High Prevalence of Both Previous Infection with SARS-CoV-2 and Persistent Symptoms

Abstract

Introduction: Universities are unique settings with large populations, congregate housing, and frequent attendance of events in large groups. However, the current prevalence of previous COVID-19 infection in university students, including symptomatic and asymptomatic disease, is unknown. Our goal therefore was to determine the prevalence of previous infection, risk factors for infection, and the prevalence of persistent symptoms following infection among university students.Methods: This was a cross-sectional study set in a large public university between January 22 and March 22, 2021. We surveyed students about demographics, risk factors, and symptoms, and simultaneously tested their saliva for IgA antibodies to SARS-CoV-2. To estimate the prevalence of previous infection we adjusted our intentional sample of a diverse student population for year in school and age to resemble the composition of the entire student body and adjusted for the imperfect sensitivity and specificity of the antibody test. Univariate and multiple regression analysis was used to identify independent risk factors for infection, and the proportion of students with persistent symptoms following acute infection was determined.Results: A total of 488 students completed the survey, 432 had a valid antibody result, and 428 had both. The estimated prevalence of previous infection for 432 participants with valid antibody results was 41%. Of 145 students in our sample with a positive antibody test, 41.4% denied having a previous positive polymerase chain reaction (PCR) test for SARS-CoV-2 and presumably had an asymptomatic infection; in our adjusted analysis we estimate that approximately 2-thirds of students had asymptomatic infections. Independent risk factors for infection included male sex, having a roommate with a known symptomatic infection, and having two or fewer roommates. More frequent attendance of parties and bars was a univariate risk factor, but not in the multiple regression analysis. Of 122 students reporting a previous symptomatic infection, 14 (11.4%) reported persistent symptoms consistent with postacute COVID-19 a median of 132 days later.Conclusions and Relevance: Previous COVID-19 infection, both symptomatic and asymptomatic, was common at a large university. Measures that could prevent resurgence of the infection when students return to campus include mandatory vaccination policies, mass surveillance testing, and testing of sewage for antigen to SARS-CoV-2.

Postacute Sequelae of SARS-CoV-2 in University Setting

“…Our study also found an increased odds of reporting symptoms consistent with long COVID for each additional symptom reported during the initial infection. This finding is consistent with recent studies conducted with a high proportion of young adults that also found a higher number of acute symptoms during a COVID-19 infection predicted > 1 long COVID symptom ( 32 ). Monitoring symptoms of initial cases could help identify persons at risk for long COVID.…”

An Investigation of COVID-19 Outcomes and College Student Demographics: Results from a National Sample

“…There have been over 90 million cases of COVID-19 and more than one million deaths in the U.S. 1 Colleges and universities, which enroll 20 million students annually, 2 are a high-risk environment for COVID-19 transmission 3 and contribute to community spread. 4 COVID-19 can cause major morbidity among young people, 5,6 and college campuses are a critical setting for COVID-19 mitigation efforts. 7 Research on college students and COVID-19 has primarily focused on the mental health of students enrolled at a single institution or in a small national sample, 8 with most studies finding that students' mental health has deteriorated as a result of the pandemic.…”

Age and political leaning predict COVID-19 vaccination status at a large, multi-campus, public university in Pennsylvania: A cross-sectional survey

“…It should be noted that aspects of a university setting (e.g., social gatherings, having a roommate) may facilitate the spread of COVID-19, emphasizing the need to study this population [ 10 , 11 ]. Additionally, comparing the views of different groups on campus, such as the student body (including undergraduate, graduate, and professional students), faculty, and staff may aid in the development of targeted policies that promote evidence-based measures such as vaccination [ 1 , 12 ].…”