Association of Self-reported COVID-19 Infection and SARS-CoV-2 Serology Test Results With Persistent Physical Symptoms Among French Adults During the COVID-19 Pandemic
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Importance: After an infection by SARS-CoV-2, many patients present with persistent physical symptoms that may impair their quality of life. Beliefs regarding the causes of these symptoms may influence their perception and promote maladaptive health behaviors. Objective: To examine the associations of self-reported COVID-19 infection and SARS-CoV-2 serology test results with persistent physical symptoms (eg, fatigue, breathlessness, or impaired attention) in the general population during the COVID-19 pandemic. Design, Setting, and Participants: Participants in this cross-sectional analysis were 26 823 individuals from the French population-based CONSTANCES cohort, included between 2012 and 2019, who took part in the nested SAPRIS and SAPRIS-SERO surveys. Between May and November 2020, an enzyme-linked immunosorbent assay was used to detect anti-SARS-CoV-2 antibodies. Between December 2020 and January 2021, the participants reported whether they believed they had experienced COVID-19 infection and had physical symptoms during the previous 4 weeks that had persisted for at least 8 weeks. Participants who reported having an initial COVID-19 infection only after completing the serology test were excluded. Main Outcomes and Measures: Logistic regressions for each persistent symptom as the outcome were computed in models including both self-reported COVID-19 infection and serology test results and adjusting for age, sex, income, and educational level. Results: Of 35 852 volunteers invited to participate in the study, 26 823 (74.8%) with complete data were included in the present study (mean [SD] age, 49.4 [12.9] years; 13 731 women [51.2%]). Self-reported infection was positively associated with persistent physical symptoms, with odds ratios ranging from 1.39 (95% CI, 1.03-1.86) to 16.37 (95% CI, 10.21-26.24) except for hearing impairment (odds ratio, 1.45; 95% CI, 0.82-2.55) and sleep problems (odds ratio, 1.14; 95% CI, 0.89-1.46). A serology test result positive for SARS-COV-2 was positively associated only with persistent anosmia (odds ratio, 2.72; 95% CI, 1.66-4.46), even when restricting the analyses to participants who attributed their symptoms to COVID-19 infection. Further adjusting for self-rated health or depressive symptoms yielded similar results. There was no significant interaction between belief and serology test results. Conclusions and Relevance: The findings of this cross-sectional analysis of a large, population-based French cohort suggest that persistent physical symptoms after COVID-19 infection may be associated more with the belief in having been infected with SARS-CoV-2 than with having laboratory-confirmed COVID-19 infection. Further research in this area should consider underlying mechanisms that may not be specific to the SARS-CoV-2 virus. A medical evaluation of these patients may be needed to prevent symptoms due to another disease being erroneously attributed to "long COVID."
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Long COVID patients without confirmed diagnoses of acute SARS-CoV2 infection (defined by RT-PCR or serology test) were more likely to report symptomatic worsening, possibly suggesting increased nocebo effects in the population without biological proof.
“In addition, long COVID patients without confirmed diagnoses of acute SARS-CoV2 infection (defined by RT-PCR or serology test) were more likely to report symptomatic worsening, possibly suggesting increased nocebo effects in the population without biological proof [28,39].”
From Protective effect of COVID-19 vaccination against long COVID syndrome: A systematic review and meta-analysis (2023) · cites this paper as [39]
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- Authors
- Matta, J., Wiernik, E., Robineau, O., Carrat, F., Touvier, M., Severi, G., de Lamballerie, X., Blanché, H., Deleuze, J.-F., Gouraud, C., Hoertel, N., Ranque, B., Goldberg, M., Zins, M., Lemogne, C., Santé, P., Kab, S., Renuy, A., Le-Got, S., Ribet, C., Wiernik, E., Goldberg, M., Zins, M., Artaud, F., Gerbouin-Rérolle, P., Enguix, M., Laplanche, C., Gomes-Rima, R., Hoang, L., Correia, E., Barry, A. A., Senina, N., Severi, G., Allegre, J., Szabo de Edelenyi, F., Druesne-Pecollo, N., Esseddik, Y., Hercberg, S., Touvier, M., Charles, M.-A., Ancel, P.-Y., Benhammou, V., Ritmi, A., Marchand, L., Zaros, C., Lordmi, E., Candea, A., de Visme, S., Simeon, T., Thierry, X., Geay, B., Dufourg, M.-N., Milcent, K., Rahib, D., Lydie, N., Lusivika-Nzinga, C., Pannetier, G., Lapidus, N., Goderel, I., Dorival, C., Nicol, J., Carrat, F., Lai, C., Belhadji, L., Esperou, H., Couffin-Cadiergues, S., Gagliolo, J.-M., Blanché, H., Sébaoun, J.-M., Beaudoin, J.-C., Gressin, L., Morel, V., Ouili, O., Deleuze, J.-F., Ninove, L., Priet, S., Saba Villarroel, P. M., Fourié, T., Mohamed Ali, S., Amroun, A., Seston, M., Ayhan, N., Pastorino, B., & de Lamballerie, X.
- Affiliations
- Inserm (FR)
- Assistance Publique – Hôpitaux de Paris (FR)
- Université Paris Cité (FR)
- for the Santé, Pratiques, Relations et Inégalités Sociales en Population Générale Pendant la Crise COVID-19–Sérologie (SAPRIS-SERO) Study Group
- Corresponding author
- Lemogne, Cédric
- ORCID
- Matta, Joane
- Robineau, Olivier
- Gouraud, Clément
- Hoertel, Nicolas
- Ranque, Brigitte
- Lemogne, Cédric
- Kab, Sofiane
- Renuy, Adeline
- Artaud, Fanny
- Correia, Emmanuelle
- Esseddik, Younes
- Charles, Marie-Aline
- Ancel, Pierre-Yves
- Benhammou, Valérie
- Zaros, Cécile
- Thierry, Xavier
- Geay, Bertrand
- Rahib, Delphine
- Priet, Stéphane
- Fourié, Toscane
- Seston, Morgan
- Pastorino, Boris
- Venue
- JAMA Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2022-01-01
- Volume
- 182
- Issue
- 1
- Pages
- 19
- ISSN
- 2168-6106 (ISSN-L)
- PMC
- PMC8576624
- OpenAlex
- W3213545755
- Cited by
- 266
- References
- 23
- Citations by year
- 2026: 14 · 2025: 28 · 2024: 47 · 2023: 67 · 2022: 102 · 2021: 7 · 2014: 1
- FWCI
- 26.67
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- other-oa
- Locations
- JAMA Internal Medicine (publishedVersion, other-oa)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- HAL (submittedVersion, other-oa)
- Florence Research (University of Florence) (submittedVersion)
- LillOA (Université de Lille (University Of Lille)) (submittedVersion, other-oa)
- Funders
- AstraZeneca
- L'Oreal USA
- Agence Nationale de la Recherche (10-COHO-06, #ANR-20-COVI-000, ANR-20-COV5-0005, ANR-11-INBS-0002, ANR-10-COHO-0006, ANR-11-INBS, ANR-20-COVI-0009, ANR-10, #ANR-10-COHO-06)
- Institut National de la Santé et de la Recherche Médicale (C20-26)
- H. Lundbeck A/S
- Topics
- Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
- Keywords
- COVID-19 pandemic, SARS-CoV-2, persistent physical symptoms, long COVID, self-reported infection, SARS-CoV-2 antibodies, serology testing, fatigue, dyspnea, sleep disorders, hearing loss, CONSTANCES cohort, French adults, health beliefs, quality of life
- MeSH terms
- COVID-19, COVID-19 Serological Testing, Adult, Cross-Sectional Studies, Female, France, Humans, Male, Middle Aged, Surveys and Questionnaires, Syndrome, Self Report
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