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. 2024 Jun 3;7(6):e2417440.
doi: 10.1001/jamanetworkopen.2024.17440.

Epidemiologic Features of Recovery From SARS-CoV-2 Infection

Elizabeth C Oelsner  1 , Yifei Sun  2 , Pallavi P Balte  1 , Norrina B Allen  3 , Howard Andrews  2 , April Carson  4 , Shelley A Cole  5 , Josef Coresh  6 , David Couper  7 , Mary Cushman  8 , Martha Daviglus  9 , Ryan T Demmer  10 , Mitchell S V Elkind  11   12 , Linda C Gallo  13 , Jose D Gutierrez  11 , Virginia J Howard  4 , Carmen R Isasi  14 , Suzanne E Judd  4 , Alka M Kanaya  15 , Namratha R Kandula  3   16 , Robert C Kaplan  14 , Gregory L Kinney  17 , Anna M Kucharska-Newton  18 , Daniel T Lackland  19 , Joyce S Lee  20 , Barry J Make  21 , Yuan-I Min  22 , Joanne M Murabito  23 , Arnita F Norwood  22 , Victor E Ortega  24 , Kelley Pettee Gabriel  4 , Bruce M Psaty  25 , Elizabeth A Regan  26 , Daniela Sotres-Alvarez  7 , David Schwartz  20 , James M Shikany  27 , Bharat Thyagarajan  28 , Russell P Tracy  29 , Jason G Umans  30 , Ramachandran S Vasan  31 , Sally E Wenzel  32 , Prescott G Woodruff  33 , Vanessa Xanthakis  34   35 , Ying Zhang  36 , Wendy S Post  37
Affiliations

Epidemiologic Features of Recovery From SARS-CoV-2 Infection

Elizabeth C Oelsner et al. JAMA Netw Open. .

Erratum in

  • Error in Figure 2.
    [No authors listed] [No authors listed] JAMA Netw Open. 2024 Jul 1;7(7):e2427640. doi: 10.1001/jamanetworkopen.2024.27640. JAMA Netw Open. 2024. PMID: 39018078 Free PMC article. No abstract available.

Abstract

Importance: Persistent symptoms and disability following SARS-CoV-2 infection, known as post-COVID-19 condition or "long COVID," are frequently reported and pose a substantial personal and societal burden.

Objective: To determine time to recovery following SARS-CoV-2 infection and identify factors associated with recovery by 90 days.

Design, setting, and participants: For this prospective cohort study, standardized ascertainment of SARS-CoV-2 infection was conducted starting in April 1, 2020, across 14 ongoing National Institutes of Health-funded cohorts that have enrolled and followed participants since 1971. This report includes data collected through February 28, 2023, on adults aged 18 years or older with self-reported SARS-CoV-2 infection.

Exposure: Preinfection health conditions and lifestyle factors assessed before and during the pandemic via prepandemic examinations and pandemic-era questionnaires.

Main outcomes and measures: Probability of nonrecovery by 90 days and restricted mean recovery times were estimated using Kaplan-Meier curves, and Cox proportional hazards regression was performed to assess multivariable-adjusted associations with recovery by 90 days.

Results: Of 4708 participants with self-reported SARS-CoV-2 infection (mean [SD] age, 61.3 [13.8] years; 2952 women [62.7%]), an estimated 22.5% (95% CI, 21.2%-23.7%) did not recover by 90 days post infection. Median (IQR) time to recovery was 20 (8-75) days. By 90 days post infection, there were significant differences in restricted mean recovery time according to sociodemographic, clinical, and lifestyle characteristics, particularly by acute infection severity (outpatient vs critical hospitalization, 32.9 days [95% CI, 31.9-33.9 days] vs 57.6 days [95% CI, 51.9-63.3 days]; log-rank P < .001). Recovery by 90 days post infection was associated with vaccination prior to infection (hazard ratio [HR], 1.30; 95% CI, 1.11-1.51) and infection during the sixth (Omicron variant) vs first wave (HR, 1.25; 95% CI, 1.06-1.49). These associations were mediated by reduced severity of acute infection (33.4% and 17.6%, respectively). Recovery was unfavorably associated with female sex (HR, 0.85; 95% CI, 0.79-0.92) and prepandemic clinical cardiovascular disease (HR, 0.84; 95% CI, 0.71-0.99). No significant multivariable-adjusted associations were observed for age, educational attainment, smoking history, obesity, diabetes, chronic kidney disease, asthma, chronic obstructive pulmonary disease, or elevated depressive symptoms. Results were similar for reinfections.

Conclusions and relevance: In this cohort study, more than 1 in 5 adults did not recover within 3 months of SARS-CoV-2 infection. Recovery within 3 months was less likely in women and those with preexisting cardiovascular disease and more likely in those with COVID-19 vaccination or infection during the Omicron variant wave.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Oelsner reported receiving grants from the National Institutes of Health (NIH) during the conduct of the study and outside the submitted work. Dr Sun reported receiving grants from NIH during the conduct of the study. Dr Balte reported receiving grants from the National Heart, Lung, and Blood Institute (NHLBI) during the conduct of the study. Dr Allen reported receiving grants from NHLBI during the conduct of the study. Dr Carson reported receiving grants from NIH during the conduct of the study and from Amgen outside the submitted work. Prof Coresh reported receiving grants from NIH during the conduct of the study. Dr Couper reported receiving grants from NHLBI during the conduct of the study. Dr Cushman reported receiving grants from NIH during the conduct of the study. Dr Daviglus reported receiving grants from NIH during the conduct of the study. Dr Elkind reported receiving nonfinancial support from the Bristol Myers Squibb-Pfizer Alliance outside the submitted work. Dr Howard reported receiving grants from the National Institute of Neurological Disorders and Stroke, NHLBI, and the National Institute on Aging during the conduct of the study. Dr Kandula reported receiving grants from NHLBI during the conduct of the study and a stipend from the American Diabetes Association for service as an associate editor for Diabetes Care. Dr Lee reported receiving grants from NIH and Pliant Therapeutics; and personal fees from Boehringer Ingelheim, United Therapeutics, Blade Therapeutics, AstraZeneca, Eleven P15, and Elima; and medical advisor fees from the Pulmonary Fibrosis Foundation outside the submitted work. Dr Min reported receiving grants from NIH outside the submitted work. Dr Murabito reported receiving grants from NHLBI during the conduct of the study. Dr Ortega reported data monitoring committee membership with Regeneron and Sanofi outside the submitted work. Dr Pettee Gabriel reported receiving grants from NIH outside the submitted work. Prof Psaty reported steering committee membership of the Yale Open Data Access Project funded by Johnson & Johnson. Dr Regan reported receiving grants from NHLBI during the conduct of the study. Dr Schwartz reported receiving grants from the University of Colorado during the conduct of the study. Dr Shikany reported receiving contract fees from the University of Alabama at Birmingham Coronary Artery Risk Development in Young Adults (CARDIA) Study Coordinating Center during the conduct of the study. Dr Thyagarajan reported receiving grants from NIH during the conduct of the study. Dr Tracy reported receiving grants from NIH during the conduct of the study. Dr Umans reported receiving grants from NIH during the conduct of the study. Dr Vasan reported receiving grants from NIH during the conduct of the study. Dr Wenzel reported receiving grants from NIH during the conduct of the study. Dr Woodruff reported receiving consulting fees from Roche, AstraZeneca, Sanofi, and Regeneron outside the submitted work. Dr Zhang reported receiving grants from NIH during the conduct of the study. Dr Post reported receiving grants from NIH during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Trends in Median Time to Recovery After SARS-CoV-2 by Vaccination Status at Time of Infection
WT indicates wild type.
Figure 2.
Figure 2.. Unadjusted Restricted Mean Recovery Time From SARS-CoV-2 Infection
Restricted mean recovery time was calculated from the unadjusted Kaplan-Meier curve for each characteristic, censored at 90 days post infection. Characteristics of participants who had been observed to recover by 90 days were compared with those who had not recovered, or whose follow-up was censored prior to 90 days, by log-rank test. COPD indicates chronic obstructive pulmonary disease; CVD, cardiovascular disease; eGFR, estimated glomerular filtration rate; WT, wild type.
See this image and copyright information in PMC

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