Determinants and Consequences of Long Impact of COVID-19: A National Cross-Sectional Study in Saudi Arabia

Background: The post-acute consequences of prolonged Coronavirus Disease 2019 (COVID-19) infection are a major public health problem characterized by long-lasting, multisystem manifestations. There is limited evidence from Saudi Arabia, particularly from nationally representative studies using standard case definitions. Objective: This study aimed to estimate the prevalence of Long COVID, characterize its symptoms, identify risk factors, and assess disease burden and healthcare utilization among Saudi adults. Methods: Between June 2023 and December 2024, we conducted a national cross-sectional mixed-methods study among 1790 adults with PCR-confirmed COVID-19 infection in all 13 regions of Saudi Arabia. Long COVID was defined using the WHO consensus case definition (symptoms persisting ≥ 3 months post-infection not attributable to alternative diagnoses). Results: The prevalence of Long COVID was 32.0% (95% CI 29.8-34.3). The most common symptoms were fatigue (68%), dyspnea (45%), and cognitive impairment (39%). Independent predictors included female sex (adjusted odds ratio [aOR] 1.8, 95% CI 1.4-2.3), moderate-to-severe acute infection (aOR 2.5, 95% CI 2.0-3.1), incomplete vaccination (aOR 1.6, 95% CI 1.2-2.1), metabolic disorders (aOR 1.6, 95% CI 1.2-2.1), and obesity (aOR 1.5, 95% CI 1.2-1.9). Among Long COVID patients, 41% required specialty care and 12% reported work disability. Conclusions: Long COVID affects approximately one-third of COVID-19 survivors in Saudi Arabia, imposing a significant healthcare and socioeconomic burden. These findings highlight the need for swift action and policy implementation within the health care system to mitigate long-term consequences.