Long-term outcomes of COVID-19 in primary care: 5-Year follow-up of hospitalized and non-hospitalized patients in a population-based cohort study.

PURPOSE: To describe the prevalence and determinants of persistent symptoms and long-term sequelae up to five years after SARS-CoV-2 infection.

METHODS

Population-based, prospective cohort study. Urban primary care setting. Adults identified as having post-acute COVID-19 in 2021 were included and followed for a single assessment five years after their initial SARS-CoV-2 diagnosis. The cohort comprised 56 unvaccinated patients, including both previously hospitalized and non-hospitalized individuals.

RESULTS

At five-year follow-up, persistent symptoms remained frequent. Asthenia, dyspnea, and anosmia were the most commonly reported manifestations, followed by cognitive complaints and chronic cough. Pulmonary sequelae were identified in 14.3% of participants, whereas neurological impairment was rare (1.79%). Most chronic comorbidities showed a declining trend over time; however, respiratory diseases exhibited a slight increase. Severe complications and mortality were uncommon. Notably, thromboembolic events and herpes zoster occurred more frequently than expected, suggesting possible post-viral immune dysregulation. Overall, persistent respiratory and neurocognitive symptoms represented the main long-term burden in this cohort.

CONCLUSION

Five years after acute SARS-CoV-2 infection, a substantial proportion of patients continue to experience persistent symptoms, particularly affecting respiratory function and cognitive health. Although severe outcomes were rare, the increased incidence of thromboembolic events and herpes zoster highlights potential long-term immune alterations following COVID-19. This study addresses gaps in existing literature, which has predominantly focused on hospitalized patients with short-term follow-up. The findings underscore the importance of long-term monitoring, rehabilitation strategies, and interdisciplinary care models in primary care to optimize early intervention and healthcare resource allocation for individuals with post-COVID conditions.