Prevalence of Symptoms ≤12 Months After Acute Illness, by COVID-19 Testing Status Among Adults

Abbreviations: CAD = coronary artery disease; COPD = chronic obstructive pulmonary disease; GED = general educational development; HEENT = head, ears, eyes, nose, and throat.
*Excluding participants who reported receiving a negative test result during follow-up.
^†Data were recorded at time of enrollment. The preexisting conditions data were collected at 3 months follow-up, which resulted in the high level of missingness in these variables.
^§Calculation of percentage and p-values excluded cases with missing values.
^¶Persons of Hispanic or Latino (Hispanic) origin might be of any race but are categorized as Hispanic; all racial groups are non-Hispanic.
**Symptom categories were any symptom (one or more symptoms), HEENT (headache, runny nose, loss of smell, loss of taste, sore throat, and loss of hair), constitutional (tired, chills, feeling hot, fever, and shakes), pulmonary (cough, shortness of breath, and wheezing), musculoskeletal (aches and joint pains), gastrointestinal (diarrhea, nausea or vomiting, and abdominal pain), cardiovascular (chest pain and palpitations), cognitive difficulties (forgetfulness/memory problems, difficulty thinking, or difficulty concentrating), and extreme fatigue (fatigue severity score ≥25).
^††Among participants who did not have any symptom at time of enrollment or 3 months after a COVID-like illness.

Abbreviation: HEENT = head, ears, eyes, nose, and throat.
*Symptom categories were any symptom (one or more symptoms), HEENT (headache, runny nose, loss of smell, loss of taste, sore throat, and loss of hair), constitutional (tired, chills, feeling hot, fever, and shakes), pulmonary (cough, shortness of breath, and wheezing), musculoskeletal (aches and joint pains), gastrointestinal (diarrhea, nausea or vomiting, and abdominal pain), cardiovascular (chest pain and palpitations), cognitive difficulties (forgetfulness/memory problems, difficulty thinking, or difficulty concentrating), and extreme fatigue (fatigue severity score ≥25). Percentage of participants reporting symptoms at each of the time points is presented for each symptom category, stratified by SARS-CoV-2 test result status at time of enrollment.
^†Persistent symptoms were defined as those present at time of enrollment and reported at each follow-up time point. Binomial 95% CIs were calculated for each outcome within each group. Pearson's chi-square tests were used to test for differences in proportions at each time point.
^§Without evidence of new SARS-CoV-2 infection.

Authors and Disclosures

Juan Carlos C. Montoy, MD, PhD¹, James Ford, MD¹, Huihui Yu, PhD^2,3, Michael Gottlieb, MD⁴, Dana Morse⁵, Michelle Santangelo, MS⁶, Kelli N. O'Laughlin, MD^7,8, Kevin Schaeffer⁹, Pamela Logan, MD¹⁰, Kristin Rising, MD^11,12, Mandy J. Hill, DrPH¹³, Lauren E. Wisk, PhD¹⁴, Wafah Salah¹⁵, Ahamed H. Idris, MD¹⁶, Ryan M. Huebinger, MD¹³, Erica S. Spatz, MD^2,3, Robert M. Rodriguez, MD¹, Robin E. Klabbers, MSc⁸, Kristyn Gatling, MA⁶, Ralph C. Wang, MD¹, Joann G. Elmore, MD^17,18, Samuel A. McDonald, MD^19,20, Kari A. Stephens, PhD^21,22, Robert A. Weinstein, MD^23,24, Arjun K. Venkatesh, MD^3,25 and Sharon Saydah, PhD¹⁰, Innovative Support for Patients with SARS-CoV-2 Infections Registry (INSPIRE) Group

¹Department of Emergency Medicine, University of California, San Francisco, San Francisco, California; ²Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University, New Haven, Connecticut; ³Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut; ⁴Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois; ⁵Department of Emergency Medicine, University of Washington, Seattle, Washington; ⁶Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois; ⁷Department of Emergency Medicine, University of Washington, Seattle, Washington; ⁸Department of Global Health, University of Washington, Seattle, Washington; ⁹Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania; ¹⁰National Center for Immunizations and Respiratory Diseases, CDC; ¹¹Center for Connected Care, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania; ¹²Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania; ¹³UTHealth Houston, Houston, Texas; ¹⁴University of California, Los Angeles, Los Angeles, California; ¹⁵Department of Emergency Medicine, Yale University, New Haven, Connecticut; ¹⁶University of Texas Southwestern Medical Center, Dallas, Texas; ¹⁷Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; ¹⁸Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California; ¹⁹Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; ²⁰Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas; ²¹Department of Family Medicine, University of Washington, Seattle, Washington; ²²Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington; ²³Department of Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois; ²⁴Department of Medicine, Division of Infectious Diseases, Cook County Hospital, Chicago, Illinois; ²⁵Department of Internal Medicine, Yale University, New Haven, Connecticut.

Corresponding author
Sharon Saydah, media@cdc.gov.

Innovative Support for Patients with SARS-CoV-2 Infections Registry (INSPIRE) Group
Zohaib Ahmed, Rush University; Michael Choi, Rush University; Antonia Derden, Rush University; Michael Gottlieb, Rush University; Diego Guzman, Rush University; Minna Hassaballa, Rush University; Ryan Jerger, Rush University; Marshall Kaadan, Rush University; Katherine Koo, Rush University; Geoffrey Yang, Rush University; Jocelyn Dorney, Yale University; Jeremiah Kinsman, Yale University; Shu-Xia Li, Yale University; Zhenqiu Lin, Yale University; Imtiaz Ebna Mannan, Yale University; Senyte Pierce, Yale University; Xavier Puente, Yale University; Andrew Ulrich, Yale University; Zimo Yang, Yale University; Huihui Yu, Yale University; Karen Adams, University of Washington; Jill Anderson, University of Washington; Gary Chang, University of Washington; Nikki Gentile, University of Washington; Rachel E. Geyer, University of Washington; Zenoura Maat, University of Washington; Kerry Malone, University of Washington; Graham Nichol, University of Washington; Jasmine Park, University of Washington; Luis Ruiz, University of Washington; Mary Schiffgens, University of Washington; Tracy Stober, University of Washington; Michael Willis, University of Washington; Zihan Zhang, University of Washington; Grace Amadio, Thomas Jefferson University; Alex Charlton, Thomas Jefferson University; David Cheng, Thomas Jefferson University; Dylan Grau, Thomas Jefferson University; Paavali Hannikainen, Thomas Jefferson University; Efrat Kean, Thomas Jefferson University; Morgan Kelly, Thomas Jefferson University; Jessica Miao, Thomas Jefferson University; Nicole Renzi, Thomas Jefferson University; Hailey Shughart, Thomas Jefferson University; Lindsey Shughart, Thomas Jefferson University; Carly Shutty, Thomas Jefferson University; Phillip Watts, Thomas Jefferson University; Arun Kane, University of Texas Health Science Center at Houston; Peter Nikonowicz, University of Texas Health Science Center at Houston; Sarah Sapp, University of Texas Health Science Center at Houston; David Gallegos, University of Texas Southwestern Medical Center; Riley Martin, University of Texas Southwestern Medical Center; Chris Chandler, University of California, Los Angeles; Megan Eguchi, University of California, Los Angeles; Michelle L'Hommedieu, University of California, Los Angeles; Raul Moreno, University of California, Los Angeles; Kate Diaz Roldan, University of California, Los Angeles; Mireya Arreguin, University of California, San Francisco; Virginia Chan, University of California, San Francisco; Cecilia Lara Chavez, University of California, San Francisco; Robin Kemball, University of California, San Francisco; Angela Wong, University of California, San Francisco; Melissa Briggs-Hagen, CDC; Aron J. Hall, CDC; Ian D. Plumb, CDC.

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. Joann G. Elmore reports serving as editor-in-chief and receiving royalties from UpToDate, Inc. Michael Gottlieb reports grant support from the Society for Academic Emergency Medicine, the Society of Directors of Research in Medical Education, Rush Center for Emerging Infectious Diseases, Emergency Medicine: Reviews and Perspective, and the Emergency Medicine Foundation. Ahamed H. Idris reports travel support from the University of Michigan for attendance at Wolf Creek 17 conference, unpaid membership on the Stryker clinical advisory board, and unpaid volunteer chairmanship of the American Heart Association ethics writing group. Kelli N. O'Laughlin reports support from PROCOVAXED, from the National Institute on Allergy and Infectious Diseases, National Institutes of Health (NIH). Kristin Rising reports research grants from Abbott, Siemens diagnostics, DermTech, Ortho Diagnostics, NIH, and the Philadelphia Department of Public Health. Arjun K. Venkatesh reports grant support from the Society for Academic Emergency Medicine Foundation to study COVID-19 effects on hospitals. Robert A. Weinstein reports payments from UpToDate, Inc. for reviewing topics. No other potential conflicts of interest were disclosed.

Sidebar

Summary

What is already known about this topic?

Post-COVID conditions, or long COVID, can persist for months or years after an acute COVID-19 illness and can include emergence of new symptoms or the occurrence of symptoms that come and go.

What is added by this report?

In a multicenter study of adults with a COVID-like illness, symptom prevalence decreased over time after the acute illness. Approximately 16% of adults with COVID-like symptoms reported persistent symptoms 12 months after a positive or negative SARS-CoV-2 test result. At 3, 6, 9, and 12 months after testing, some symptomatic persons had ongoing symptoms, and others had emerging symptoms not reported during the previous period.

What are the implications for public health practice?

Health care providers should be aware that symptoms can persist, emerge, reemerge, or resolve after COVID-like illness and are not unique to COVID-19 or to post-COVID conditions.