Kamal, Sanaa M, Al Qahtani, Mohammed S, Al Aseeri, Ali et al. · BMC infectious diseases · 2025 · DOI
This study followed 816 people in Saudi Arabia for up to four years after they had COVID-19 to see who developed long COVID and what symptoms they experienced. Researchers found that about 29% developed long COVID, with fatigue, post-exertional malaise (worsening after activity), cough, and brain fog being the most common symptoms. Women and people with diabetes were at higher risk, and those who got reinfected or were hospitalized took longer to recover.
This study provides robust long-term data on post-COVID symptom burden and recovery trajectories in an underrepresented Middle Eastern population. The identification of post-exertional malaise as a cardinal feature and documentation of persistent quality-of-life impairment directly parallels ME/CFS presentations and highlights the need for specialized post-COVID care protocols.
This study does not prove that long COVID is identical to ME/CFS, as it does not use ME/CFS diagnostic criteria and includes a broader symptom spectrum. It cannot establish causation between risk factors (female sex, diabetes) and long COVID—only association. It does not determine whether specific pathophysiological mechanisms drive the observed symptoms or recovery delays.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
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