Persistent COVID-19 symptoms are more likely to occur among individuals with severe infection, those with high Charlson comorbidity index (CCI) scores, and those who are unvaccinated at infection onset. Moreover, health care encounters for pulmonary-, diabetes-, neurologic-, and mental health-related illness are more likely to occur for at least 6 months after infection onset. These study results were published in JAMA Network Open.
Researchers conducted a study to identify risk factors associated with persistent COVID-19 symptoms among adults who tested positive for infected between February 2020 and December 2021. Participants with recurrent COVID-19 infection were excluded. Periodic surveys on symptom duration and severity were completed at enrollment and at 1, 3, 6, 9, and 12 months. Outcomes assessed included survey-reported symptoms through 6 months following COVID-19 infection onset. Poisson regression models were used to identify risk factors associated with persistent COVID-19 symptoms (≥28 and ≥90 days).
Among 1832 participants included in the analysis, the mean (SD) age was 40.5 (13.7) years, 61.0% were men, 70.4% had no comorbidities, and 77.1% were unvaccinated at the onset of COVID-19 infection.
Risk factors associated with COVID-19 symptoms for a duration of 28 days or longer included being unvaccinated at infection onset (risk ratio [RR], 1.39; 95% CI, 1.04-1.85), CCI scores of at least 5 (RR, 1.55; 95% CI, 1.01-2.27), and moderate (RR, 1.80; 95% CI, 1.47-2.22) or severe (RR, 2.25; 95% CI, 1.80-2.80) symptoms during the acute phase of infection.
Of these risk factors, moderate to severe symptoms during acute infection were also associated with persistent COVID-19 symptoms for 90 days or longer but not lack of vaccination at infection onset or CCI scores of at least 5.
Further analysis was performed among participants with organ-specific diagnoses in the 61 to 90 days prior to COVID-19 infection onset. In the 6 months following symptom onset, an increased risk for pulmonary- (RR, 2.00; 95% CI, 1.40-2.80), diabetes- (RR, 1.46; 95% CI, 1.00-2.13), neurologic- (RR, 1.29; 95% CI, 1.02-1.64), and mental health- (RR, 1.28; 95% CI, 1.01-1.62) related health care encounters was observed.
Limitations of this study include the lack of a control group, the predominance of participants with symptomatic infection, and the exclusion of those infected with the Omicron variant. In addition, some reports of persistent symptoms may have been unrelated to COVID-19 infection.
“Taken together, these findings may inform the risk-benefit ratio of COVID-19 vaccination policy,” the researchers concluded.
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Richard SA, Pollett SD, Fries AC, et al. Persistent COVID-19 symptoms at 6 months after onset and the role of vaccination before or after SARS-COV-2 infection. JAMA Netw Open. 2023;6(1). doi:10.1001/jamanetworkopen.2022.51360