Long COVID and Associated Outcomes Following COVID-19 Reinfections: Insights from an International Patient-Led Survey

Background: COVID-19 reinfections are common worldwide. Long COVID is a serious infection-associated chronic condition and a major public health concern. Using a patient-centered approach, we characterized the association between reinfections and Long COVID. Methods: We developed and disseminated internationally a patient-centered online survey examining the outcomes of COVID-19 reinfections. The survey incorporated validated instruments on fatigue, post-exertional malaise, and physical function with questions about COVID-19 infection history, vaccination, and Long COVID symptoms, including symptoms related to immune and reproductive health. We tested whether the likelihood of Long COVID and related outcomes increases with COVID-19 infection numbers. Results: Here we show that reinfections increase the likelihood of reporting Long COVID, which increased 2.1-fold from one to two infections. Among 3,382 participants, 22% reported never having had COVID-19, 42% experienced it once, and 35% reported reinfections. Relative to those who did not report infections or experienced COVID-19 once, reinfections were associated with increased likelihood of severe fatigue, post-exertional malaise, decreased physical function, poorer immune health, symptom exacerbation before menstruation, and multiple other Long COVID symptoms. While vaccinations and boosters prior to infection are associated with lower likelihood of Long COVID, reinfections diminish their protective effect. The probability of reporting Long COVID remission is generally low (11.5%-6.5%). Conclusions: COVID-19 reinfections are associated with higher likelihood of Long COVID and related outcomes. These findings underscore the need for robust public health measures for COVID-19 infection prevention and the importance of considering reinfections in Long COVID research and clinical practice.