Xu, Zijun, Wang, Wenyue, Zhang, Dexing et al. · Journal of global health · 2024 · DOI
This study examined whether people who had COVID-19 experience certain long-lasting symptoms more often than people who never had COVID-19. Researchers combined results from 51 studies involving millions of people and found that COVID-19 survivors had about twice the risk of developing long COVID symptoms. The most striking findings were for loss of smell and taste, followed by post-exertional malaise (feeling worse after activity), shortness of breath, brain fog, and fatigue.
For ME/CFS patients and researchers, this study provides robust quantitative evidence that post-exertional malaise and cognitive dysfunction are genuine excess symptoms following COVID-19, not merely background population prevalence. This meta-analysis strengthens the case for recognizing long COVID and ME/CFS overlap syndromes as legitimate medical conditions requiring specific interventions, not psychiatric attribution.
This meta-analysis demonstrates association, not causation, and does not establish mechanism. It does not determine whether long COVID and ME/CFS are identical conditions, whether symptoms represent persistent viral infection or post-viral dysfunction, or whether documented symptoms constitute the same phenotype across all studies. The study also cannot assess individual-level outcomes or predict which COVID-19 survivors will develop long-term illness.
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
Xu, Zijun, Wang, Wenyue, Zhang, Dexing, Tam, King Wa, Li, Yiqi, Chan, Dicken Cheong Chun, et al. (2024). Excess risks of long COVID symptoms compared with identical symptoms in the general population: A systematic review and meta-analysis of studies with control groups.. Journal of global health. https://doi.org/10.7189/jogh.14.05022
BibTeX
@article{mecfsatlas-xu-2024-excess-risks,
author = {Xu, Zijun and Wang, Wenyue and Zhang, Dexing and Tam, King Wa and Li, Yiqi and Chan, Dicken Cheong Chun and Yang, Zuyao and Wong, Samuel Yeung Shan},
title = {Excess risks of long COVID symptoms compared with identical symptoms in the general population: A systematic review and meta-analysis of studies with control groups.},
journal = {Journal of global health},
year = {2024},
doi = {10.7189/jogh.14.05022},
note = {PubMed: 39129538},
url = {https://www.mecfsatlas.com/evidence/xu-2024-excess-risks},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-27. https://www.mecfsatlas.com/evidence/xu-2024-excess-risks
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