Studies Highlight Lingering Risks and Disparities of Long COVID

Five years after the initial wave of COVID-19, its long-term effects continue to impact patient recovery, particularly for those with severe infections, cancer histories, or limited health care access.

While COVID-19 is no longer an active public health emergency, it remains a public health concern. | Image credit: Parradee – stock.adobe.com

A trio of abstracts presented at the Conference on Retroviruses and Opportunistic Infections (CROI) 2025 highlighted the ongoing challenges posed by COVID-19, with studies examining long COVID resolution, disparities among cancer survivors, and persistent mortality risks in rural communities. These findings emphasize the need for targeted health care strategies to address long-term complications and disparities in COVID-19 outcomes.

Recovery Varies Based on Disease Severity, Vaccination Status

A Zambian cohort study examined how long it takes for patients with long COVID to recover and identified key factors that influence symptom resolution.1 Researchers followed 823 patients with long COVID between August 2020 and December 2022, tracking symptom duration and resolution rates. Most of the patient cohort (57.4%) had comorbidities, and 38.2% were vaccinated.

The researchers found that nearly three-quarters (72.5%) recovered, but the median (IQR) time to full resolution was 51 (34-104) days, highlighting that many patients endure prolonged recovery periods. Some of the most commonly reported symptoms were cough (17.2%), fatigue (15.6%), chest pain (10.3%), and shortness of breath (7.8%).

Patients who had severe COVID-19 (n = 616) were less likely to recover quickly (adjusted HR [aHR], 0.60), while those infected with the Omicron variant had a faster recovery (aHR: 3.59). Additionally, vaccinated patients had a 25% lower likelihood of rapid recovery (aHR: 0.75).

However, the resolution rate followed a distinct pattern: initially increasing and peaking at around 20 days before declining, suggesting that while some recover quickly, others face extended health challenges.

“This may likely help in treatment planning and in providing persons with long COVID realistic expectations about their recovery process,” the researchers said.

Cancer Survivors Have Similar Long COVID Risk

A secondary analysis of the 2022 National Health Interview Survey revealed that cancer survivors experience more severe COVID-19 symptoms than the general population, though their risk of developing long COVID appears similar.2 Researchers analyzed data from 8936 adults, with 7.6% of patients being cancer survivors.

Compared with the general population, cancer survivors were significantly more likely to report severe COVID-19 symptoms (17.9% vs 14.3%; P = .019). They also had higher vaccination rates, with 88.6% having received at least 1 dose compared with 78.6% of the general population (P < .001).

Despite these differences, the overall rate of long COVID—defined as symptoms lasting 3 months or longer—was not significantly different between those with and without a history of cancer after adjusting for demographics and vaccination status (AOR, 1.05; 95% CI, 0.85-1.31; P = .635). The prevalence of long COVID was only slightly higher in cancer survivors at 23.6%, compared with 19.4% in the general population.

These findings suggest that while cancer survivors may experience more severe acute COVID-19 symptoms, they do not appear to be at a heightened risk for prolonged illness from the infection.

“Strategies are needed to address COVID-19 symptom severity in cancer survivors while ensuring equitable COVID-19 care access,” the researchers said. “Future research should also consider other factors beyond cancer history when assessing long COVID.”

Rural Communities Continue to Face Mortality Gaps

A retrospective study analyzing data from over 2.6 million patients with COVID-19 showed that residents of rural areas face a significantly higher risk of death for at least 2 years after infection compared with residents of urban areas.3

Using data from the National COVID Cohort Collaborative, researchers demonstrated that rural-adjacent residents had a 27% higher mortality risk (aHR: 1.27), while nonurban-adjacent rural residents had a 31% increased risk (aHR: 1.31). Even after adjusting for vaccination status, pre-existing conditions, and the dominant virus variant at the time of infection, rural patients consistently exhibited higher mortality rates at 1, 3, 12, and 24 months post-infection.

“The COVID-19-exacerbated rural mortality penalty persists beyond the immediate acute period after infection, highlighting a need for continued public health prioritization of rural communities,” the researchers said.

Together, these findings reinforce that while COVID-19 is no longer an active public health emergency, it remains a public health concern with long-term consequences.

References

1. Malambo W, Kaonga P, Kawana MS. Parametric survival analysis of long COVID: a cohort study on the time to symptom resolution. Presented at: Conference on Retroviruses and Opportunistic Infections, San Francisco, CA; March 9-12, 2025. https://www.croiconference.org/abstract/2853-2025/
2. Freeman JQ, Umutoni V, Li X, Zou O, Akhiwu TO. COVID-19 symptoms, vaccination, and long COVID between cancer survivors and the US general population. Presented at: Conference on Retroviruses and Opportunistic Infections, San Francisco, CA; March 9-12, 2025. https://www.croiconference.org/abstract/143-2025/
3. Anzalone J, Vest MT, Schissel ME, et al. Higher mortality following SARS-CoV-2 infection in rural dwellers persists 2 years after infection. Presented at: Conference on Retroviruses and Opportunistic Infections, San Francisco, CA; March 9-12, 2025. https://www.croiconference.org/abstract/1512-2025/