Persistence, Magnitude, and Patterns of Postacute Symptoms and Quality of Life Following Onset of SARS-CoV-2 Infection: Cohort Description and Approaches for Measurement

Michael J Peluso; J Daniel Kelly; Scott Lu; Sarah A Goldberg; Michelle C Davidson; Sujata Mathur; Matthew S Durstenfeld; Matthew A Spinelli; Rebecca Hoh; Viva Tai; Emily A Fehrman; Leonel Torres; Yanel Hernandez; Meghann C Williams; Mireya I Arreguin; Lynn H Ngo; Monika Deswal; Sadie E Munter; Enrique O Martinez; Khamal A Anglin; Mariela D Romero; Jacqueline Tavs; Paulina R Rugart; Jessica Y Chen; Hannah M Sans; Victoria W Murray; Payton K Ellis; Kevin C Donohue; Jonathan A Massachi; Jacob O Weiss; Irum Mehdi; Jesus Pineda-Ramirez; Alex F Tang; Megan A Wenger; Melissa T Assenzio; Yan Yuan; Melissa R Krone; Rachel L Rutishauser; Isabel Rodriguez-Barraquer; Bryan Greenhouse; John A Sauceda; Monica Gandhi; Aaron Wolfe Scheffler; Priscilla Y Hsue; Timothy J Henrich; Steven G Deeks; Jeffrey N Martin

doi:10.1093/ofid/ofab640

Persistence, Magnitude, and Patterns of Postacute Symptoms and Quality of Life Following Onset of SARS-CoV-2 Infection: Cohort Description and Approaches for Measurement

Open Forum Infect Dis. 2021 Dec 21;9(2):ofab640. doi: 10.1093/ofid/ofab640. eCollection 2022 Feb.

Authors

Michael J Peluso¹, J Daniel Kelly^{2

3

4}, Scott Lu², Sarah A Goldberg², Michelle C Davidson², Sujata Mathur², Matthew S Durstenfeld⁵, Matthew A Spinelli¹, Rebecca Hoh¹, Viva Tai¹, Emily A Fehrman¹, Leonel Torres^{1

6}, Yanel Hernandez¹, Meghann C Williams¹, Mireya I Arreguin¹, Lynn H Ngo¹, Monika Deswal¹, Sadie E Munter^{1

6}, Enrique O Martinez^{1

2}, Khamal A Anglin², Mariela D Romero², Jacqueline Tavs², Paulina R Rugart², Jessica Y Chen^{2

6}, Hannah M Sans², Victoria W Murray¹, Payton K Ellis², Kevin C Donohue², Jonathan A Massachi², Jacob O Weiss², Irum Mehdi², Jesus Pineda-Ramirez², Alex F Tang², Megan A Wenger², Melissa T Assenzio², Yan Yuan², Melissa R Krone², Rachel L Rutishauser⁶, Isabel Rodriguez-Barraquer¹, Bryan Greenhouse¹, John A Sauceda⁷, Monica Gandhi¹, Aaron Wolfe Scheffler², Priscilla Y Hsue⁵, Timothy J Henrich⁶, Steven G Deeks¹, Jeffrey N Martin²

Affiliations

¹ Division of HIV, Infectious Diseases, and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA.
² Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA.
³ Institute of Global Health Sciences, University of California, San Francisco, San Francisco, California, USA.
⁴ F.I. Proctor Foundation, University of California, San Francisco, San Francisco, California, USA.
⁵ Division of Cardiology, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA.
⁶ Division of Experimental Medicine, University of California, San Francisco, San Francisco, California, USA.
⁷ Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California, USA.

Abstract

Background: There is mounting evidence for the presence of postacute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (PASC), but there is limited information on the spectrum, magnitude, duration, and patterns of these sequelae as well as their influence on quality of life.

Methods: We assembled a cohort of adults with a documented history of SARS-CoV-2 RNA positivity at ≥2 weeks past onset of coronavirus disease 2019 (COVID-19) symptoms or, if asymptomatic, first positive test. At 4-month intervals, we queried physical and mental health symptoms and quality of life.

Results: Of the first 179 participants enrolled, 10 were asymptomatic during the acute phase of SARS-CoV-2 infection, 125 were symptomatic but not hospitalized, and 44 were symptomatic and hospitalized. During the postacute phase, fatigue, shortness of breath, concentration problems, headaches, trouble sleeping, and anosmia/dysgeusia were most common through 8 months of observation. Symptoms were typically at least somewhat bothersome and sometimes exhibited a waxing-and-waning course. Some participants experienced symptoms of depression, anxiety, and post-traumatic stress, as well as difficulties with performance of usual activities. The median visual analogue scale rating of general health was lower at 4 and 8 months compared with pre-COVID-19. Two clusters of symptom domains were identified.

Conclusions: Many participants report bothersome symptoms following onset of COVID-19 with variable patterns of persistence and impact on quality of life. The substantial variability suggests the existence of multiple subphenotypes of PASC. A rigorous approach to the prospective measurement of symptoms and functional manifestations sets the stage for the next phase of research focusing on the pathophysiologic causes of the various subgroups of PASC.

Keywords: COVID-19; SARS-CoV-2; long COVID; post-acute sequelae of SARS-CoV-2 (PASC); quality of life.

Abstract

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