Long COVID Persistence and Surveillance Gaps Across 58 US Hospitals

What is the true burden of chronic disease following COVID-19, and why does current surveillance fail to capture it?In this cohort study of 457 950 patients with COVID-19 across 58 hospitals, validated computable phenotyping identified postacute sequelae of SARS-CoV-2 infection in 16.28% of cases, 2-fold higher than diagnostic code–based surveillance. Of identified manifestations, 89.31% represented chronic conditions, with prevalence increasing through mid-2024.These findings suggest that approximately 1 in 6 patients with COVID-19 develops postacute sequelae, predominantly chronic conditions currently invisible to surveillance systems, representing an accumulating rather than resolving health care burden.

Corresponding Author: Hossein Estiri, PhD, Department of Medicine, Massachusetts General Hospital, 399 Revolution Dr, Ste 790, Somerville, MA 02145 (hestiri@mgh.harvard.edu).

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