Risk Predictors and Symptom Features of Long COVID Within a Broad Primary Care Patient Population Including Both Tested and Untested Patients

Rupert Jones, Andrew Davis, Brooklyn Stanley, Steven A. Julious, Dermot Ryan, David J Jackson, David MG Halpin, Katherine Hickman, Hilary Pinnock, Jennifer K Quint, Kamlesh Khunti, Liam G Heaney, Phillip Oliver, Salman Siddiqui, Ian D. Pavord, David HM Jones, Michael E Hyland, Lewis Ritchie, Pam Young, Tony MegawAntony Hardjojo, Victoria Carter, Marije van Melle

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Introduction: Symptoms may persist after the initial phases of COVID-19 infection, a phenomenon termed long COVID. Current knowledge on long COVID has been mostly derived from test-confirmed and hospitalized COVID-19 patients. Data are required on the burden and predictors of long COVID in a broader patient group, which includes both tested and untested COVID-19 patients in primary care. Methods: This is an observational study using data from Platform C19, a quality improvement program-derived research database linking primary care electronic health record data (EHR) with patient-reported questionnaire information. Participating general practices invited consenting patients aged 18–85 to complete an online questionnaire since 7th August 2020. COVID-19 self-diagnosis, clinician-diagnosis, testing, and the presence and duration of symptoms were assessed via the questionnaire. Patients were considered present with long COVID if they reported symptoms lasting ≥4 weeks. EHR and questionnaire data up till 22nd January 2021 were extracted for analysis. Multivariable regression analyses were conducted comparing demographics, clinical characteristics, and presence of symptoms between patients with long COVID and patients with shorter symptom duration. Results: Long COVID was present in 310/3151 (9.8%) patients with self-diagnosed, cliniciandiagnosed, or test-confirmed COVID-19. Only 106/310 (34.2%) long COVID patients had testconfirmed COVID-19. Risk predictors of long COVID were age ≥40 years (adjusted Odds Ratio [AdjOR]=1.49 [1.05–2.17]), female sex (adjOR=1.37 [1.02–1.85]), frailty (adjOR=2.39 [1.29– 4.27]), visit to A&E (adjOR=4.28 [2.31–7.78]), and hospital admission for COVID-19 symptoms (adjOR=3.22 [1.77–5.79]). Aches and pain (adjOR=1.70 [1.21–2.39]), appetite loss (adjOR=3.15 [1.78–5.92]), confusion and disorientation (adjOR=2.17 [1.57–2.99]), diarrhea (adjOR=1.4 [1.03–1.89]), and persistent dry cough (adjOR=2.77 [1.94–3.98]) were symptom features statistically more common in long COVID. Conclusion: This study reports the factors and symptom features predicting long COVID in a broad primary care population, including both test-confirmed and the previously missed group of COVID-19 patients
Original languageEnglish
Pages (from-to)93-104
Number of pages12
JournalPragmatic and Observational Research
Issue number12
Early online date11 Aug 2021
Publication statusPublished - 11 Aug 2021

Bibliographical note

Other members of the Platform C19 steering committee consist of Sir Prof Lewis Ritchie, OBE from the University of Aberdeen, Steve Davis from Interface Clinical Services, Dr Samantha Walker from Asthma UK & British Lung Foundation, Prof Stephen Holgate from the University of
Southampton and the Medical Research Council, and Sue Beacroft from Open Vie/Harvey Walsh and OPCRD-NEXUS. We wish to acknowledge our GP Partner Practices:
Alnwick Medical Group, Guide Post Medical Group, Priory Medical Group, Highgate Medical Centre, Clifton Medical Centre, Bridge Street Surgery, Park and St Francis Surgery, Brockworth Surgery, Whitemoor Medical Centre, Tong Medical Practice, Eric Moore Partnership, Bridgewater
Surgeries, The Village Surgery, and Queen Square Medical Practice.
The design, conduct, and writing of this study are funded by Optimum Patient Care UK and the Observational and Pragmatic Research Institute Singapore.


  • SARS-CoV-2
  • questionnaire
  • observational study
  • frailty
  • chronic disease


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