Long-term COVID-19 symptoms in a large unselected population

Abstract

It is increasingly recognized that SARS-CoV-2 can produce long-term complications after recovery from the acute effects of infection. Here, we report the analysis of 32 self-reported short and long-term symptoms in a general adult population cohort comprised of 233 COVID-19+ cases, 3,652 SARS-CoV-2-negative controls, and 17,474 non-tested individuals. The majority of our COVID-19+ cases are mild, with only 8 of the 233 COVID-19+ cases having been hospitalized. Our results show that 43.4% of COVID-19+ cases have symptoms lasting longer than 30 days, and 24.1% still have at least one symptom after 90 days. These numbers are higher for COVID-19+ cases who were initially more ill, 59.4% at 30 days and 40.6% at 90 days, but even for very mild and initially asymptomatic cases, 14.3% have complications persist for 30 days or longer. In contrast, only 8.6% of participants from the general untested population develop new symptoms lasting longer than 30 days due to any illness during the same study period. The long-term symptoms most enriched in those with COVID-19 are anosmia, ageusia, difficulty concentrating, dyspnea, memory loss, confusion, headache, heart palpitations, chest pain, pain with deep breaths, dizziness, and tachycardia. We additionally observe that individuals who had an initial symptom of dyspnea are significantly more likely to develop long-term symptoms. Importantly, our study finds that the overall level of illness is an important variable to account for when assessing the statistical significance of symptoms that are associated with COVID-19. Our study provides a baseline from which to understand the frequency of COVID-19 long-term symptoms at the population level and demonstrates that, although those most likely to develop long-term COVID-19 complications are those who initially have more severe illness, even those with mild or asymptomatic courses of infection are at increased risk of long-term complications.

Diabetes, obesity, metabolism, and SARS-CoV-2 infection: the end of the beginning

“…The number of symptoms reported in the first week of illness, older age, and female sex were the strongest predictors of long-COVID syndrome. Moreover, persistent symptoms beyond 30 days of COVID-19 clinical diagnosis are more common in those with severe illness, yet 14.3% of survey respondents in a US general adult population with mild COVID-19 illness report persistent symptoms more than 30 days later ( Cirulli et al., 2020 ). Preliminary interrogation of individuals more than 90 days after hospitalization with a COVID-19 diagnosis including a substantial proportion of subjects with diabetes and obesity revealed high levels of persistent fatigue, anxiety, and neurological symptoms ( Savarraj et al., 2020 ).…”

Attributes and predictors of Long-COVID: analysis of COVID cases and their symptoms collected by the Covid Symptoms Study App

“…b) OR and 95% CI of LC28 with each successive decile compared to 20-30-year-olds Of the 4182 COVID-19 swab positive users, 558 (13.3%) met the LC28 definition with a median duration of 41 days (IQR[33,63] of whom 189 (4.5%) met LC-56, and 95 (2.3%) LC94. In contrast 1591 (38.0%) had short disease duration (median 6, IQR [4][5][6][7][8]). The proportion with LC28 were comparable in all three separate countries (GB 13.3%, USA 16.1%, Sweden 12.1% p=0.35) and for LC56 (GB 4.7%, USA 5.5%, Sweden 2.5% p=0.07).…”

“…Our previous findings that clusters of symptoms predicted the need for acute care 6 led us to hypothesize that persistent symptomatology in COVID-19 (Long-COVID) is associated with a particular symptom pattern early in the disease which could be used to predict who might be affected. In particular, dyspnoea has been shown to be a significant predictor of long-term symptoms in an unselected population 7 . Figure 1 shows the duration of symptoms reported in COVID+ cases (orange) over-laid on age, sex and BMI matched negative testing symptomatic controls (blue), depicting lines for the definitions of short-COVID, LC28 and LC56 (symptoms for more than 56 days) used in this study.…”

“…Asthma was the only/unique pre-existing condition providing significant association with long-COVID-19 (OR = 2.14 [1.55-2.96]). Relapse in the context of long-COVID was longer than in the matched controls (median = 9 [5-18] vs 6 [4][5][6][7][8][9][10] days).…”

Integrative Medicine and the Long Hauler Syndrome—We Meet Again

“…This phenomenon is so widespread and common that it has been given a name: "long hauler syndrome." A preliminary study of 233 Covid-19 cases showed that over 43% of individuals have symptoms lasting longer than 30 days, and 24% still have at least one symptom after 90 days 3 . It is estimated that millions of people are suffering from long-term debilitating symptoms, even those who reportedly experienced mild cases of Covid-19.…”