The risk of new disease, disability and death remains elevated in some patients as long as two years after catching COVID-19, according to a large study showing the infection’s prolonged heath impact.

People who were never sick enough to be hospitalized for acute COVID-19 still had a higher risk than uninfected people of developing long COVID-related disorders such as dangerous blood clots, diabetes and lung, gastrointestinal and musculoskeletal disease two years later, according to the study published Monday in the journal Nature Medicine.

Some 65 million people globally are estimated to be living with so-called post-acute COVID syndrome — a number reported to be steadily increasing in the absence of approved treatments and continuing viral spread. The research from the Clinical Epidemiology Center of the Veterans Affairs St. Louis Health Care System in Missouri shows how long-term ailments that afflict COVID-19 survivors add to the disease burden of the pandemic.