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Persistent Symptoms in Patients After Acute COVID-19
Open accessAbstract
case rate of 587 per 100 000.The crude COVID-19 death rate in prisons was 39 deaths per 100 000 prisoners, which was higher than the US population rate of 29 deaths per 100 000 (Table).However, individuals aged 65 years or older comprised a smaller share of the prison population than of the US population (3% vs 16%, respectively) and accounted for 81% of COVID-19 deaths in the US population.The Table provides a standardized calculation showing that the adjusted death rate in the prison population was 3.0 times higher than would be expected if the age and sex distributions of the US and prison populations were equal.The Figure displays the daily trends in cumulative, confirmed cases of COVID-19 in state and federal prisons and the US population from March 31, 2020, to June 6, 2020.The COVID-19 case rate was initially lower in prisons but surpassed the US population on April 14, 2020.The mean daily case growth rate was 8.3% per day in prisons and 3.4% per day in the US population.Discussion | COVID-19 case rates have been substantially higher and escalating much more rapidly in prisons than in the US population.One limitation of the study is that it relied on officially reported data, which may be subject to inaccuracies and reporting delays, but are the only data available.Comprehensive data on testing rates were not available, and testing rates in both prisons and the overall population were uneven, with many facilities testing no prisoners or only symptomatic persons.2,5 Mass testing in select prisons revealed wide COVID-19 outbreaks, with infection rates exceeding 65% in several facilities. 2 Reported case rates for prisoners therefore likely understated the true prevalence of COVID-19 in prisons.A second limitation is that departments of corrections generally did not report demographic data on decedents, and therefore we could not adjust death rates to account for race/ ethnicity and comorbidity.This study focused on prisons but did not include jails or other detention facilities where there have been notable COVID-19 outbreaks.Although some facilities did engage in efforts to control outbreaks, the findings suggest that overall, COVID-19 in US prisons is unlikely to be contained without implementation of more effective infection control.
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“Nevertheless, what emerges from preliminary data is the negative impact of long COVID on quality of life and its effects on patient work ability and social relationships [1,4,19].”
From Female gender is associated with long COVID syndrome: a prospective cohort study (2022) · cites this paper as [4]
Experimental — accuracy not yet measuredIn the citing paper
“The high incidence of long COVID within our cohort was similar to that previously reported: more than half of patients reported symptoms lasting more than 2 months after symptom onset [4,5,16,18,19].”
From Female gender is associated with long COVID syndrome: a prospective cohort study (2022) · cites this paper as [4]
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“done across the world showed chronic fatigue as the most frequent persisting symptom of long-COVID, irrespective of initial COVID-19 presentation severity or presence of respiratory distress (17, 30-33)”
BackgroundThe Clinical Course of COVID-19 in the Outpatient Setting: A Prospective Cohort Study
Blair, P. W., Brown, D. M., Jang, M., Antar, A. A. R., Keruly, J. C., Bachu, V. S., Townsend, J., Tornheim, J. A., Keller, S. C., Sauer, L. M., et al. (2021) · Open Forum Infectious Diseases · doi:10.1093/ofid/ofab007 · Cited by 69
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“, long COVID-19) after acute infection has been noted since April 2020 (4).”
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Eccles, J., & Davies, K. A. (2021) · Clinical Medicine · doi:10.7861/clinmed.2020-1009 · Cited by 70
Promoting Ethical Payment in Human Infection Challenge Studies
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“Students from four universities were included in the control: (1) Matej Bel University, Department of Physical Education and Sports; (2) Slovak Medical University, Faculty of Healthcare Banská Bystrica; (3) Alexander Dubček University of Trenčín, Faculty of Healthcare; and (4) Technical University, Košice Department o…”
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“4% of patients who had recovered from COVID-19, after negative PCR test [3].”
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“Moreover, several studies have employed established grading scales to assess quality of life, disability, and speci fi c levels of impairment in various tissues and physiological systems among long COVID patients (26).”
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“[25], worked about a study on the persistence of symptoms in recovered patients from COVID-19.”
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“However, our sample size is larger than the ICU subgroups reported in previous studies [14,17,18].”
BackgroundResultSymptoms and management of long COVID: A scoping review
Cha, C., & Baek, G. (2021) · Journal of Clinical Nursing · doi:10.1111/jocn.16150 · Cited by 67
Endothelial Dysfunction in COVID-19: Potential Mechanisms and Possible Therapeutic Options
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Decoding the unknowns in long covid
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“It has been reported that about 27% of patients demonstrate joint pain even after recovery from COVID-19 disease [15].”
BackgroundPulmonary Function and Long-Term Respiratory Symptoms in Children and Adolescents After COVID-19
Knoke, L., Schlegtendal, A., Maier, C., Eitner, L., Lücke, T., & Brinkmann, F. (2022) · Frontiers in Pediatrics · doi:10.3389/fped.2022.851008 · Cited by 66
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“Reports regarding sensorineural hearing loss caused by viral infection were rare before the outbreak of coronavirus disease (COVID-19); however, sensorineural hearing loss caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been increasing [11,12].”
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“2 symptoms, such as fatigue, headache, attention disorders, and dyspnea [7,8].”
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Brain fog as a Long-term Sequela of COVID-19
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A Prospective Study of Voice, Swallow, and Airway Outcomes Following Tracheostomy for COVID ‐19
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“To date, approximately 10% of patients who have recovered from Sars-Cov-2 chronically suffer from or relapse into a complex post-viral syndrome with respiratory complaints, dyspnea, fatigue, lingering loss of smell or taste, cardiomyopathy, myalgia, “brain fog,” headaches, and mental illness (Carfì et al., 2020; Green…”
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“The overall reduction in quality of life seen in survivors of severe COVID-19 is likely multifactorial, due to the combination of prolonged hospital stay, pre-existing conditions and post-viral fatigue, a symptom very often reported by survivors [4] and already shown in previous SARS and MERS epidemics [27].”
BackgroundThe kids are not alright: A preliminary report of Post-COVID syndrome in university students
Walsh‐Messinger, J., Manis, H., Vrabec, A., Sizemore, J., Bishof, K., Debidda, M., Malaspina, D., & Greenspan, N. (2021) · Journal of American College Health · doi:10.1080/07448481.2021.1927053 · Cited by 67
Long COVID-19 Pulmonary Sequelae and Management Considerations
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Protracted respiratory findings in children post‐SARS‐CoV‐2 infection
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“In comparable studies of adults who did not require hospitalization during acute COVID‐19, the most common complaints were dyspnea and fatigue.(14,15) In contrast, in our pediatric study population, fatigue was only reported by four patients (13.”
BackgroundPatients, Families, and Communities COVID-19 Impact Assessment: Lessons Learned and Compelling Needs
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Association of mast-cell-related conditions with hypermobile syndromes: a review of the literature
Monaco, A., Choi, D., Uzun, S., Maitland, A. L., & Riley, B. A. (2022) · Immunologic Research · doi:10.1007/s12026-022-09280-1 · Cited by 67
Campos, M. C., Nery, T., Starke, A. C., Alves, A. C. D. B., Speck, A. E., & Aguiar, A. S. (2022) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2022.104902 · Cited by 71
“Carfi et al. (2020) demonstrated that fatigue was the main symptom reported in hospitalized patients during the acute phase and after a mean follow-up of 60 days (Carfì et al., 2020).”
DMW - Deutsche Medizinische Wochenschrift
Medizin, D. G. F. I., & Ärzte, G. D. N. U. (2026) · DMW - Deutsche Medizinische Wochenschrift · doi:10.1055/s-00000011 · Cited by 64
Lacasse, A., Pagé, M. G., Dassieu, L., Sourial, N., Janelle-Montcalm, A., Dorais, M., Nguena Nguefack, H. L., Godbout-Parent, M., Hudspith, M., Moor, G., et al. (2021) · PAIN Reports · doi:10.1097/pr9.0000000000000891 · Cited by 62
Wang, L., Foer, D., MacPhaul, E., Lo, Y.-C., Bates, D. W., & Zhou, L. (2021) · Journal of Biomedical Informatics · doi:10.1016/j.jbi.2021.103951 · Cited by 61
“We used all clinical notes from days 51 to 110 (a total of 60 days) during the post-acute period for each patient [13,27,28].”
Marques, K. C., Silva, C. C., Trindade, S. D. S., Santos, M. C. D. S., Rocha, R. S. B., Vasconcelos, P. F. D. C., Quaresma, J. A. S., & Falcão, L. F. M. (2022) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2022.862001 · Cited by 63
O’Brien, K., Townsend, L., Dowds, J., Bannan, C., Nadarajan, P., Kent, B. D., Murphy, N., Sheill, G., Martín‐Loeches, I., & Guinan, E. M. (2022) · Respiratory Research · doi:10.1186/s12931-022-02032-7 · Cited by 65
“Functional impairment can persist following discharge, most frequently characterised by dyspnoea on exertion and fatigue [4, 5].”
BackgroundInfluentialPersistent SARS‐CoV ‐2 infection in patients seemingly recovered from COVID ‐19
Bussani, R., Zentilin, L., Correa, R., Colliva, A., Silvestri, F., Zacchigna, S., Collesi, C., & Giacca, M. (2023) · The Journal of Pathology · doi:10.1002/path.6035 · Cited by 69
Trajectories of Hospitalization in COVID-19 Patients: An Observational Study in France
Boëlle, P., Delory, T., Maynadier, X., Janssen, C., Piarroux, R., Pichenot, M., Lemaire, X., Baclet, N., Weyrich, P., Melliez, H., et al. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9103148 · Cited by 62
“Age Trajectory Characteristics 18–65 66–80 >80 Overall (n = 523) (n = 400) (n = 398) (n = 1321) Overall length of stay 10 [6, 16] 14 [9, 24] 13 [8, 21] 12 [7, 20] Death (%) 9 20 38 20 Time to death (days) 53 [31, 91] 16 [9, 28] 10 [6, 17] 14 [8, 25] Time to discharge (days) 8 [5, 13] 14 [9, 22] 14 [9, 23] 12 [7, 19] I…”
BackgroundSARS-CoV-2 Causes a Systemically Multiple Organs Damages and Dissemination in Hamsters
Song, Z., Bao, L., Yü, P., Qi, F., Gong, S., Wang, J., Zhao, B., Liu, M., Han, Y., Deng, W., et al. (2021) · Frontiers in Microbiology · doi:10.3389/fmicb.2020.618891 · Cited by 59
Ocular findings among patients surviving COVID-19
Costa, Í. F., Bonifácio, L. P., Bellissimo‐Rodrigues, F., Rocha, E. M., Jorge, R., Bóllela, V. R., & Antunes-Foschini, R. (2021) · Scientific Reports · doi:10.1038/s41598-021-90482-2 · Cited by 62
Persistent symptoms and lab abnormalities in patients who recovered from COVID-19
Varghese, J., Sandmann, S., Ochs, K., Schrempf, I. M., Frömmel, C., Dugas, M., Schmidt, H., Vollenberg, R., & Tepasse, P. (2021) · Scientific Reports · doi:10.1038/s41598-021-91270-8 · Cited by 68
Swiss Recommendations for the Follow-Up and Treatment of Pulmonary Long COVID
Funke-Chambour, M., Bridevaux, P., Clarenbach, C. F., Soccal, P. M., Nicod, L. P., von Garnier, C., & on behalf of the Swiss COVID Lung Study Group and the Swiss Society of Pulmonology (2021) · Respiration · doi:10.1159/000517255 · Cited by 64
Jones, R. C. M., Davis, A., Stanley, B. O. C., Julious, S. A., Ryan, D. P., Jackson, D. J., Halpin, D. M. G., Hickman, K., Pinnock, H., Quint, J. K., et al. (2021) · Pragmatic and Observational Research · doi:10.2147/por.s316186 · Cited by 67
Cascella, M., Gaudio, A. D., Vittori, A., Bimonte, S., Prete, P. D., Forte, C. A., Cuomo, A., & Blasio, E. D. (2021) · Journal of Pain Research · doi:10.2147/jpr.s313978 · Cited by 63
Long-Term COVID 19 Sequelae in Adolescents: the Overlap with Orthostatic Intolerance and ME/CFS
Morrow, A. K., Malone, L. A., Kokorelis, C., Petracek, L. S., Eastin, E. F., Lobner, K. L., Neuendorff, L., & Rowe, P. C. (2022) · Current Pediatrics Reports · doi:10.1007/s40124-022-00261-4 · Cited by 63
SARS-CoV-2 infection induces inflammatory bone loss in golden Syrian hamsters
Qiao, W., Lau, H. E., Xie, H., Poon, V. K., Chan, C. C., Chu, H., Yuan, S., Yuen, T. T., Chik, K. K., Tsang, J. O., et al. (2022) · Nature Communications · doi:10.1038/s41467-022-30195-w · Cited by 62
Care Models for Acute Chest Pain That Improve Outcomes and Efficiency
Dawson, L. P., Smith, K. L., Cullen, L., Nehme, Z., Lefkovits, J., Taylor, A. J., & Stub, D. A. (2022) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2022.03.380 · Cited by 67
Giron, L. B., Peluso, M. J., Ding, J., Kenny, G., Zilberstein, N., Koshy, J., Hong, K. Y., Rasmussen, H. E., Miller, G. E., Bishehsari, F., et al. (2022) · JCI Insight · doi:10.1172/jci.insight.160989 · Cited by 67
Vascular “Long COVID”: A New Vessel Disease?
Zanini, G., Selleri, V., Roncati, L., Coppi, F., Nasi, M., Farinetti, A., Manenti, A., Pinti, M., & Mattioli, A. V. (2023) · Angiology · doi:10.1177/00033197231153204 · Cited by 66
Camargo, C. R. D. (2021) · Policing & Society · doi:10.1080/10439463.2021.1883609 · Cited by 62
Persistent Symptoms in Patients Recovering From COVID-19 in Denmark
Leth, S., Gunst, J. D., Dahl, V. N., Hansen, K. S., Søgaard, O. S., Østergaard, L. J., Jensen‐Fangel, S., Storgaard, M., & Agergaard, J. (2021) · Open Forum Infectious Diseases · doi:10.1093/ofid/ofab042 · Cited by 60
“Symptoms after hospitalization were reported in an early study including 143 patients discharged after COVID-19 from the Fondazione Policlinico Universitario Agostino Gemelli IRCCS in Rome, Italy [6].”
BackgroundPlassmeyer, M. L., Alpan, O., Corley, M. J., Premeaux, T. A., Lillard, K., Coatney, P., Vaziri, T., Michalsky, S., Pang, A. P. S., Bukhari, Z., et al. (2021) · Allergy · doi:10.1111/all.14907 · Cited by 64
Inhalation Delivery for the Treatment and Prevention of COVID-19 Infection
Eedara, B. B., Alabsi, W., Encinas-Basurto, D., Polt, R. L., Ledford, J. G., & Mansour, H. M. (2021) · Pharmaceutics · doi:10.3390/pharmaceutics13071077 · Cited by 60
Aul, R., Gates, D. J., Draper, A., Dunleavy, A., Ruickbie, D. S., Meredith, H., Walters, N., Zeller, C. V., Taylor, V., Bridgett, M., et al. (2021) · Respiratory Medicine · doi:10.1016/j.rmed.2021.106602 · Cited by 61
“This is similar to the results seen in other studies [12,13,26,27].”
ResultLenoir, C., Terrier, J. E., Gloor, Y. S., Curtin, F., Rollason, V., Desmeules, J. A., Daali, Y., Reny, J., & Samer, C. F. (2021) · Clinical Pharmacology & Therapeutics · doi:10.1002/cpt.2412 · Cited by 64
Wahlgren, C., Divanoglou, A., Larsson, M., Nilsson, E., Balkhed, Å. Ö., Niward, K., Thornberg, U. B., Gudmundsson, E. L., & Levi, R. (2021) · EClinicalMedicine · doi:10.1016/j.eclinm.2021.101219 · Cited by 60
Hormonal trends in patients suffering from long COVID symptoms
Sunada, N., Honda, H., Nakano, Y., Yamamoto, K., Tokumasu, K., Sakurada, Y., Matsuda, Y., Hasegawa, T., Otsuka, Y., Obika, M., et al. (2022) · Endocrine Journal · doi:10.1507/endocrj.ej22-0093 · Cited by 61
Impact of long-COVID on health-related quality of life in Japanese COVID-19 patients
Tsuzuki, S., Miyazato, Y., Terada, M., Morioka, S., Ohmagari, N., & Beutels, P. (2022) · Health and Quality of Life Outcomes · doi:10.1186/s12955-022-02033-6 · Cited by 59
Naik, H., Shao, S., Tran, K. C., Wong, A. W., Russell, J. A., Khor, E., Nacul, L., Mckay, R. J., Carlsten, C., Ryerson, C. J., et al. (2022) · Health and Quality of Life Outcomes · doi:10.1186/s12955-022-02082-x · Cited by 63
“In many of the observational studies thus far, fatigue was evaluated via interview or questionnaire as a single item as part of a symptom inventory [4, 5, 6, 7, 8, 9, 10].”
BackgroundCOPD assessment test for the evaluation of COVID-19 symptoms
Daynes, E., Gerlis, C., Briggs‐Price, S., Jones, P., & Singh, S. J. (2020) · Thorax · doi:10.1136/thoraxjnl-2020-215916 · Cited by 61
Whole of population-based cohort study of recovery time from COVID-19 in New South Wales Australia
Liu, B. C., Jayasundara, D., Pye, V., Dobbins, T., Dore, G. J., Matthews, G. V., Kaldor, J. M., & Spokes, P. (2021) · The Lancet Regional Health - Western Pacific · doi:10.1016/j.lanwpc.2021.100193 · Cited by 60
A Narrative Review of COVID-19 Vaccines
Eroglu, B., Nuwarda, R. F., Ramzan, I. M., & Kayser, V. (2021) · Vaccines · doi:10.3390/vaccines10010062 · Cited by 59
Han, J. H., Womack, K. N., Tenforde, M. W., Files, D. C., Gibbs, K. W., Shapiro, N. I., Prekker, M. E., Erickson, H. L., Steingrub, J. S., Qadir, N., et al. (2022) · Influenza and Other Respiratory Viruses · doi:10.1111/irv.12980 · Cited by 65
“Therefore, patients with milder acute disease may be at lower risk for severe long-term morbidity than those with more severe illness during the acute phase of COVID-19.(4,5) Nonetheless, impaired long-term health, reduced quality of life, and increased psychological distress postCOVID were reported by a substantial n…”
BackgroundInfluentialNeurological post‐acute sequelae of SARS‐CoV ‐2 infection
Takao, M., & Ohira, M. (2022) · Psychiatry and Clinical Neurosciences · doi:10.1111/pcn.13481 · Cited by 66
Epidemiology and Clinical Presentation of COVID-19 in Older Adults
Abul, Y., Leeder, C., & Gravenstein, S. (2022) · Clinics in Geriatric Medicine · doi:10.1016/j.cger.2025.09.007 · Cited by 69
Misra, D. P., Gasparyan, A. Y., & Zimba, O. (2020) · Rheumatology International · doi:10.1007/s00296-020-04694-2 · Cited by 61
Men and COVID-19: the aftermath
White, A. (2020) · Postgraduate Medicine · doi:10.1080/00325481.2020.1823760 · Cited by 63
Qualitative smell/taste disorders as sequelae of acute COVID-19
Ercoli, T., Masala, C., Pinna, I., Orofino, G., Solla, P., Rocchi, L., & Defazio, G. (2021) · Neurological Sciences · doi:10.1007/s10072-021-05611-6 · Cited by 59
“6 days after COVID-19 acute infection while gustatory hallucination has never been described as sequalae of COVID-19 [4].”
BackgroundInfluentialPost-Pulmonary Embolism Syndrome and Functional Outcomes after Acute Pulmonary Embolism
Luijten, D., de Jong, C. M. M., Ninaber, M. K., Spruit, M. A., Huisman, M. V., & Klok, F. A. (2022) · Seminars in Thrombosis and Hemostasis · doi:10.1055/s-0042-1749659 · Cited by 61
Metadata
- Authors
- Carfì, A., Bernabei, R., Landi, F., & for the Gemelli Against COVID-19 Post-Acute Care Study Group
- Affiliations
- Agostino Gemelli University Polyclinic (IT)
- Corresponding author
- Carfì, Angelo
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2020-08-11
- Volume
- 324
- Issue
- 6
- Pages
- 603
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- PMC
- PMC7349096
- OpenAlex
- W3041493976
- Cited by
- 4,561
- References
- 7
- Citations by year
- 2026: 139 · 2025: 292 · 2024: 495 · 2023: 827 · 2022: 1183 · 2021: 1373 · 2020: 245
- FWCI
- 393.49
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- University of Pennsylvania
- Topics
- Health Sciences › Medicine › Clinical Neurology › Long-Term Effects of COVID-19
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
- Keywords
- COVID-19 pandemic, long COVID, post-acute symptoms, prisoners, prison population, COVID-19 mortality, COVID-19 case rates, infection control, jails, detention centers, COVID-19 outbreak
- MeSH terms
- Betacoronavirus, COVID-19, SARS-CoV-2, Adult, Aged, Chest Pain, Dyspnea, Fatigue, Female, Follow-Up Studies, Humans, Italy, Male, Middle Aged, Pneumonia, Viral, Coronavirus Infections, Arthralgia, Pandemics, Symptom Assessment
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