Prevalence of Post-COVID Symptoms Across Variants of Concern and Follow-up Periods: A Systematic Review and Meta-Analysis, 2026, Lugtu et al.

[Chandelier]

Prevalence of Post-COVID Symptoms Across Variants of Concern and Follow-up Periods: A Systematic Review and Meta-Analysis

Spoiler: Authors

Lugtu, Eiron John; IV, Delfin Ynigo Pilapil; Cabunoc, Mikhail Harvey; Bautista, Joshua Lawrence; Pleta, Francis Matthew; Ng, Jeremy Ace; Shahid, Farid; Carandang, Timothy Hudson David Culasino; Lippi, Giuseppe; Henry, Brandon Michael; Fernández-de-las-Peñas, César; Notarte, Kin Israel

Highlights​

• First meta-analysis assessing how SARS-CoV-2 variant and time shape post-COVID symptomatology
• Post-COVID symptoms were more prevalent during the pre-Omicron era than in the Omicron era
• Post-COVID symptom trajectories of pre-Omicron and Omicron infections varied over time
• Pre-Omicron infection is linked to dyspnea and anosmia; Omicron to brain fog and paresthesia
• Fatigue is the most prevalent post-COVID symptom across SARS-CoV-2 variant and follow-up periods

Abstract​

Objectives​

The interaction between SARS-CoV-2 variants of concern (VoC) and post-COVID symptom duration remains unexplored.
This is the first study to evaluate post-COVID prevalence stratified by VoC and follow-up periods.

Methods​

Six databases were searched (12/2019-12/2024) for studies of adults with laboratory-confirmed SARS-CoV-2 and symptoms lasting ≥3 months.
Data were stratified by VoC (Alpha through Omicron) and follow-up (<6 vs. ≥6 months) to estimate pooled prevalence using random-effects models.

Results​

Pooled prevalence across 35 studies (n=159,000) was 28.5% (95% CI: 21.6-36.0), higher in pre-Omicron (35.5%) than Omicron (22.8%) eras (p=0.04).
Symptoms persisted beyond six months in 29.9% of cases.
Fatigue was the most prevalent symptom across all VoCs and follow-ups followed by brain fog, dyspnea, and sleep impairment.
Pre-Omicron variants were linked to dyspnea and anosmia, while Omicron was associated with brain fog and paresthesia.
Most symptoms showed no significant reduction beyond six months.
Sleep problems were higher in early pre-Omicron cohorts but improved over time; conversely, palpitations and ocular manifestations increased in later pre-Omicron follow-ups.

Conclusions​

Post-COVID condition remains a burden despite vaccination.
Distinct symptomatology patterns across VoC and timelines highlight the need for tailored management strategies to mitigate long-term global impacts.

Graphical abstract​

Web | DOI | International Journal of Infectious Diseases

 

[rvallee]

That's definitely not a significant enough reduction in burden. It could have been somewhat significant if most cases stemmed from severe acute cases, but we've known that's not the case for at least 3 years now. Because of the nature of how this is done, this is likely a slightly higher estimate, so the upper bound, but that's still way too high a burden.

Especially when considering that many studies have found similar burdens for other common respiratory illnesses, which means that while those have been unfairly neglected for decades, COVID only added to this burden. It did not displace anything, it's all in addition to an existing baseline level of chronic illness.

Most symptoms showed no significant reduction beyond six months.

There is no amount of magical thinking / biopsychosocial rehabilitation that will change that. A monumental mistake considering that we have known for years that this was not an effective model, but tantrums were thrown and evidence was damned. This is the kind of failure that should lead to heads figuratively rolling, investigations, reforms. None of this will happen, and this is exactly why it happened this time, and why it will happen the same way the next time, likely again with feigned surprise at how this was totally unexpected.

Data don't seem good enough to show a stratification gradient, there aren't enough data points. It would be interesting to see where it tapers off, I'm not sure it really is 6 months, and it's all missing the disability burden. Data on this remain shockingly inadequate, an ongoing failure of choice.

While there is a lot of reasonable criticism to make of the studies that over-inflated prevalence, the studies that asserted "nothing there" are far worse, and yet there will never be any criticism for this. Which is completely backwards. Risk assessment should always be based on preparing for the worst-case scenario, while hoping for the best case. And that's not "advanced 400 pages of dense figures and complex formulas" manual for PhDs but literal "risk management for dummies". But medicine's obsession with magical mind-illness has convinced them that downplaying those problems is always fair and just.

Beliefs need to be entirely rooted out of health care. This is beyond unacceptable, it's outrageous. Psychosomatic ideology is a plague on humanity, and an insult to the scientific revolution and so-called human rights to competent, evidence-based health care.

 

[Sean]

Psychosomatic ideology is a plague on humanity, and an insult to the scientific revolution and so-called human rights to competent, evidence-based health care.

It is now beyond any doubt that this is the greatest and cruelest catastrophe in modern medicine.

It has failed every serious test of explanatory and therapeutic power.

Yet there it stands, apparently completely immune to any legitimate criticism and meaningful accountability, instead metastasing unrestrained and fundamentally corrupting the entire global health system. Entirely self-inflicted by the medical profession, against all evidence and warnings, let alone pleading from their victims to stop.

If I had not witnessed it with my own eyes and experienced the profound impact upon my own life I would have trouble believing it is this bad.

But, holy shit, it really is.

 

[V.R.T.]

It is now beyond any doubt that this is the greatest and cruelest catastrophe in modern medicine.

It has failed every serious test of explanatory and therapeutic power.

Yet there it stands, apparently completely immune to any legitimate criticism and meaningful accountability, instead metastasing unrestrained and fundamentally corrupting the entire global health system. Entirely self-inflicted by the medical profession, against all evidence and warnings, let alone pleading from their victims to stop.

If I had not witnessed it with my own eyes and experienced the profound impact upon my own life I would have trouble believing it is this bad.

But, holy shit, it really is.

I have come to the conclusion that it's literally all bullshit. All of it. As in: there is no such thing as a psychosomatic illness.

After the destruction they've caused, all the obfuscation, all the fudged and fraudulent data, I really can't see any good reason to think there are any illnesses caused by peoples mental health in the way the psychobehaviouralists claim.

I spent my entire adult life afraid that I was someone who's thoughts were making them sick. I certaintly never thought that nobody's thoughts made them sick. After all, the idea is everywhere, all throughout our culture. After the last five years of looking at their work, I think psychosomatic illness is like miasma or humours or blood letting. Something medicine should have left in the past.

Maybe I'm wrong and there are some genuinely psychosomatic illnesses. But the burden of proof should be infinitely higher than for anything else. Not lower, as it is now. And as far as I can see you can never prove or disprove it. Its unfalsifiable. And thus unscientific.

 

[ScoutB]

there is no such thing as a psychosomatic illness.

Yes, strongly agree. Perhaps it's theoretically possible, but I've never seen any real evidence and history is piled with cases of these ideas being wrong over and over. What a travesty to pointlessly convince people they are causing their own suffering.

Psychosomatic theories just seem a mashup of three sort of base issues: human instinct, when given no other information, to blame people for their own problems, especially chronic ones; how compelling we find any theory that tells us we can control our own health with "good" behaviours; and screwing up the causation on the completely unsurprising fact that sick people experience more negative thoughts and feelings than healthy people.

 

[Sean]

I have come to the conclusion that it's literally all bullshit. All of it. As in: there is no such thing as a psychosomatic illness.

They certainly have not put forward any robust body of evidence for it, let alone demonstrated a capacity to deal with it in any constructive manner.

In short, they have no claim to actual expertise, nor hence any authority over our lives.

 

[Nightsong]

I do not think the term "psychosomatic" is at all useful but there remain certain entities, now generally considered to be under the rubric of FND, such as complaints of uniform sensory loss in a hand with a sharp transition to normalcy at the wrist rather than along the actual nerve distribution - where the symptoms seem to be mediated by the patient's idea of an affected hand and a non-affected arm but where the symptoms are actually incompatible with the anatomy. That must be a problem of perception, but it must involve the idea of a "hand" and a "wrist" somehow; it must occur at, essentially, a higher level in the brain.

Then there is e.g. pseudoseizure, which often superficially resembles a tonic-clonic/"grand mal" seizure but is not and on being witnessed by someone competent to make the diagnosis it becomes apparent that the activity is occurring with the patient in a fully conscious state. But it nonetheless superficially resembles a "seizure" in the popular imagination, so is likely to involve the patient's ideas of what a seizure actually is. And some forms of what is now called FND do seem to involve suggestibility - that is something that appears across many historical accounts. The high placebo response rate in these patients also points in that direction.

There are other unrelated conditions that seem at some level to involve ideas that are nonetheless very real. Coprolalia in Tourette's, for example - it is now generally accepted that the utterances are involuntary but they must involve that patient's ideas of social appropriateness and inappropriateness at some level we do not currently understand.

"Psychosomatic" is probably always inappropriate but there are some conditions that do appear to exist at a higher 'level of processing', for want of a better term.

I also really do not think this kind of thing has anything whatsoever to do with ME/CFS, save for the fact that some patients with ME/CFS are misdiagnosed with FND and that some patients with FND seem to acquire erroneous ME/CFS diagnoses (with a small number of the latter becoming prominent 'ME advocates', to our detriment).

 

[Liie]

there remain certain entities, now generally considered to be under the rubric of FND

I have thought something similar. That maybe FND started out as a grouping of such conditions, which might be reasonable to group together. But later someone had the bright idea that why not throw in all these fatigue patients that no one understands in the same group?

I still think the term "functional" is silly though. Without having though much about it I think "psychosomatic" feels like a reasonable term for such conditions.

 

[rvallee]

I have thought something similar. That maybe FND started out as a grouping of such conditions, which might be reasonable to group together. But later someone had the bright idea that why not throw in all these fatigue patients that no one understands in the same group?

If they stick with groups for which their models make even the tiniest bit of sense, it would be so small as to be insignificant. They would never have resources for anything, because it would be so rare that a single clinic could serve a large nation's worth of cases, and even then it would probably be idle most of the time.

So they over-inflate, and don't seem to mind something on the order of 99.9% collateral damage to their ideology, because they are encouraged at all levels to go even further. People almost never learn from mistakes. There have to be consequences. And here the consequences are more resources and awards. Harm has been turned into good, so the more harm they do the more rewards they get.

Ideology. Ideology never changes. It has made good people do horrible things for all of human history, and even before that.

 

[ScoutB]

"Psychosomatic" is probably always inappropriate but there are some conditions that do appear to exist at a higher 'level of processing', for want of a better term.

Yeah, this is a fair point. Brains are complicated, sometimes perceptions have bizarre effects, and it seems reasonable to have *some* label for the category.

I like JE's example of narcoleptic cataplexy -- "the sudden, brief loss of voluntary muscle tone triggered by strong emotions while maintaining full consciousness". I think it's telling, because if we didn't know people with narcolepsy were missing hypocretin, the same FND arguments (no biological explanation, patient is conscious, emotionally-triggered) could be applied, especially in mild cases. We'd likely blame the emotions, the proximate trigger, without considering that maybe some background biological difference is why the emotions are able to cause so much trouble in the first place.

So I think my objection is just to the assumption that, when a problem seems to involve 'higher processing', it follows the patient could surely cure themselves if they thought the right thoughts. (Perhaps some can! But I get the sense some therapists firmly believe the illness is under the patient's control, ergo, if their treatment fails, it is because the patient did it wrong).

Even in the realm of purely psychological conditions, it's unclear to me that talk therapy or CBT are really curative treatments. I have two friends with depression who have been in therapy for years (and have found it a positive experience) but they are still continually managing their depression and also taking anti-depressants. For ADHD, last time I looked at the data, stimulants totally blow all talk therapy treatments out of the water. Severe anxiety, OCD, Bipolar, etc. etc. remain long term conditions for many people. I think there's probably a lot of biology there waiting to be uncovered.