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Postacute Sequelae of SARS-CoV-2 Infection in the Pre-Delta, Delta, and Omicron Eras
Article Number: SIS609837AI080825
8th August, 2025
Author(s):
Yan Xie, Taeyoung Choi, Ziyad Al-Aly
Abstract:
This retrospective cohort study used U.S. Department of Veterans Affairs health records to assess the cumulative incidence and burden of postacute sequelae of SARS-CoV-2 infection (PASC, or long Covid) across three pandemic eras: pre-delta, delta, and omicron. Among 441,583 infected veterans and 4.7 million noninfected controls, the 1-year cumulative incidence of PASC declined from 10.42 events per 100 persons (pre-delta, unvaccinated) to 3.50 events per 100 persons (omicron, vaccinated). Decomposition analyses attributed 71.89% of the reduction to vaccination and 28.11% to era-related effects (e.g., viral evolution, improved care). Vaccination consistently reduced PASC risk across disease categories, though residual burden remained. Disability-adjusted life-year (DALY) estimates confirmed substantial health impact, especially among unvaccinated individuals. The study highlights the evolving epidemiology of PASC and the critical role of vaccination in mitigating long-term Covid-19 consequences.