Chapter 9 270 In this thesis, a detailed analysis of the epidemiological features and long-term clinical sequelae of SARS-CoV-2 infection in Amsterdam, the Netherlands, is presented. The general discussion will elaborate on several key themes. Firstly, I will discuss why COVID-19 disproportionally affected certain communities and highlight attempts to tackle these disparities. I will then zoom in on what our research revealed about long COVID, its risk factors and implications, and which research gaps remain. Finally, I reflect on the challenges in collecting and interpreting data during a pandemic. Throughout the general discussion, I will consider how our findings may encourage policymakers to invest in mitigating future disease outbreaks, including prevention of long-term symptomatology. It should be noted that, in this thesis, persistent symptoms following SARS-CoV-2 infection are referred to as ‘post-COVID syndrome’ in Chapter 4, ‘post-acute COVID-19 syndrome’ (PACS) in Chapter 5 and ‘post-acute sequelae of COVID-19’ (PASC) in Chapters 6, 7 and 8. This is a reflection of changing terminology as knowledge of long COVID evolved. Throughout this general discussion the umbrella term of ‘long COVID’ will be used to describe the presence of persistent symptoms, as this is the term preferred by the patient community to denote their lived experience[1, 2]. In addition, the general discussion will reflect on different phases of the COVID-19 pandemic in the Netherlands. We define the first wave of COVID-19 as the period between 27 February and 1 June 2020. The second wave of COVID-19 will be defined as infections occurring between 1 June 2020 and 6 January 2021 – the day upon which the first COVID-19 vaccine was administered in the Netherlands. Together, the first and second waves encompass the pre-vaccination period. Subsequent waves of the pandemic, following the introduction of widespread vaccination programmes, were characterized by the specific features of each variant of concern (VoC) and will be specified in context. 9.1 DISPARITIES IN THE BURDEN OF COVID-19 IN AMSTERDAM, THE NETHERLANDS We found that, throughout the COVID-19 pre-vaccination period, socio-economic status (as measured by city district) and having a first- or second-generation migration background were independent determinants of COVID-19 hospitalisation rates among the general population in Amsterdam, the Netherlands (this thesis, Chapters 2 and 3). Our findings were confirmed in other Dutch studies using alternative outcome measures. Firstly, a longitudinal serological study not only identified a higher cumulative COVID-19 incidence among migrant communities compared to those of Dutch origin, but also
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