Analysis of Long COVID characteristics and risk factors in individuals infected with COVID-19: a follow-up study based on a cohort of 2,792 participants

Chu et al., Frontiers in Public Health, doi:10.3389/fpubh.2026.1760355, Mar 2026
Long COVID -10% improvement lower risk ← → higher risk Paxlovid for COVID-19  Chu et al.  EARLY TREATMENT Is early treatment with paxlovid beneficial for COVID-19? Prospective study of 873 patients in China Study underpowered to detect differences c19early.org Chu et al., Frontiers in Public Health, Mar 2026 0 0.5 1 1.5 2+ RR
Prospective study of 2,792 COVID-19 patients in China. After propensity score matching, neither paxlovid nor azvudine showed a statistically significant association with long COVID.
Standard of Care (SOC) for COVID-19 in the study country, China, is average with moderate efficacy for approved treatments1.
Study covers azvudine and paxlovid.
risk of long COVID, 9.7% higher, OR 1.10, p = 0.83, treatment 7 of 178 (3.9%) cases, 25 of 695 (3.6%) controls, case control OR.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Chu et al., 10 Mar 2026, prospective, China, peer-reviewed, mean age 51.6, 6 authors. Contact: wjb0386@126.com.
$0 $500 $1,000+ Efficacy vs. cost for COVID-19 treatment protocols c19early.org March 2026 China United Kingdom USA Russia Sudan Angola Colombia Kenya Mozambique Pakistan Peru Philippines Argentina Vietnam Spain Brazil Italy France Japan Nepal Ethiopia Iran Mexico South Korea Ghana Germany Bangladesh Saudi Arabia Algeria Morocco Yemen Poland India DR Congo Madagascar Thailand Uganda Venezuela Nigeria Egypt Bolivia Taiwan Zambia Fiji Bosnia-Herzegovina Côte d'Ivoire Eritrea Bulgaria Greece Slovakia Singapore Iceland New Zealand Mongolia Czechia Israel Trinidad and Tobago Hong Kong Belarus North Macedonia Qatar Panama Serbia CAR China favored low-cost treatments.The average efficacy of treatments was moderate.Low-cost treatments improve early treatment, andprovide complementary/synergistic benefits. More effective More expensive 75% 50% 25% ≤0%
$0 $500 $1,000+ Efficacy vs. cost for COVID-19treatment protocols worldwide c19early.org March 2026 China United Kingdom USA Russia Sudan Angola Colombia Kenya Mozambique Pakistan Peru Philippines Argentina Vietnam Spain Brazil Italy France Japan Nepal Ethiopia Iran Mexico South Korea Ghana Germany Bangladesh Saudi Arabia Algeria Morocco Yemen Poland India DR Congo Madagascar Thailand Uganda Venezuela Nigeria Egypt Bolivia Taiwan Zambia Fiji Côte d'Ivoire Eritrea Togo Bulgaria Greece Slovakia Singapore Iceland New Zealand Mongolia Czechia Israel Trinidad and Tobago Hong Kong Belarus North Macedonia Qatar Panama Serbia CAR China favored low-cost treatments.The average efficacy was moderate.Low-cost protocols improve early treatment,and add complementary/synergistic benefits. More effective More expensive 75% 50% 25% ≤0%
Abstract: TYPE Original Research PUBLISHED 10 March 2026 DOI 10.3389/fpubh.2026.1760355 OPEN ACCESS EDITED BY Chutian Zhang, Northwest A&F University, China REVIEWED BY Kin Israel Notarte, Johns Hopkins University, United States Andreu Comas-Garcia, Universidad Cuauhtémoc San Luis Potosí, Mexico Analysis of Long COVID characteristics and risk factors in individuals infected with COVID-19: a follow-up study based on a cohort of 2,792 participants *CORRESPONDENCE Jiabing Wu wjb0386@126.com † These authors have contributed equally to this work and share first authorship RECEIVED 04 December 2025 REVISED 04 February 2026 ACCEPTED 16 February 2026 PUBLISHED 10 March 2026 CITATION Chu X, Hou S, Zhu Q, Chang J, Gong L and Wu J (2026) Analysis of Long COVID characteristics and risk factors in individuals infected with COVID-19: a follow-up study based on a cohort of 2,792 participants. Front. Public Health 14:1760355. doi: 10.3389/fpubh.2026.1760355 COPYRIGHT © 2026 Chu, Hou, Zhu, Chang, Gong and Wu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. Xiujie Chu1† , Sai Hou2† , Qian Zhu2† , Jingru Chang2 , Lei Gong1 and Jiabing Wu1* 1 Institute for the Prevention and Control of Infectious Diseases, Anhui Provincial Center for Disease Control and Prevention, Hefei, Anhui, China, 2 Health Emergency Center, Anhui Provincial Center for Disease Control and Prevention, Hefei, Anhui, China Background: Since the emergence of SARS-CoV-2 in 2019, Long COVID has emerged as a significant global public health challenge. The identification of accessible biomarkers and risk factors is critical to enabling early intervention and improving long-term outcomes. Methods: This prospective cohort study enrolled 2,792 individuals with confirmed COVID-19 from Anhui Province in September 2024. A propensity score matching analysis was performed using a 1:4 ratio. Cases and matched controls were selected from cohort, serum sample were analyzed to assess hematological parameters. Multivariable logistic regression models were applied to identify independent risk factors associated with the development of Long COVID. Results: 2,792 participants (average age 51.64 years) identified 182 (6.52%) long COVID patients during follow-up. Common symptoms included fatigue, cough, insomnia, throat discomfort, and appetite loss. After propensity score matching, risk factors were age, more severe acute symptoms. Long COVID patients exhibited higher red blood cell counts but lower hemoglobin-related indices and platelet count. Conclusion: This study confirms the persistent risk of Long COVID following reinfection, with heightened susceptibility associated with advanced age, specific acute-phase symptoms. Alterations in routine hematological parameters may serve as valuable biomarkers for the monitoring and management of Long COVID. KEYWORDS biomarker, characteristic, cohort, Long COVID, risk factor Frontiers in Public Health 01 frontiersin.org Chu et al. 10.3389/fpubh.2026.1760355 1 Background diagnosis of long COVID. However, there remains a notable lack of systematic, long-term studies that..
DOI record: { "DOI": "10.3389/fpubh.2026.1760355", "ISSN": [ "2296-2565" ], "URL": "http://dx.doi.org/10.3389/fpubh.2026.1760355", "abstract": "<jats:sec>\n <jats:title>Background</jats:title>\n <jats:p>Since the emergence of SARS-CoV-2 in 2019, Long COVID has emerged as a significant global public health challenge. The identification of accessible biomarkers and risk factors is critical to enabling early intervention and improving long-term outcomes.</jats:p>\n </jats:sec>\n <jats:sec>\n <jats:title>Methods</jats:title>\n <jats:p>This prospective cohort study enrolled 2,792 individuals with confirmed COVID-19 from Anhui Province in September 2024. A propensity score matching analysis was performed using a 1:4 ratio. Cases and matched controls were selected from cohort, serum sample were analyzed to assess hematological parameters. Multivariable logistic regression models were applied to identify independent risk factors associated with the development of Long COVID.</jats:p>\n </jats:sec>\n <jats:sec>\n <jats:title>Results</jats:title>\n <jats:p>2,792 participants (average age 51.64 years) identified 182 (6.52%) long COVID patients during follow-up. Common symptoms included fatigue, cough, insomnia, throat discomfort, and appetite loss. After propensity score matching, risk factors were age, more severe acute symptoms. Long COVID patients exhibited higher red blood cell counts but lower hemoglobin-related indices and platelet count.</jats:p>\n </jats:sec>\n <jats:sec>\n <jats:title>Conclusion</jats:title>\n <jats:p>This study confirms the persistent risk of Long COVID following reinfection, with heightened susceptibility associated with advanced age, specific acute-phase symptoms. Alterations in routine hematological parameters may serve as valuable biomarkers for the monitoring and management of Long COVID.</jats:p>\n </jats:sec>", "alternative-id": [ "10.3389/fpubh.2026.1760355" ], "article-number": "1760355", "author": [ { "affiliation": [ { "name": "Institute for the Prevention and Control of Infectious Diseases, Anhui Provincial Center for Disease Control and Prevention", "place": [ "Hefei, Anhui, China" ] } ], "family": "Chu", "given": "Xiujie", "sequence": "first" }, { "affiliation": [ { "name": "Health Emergency Center, Anhui Provincial Center for Disease Control and Prevention", "place": [ "Hefei, Anhui, China" ] } ], "family": "Hou", "given": "Sai", "sequence": "additional" }, { "affiliation": [ { "name": "Health Emergency Center, Anhui Provincial Center for Disease Control and Prevention", "place": [ "Hefei, Anhui, China" ] } ], "family": "Zhu", "given": "Qian", "sequence": "additional" }, { "affiliation": [ { "name": "Health Emergency Center, Anhui Provincial Center for Disease Control and Prevention", "place": [ "Hefei, Anhui, China" ] } ], "family": "Chang", "given": "Jingru", "sequence": "additional" }, { "affiliation": [ { "name": "Institute for the Prevention and Control of Infectious Diseases, Anhui Provincial Center for Disease Control and Prevention", "place": [ "Hefei, Anhui, China" ] } ], "family": "Gong", "given": "Lei", "sequence": "additional" }, { "affiliation": [ { "name": "Institute for the Prevention and Control of Infectious Diseases, Anhui Provincial Center for Disease Control and Prevention", "place": [ "Hefei, Anhui, China" ] } ], "family": "Wu", "given": "Jiabing", "sequence": "additional" } ], "container-title": "Frontiers in Public Health", "container-title-short": "Front. Public Health", "content-domain": { "crossmark-restriction": true, "domain": [ "frontiersin.org" ] }, "created": { "date-parts": [ [ 2026, 3, 10 ] ], "date-time": "2026-03-10T06:43:41Z", "timestamp": 1773125021000 }, "deposited": { "date-parts": [ [ 2026, 3, 10 ] ], "date-time": "2026-03-10T06:43:43Z", "timestamp": 1773125023000 }, "indexed": { "date-parts": [ [ 2026, 3, 11 ] ], "date-time": "2026-03-11T03:08:27Z", "timestamp": 1773198507082, "version": "3.50.1" }, "is-referenced-by-count": 0, "issued": { "date-parts": [ [ 2026, 3, 10 ] ] }, "license": [ { "URL": "https://creativecommons.org/licenses/by/4.0/", "content-version": "vor", "delay-in-days": 0, "start": { "date-parts": [ [ 2026, 3, 10 ] ], "date-time": "2026-03-10T00:00:00Z", "timestamp": 1773100800000 } } ], "link": [ { "URL": "https://www.frontiersin.org/articles/10.3389/fpubh.2026.1760355/full", "content-type": "unspecified", "content-version": "vor", "intended-application": "similarity-checking" } ], "member": "1965", "original-title": [], "prefix": "10.3389", "published": { "date-parts": [ [ 2026, 3, 10 ] ] }, "published-online": { "date-parts": [ [ 2026, 3, 10 ] ] }, "publisher": "Frontiers Media SA", "reference": [ { "key": "B1", "unstructured": "COVID-19 cases\n \n 2025" }, { "DOI": "10.1016/j.socscimed.2020.113426", "article-title": "How and why patients made long COVID", "author": "Callard", "doi-asserted-by": "publisher", "first-page": "113426", "journal-title": "Socl Sci Med.", "key": "B2", "volume": "268", "year": "2021" }, { "DOI": "10.1016/S0140-6736(24)01136-X", "article-title": "Long COVID: a clinical update", "author": "Greenhalgh", "doi-asserted-by": "publisher", "first-page": "707", "journal-title": "Lancet", "key": "B3", "volume": "404", "year": "2024" }, { "DOI": "10.1016/j.eclinm.2022.101762", "article-title": "The prevalence and long-term health effects of Long COVID among hospitalised and non-hospitalised populations: a systematic review and meta-analysis", "author": "O'Mahoney", "doi-asserted-by": "publisher", "first-page": "101762", "journal-title": "EClinicalMedicine", "key": "B4", "volume": "55", "year": "2023" }, { "DOI": "10.1038/s41591-021-01361-2", "article-title": "Attributes and predictors of long COVID", "author": "Sudre", "doi-asserted-by": "publisher", "first-page": "626", "journal-title": "Nature Med.", "key": "B5", "volume": "27", "year": "2021" }, { "DOI": "10.1038/s41591-022-01909-w", "article-title": "Symptoms and risk factors for long COVID in non-hospitalized adults", "author": "Subramanian", "doi-asserted-by": "publisher", "first-page": "1706", "journal-title": "Nature Med.", "key": "B6", "volume": "28", "year": "2022" }, { "DOI": "10.1038/s43856-024-00549-0", "article-title": "Identification of risk factors of long COVID and predictive modeling in the RECOVER EHR cohorts", "author": "Zang", "doi-asserted-by": "publisher", "first-page": "130", "journal-title": "Communications Med.", "key": "B7", "volume": "4", "year": "2024" }, { "DOI": "10.1038/s41590-024-01754-8", "article-title": "Iron dysregulation and inflammatory stress erythropoiesis associates with long-term outcome of COVID-19", "author": "Hanson", "doi-asserted-by": "publisher", "first-page": "471", "journal-title": "Nature Immunol.", "key": "B8", "volume": "25", "year": "2024" }, { "article-title": "M G o t S The joint prevention and control mechanism group of the State Council Chinese", "author": "Prevention", "first-page": "108", "journal-title": "J Viral Diseases.", "key": "B9", "volume": "13", "year": "2023" }, { "DOI": "10.1146/annurev-med-043021-030635", "article-title": "Post-COVID-19 condition", "author": "Nalbandian", "doi-asserted-by": "publisher", "first-page": "55", "journal-title": "Annu Rev Med.", "key": "B10", "volume": "74", "year": "2023" }, { "DOI": "10.1080/22221751.2023.2220578", "article-title": "A one-year follow-up study of systematic impact of long COVID symptoms among patients post SARS-CoV-2 omicron variants infection in Shanghai, China", "author": "Cai", "doi-asserted-by": "publisher", "first-page": "2220578", "journal-title": "Emerg Microbes Infect.", "key": "B11", "volume": "12", "year": "2023" }, { "DOI": "10.1038/s41586-023-06651-y", "article-title": "Distinguishing features of long COVID identified through immune profiling", "author": "Klein", "doi-asserted-by": "publisher", "first-page": "139", "journal-title": "Nature.", "key": "B12", "volume": "623", "year": "2023" }, { "DOI": "10.3390/jcm11247314", "article-title": "Age, sex and previous comorbidities as risk factors not associated with SARS-CoV-2 infection for long COVID-19: a systematic review and meta-analysis", "author": "Notarte", "doi-asserted-by": "publisher", "first-page": "7314", "journal-title": "J Clinic Med", "key": "B13", "volume": "11", "year": "2022" }, { "DOI": "10.1016/j.jinf.2023.12.004", "article-title": "Persistence of post-COVID symptoms in the general population two years after SARS-CoV-2 infection: a systematic review and meta-analysis", "author": "Fernandez-de-Las-Peñas", "doi-asserted-by": "publisher", "first-page": "77", "journal-title": "J Infect", "key": "B14", "volume": "88", "year": "2024" }, { "DOI": "10.1001/jamanetworkopen.2022.38804", "article-title": "Prevalence and correlates of long COVID symptoms among US Adults", "author": "Perlis", "doi-asserted-by": "publisher", "first-page": "e2238804", "journal-title": "JAMA Netw Open.", "key": "B15", "volume": "5", "year": "2022" }, { "DOI": "10.3390/biomedicines11113002", "article-title": "Risk factors for long COVID in older adults", "author": "Hu", "doi-asserted-by": "publisher", "first-page": "3002", "journal-title": "Biomedicines.", "key": "B16", "volume": "11", "year": "2023" }, { "DOI": "10.1016/j.amjmed.2023.08.008", "article-title": "Long COVID: clinical findings, pathology, and endothelial molecular mechanisms", "author": "Hawley", "doi-asserted-by": "publisher", "first-page": "91", "journal-title": "Am J Med.", "key": "B17", "volume": "138", "year": "2025" }, { "DOI": "10.1016/j.isci.2022.104723", "article-title": "Immune response to SARS-CoV-2 in severe disease and long COVID-19", "author": "Sumi", "doi-asserted-by": "publisher", "first-page": "104723", "journal-title": "iScience.", "key": "B18", "volume": "25", "year": "2022" }, { "DOI": "10.3390/ijms231911845", "article-title": "Cellular senescence in immunity against infections", "author": "Marrella", "doi-asserted-by": "publisher", "first-page": "11845", "journal-title": "Int J Mol Sci.", "key": "B19", "volume": "23", "year": "2022" }, { "DOI": "10.1038/s41590-023-01601-2", "article-title": "SARS-CoV-2 reservoir in post-acute sequelae of COVID-19 (PASC)", "author": "Proal", "doi-asserted-by": "publisher", "first-page": "1616", "journal-title": "Nature Immunol.", "key": "B20", "volume": "24", "year": "2023" }, { "DOI": "10.1016/j.medj.2022.04.001", "article-title": "Gastrointestinal symptoms and fecal shedding of SARS-CoV-2 RNA suggest prolonged gastrointestinal infection", "author": "Natarajan", "doi-asserted-by": "publisher", "first-page": "37", "journal-title": "Med.", "key": "B21", "volume": "3", "year": "2022" }, { "DOI": "10.3389/fmicb.2024.1470193", "article-title": "Proteomic and metabolomic profiling of plasma uncovers immune responses in patients with long COVID-19", "author": "Wei", "doi-asserted-by": "publisher", "first-page": "1470193", "journal-title": "Front Microbiol.", "key": "B22", "volume": "15", "year": "2024" }, { "DOI": "10.1093/nsr/nwae410", "article-title": "Integrated multi-omics characterization across clinically relevant subgroups of long COVID", "author": "Ai", "doi-asserted-by": "publisher", "first-page": "nwae410", "journal-title": "National Sci Rev", "key": "B23", "volume": "12", "year": "2025" }, { "DOI": "10.1056/NEJMra1401038", "article-title": "Iron-deficiency anemia", "author": "Camaschella", "doi-asserted-by": "publisher", "first-page": "1832", "journal-title": "New Engl J Med.", "key": "B24", "volume": "372", "year": "2015" }, { "DOI": "10.1016/j.taap.2004.06.021", "article-title": "Iron metabolism and toxicity", "author": "Papanikolaou", "doi-asserted-by": "publisher", "first-page": "199", "journal-title": "Toxicol Appl Pharmacol.", "key": "B25", "volume": "202", "year": "2005" }, { "DOI": "10.3390/biology13110948", "article-title": "Red blood cell morphology is associated with altered hemorheological properties and fatigue in patients with long COVID", "author": "Grau", "doi-asserted-by": "publisher", "first-page": "948", "journal-title": "Biology", "key": "B26", "volume": "13", "year": "2024" }, { "DOI": "10.3389/fimmu.2024.1397629", "article-title": "Longitudinal transcriptomic analysis reveals persistent enrichment of iron homeostasis and erythrocyte function pathways in severe COVID-19 ARDS", "author": "Eltobgy", "doi-asserted-by": "publisher", "first-page": "1397629", "journal-title": "Front Immunol.", "key": "B27", "volume": "15", "year": "2024" }, { "DOI": "10.1186/s12916-025-03971-w", "article-title": "Longitudinal multi-omics analysis of convalescent individuals with respiratory sequelae 6–36 months after COVID-19", "author": "Yang", "doi-asserted-by": "publisher", "first-page": "134", "journal-title": "BMC Med", "key": "B28", "volume": "23", "year": "2025" }, { "DOI": "10.3390/jcm13072049", "article-title": "Anemia and its connections to inflammation in older adults: a review", "author": "Wacka", "doi-asserted-by": "publisher", "first-page": "2049", "journal-title": "J Clinic Med", "key": "B29", "volume": "13", "year": "2024" }, { "DOI": "10.1038/s41392-021-00618-z", "article-title": "Sequential infection with H1N1 and SARS-CoV-2 aggravated COVID-19 pathogenesis in a mammalian model, and co-vaccination as an effective method of prevention of COVID-19 and influenza", "author": "Bao", "doi-asserted-by": "publisher", "first-page": "200", "journal-title": "Signal Transduct Target Ther", "key": "B30", "volume": "6", "year": "2021" } ], "reference-count": 30, "references-count": 30, "relation": {}, "resource": { "primary": { "URL": "https://www.frontiersin.org/articles/10.3389/fpubh.2026.1760355/full" } }, "score": 1, "short-title": [], "source": "Crossref", "subject": [], "subtitle": [], "title": "Analysis of Long COVID characteristics and risk factors in individuals infected with COVID-19: a follow-up study based on a cohort of 2,792 participants", "type": "journal-article", "update-policy": "https://doi.org/10.3389/crossmark-policy", "volume": "14" }
Please send us corrections, updates, or comments. c19early involves the extraction of 200,000+ datapoints from thousands of papers. Community updates help ensure high accuracy. Treatments and other interventions are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment or intervention is 100% available and effective for all current and future variants. We do not provide medical advice. Before taking any medication, consult a qualified physician who can provide personalized advice and details of risks and benefits based on your medical history and situation. IMA and WCH provide treatment protocols.
  or use drag and drop   
Submit