Symptom Duration and Risk Factors for Delayed Return to Usual Health Among Outpatients with COVID-19 in a Multistate Health Care Systems Network - United States, March-June 2020

Abstract

Prolonged symptom duration and disability are common in adults hospitalized with severe coronavirus disease 2019 (COVID-19). Characterizing return to baseline health among outpatients with milder COVID-19 illness is important for understanding the full spectrum of COVID-19-associated illness and tailoring public health messaging, interventions, and policy. During April 15-June 25, 2020, telephone interviews were conducted with a random sample of adults aged ≥18 years who had a first positive reverse transcription-polymerase chain reaction (RT-PCR) test for SARS-CoV-2, the virus that causes COVID-19, at an outpatient visit at one of 14 U.S. academic health care systems in 13 states. Interviews were conducted 14-21 days after the test date. Respondents were asked about demographic characteristics, baseline chronic medical conditions, symptoms present at the time of testing, whether those symptoms had resolved by the interview date, and whether they had returned to their usual state of health at the time of interview. Among 292 respondents, 94% (274) reported experiencing one or more symptoms at the time of testing; 35% of these symptomatic respondents reported not having returned to their usual state of health by the date of the interview (median = 16 days from testing date), including 26% among those aged 18-34 years, 32% among those aged 35-49 years, and 47% among those aged ≥50 years. Among respondents reporting cough, fatigue, or shortness of breath at the time of testing, 43%, 35%, and 29%, respectively, continued to experience these symptoms at the time of the interview. These findings indicate that COVID-19 can result in prolonged illness even among persons with milder outpatient illness, including young adults. Effective public health messaging targeting these groups is warranted. Preventative measures, including social distancing, frequent handwashing, and the consistent and correct use of face coverings in public, should be strongly encouraged to slow the spread of SARS-CoV-2.

Conflict of interest statement

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. Christopher J. Lindsell reports grants from National Institutes of Health and Department of Defense, and contracts with the Marcus Foundation, CDC, Endpoint Health, Entegrion, bioMerieux, and Bioscape Digital, outside the submitted work. Daniel J. Henning reports personal fees from CytoVale and grants from Baxter, outside the submitted work. Akram Khan reports grants from United Therapeutics, Actelion Pharmaceuticals, Regeneron, and Reata Pharmaceuticals, outside the submitted work. Samuel M. Brown reports grants from National Institutes of Health, Department of Defense, Intermountain Research and Medical Foundation, and Janssen, consulting fees paid to his employer from Faron and Sedana, and royalties from Oxford University Press, outside the submitted work. Ithan D. Peltan reports grants from National Institutes of Health, Asahi Kasei Pharma, Immunexpress Inc., Janssen Pharmaceuticals, and Regeneron, outside the submitted work. Todd W. Rice reports personal fees from Cumberland Pharmaceuticals, Inc., Cytovale, Inc., and Avisa, LLC, outside the submitted work. No other potential conflicts of interest were disclosed.

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Self-reported symptoms at the time of positive SARS-CoV-2 reverse transcription–polymerase chain reaction (RT-PCR) testing results and unresolved symptoms 14–21 days later among outpatients (N = 274) — 14 academic health care systems, United States, March–June 2020 * 294 patients responded to 14–21-day interview, did not report a previous positive SARS-CoV-2 test before the reference test, and answered questions about symptoms; 276 (94%) of these reported one or more symptoms at the time of SARS-CoV-2 RT-PCR testing; those who were interviewed at 7 days were excluded, with 274 included here. † Patients were randomly sampled from 14 academic health care systems in 13 states (University of Washington [Washington], Oregon Health and Sciences University [Oregon], University of California Los Angeles and Stanford University [California], Hennepin County Medical Center [Minnesota], Vanderbilt University [Tennessee], Ohio State University [Ohio], Wake Forest University [North Carolina], Montefiore Medical Center [New York], Beth Israel Deaconess Medical Center and Baystate Medical Center [Massachusetts], Intermountain Healthcare [Utah/Idaho], University of Colorado Hospital [Colorado], and Johns Hopkins University [Maryland]).