Predictors of chronic COVID-19 symptoms in a community-based cohort of adults


Jonathan I. Silverberg, Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC, United States of America.
Israel Zyskind, Department of Pediatrics, NYU Langone Medical Center, New York, NY, United States of America.
Hiam Naiditch, Department of Medicine, Yale University School of Medicine, New Haven, CT, United States of America.
Jason Zimmerman, Maimonides Medical Center, Brooklyn, NY, United States of America.
Aaron E. Glatt, Department of Medicine, Mount Sinai South Nassau and the Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
Abraham Pinter, Public Health Research Institute, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ, United States of America.
Elitza S. Theel, Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America.
Michael J. Joyner, Department of Anesthesiology & Perioperative Medicine, Mayo Clinic, Rochester, MN, United States of America.
D Ashley Hill, ResourcePath, Sterling, VA, United States of America.
Miriam R. Lieberman, Department of Dermatology, State University of New York Downstate Medical Center, New York, NY, United States of America.
Elliot Bigajer, Division of Gastroenterology, Department of Medicine, Brookdale University Hospital and Medical Center, Brooklyn, NY, United States of America.
Daniel Stok, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America.
Elliot Frank, Division of Infectious Diseases, Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ, United States of America.
Avi Z. Rosenberg, Department of Pathology, Johns Hopkins University, Baltimore, MD, United States of America.

Document Type

Journal Article

Publication Date



PloS one








BACKGROUND: COVID-19 can cause some individuals to experience chronic symptoms. Rates and predictors of chronic COVID-19 symptoms are not fully elucidated. OBJECTIVE: To examine occurrence and patterns of post-acute sequelae of SARS-CoV2 infection (PASC) symptomatology and their relationship with demographics, acute COVID-19 symptoms and anti-SARS-CoV-2 IgG antibody responses. METHODS: A multi-stage observational study was performed of adults (≥18 years) from 5 US states. Participants completed two rounds of electronic surveys (May-July 2020; April-May 2021) and underwent testing to anti-SARS-CoV-2 nucleocapsid protein IgG antibody testing. Latent Class Analysis was used to identify clusters of chronic COVID-19 symptoms. RESULTS: Overall, 390 adults (median [25%ile, 75%ile] age: 42 [31, 54] years) with positive SARS-CoV-2 antibodies completed the follow-up survey; 92 (24.7%) had ≥1 chronic COVID-19 symptom, with 11-month median duration of persistent symptoms (range: 1-12 months). The most common chronic COVID-19 symptoms were fatigue (11.3%), change in smell (9.5%) or taste (5.6%), muscle or joint aches (5.4%) and weakness (4.6%). There were significantly higher proportions of ≥1 persistent COVID-19 symptom (31.5% vs. 18.6%; Chi-square, P = 0.004), and particularly fatigue (15.8% vs. 7.3%, P = 0.008) and headaches (5.4% vs. 1.0%, P = 0.011) in females compared to males. Chronic COVID-19 symptoms were also increased in individuals with ≥6 acute COVID-19 symptoms, Latent class analysis revealed 4 classes of symptoms. Latent class-1 (change of smell and taste) was associated with lower anti-SARS-CoV-2 antibody levels; class-2 and 3 (multiple chronic symptoms) were associated with higher anti-SARS-CoV-2 antibody levels and more severe acute COVID-19 infection. LIMITATIONS: Ambulatory cohort with less severe acute disease. CONCLUSION: Individuals with SARS-CoV-2 infection commonly experience chronic symptoms, most commonly fatigue, changes in smell or taste and muscle/joint aches. Female sex, severity of acute COVID-19 infection, and higher anti-SARS-CoV-2 IgG levels were associated with the highest risk of having chronic COVID-19 symptoms.