Chapter 6 188 Finally, in a multivariable ordinal logit model, every 10-point increase in the B-IPQ score at M1 was associated with a 2.4 higher proportional odds (p<0.001) of belonging to Trajectory 4 compared to Trajectory 1, 2 or 3 (Supplementary Table S9). DISCUSSION In our prospective cohort based in Amsterdam, the Netherlands, we identified four distinct trajectories of long COVID symptoms over a two-year follow-up since illness onset, ranging from almost no symptoms (Trajectory 1) to reporting on average 7-8 symptoms over time (Trajectory 4). Interestingly, the mean number of long COVID symptoms remained relatively stable over time in each trajectory. In contrast, trajectories of the proportion of study participants reporting individual symptoms (fatigue, loss of smell/ taste, myalgia and dyspnoea) showed distinct patterns of improvement and recovery. These findings demonstrate the importance of examining the progression of specific types of symptoms next to composite measures. By investigating trajectories of the mean total number of long COVID symptoms over time, we aimed to shed light on both the progression of long COVID and the range of the number of symptoms that individuals with long COVID may experience. We found that approximately 1 of 10 participants in our cohort experienced more debilitating long COVID – denoted by a higher mean total number of symptoms and more negative illness perception compared to individuals with fewer symptoms. Determinants of belonging to a trajectory with a greater number of long COVID symptoms were overweight or obesity and female sex; findings highly consistent with our previous analysis on symptom recovery[9] and research by others[16-19]. Our findings add value to existing evidence by demonstrating that obesity and female sex are not only risk factors for developing long COVID, but also for experiencing more severe long COVID with potentially greater support and rehabilitation needs. Although the proportion of individuals reporting 7-8 symptoms was small, the scale of the COVID-19 pandemic (with an estimated 1 in 8 of the Dutch population experiencing long COVID[3]) means that the public health and socioeconomic consequences are likely to be substantial. Moreover, the lack of improvement observed in the total numbers of symptoms reported, even over a 24 month period, is worrying, and suggests prognosis for overall recovery from long COVID is poor. In contrast to the analysis of the mean total number of symptoms, the pattern of specific symptom progression was not always stable over time. These findings suggest that some individuals may experience new symptoms as other symptoms resolve.
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