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
Open accessAbstract
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.
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Pre-existing comorbidities, such as asthma, diabetes, obesity, and immunosuppressive conditions, can also be associated with higher risks of long COVID.
“Since pre-existing comorbidities, such as asthma, diabetes, obesity, and immunosuppressive conditions, can also be associated with higher risks of long COVID [3,7,8]”
From Protective effect of COVID-19 vaccination against long COVID syndrome: A systematic review and meta-analysis (2023) · cites this paper as [8]
The Return to Usual State of Health section associates obesity and having three or more chronic conditions with delayed return to usual health among symptomatic outpatients. Table 1 also shows an association for immunosuppressive conditions, but not for asthma or diabetes. The study assessed recovery 14–21 days after testing, so its findings do not establish risk of longer-term long COVID. (LLM, conf=0.88)
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- Authors
- Tenforde, M. W., Kim, S. S., Lindsell, C. J., Billig Rose, E., Shapiro, N. I., Files, D. C., Gibbs, K. W., Erickson, H. L., Steingrub, J. S., Smithline, H. A., Gong, M. N., Aboodi, M. S., Exline, M. C., Henning, D. J., Wilson, J. G., Khan, A., Qadir, N., Brown, S. M., Peltan, I. D., Rice, T. W., Hager, D. N., Ginde, A. A., Stubblefield, W. B., Patel, M. M., Self, W. H., Feldstein, L. R., IVY Network Investigators, CDC COVID-19 Response Team, IVY Network Investigators, Hart, K. W., McClellan, R., CDC COVID-19 Response Team, Dorough, L., Dzuris, N., Griggs, E. P., Kassem, A. M., Marcet, P. L., Ogokeh, C. E., Sciarratta, C. N., Siddula, A., Smith, E. R., & Wu, M. J.
- Affiliations
- Centers for Disease Control and Prevention (UG)
- Beth Israel Deaconess Medical Center (US)
- Atrium Health Wake Forest Baptist (US)
- Hennepin County Medical Center (US)
- Baystate Medical Center (US)
- Albert Einstein College of Medicine (US)
- The Ohio State University Wexner Medical Center (US)
- University of Washington Medical Center (US)
- Oregon Health & Science University (US)
- University of California, Los Angeles (US)
- Intermountain Healthcare (US)
- Johns Hopkins University (US)
- Vanderbilt University Medical Center (US)
- Corresponding author
- Tenforde, Mark W.
- ORCID
- Tenforde, Mark W.
- Kim, Sara S.
- Lindsell, Christopher J.
- Shapiro, Nathan I.
- Files, D. Clark
- Gibbs, Kevin W.
- Erickson, Heidi L.
- Steingrub, Jay S.
- Smithline, Howard A.
- Gong, Michelle N.
- Exline, Matthew C.
- Wilson, Jennifer G.
- Khan, Akram
- Qadir, Nida
- Brown, Samuel M.
- Peltan, Ithan D.
- Rice, Todd W.
- Hager, David N.
- Ginde, Adit A.
- Stubblefield, William B.
- Patel, Manish M.
- Self, Wesley H.
- Feldstein, Leora R.
- Hart, Kimberly W.
- Griggs, Eric P.
- Kassem, Ahmed M.
- Marcet, Paula L.
- Ogokeh, Constance E.
- Sciarratta, Courtney N.
- Wu, Michael J.
- Venue
- MMWR. Morbidity and Mortality Weekly Report
- Published
- 2020-07-31
- Volume
- 69
- Issue
- 30
- Pages
- 993-998
- ISSN
- 0149-2195 (ISSN-L)
- 1545-861X
- PMC
- PMC7392393
- OpenAlex
- W3044231852
- Cited by
- 1,319
- References
- 6
- Citations by year
- 2026: 32 · 2025: 74 · 2024: 148 · 2023: 253 · 2022: 335 · 2021: 395 · 2020: 79 · 2018: 3
- FWCI
- 115.07
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- MMWR Morbidity and Mortality Weekly Report (publishedVersion)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion, cc-by)
- Funders
- U.S. Department of Defense
- United Therapeutics Corporation
- Intermountain Research and Medical Foundation
- Cumberland Pharmaceuticals
- Regeneron Pharmaceuticals
- Marcus Foundation
- University of Oxford
- National Institutes of Health
- Centers for Disease Control and Prevention
- National Institute of General Medical Sciences (K23GM129661)
- Janssen Pharmaceuticals
- Actelion Pharmaceuticals
- 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, prolonged illness, symptom duration, long COVID, fatigue, cough, dyspnea, young adults, chronic disease, risk factors, public health communication, social distancing, face coverings
- MeSH terms
- COVID-19, Adolescent, Adult, Ambulatory Care, Delivery of Health Care, Female, Humans, Male, Middle Aged, Pneumonia, Viral, Risk Factors, Time Factors, United States, Treatment Outcome, Coronavirus Infections, Recovery of Function, Young Adult, Pandemics
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