Persistence of symptoms up to 10 months following acute COVID-19 illness

Abstract

Importance: COVID-19 symptoms are increasingly recognized to persist among a subset of individual following acute infection, but features associated with this persistence are not well-understood. Objective: We aimed to identify individual features that predicted persistence of symptoms over at least 2 months at the time of survey completion. Design: Non-probability internet survey. Participants were asked to identify features of acute illness as well as persistence of symptoms at time of study completion. We used logistic regression models to examine association between sociodemographic and clinical features and persistence of symptoms at or beyond 2 months. Setting: Ten waves of a fifty-state survey between June 13, 2020 and January 13, 2021. Participants: 6,211 individuals who reported symptomatic COVID-19 illness confirmed by positive test or clinician diagnosis. Exposure: symptomatic COVID-19 illness Results: Among 6,211 survey respondents reporting COVID-19 illness, with a mean age of 37.8 (SD 12.2) years and 45.1% female, 73.9% white, 10.0% Black, 9.9% Hispanic, and 3.1% Asian, a total of 4946 (79.6%) had recovered within less than 2 months, while 491 (7.9%) experienced symptoms for 2 months or more. Of the full cohort, 3.4% were symptomatic for 4 months or more and 2.2% for 6 months or more. In univariate analyses, individuals with persistent symptoms on average reported greater initial severity. In logistic regression models, older age was associated with greater risk of persistence (OR 1.10, 95% CI 1.01-1.19 for each decade beyond 40); otherwise, no significant associations with persistence were identified for gender, race/ethnicity, or income. Presence of headache was significantly associated with greater likelihood of persistence (OR 1.44, 95% CI 1.11-1.86), while fever was associated with diminished likelihood of persistence (OR 0.66, 95% CI 0.53-0.83). Conclusion and Relevance: A subset of individuals experience persistent symptoms from 2 to more than 10 months after acute COVID-19 illness, particularly those who recall headache and absence of fever. In light of this prevalence, strategies for predicting and managing such sequelae are needed. Trial Registration: NA

Global Prevalence of Post-Acute Sequelae of COVID-19 (PASC) or Long COVID: A Meta-Analysis and Systematic Review

“…37,45,50,52 Additionally, two studies found older age to be associated with PASC. 20,58 Other risk factors for PASC including number of symptoms during acute COVID-19, 16 fatigue 18 , dyspnea, 18,39 muscle pain, 50 headache, 18,20 myalgia, 18 and pre-existing conditions such as obesity, 18,52 comorbidity, 45 and hypothyroidism 37 were found positively associated with PASC (eTable 4).…”

“…19 Existing research suggests older age to be associated with a moderate increased risk of persisting symptoms (for ten-year increments past age of 40, estimated odds ratio (OR) is 1.10 [95% CI: 1.01-1.19]). 20 Moreover, the existing inequities by race/ethnicity as it pertains to PASC remain largely unexplored, 21 despite the same having been shown for COVID-19. Select comorbidities have been identified as being associated with PASC in the existent literature (e.g., increased risk of PASC among individuals with asthma, 18 though these findings are generally in early stages).…”

Post-Acute Sequelae of COVID-19 and Cardiovascular Autonomic Dysfunction: What Do We Know?

“…The idea that SARS-CoV-2 infection could be associated with long-term health outcomes first appeared in the literature in mid-2020 [11], along with previous evidence of longhaul symptoms following the Ebola [12] virus outbreak and infections from previous coronaviruses [13,14]. COVID-19 survivors have been shown to experience a constellation of symptoms such as fatigue, dyspnea or breathlessness [8,15], palpitations [16,17], brain fog, lack of concentration [18,19], sleep disturbances (i.e., insomnia) [20], headache [17,[21][22][23][24][25], orthostatic intolerance [25], anxiety and post-traumatic stress disorder [20,23,[26][27][28], chest pain, joint pain [8], sore throat [17], and hair loss [15] persisting >4 weeks after recovery. These clinical sequelae share similarities with post-acute symptoms reported after severe acute respiratory syndrome (SARS) and Middle East Respiratory Syndrome (MERS) epidemics, caused by previous coronaviruses [14].…”

One Year after Mild COVID-19: The Majority of Patients Maintain Specific Immunity, But One in Four Still Suffer from Long-Term Symptoms

“…Other complaints include respiratory impairment, especially in patients with a severe COVID-19 course, and muscle or limb pain [5]. These symptoms post-COVID-19 decrease in frequency over months after the acute phase of infection [6], but how long they may persist, and whether they correlate with specific immunity, is unclear up to now.…”