Over 2 million adults in England may have had long COVID - Imperial REACT

A study of over half a million adults in England found that one in 20 had persistent COVID-19 symptoms.

The research looked at survey data from the Imperial College London-led REACT-2 study, collected from random samples of the population between September and February. Nearly 27,000 (around 6%) reported experiencing at least one of 29 symptoms linked with COVID-19 for 12 weeks or more.

These figures are based on reports from the people (almost one in five) who reported having had COVID-19, either suspected or confirmed by PCR test, one-third of whom reported persistent symptoms at 12 weeks. This could mean that more than two million people in England may have been affected by these persistent symptoms after COVID-19.

“Our findings do paint a concerning picture of the longer-term health consequences of COVID-19." Prof Paul Elliott School of Public Health

Women, people who smoked, were overweight or obese, lived in deprived areas, or had been admitted to hospital, all had a higher risk of persistent symptoms, while Asian people had a lower risk. Increasing age was also linked with having persistent symptoms, with the risk rising by 3.5% with each decade of life.

The proportion of people with symptoms rapidly declined in the first four weeks, followed by a small drop by 12 weeks. However after 12 weeks there was little change up to 150 days (5 months) of follow-up.

Professor Paul Elliott, director of the REACT programme from Imperial’s School of Public Health, said: “Our findings do paint a concerning picture of the longer-term health consequences of COVID-19, which need to be accounted for in policy and planning.

“Long COVID is still poorly understood but we hope through our research that we can contribute to better identification and management of this condition, which our data and others’ suggest may ultimately affect millions of people in the UK alone.”

Symptom profiles

People with symptoms at 12 weeks fell into one of two groups based on the symptoms they were experiencing. One group was characterised by respiratory symptoms like shortness of breath, tight chest and chest pain, and in this group more people had reported severe COVID-19 symptoms. In the other group the predominant symptoms were tiredness often with muscle aches, and difficulty sleeping.

"This represents a significant public health issue that needs to be urgently addressed through appropriate support and treatment." Prof Helen Ward School of Public Health

Helen Ward, Professor of Public Health at the School of Public Health, said: “Our research shows that many people who have had COVID-19 will have lasting symptoms and for some these may have a big impact on their quality of life. Given the number of infections in England this represents a significant public health issue that needs to be urgently addressed through appropriate support and treatment.”

The REACT-2 programme, funded by the Department of Health and Social Care, is tracking past coronavirus infections in England. Every 2-4 months random samples of the population are invited to participate and almost 200,000 adults take part, who complete a questionnaire and finger-prick test which looks for coronavirus antibodies.

This study looked at rounds 3-5 of the REACT programme, carried out from 15 to 28 September 2020 (round 3), 27 October to 10 November 2020 (round 4) and 25 January to 8 February 2021 (round 5). 508,707 adults aged 18 and above were included.

"Studies like this help us to rapidly build our understanding of the impact of the condition." Matt Hancock Health and Social Care Secretary

Matt Hancock, Health and Social Care Secretary, said: “I know long COVID can have a lasting and debilitating impact on the lives of those affected. Studies like this help us to rapidly build our understanding of the impact of the condition and we are using these findings and other new research to develop support and treatments.

“We are learning more about Long COVID all the time and have made £50 million research funding available to support innovative projects, with clinics established across the country to help improve the treatment available.”

The long-term health impacts of COVID-19

The REACT programme has been expanded to study long COVID and was awarded £5.5 million by the National Institute for Health Research and UK Research and Innovation to help understand and address the longer-term effects of COVID-19 on physical and mental health.

Lord Bethell, Health Minister, said: “We are learning more about long COVID every day. Surveillance programmes like REACT-2 are absolutely essential to advancing our understanding of the long term impacts of COVID-19.

“We are completely committed to backing innovative research projects into long COVID. They add to our body of understanding and help us develop better treatments to make sure people get the support they need.”

The findings are available in a pre-print report and will be submitted for peer review. Download the pre-print report here.