Long COVID in the population of COVID-19 hospitalized patients discharged from SUS' hospitals in Rio de Janeiro City, Brazil: a patient-engaged cohort survey study. — CFSMEATLAS
Long COVID in the population of COVID-19 hospitalized patients discharged from SUS' hospitals in Rio de Janeiro City, Brazil: a patient-engaged cohort survey study.
Portela, Margareth Crisóstomo, Lima, Sheyla Maria Lemos, Escosteguy, Claudia Caminha et al. · BMC infectious diseases · 2025 · DOI
Quick Summary
This Brazilian study surveyed over 11,000 people who were hospitalized with COVID-19 to see how many experienced long-lasting symptoms months later. About 71% reported frequent ongoing symptoms like fatigue, brain fog, and joint pain, while 39% said they had Long COVID. The researchers found that women, people with previous health conditions, and certain age groups were more likely to experience these persistent symptoms.
Why It Matters
This study addresses a critical gap in Long COVID research from low- and middle-income countries, providing population-level evidence of substantial LC burden in a vulnerable, hospitalized cohort. The explicit inclusion of post-exertional malaise—a hallmark symptom often neglected in LC research—and emphasis on symptom frequency aligns with ME/CFS clinical understanding and improves case characterization.
Observed Findings
Among 11,328 hospitalized COVID-19 survivors, 71.3% reported frequently experiencing at least one persistent symptom 6–24 months post-discharge.
39.3% self-reported a Long COVID diagnosis.
The five most frequent symptoms were fatigue, post-exertional malaise, joint pain, sleep disturbance, and cognitive impairment.
Symptoms were consistently more prevalent in women compared to men.
Pre-existing comorbidities were positively associated with LC symptoms, and age showed a non-linear relationship with LC occurrence.
Inferred Conclusions
Long COVID imposes a substantial burden on hospitalized COVID-19 survivors in Rio de Janeiro, even 24 months post-discharge, particularly affecting women and individuals with prior comorbidities.
Post-exertional malaise is a prevalent and clinically important symptom in the LC population that warrants greater attention in surveillance and clinical care.
Access to appropriate, culturally informed healthcare for Long COVID is urgent in low- and middle-income settings.
Remaining Questions
Do the identified LC cases meet formal ME/CFS diagnostic criteria (e.g., Canadian Consensus Criteria or ICC), and how do prevalence estimates change when stricter case definitions are applied?
What This Study Does Not Prove
This cross-sectional design cannot establish causation or determine whether observed symptoms directly result from COVID-19 versus other factors. The study does not clarify whether cases meet ME/CFS diagnostic criteria (e.g., using Canadian Consensus Criteria), and reliance on self-reported LC diagnosis without independent clinical validation limits specificity.
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 →