Smith, Maia P · Journal of clinical epidemiology · 2022 · DOI
This study looked at the total health impact of COVID-19 by measuring not just deaths, but also the years of healthy life lost due to long-COVID symptoms. The researchers found that most of the burden from COVID-19 actually comes from people who survive but live with ongoing disability—not from deaths alone. The study suggests that resources should focus on preventing and treating long-COVID, especially in younger people and women who appear to bear a larger share of this burden.
This work is crucial for ME/CFS patients because it establishes that long-COVID—which resembles chronic fatigue syndrome—represents a major public health burden comparable to or exceeding acute mortality. By quantifying disability burden in survivors, the study provides a framework for justifying resource allocation toward long-COVID research and treatment, areas historically underfunded. For ME/CFS researchers, it demonstrates methodologically how to measure and communicate the true disease burden of post-infectious conditions.
This study does not prove the actual incidence or prevalence of long-COVID in real-world populations, as it relies on modeled scenarios rather than empirical epidemiological data. It does not establish causation between COVID-19 and long-COVID outcomes, nor does it identify specific mechanisms or risk factors that determine who develops disabling long-COVID. The model outputs are highly sensitive to underlying assumptions about symptom duration and severity, which remain uncertain.
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
Smith, Maia P (2022). Estimating total morbidity burden of COVID-19: relative importance of death and disability.. Journal of clinical epidemiology. https://doi.org/10.1016/j.jclinepi.2021.10.018
BibTeX
@article{mecfsatlas-smith-2022-estimating-total,
author = {Smith, Maia P},
title = {Estimating total morbidity burden of COVID-19: relative importance of death and disability.},
journal = {Journal of clinical epidemiology},
year = {2022},
doi = {10.1016/j.jclinepi.2021.10.018},
note = {PubMed: 34715312},
url = {https://www.mecfsatlas.com/evidence/smith-2022-estimating-total},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-27. https://www.mecfsatlas.com/evidence/smith-2022-estimating-total
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