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. 2021 May;15(3):345-351.
doi: 10.1111/irv.12832. Epub 2021 Jan 6.

Symptoms and recovery among adult outpatients with and without COVID-19 at 11 healthcare facilities-July 2020, United States

Kiva A Fisher  1 , Samantha M Olson  1 , Mark W Tenforde  1   2 , Wesley H Self  3   4 , Michael Wu  1 , Christopher J Lindsell  3   4 , Nathan I Shapiro  3   5 , D Clark Files  3   6 , Kevin W Gibbs  3   6 , Heidi L Erickson  3   7 , Matthew E Prekker  3   7 , Jay S Steingrub  3   8 , Matthew C Exline  3   9 , Daniel J Henning  3   10 , Jennifer G Wilson  3   11 , Samuel M Brown  3   12 , Ithan D Peltan  3   12 , Todd W Rice  3   4 , David N Hager  3   13 , Adit A Ginde  3   14 , H Keipp Talbot  3   4 , Jonathan D Casey  3   4 , Carlos G Grijalva  3   5 , Brendan Flannery  1 , Manish M Patel  1 , Leora R Feldstein  1
Affiliations

Symptoms and recovery among adult outpatients with and without COVID-19 at 11 healthcare facilities-July 2020, United States

Kiva A Fisher et al. Influenza Other Respir Viruses. 2021 May.

Abstract

Background: Symptoms of mild COVID-19 illness are non-specific and may persist for prolonged periods. Effects on quality of life of persistent poor physical or mental health associated with COVID-19 are not well understood.

Methods: Adults aged ≥18 years with laboratory-confirmed COVID-19 and matched control patients who tested negative for SARS-CoV-2 infection at outpatient facilities associated with 11 medical centers in the United States were interviewed to assess symptoms, illness duration, and health-related quality of life. Duration of symptoms, health-related quality of life measures, and days of poor physical health by symptoms experienced during illness were compared between case patients and controls using Wilcoxon rank-sum tests. Symptoms associated with COVID-19 case status were evaluated by multivariable logistic regression.

Results: Among 320 participants included, 157 were COVID-19 cases and 163 were SARS-CoV-2 negative controls. Loss of taste or smell was reported by 63% of cases and 6% of controls and was strongly associated with COVID-19 in logistic regression models (adjusted odds ratio [aOR] = 32.4; 95% confidence interval [CI], 12.6-83.1). COVID-19 cases were more likely than controls to have experienced fever, body aches, weakness, or fatigue during illness, and to report ≥1 persistent symptom more than 14 days after symptom onset (50% vs 32%, P < .001). Cases reported significantly more days of poor physical health during the past 14 days than controls (P < .01).

Conclusions: Differentiating COVID-19 from other acute illnesses will require widespread diagnostic testing, especially during influenza seasons. Persistent COVID-19-related symptoms may negatively affect quality of life, even among those initially presenting with mild illness.

Keywords: COVID-19; SARS-CoV-2; anosmia; convalescence; quality of life; recovery; symptoms duration.

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Conflict of interest statement

Carlos G. Grijalva reports grants from Campbell Alliance, the National Institutes of Health, the Food and Drug Administration, the Agency for Health Care Research and Quality and Sanofi‐Pasteur, and consultation fees from Pfizer, Merck, and Sanofi‐Pasteur. Christopher J. Lindsell reports grants from National Institutes of Health and the Department of Defense and other support from Marcus Foundation, Endpoint Health, Entegrion, bioMerieux, and Bioscape Digital, outside the submitted work. Nathan I. Shapiro reports grants from the National Institutes of Health, Rapid Pathogen Screening, Inflammatix, and Baxter, outside the submitted work. Daniel J. Henning reports personal fees from CytoVale and grants from Baxter, outside the submitted work. Samuel M. Brown reports grants from National Institutes of Health, Department of Defense, Intermountain Research and Medical Foundation, and Janssen and consulting fees paid to his employer from Faron and Sedana, outside the submitted work. Ithan D. Peltan reports grants from the National Institutes of Health, Asahi Kasei Pharma, Immunexpress Inc, Janssen Pharmaceuticals, and Regeneron, outside the submitted work. Todd W. Rice reports personal fees from Cumberland Pharmaceuticals, Inc, Cytovale, Inc, and Avisa, LLC, outside the submitted work. Adit A. Ginde reports grants from the National Institutes of Health and Department of Defense, outside the submitted work. H. Keipp Talbot reports serving on the Data Safety Monitoring Board for Seqirus. No other potential conflicts of interest were disclosed.

Figures

FIGURE 1
FIGURE 1
Adjusteda odds ratios comparing odds of reported symptoms among COVID‐19 casesb compared with controlsc, July 2020. aAdjusted for race/ethnicity, sex, age, and presence of ≥1 underlying chronic medical condition (at least one of the following underlying chronic medical conditions: cardiac condition, hypertension, asthma, chronic obstructive pulmonary disease (COPD), immunodeficiency, psychiatric condition, diabetes, or obesity). bA COVID‐19 case was laboratory‐confirmed for SARS‐CoV‐2 by reverse transcriptase polymerase chain reaction (RT‐PCR). cControl participants tested negative for SARS‐CoV‐2 infection by RT‐PCR at the same health facilities. Potentially eligible patients were randomly selected in a ratio of 2 controls for each case patient from lists of adults who were tested at outpatient clinics associated with 11 academic medical centers participating in the Influenza Vaccine Effectiveness in the Critically Ill (IVY) Network
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