Patients who tested positive for COVID-19 were more likely than patients who tested negative to have new symptoms and health conditions more than a month later, according to a study of over 2 million patients in the United States.
While most COVID-19 patients recovered fully, approximately one in ten had new symptoms or health conditions, also referred to as “long COVID” or “post-COVID conditions”, suggesting that doctors should monitor the health of their COVID-19 patients for many months after they test positive for the virus.
Earlier studies have reported a variety of symptoms and conditions can follow four or more weeks after a COVID-19 illness. These symptoms or conditions can be ongoing, returning, or new. They range from shortness of breath, tiredness, muscle weakness, and “brain fog” (difficulty thinking or concentrating) to serious or long-lasting new health conditions, such as new-onset type 2 diabetes and nerve disorders. However, not many reports have assessed whether certain symptoms and conditions are more common among people who had COVID-19 compared with people who did not.
“Several studies have documented a variety of post-COVID conditions, but we had little information about the occurrence of these conditions at the population level or about the ongoing medical needs of patients with COVID-19,” said Dr. Alfonso Hernandez-Romieu, an infectious disease physician and epidemic intelligence service officer at the U.S. Centers for Disease Control and Prevention (CDC) and the lead investigator for the study.
Public health researchers from CDC, universities, health systems, and public health institutes accessed electronic health record data from healthcare facilities participating in PCORnet®, the National Patient-Centered Clinical Research Network.
The researchers identified more than 2 million patients of all ages in 42 participating healthcare systems who had a COVID-19 test between March and December 2020 and received medical care for any reason 31–150 days after they were tested. Researchers compared 170,000 patients who tested positive for COVID-19 to 1.9 million patients who tested negative for COVID-19 and separated data for hospitalized and nonhospitalized patients.
The most common new symptoms among adults who tested positive for COVID-19 were shortness of breath, tiredness, and sleep disorders. Children and young adults who tested positive for COVID-19 more commonly experienced constipation or diarrhea, tiredness, and shortness of breath.
Among the hospitalized patients, the researchers found that about 1 in 10 hospitalized patients who had a positive COVID-19 test had new symptoms like shortness of breath, fatigue, abnormal heart rate, or other problems, like endocrine or neurologic problems, a month or more after their positive test. Hospitalized patients with a positive COVID-19 test were more likely than hospitalized patients with a negative test to get these new symptoms.
Also, patients who had more severe COVID-19 illness were more likely to be newly diagnosed with symptoms or health conditions within 31–150 days. Adults who had been hospitalized and placed on a ventilator were more likely to have new symptoms and conditions than patients who had not been on a ventilator. The rate of new-onset type 2 diabetes was higher among adults who had been hospitalized, and the rate of new neurological disorders was higher among adults who had been placed on a ventilator during their COVID-19 illness.
“Although new symptoms and conditions occurred infrequently, applying the proportions of these rare events to the millions of adults and children infected with SARS-CoV-2 means that tens of thousands of people might develop post-COVID conditions after their initial bout with the disease,” said Dr. Thomas Carton of the Louisiana Public Health Institute, principal investigator for REACHnet, a PCORnet Network Partner, and a researcher in the study.
“Some patients may have sought care after their initial COVID-19 illness for symptoms that were long-lasting as well as chronically debilitating conditions such as type 2 diabetes and nerve disorders,” said Dr. Hernandez-Romieu. “Greater awareness of post-COVID conditions among health care professionals is crucial for meeting the needs of patients with prolonged or chronic consequences of COVID-19,” he said.
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This research was supported by Cooperative Agreement number 6- NU38OT000316, funded by the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services.
Read about this important research in JAMA Network and in a lay summary.