The Lancet Infectious Diseases in conversation with Julia Moore Vogel and Danilo Buonsenso on long COVID
Dec 19, 2025
Danilo Buonsenso, a pediatric infectious disease specialist from Rome, and Julia Moore Vogel, an assistant professor and long COVID advocate, dive deep into the complexities of long COVID. They discuss its prevalence across different age groups, the varying definitions of the condition, and the underlying mechanisms like viral persistence and immune dysfunction. With insights on the challenges facing clinical trials and the need for robust pediatric research, they emphasize the importance of tailored management strategies and patient support.
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Reasonable Current Prevalence Estimates
- A June 2025 US EHR study estimates long COVID affects ~4% of children and 10–25% of adults, with incidence ~1.5% in children and 5–6% in adults when compared to controls.
- Female sex, history of allergies, and adolescence increase risk, but virtually anyone infected can develop long COVID.
Heterogeneous Clinical Definition
- Long COVID includes over 200 documented symptoms and relapsing–remitting or progressive courses, complicating a single narrow definition.
- Most research uses the broad National Academies definition and ICD code U09.9 for diagnosis in EHRs.
Biological Mechanisms Underpinning Long COVID
- Emerging evidence shows biological mechanisms: viral persistence, immune dysregulation, and endothelial inflammation/coagulopathy.
- These overlapping processes may stem from infection plus genetic predisposition and guide targeted pharmacological trials.