Three-Month Symptom Profiles Among Symptomatic Adults With Positive and Negative Severe Acute Respiratory Syndrome Coronavirus 2 Tests: A Prospective Cohort Study From the INSPIRE Group

Erica S Spatz; Michael Gottlieb; Lauren E Wisk; Jill Anderson; Anna Marie Chang; Nicole L Gentile; Mandy J Hill; Ryan M Huebinger; Ahamed H Idris; Jeremiah Kinsman; Katherine Koo; Shu-Xia Li; Samuel McDonald; Ian D Plumb; Robert M Rodriguez; Sharon Saydah; Benjamin Slovis; Kari A Stephens; Elizabeth R Unger; Ralph C Wang; Huihui Yu; Bala Hota; Joann G Elmore; Robert A Weinstein; Arjun Venkatesh

doi:10.1093/cid/ciac966

Three-Month Symptom Profiles Among Symptomatic Adults With Positive and Negative Severe Acute Respiratory Syndrome Coronavirus 2 Tests: A Prospective Cohort Study From the INSPIRE Group

Clin Infect Dis. 2023 May 3;76(9):1559-1566. doi: 10.1093/cid/ciac966.

Authors

Erica S Spatz^{1

2}, Michael Gottlieb³, Lauren E Wisk^{4

5}, Jill Anderson⁶, Anna Marie Chang⁷, Nicole L Gentile⁸, Mandy J Hill⁹, Ryan M Huebinger⁹, Ahamed H Idris¹⁰, Jeremiah Kinsman¹¹, Katherine Koo¹², Shu-Xia Li^{1

13}, Samuel McDonald¹⁰, Ian D Plumb¹⁴, Robert M Rodriguez¹⁵, Sharon Saydah¹⁴, Benjamin Slovis⁷, Kari A Stephens¹⁶, Elizabeth R Unger¹⁷, Ralph C Wang¹⁵, Huihui Yu^{1

13}, Bala Hota¹⁸, Joann G Elmore^{4

5}, Robert A Weinstein¹⁹, Arjun Venkatesh^{11

13}

Affiliations

¹ Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
² Department of Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA.
³ Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois, USA.
⁴ Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of California, Los Angeles (UCLA), Los Angeles, California, USA.
⁵ Department of Health Policy and Management, Fielding School of Public Health at UCLA, Los Angeles, California, USA.
⁶ Harborview Center for Prehospital Emergency Care, University of Washington, Seattle, Washington, USA.
⁷ Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
⁸ Departments of Family Medicine and Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA.
⁹ Department of Emergency Medicine, UTHealth Houston, McGovern Medical School, Houston, Texas, USA.
¹⁰ Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
¹¹ Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.
¹² Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA.
¹³ Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA.
¹⁴ National Center for Immunizations and Respiratory Diseases, Centers for Disease Control & Prevention, Atlanta, Georgia, USA.
¹⁵ Department of Emergency Medicine, University of California, San Francisco, California, USA.
¹⁶ Departments of Family Medicine, Harborview Center for Prehospital Emergency Care, University of Washington, Seattle, Washington, USA.
¹⁷ National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
¹⁸ Chief Informatics Officer, Tendo Systems, Inc., San Francisco, California, USA.
¹⁹ Division of Infectious Diseases, Department of Internal Medicine, Rush University Medical Center and Cook County Health, Chicago, Illinois, USA.

PMID: 36573005
DOI: 10.1093/cid/ciac966

Abstract

Background: Long-term symptoms following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are a major concern, yet their prevalence is poorly understood.

Methods: We conducted a prospective cohort study comparing adults with SARS-CoV-2 infection (coronavirus disease-positive [COVID+]) with adults who tested negative (COVID-), enrolled within 28 days of a Food and Drug Administration (FDA)-approved SARS-CoV-2 test result for active symptoms. Sociodemographic characteristics, symptoms of SARS-CoV-2 infection (assessed with the Centers for Disease Control and Prevention [CDC] Person Under Investigation Symptom List), and symptoms of post-infectious syndromes (ie, fatigue, sleep quality, muscle/joint pains, unrefreshing sleep, and dizziness/fainting, assessed with CDC Short Symptom Screener for myalgic encephalomyelitis/chronic fatigue syndrome) were assessed at baseline and 3 months via electronic surveys sent via text or email.

Results: Among the first 1000 participants, 722 were COVID+ and 278 were COVID-. Mean age was 41.5 (SD 15.2); 66.3% were female, 13.4% were Black, and 15.3% were Hispanic. At baseline, SARS-CoV-2 symptoms were more common in the COVID+ group than the COVID- group. At 3 months, SARS-CoV-2 symptoms declined in both groups, although were more prevalent in the COVID+ group: upper respiratory symptoms/head/eyes/ears/nose/throat (HEENT; 37.3% vs 20.9%), constitutional (28.8% vs 19.4%), musculoskeletal (19.5% vs 14.7%), pulmonary (17.6% vs 12.2%), cardiovascular (10.0% vs 7.2%), and gastrointestinal (8.7% vs 8.3%); only 50.2% and 73.3% reported no symptoms at all. Symptoms of post-infectious syndromes were similarly prevalent among the COVID+ and COVID- groups at 3 months.

Conclusions: Approximately half of COVID+ participants, as compared with one-quarter of COVID- participants, had at least 1 SARS-CoV-2 symptom at 3 months, highlighting the need for future work to distinguish long COVID.

Clinical trials registration: NCT04610515.

Keywords: COVID-19; SARS-CoV-2; long COVID; outcomes; registry.

Publication types

Clinical Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
COVID-19* / diagnosis
COVID-19* / epidemiology
Female
Humans
Male
Post-Acute COVID-19 Syndrome
Prospective Studies
SARS-CoV-2
Text Messaging*

Associated data

ClinicalTrials.gov/NCT04610515