Indeed, the present study showed that a number of healthcare providers were involved in the healthcare of individuals with PCS in the second year after the onset of the disease more often than in persons without PCS. An overall increase in the utilization of healthcare services was also found in a German study comparing persons with confirmed post-acute COVID-19 (using the diagnostic code) and a control group without COVID-19 diagnosis based on nationwide claims data [26]; similar findings were reported in a study from Israel [27]. General practitioners were the major point of contact for persons with PCS in the present study. Schulz et al. [26] also reported that three out of four patients diagnosed with post-acute COVID-19 exclusively received treatment from a primary care physician, specifically referring to a problem-oriented discussion. This highlights the important role of primary care providers as a first point of contact and in the coordination of patient care over time.
Only 4.8% of the individuals with PCS made use of specialized COVID clinics. Reasons for the non-utilization of these clinics may include a low symptom burden and absence of functional impairments, lacking information on these healthcare facilities or difficulties in obtaining an appointment. The study participants’ responses to the questions on satisfaction with information and treatment indicate a lack of appropriate information on long-lasting COVID-19 symptoms and a lack of support from the healthcare system for more than one half of the participants. Largely comparable results were found in a previous German study [19].
Overall, the large variety of symptoms and involved medical disciplines suggest multidisciplinary models of healthcare coordinated by general practitioners and applying a stepped-care approach [19], mobile primary healthcare for patients in rural areas [28] and digital interventions for individuals with minor complaints [29].
Interestingly, we found a mismatch between the applied definition of PCS and the persons’ subjective perception of having PCS. Most of those who were classified as having PCS did not share this view or were unsure. Possibly, persons with a larger number of symptoms, a higher symptom severity or more functional limitations are more likely to perceive themselves as having PCS than persons with a few mild symptoms. In addition, psychological and social factors may influence a person’s perception of having an illness. Against this background, on the one hand, the broad PCS definitions restricted to persisting symptoms and resulting in a large number of affected persons may be useful for offering healthcare to everyone who needs support. On the other hand, many persons who do not feel strongly impaired by their symptoms would be labeled as being ill. Overall, it seems crucial that diagnosis and treatment of PCS are based on the bio-psycho-social disease model and also consider the impact of the individual’s psychosocial background [30,31]. Futhermore, a possible benefit of extended definitions of PCS that include functional impairment and health-related quality of life should be discussed, in order to avoid classifying people with minor symptoms as ill and in need of treatment [32]. The current WHO definition based on an expert Delphi procedure already mentions that symptoms “generally have an impact on everyday life” [5].
To our knowledge, this is the first study which is based on a two-year follow-up of non-hospitalized persons with COVID-19 investigating PCS and healthcare utilization in Germany. Only persons with confirmed positive PCR testing were included in the study. A limitation which applies to all studies investigating PCS is the lack of a common definition of long COVID and PCS. This limits the comparability of results across studies. Furthermore, the proportion of persons with PCS may be overestimated because persons who participated in both surveys may have experienced a higher symptom burden than those who rejected participation. In addition, psychosocial factors and the growing media attention on PCS may have influenced the report of symptoms [33]. Healthcare utilization was assessed retrospectively and the questions’ timeframe did not cover the first months after the onset of the disease.

5. Conclusions

Overall, the results of the present study highlight the need to (1) optimize patient information on PCS and the most common symptoms such as fatigue, (2) faciliate access to specialized healthcare providers and to easily accessible treatment options coordinated by primary care specialists, and (3) improve the education of healthcare providers on PCS. Further long-term studies are required to gain comprehensive knowledge on the course of PCS, the perceptions and needs of the affected individuals, and how the healthcare system can meet these needs.

Supplementary Materials

The following supporting information can be downloaded at:, Figure S1: Flowchart; Table S1: Frequency of symptoms experienced at baseline examination (median 9 months post diagnosis) and follow-up survey (median 26 months post diagnosis).

Author Contributions

Conceptualization, I.K., C.M. and Y.G.; methodology, C.M. and I.K.; formal analysis, I.K.; investigation, Y.G., T.D.W. and C.M.; resources, J.L. and A.H.-D.; writing—original draft preparation, I.K.; writing—review and editing, C.M., J.L., Y.G., T.D.W. and A.H.-D.; supervision, C.M., J.L. and A.H.-D.; project administration, I.K. and C.M.; funding acquisition, Y.G., C.M. and I.K. All authors have read and agreed to the published version of the manuscript.


This research was funded by the Bavarian Ministry of Science and Arts, SARS-CoV-2 Resarch Projects 2022.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki, and approved by the Ethics Committee of the Ludwig-Maximilians Universität Munich (No. 20-735, date of approval: 15 December 2020).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

The datasets generated during and/or analyzed during the current study are not publicly available due to data protection requirements but are available in an anonymized form from the corresponding author on reasonable request.


The authors wish to thank all members of the University Hospital Augsburg, the Chair of Vascular Surgery and the Chair of Epidemiology, who were involved in the planning and conduct of the study as well as the local public health departments who enabled the recruitment of study participants. Finally, we express our appreciation to all study participants.

Conflicts of Interest

The authors declare no conflict of interest.


  1. Davis, H.E.; McCorkell, L.; Vogel, J.M.; Topol, E.J. Long COVID: Major findings, mechanisms and recommendations. Nat. Rev. Microbiol. 2023, 21, 133–146. [Google Scholar] [CrossRef]
  2. Han, Q.; Zheng, B.; Daines, L.; Sheikh, A. Long-Term Sequelae of COVID-19: A Systematic Review and Meta-Analysis of One-Year Follow-Up Studies on Post-COVID Symptoms. Pathogens 2022, 11, 269. [Google Scholar] [CrossRef]
  3. Chen, C.; Haupert, S.R.; Zimmermann, L.; Shi, X.; Fritsche, L.G.; Mukherjee, B. Global prevalence of post-coronavirus disease 2019 (COVID-19) condition or long COVID: A meta-analysis and systematic review. J. Infect. Dis. 2022, 226, 1593–1607. [Google Scholar] [CrossRef]
  4. Global Burden of Disease Long COVID Collaborators; Hanson, S.W.; Abbafati, C.; Aerts, J.G.; Al-Aly, Z.; Ashbaugh, C.; Ballouz, T.; Blyuss, O.; Bobkova, P.; Bonsel, G.; et al. Estimated global proportions of individuals with persistent fatigue, cognitive, and respiratory symptom clusters following symptomatic COVID-19 in 2020 and 2021. JAMA 2022, 328, 1604–1615. [Google Scholar]
  5. World Health Organization. A Clinical Case Definition of Post COVID-19 Condition by a Delphi Consensus, 6 October 2021. World Health Organization. Lizenz: CC BY-NC-SA 3.0 IGO. Available online: (accessed on 3 April 2023).
  6. National Institute for Health and Care Excellence (NICE). COVID-19 Rapide Guideline: Managing the Long-Term Effects of COVID-19. 3 November 2022. Available online: (accessed on 3 April 2023).
  7. Förster, C.; Colombo, M.G.; Wetzel, A.J.; Martus, P.; Joos, S. Persisting Symptoms After COVID-19. Dtsch. Arztebl. Int. 2022, 119, 167–174. [Google Scholar] [CrossRef]
  8. Augustin, M.; Schommers, P.; Stecher, M.; Dewald, F.; Gieselmann, L.; Gruell, H.; Horn, C.; Vanshylla, K.; Cristanziano, V.D.; Osebold, L.; et al. Post-COVID syndrome in non-hospitalised patients with COVID-19: A longitudinal prospective cohort study. Lancet Reg. Health Eur. 2021, 6, 100122. [Google Scholar] [CrossRef]
  9. Lackermair, K.; Wilhelm, K.; William, F.; Grzanna, N.; Lehmann, E.; Sams, L.; Fichtner, S.; Kellnar, A.; Estner, H. The prevalence of persistent symptoms after COVID-19 disease. Dtsch. Arztebl. Int. 2022, 119, 175–176. [Google Scholar] [CrossRef]
  10. Wu, Z.; McGoogan, J.M. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: Summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA 2020, 323, 1239–1242. [Google Scholar] [CrossRef]
  11. Parker, A.M.; Brigham, E.; Connolly, B.; McPeake, J.; Agranovich, A.V.; Kenes, M.T.; Casey, K.; Reynolds, C.; Schmidt, K.F.R.; Kim, S.Y.; et al. Addressing the post-acute sequelae of SARS-CoV-2 infection: A multidisciplinary model of care. Lancet Respir. Med. 2021, 9, 1328–1341. [Google Scholar] [CrossRef]
  12. Baz, S.A.; Fang, C.; Carpentieri, J.D.; Sheard, L. ‘I don’t know what to do or where to go’. Experiences of accessing healthcare support from the perspectives of people living with Long Covid and healthcare professionals: A qualitative study in Bradford, UK. Health Expect. 2023, 26, 542–554. [Google Scholar] [CrossRef]
  13. Hossain, M.M.; Das, J.; Rahman, F.; Nesa, F.; Hossain, P.; Islam, A.M.K.; Tasnim, S.; Faizah, F.; Mazumder, H.; Purohit, N.; et al. Living with “long COVID”: A systematic review and meta-synthesis of qualitative evidence. PLoS ONE 2023, 18, e0281884. [Google Scholar] [CrossRef]
  14. Macpherson, K.; Cooper, K.; Harbour, J.; Mahal, D.; Miller, C.; Nairn, M. Experiences of living with long COVID and of accessing healthcare services: A qualitative systematic review. BMJ Open 2022, 12, e050979. [Google Scholar] [CrossRef]
  15. Kaufmann, J.; Gould, O.; Lloyd, V. Seeking care for long COVID: A narrative analysis of Canadian experiences. J. Patient Exp. 2023, 10, 23743735231151770. [Google Scholar] [CrossRef]
  16. Kingstone, T.; Taylor, A.K.; O’Donnell, C.A.; Atherton, H.; Blane, D.N.; Chew-Graham, C.A. Finding the ‘right’ GP: A qualitative study of the experiences of people with long-COVID. BJGP Open 2020, 4, bjgpopen20X101143. [Google Scholar] [CrossRef]
  17. Razai, M.S.; Al-Bedaery, R.; Anand, L.; Fitch, K.; Okechukwu, H.; Saraki, T.M.; Oakeshott, P. Patients’ Experiences of “Long COVID” in the community and recommendations for improving services: A quality improvement survey. J. Prim. Care Community Health 2021, 12, 21501327211041846. [Google Scholar] [CrossRef]
  18. Houben-Wilke, S.; Delbressine, J.M.; Vaes, A.W.; Goërtz, Y.M.; Meys, R.; Machado, F.V.; Van Herck, M.; Burtin, C.; Posthuma, R.; Franssen, F.M.; et al. Understanding and being understood: Information and care needs of 2113 patients with confirmed or suspected COVID-19. J. Patient Exp. 2021, 8, 2374373521997222. [Google Scholar] [CrossRef]
  19. Stengel, S.; Hoffmann, M.; Koetsenruijter, J.; Peters-Klimm, F.; Wensing, M.; Merle, U.; Szecsenyi, J. Versorgungsbedarfe zu Long-COVID aus Sicht von Betroffenen und Hausärzt*innen—eine Mixed-Methods-Studie aus Baden-Württemberg. Z. Evid. Fortbild. Qual. Gesundh. 2022, 172, 61–70. [Google Scholar] [CrossRef]
  20. Goßlau, Y.; Warm, T.D.; Hernandez Cancino, E.F.; Kirchberger, I.; Meisinger, C.; Linseisen, J.; Hyhlik-Duerr, A. The prevalence of vascular complications in SARS-CoV-2 infected outpatients. Wien. Med. Wochenschr. 2023, 173, 168–172. [Google Scholar] [CrossRef]
  21. Meisinger, C.; Kirchberger, I.; Warm, T.D.; Hyhlik-Dürr, A.; Goßlau, Y.; Linseisen, J. Elevated plasma D-dimer concentrations in adults after an outpatient-treated COVID-19 infection. Viruses 2022, 14, 2441. [Google Scholar] [CrossRef]
  22. Kirchberger, I.; Peilstöcker, D.; Warm, T.D.; Linseisen, J.; Hyhlik-Dürr, A.; Meisinger, C.; Goßlau, Y. Subjective and objective cognitive impairments in non-hospitalized persons 9 months after SARS-CoV-2 infection. Viruses 2023, 15, 256. [Google Scholar] [CrossRef]
  23. Klok, F.A.; Boon, G.J.A.M.; Barco, S.; Endres, M.; Geelhoed, J.J.M.; Knauss, S.; Rezek, S.A.; Spruit, M.A.; Vehreschild, J.; Siegerink, B. The Post-COVID-19 Functional Status scale: A tool to measure functional status over time after COVID-19. Eur. Respir. J. 2020, 56, 2001494. [Google Scholar] [CrossRef]
  24. Seeßle, J.; Waterboer, T.; Hippchen, T.; Simon, J.; Kirchner, M.; Lim, A.; Müller, B.; Merle, U. Persistent Symptoms in Adult Patients 1 Year After Coronavirus Disease 2019 (COVID-19): A Prospective Cohort Study. Clin. Infect. Dis. 2022, 74, 1191–1198. [Google Scholar] [CrossRef]
  25. Lechien, J.R.; Chiesa-Estomba, C.M.; Beckers, E.; Mustin, V.; Ducarme, M.; Journe, F.; Marchant, A.; Jouffe, L.; Barillari, M.R.; Cammaroto, G.; et al. Prevalence and 6-month recovery of olfactory dysfunction: A multicentre study of 1363 COVID-19 patients. J. Intern. Med. 2021, 290, 451–461. [Google Scholar] [CrossRef]
  26. Schulz, M.; Mangiapane, S.; Scherer, M.; Karagiannidis, C.; Czihal, T. Post-acute sequelae of SARS-CoV-2 infection. Dtsch. Arztebl. Int. 2022, 119, 177–178. [Google Scholar] [CrossRef]
  27. Tene, L.; Bergroth, T.; Eisenberg, A.; David, S.S.B.; Chodick, G. Risk factors, health outcomes, healthcare services utilization, and direct medical costs of patients with long COVID. Int. J. Infect. Dis. 2023, 128, 3–10. [Google Scholar] [CrossRef]
  28. Stallmach, A.; Katzer, K.; Besteher, B.; Finke, K.; Giszas, B.; Gremme, Y.; Hamdan, R.A.; Lehmann-Pohl, K.; Legen, M.; Lewejohann, J.C.; et al. Mobile primary healthcare for post-COVID patients in rural areas: A proof-of-concept study. Infection 2023, 51, 337–345. [Google Scholar] [CrossRef]
  29. Rinn, R.; Gao, L.; Schoeneich, S.M.; Dahmen, A.; Anand-Kumar, V.; Becker, P.; Lippke, S. A Scoping Review of Digital Interventions that Treat Post-/Long-COVID. J. Med. Internet Res. 2023, 25, e45711. [Google Scholar] [CrossRef]
  30. Erbguth, F.; Förstl, H.; Kleinschnitz, C. Long COVID und die Psycho-Ecke: Wiedergeburt eines reduktionistischen Krankheitsverständnisses. Dtsch. Arztebl. 2023, 120, A563–A565. [Google Scholar]
  31. Bahmer, T.; Borzikowsky, C.; Lieb, W.; Horn, A.; Krist, L.; Fricke, J.; Scheibenbogen, C.; Rabe, K.F.; Maetzler, W.; Maetzler, C.; et al. Severity, predictors and clinical correlates of Post-COVID syndrome (PCS) in Germany: A prospective, multi-centre, population-based cohort study. EClinicalMedicine 2022, 51, 101549. [Google Scholar] [CrossRef]
  32. Giszas, B.; Trommer, S.; Schüßler, N.; Rodewald, A.; Besteher, B.; Bleidorn, J.; Dickmann, P.; Finke, K.; Katzer, K.; Lehmann-Pohl, K.; et al. Post-COVID-19 condition is not only a question of persistent symptoms: Structured screening including health-related quality of life reveals two separate clusters of post-COVID. Infection 2023, 51, 365–377. [Google Scholar] [CrossRef]
  33. Roth, P.H.; Gadebusch-Bondio, M. The contested meaning of “long COVID”—Patients, doctors, and the politics of subjective evidence. Soc. Sci. Med. 2022, 292, 114619. [Google Scholar] [CrossRef]
Figure 1. Experiences of having COVID-19-related symptoms for at least 3 months after diagnosis (n = 138).
Figure 1. Experiences of having COVID-19-related symptoms for at least 3 months after diagnosis (n = 138).
Viruses 15 01326 g001
Figure 2. Experiences with fatigue lasting for at least 3 months after diagnosis (n = 123).
Figure 2. Experiences with fatigue lasting for at least 3 months after diagnosis (n = 123).
Viruses 15 01326 g002
Table 1. Sample characteristics.
Table 1. Sample characteristics.
(n = 304)
PCS * Yes
(n = 210)
PCS * No
(n = 94)
Sex 0.0904
Age (median IQR)53.541; 6152.040; 5952.039; 600.3455
Education 0.6278
≤9 years5217.14019.11819.1
>9 years25282.917080.97680.9
Living alone, yes6923.04521.72425.80.4388
Smoking 0.2792
Never a smoker16052.610851.45255.3
Current smoker216.9125.799.6
Body Mass Index 0.0306
≤30 kg/m225483.616980.58590.4
>30 kg/m25016.444119.5599.6
Myocardial infarction72.362.911.20.3328
Coronary artery disease165.3146.722.10.1622
Anxiety disorder185.9157.233.20.0560
Chronic bronchitis196.3178.222.10.0771
Autoimmune disorder289.2209.688.50.8877
Recurrent COVID-197324.65426.51920.40.5332
Time between first positive PCR test and follow-up survey 0.6679
>12 to ≤15 months82.652.433.2
>15 bis ≤18 months134.3104.833.2
>18 bis ≤21 months7424.35626.71819.2
>21 bis ≤24 months5217.13215.22021.3
>24 bis ≤27 months6220.44320.51920.2
>27 bis ≤30 months9430.96330.03133.0
>30 months10.310.500
Median IQR2620.5; 27.225.920.2; 27.0;26.020.7; 27.20.5134
Min/Max 14.1/30.2 14.1/30.2 14.2/29.8
Post-COVID Functional Status <0.0001
No limitations21973.012962.09097.8
Negligible limitations4214.04019.222.2
Slight limitations299.72913.900
Moderate limitations103.3104.800
Severe limitations000000
* Post-COVID-19 Syndrome.
Table 2. Symptoms at follow-up reported by study participants with or without post-COVID-19 Syndrome (PCS).
Table 2. Symptoms at follow-up reported by study participants with or without post-COVID-19 Syndrome (PCS).
(n = 210)
(n = 94)
Fatigue or exhaustion15875.200<0.0001
Muscle—or joint pain11052.41718.1<0.0001
Concentration problems10550.000<0.0001
Memory problems10148.100<0.0001
Sleep problems8440.077.5<0.0001
Dyspnea on exertion8239.100<0.0001
Mood swings7837.122.1<0.0001
Rhinitis or running nose6731.91617.00.0079
Stuffy nose6631.41414.90.0025
Depressive mood5928.122.1<0.0001
Throat pain5727.11010.60.0013
Muscle stiffness4621.944.3<0.0001
Teary eyes4521.455.30.0003
Muscle weakness4521.400<0.0001
Feelings of pins and needles in arms or legs4521.400<0.0001
Impairment of smell function4220.088.50.0125
Swallowing pain3717.644.30.0010
Chest pressure or pain3617.100<0.0001
Anxiety, panic3516.711.1<0.0001
Hair loss3014.322.10.0009
Impairment of taste function2913.866.40.0791
Stomach pain2813.333.20.0068
Impaired vision2813.322.10.0015
Problems with coordination of movements2712.900<0.0001
Dyspnea on rest2511.900<0.0001
Skin rash199.133.20.0923
Loss of appetite199.1000.0013
Increased temperature157.133.20.2916
Pink eyes or conjunctivitis136.222.10.1604
Nausea or vomiting125.711.10.0716
Fever (38.1 °C or higher)125.7000.0208
Blue lips41.9000.3151
Table 3. Health care utilization 4 weeks and 12 months before the follow-up survey in participants with and without post-COVID-19 Syndrome (PCS).
Table 3. Health care utilization 4 weeks and 12 months before the follow-up survey in participants with and without post-COVID-19 Syndrome (PCS).
(n = 304)
PCS Yes (n = 210)PCS No
(n = 94)
Past 4 weeks
COVID outpatient clinic10.310.5001.000
Other outpatient clinic10.310.5001.000
Counseling center20.721.0001.000
General practitioner/internal medicine6221.24824.01415.20.0882
Specialist in gastro-intestinal diseases62.263.2000.1815
Specialist in gynecology196.7178.922.20.0419
Specialist in dermatology93.294.7000.0613
Specialist in ear, nose and throat134.6126.211.10.0690
Specialist in cardiology144.9126.222.30.2382
Specialist in neurology82.984.2000.0584
Specialist in ophthalmology145.0136.811.10.0720
Specialist in orthopedics134.6126.211.10.0693
Specialist in pulmonology134.7115.822.30.2369
Specialist in psychiatry/psychotherapy124.3126.3000.0112
Specialist in urology20.721.1001.000
Occupational therapist31.031.5000.5545
Non-medical practitioner62.052.511.10.6692
Physical therapist124.0104.922.20.3539
Past 12 months
COVID outpatient clinic103.3104.8001.000
Other outpatient clinic31.031.4001.000
Counseling center51.742.011.11.000
General practitioner/internal medicine12542.710150.52425.8<0.0001
Specialist in gastro-intestinal diseases124.3105.322.30.3494
Specialist in gynecology3111.02513.066.70.1148
Specialist in dermatology155.4157.8000.0037
Specialist in ear, nose and throat207.1199.811.10.0057
Specialist in cardiology4415.64020.744.50.0005
Specialist in neurology238.22211.411.10.0019
Specialist in ophthalmology186.4157.833.40.1964
Specialist in orthopedics248.52211.322.30.0103
Specialist in pulmonology4114.53719.144.50.0009
Specialist in psychiatry/psychotherapy165.8168.5000.0020
Specialist in urology72.552.622.31.000
Occupational therapist31.031.5000.5545
Non-medical practitioner155.1147.011.10.0428
Physical therapist237.72110.222.20.0173
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Share and Cite

MDPI and ACS Style

Kirchberger, I.; Meisinger, C.; Warm, T.D.; Hyhlik-Dürr, A.; Linseisen, J.; Goßlau, Y. Post-COVID-19 Syndrome in Non-Hospitalized Individuals: Healthcare Situation 2 Years after SARS-CoV-2 Infection. Viruses 2023, 15, 1326.

AMA Style

Kirchberger I, Meisinger C, Warm TD, Hyhlik-Dürr A, Linseisen J, Goßlau Y. Post-COVID-19 Syndrome in Non-Hospitalized Individuals: Healthcare Situation 2 Years after SARS-CoV-2 Infection. Viruses. 2023; 15(6):1326.

Chicago/Turabian Style

Kirchberger, Inge, Christine Meisinger, Tobias D. Warm, Alexander Hyhlik-Dürr, Jakob Linseisen, and Yvonne Goßlau. 2023. "Post-COVID-19 Syndrome in Non-Hospitalized Individuals: Healthcare Situation 2 Years after SARS-CoV-2 Infection" Viruses 15, no. 6: 1326.

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop