Kamal, Sanaa M, Al Qahtani, Mohammed S, Al Aseeri, Ali et al. · BMC infectious diseases · 2025 · DOI
This study followed 816 people in Saudi Arabia for up to four years after they had COVID-19 to see who developed long COVID and what symptoms they experienced. Researchers found that about 29% developed long COVID, with fatigue, post-exertional malaise (worsening after activity), cough, and brain fog being the most common symptoms. Women and people with diabetes were at higher risk, and those who got reinfected or were hospitalized took longer to recover.
This study provides robust long-term data on post-COVID symptom burden and recovery trajectories in an underrepresented Middle Eastern population. The identification of post-exertional malaise as a cardinal feature and documentation of persistent quality-of-life impairment directly parallels ME/CFS presentations and highlights the need for specialized post-COVID care protocols.
This study does not prove that long COVID is identical to ME/CFS, as it does not use ME/CFS diagnostic criteria and includes a broader symptom spectrum. It cannot establish causation between risk factors (female sex, diabetes) and long COVID—only association. It does not determine whether specific pathophysiological mechanisms drive the observed symptoms or recovery delays.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Kamal, Sanaa M, Al Qahtani, Mohammed S, Al Aseeri, Ali, Naghib, Mohey El Deen Mohamed, Al Mazroua, Adul Majeed Mazroua, Alshamrani, Abdulaziz M M, et al. (2025). Long COVID-19: a Four-Year prospective cohort study of risk factors, recovery, and quality of life.. BMC infectious diseases. https://doi.org/10.1186/s12879-025-11468-3
BibTeX
@article{mecfsatlas-kamal-2025-long-covid,
author = {Kamal, Sanaa M and Al Qahtani, Mohammed S and Al Aseeri, Ali and Naghib, Mohey El Deen Mohamed and Al Mazroua, Adul Majeed Mazroua and Alshamrani, Abdulaziz M M and Al Mazroua, Mohamed Mazroua and AlHarbi, Faisal S F},
title = {Long COVID-19: a Four-Year prospective cohort study of risk factors, recovery, and quality of life.},
journal = {BMC infectious diseases},
year = {2025},
doi = {10.1186/s12879-025-11468-3},
note = {PubMed: 40883696},
url = {https://www.mecfsatlas.com/evidence/kamal-2025-long-covid},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-28. https://www.mecfsatlas.com/evidence/kamal-2025-long-covid
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