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. 2025 Jun 4;80(5):1013-1021.
doi: 10.1093/cid/ciae632.

Post-COVID-19 Condition Risk Factors and Symptom Clusters and Associations With Return to Pre-COVID-19 Health-Results From a 2021 Multistate Survey

Stacey L Konkle  1   2   3 , Reed Magleby  1   2   4 , Robert A Bonacci  1   2 , Hannah E Segaloff  1   2   5 , Lina V Dimitrov  1   6 , Parag Mahale  1   2   7 , Bozena Katic  4 , Miriam Nji  1 , Betsy Cadwell  1 , Jean Y Ko  1 , Dena Bushman  1   2 , Julie Rushmore  1   2 , Jennifer Cope  1 , Sharon Saydah  1
Affiliations

Post-COVID-19 Condition Risk Factors and Symptom Clusters and Associations With Return to Pre-COVID-19 Health-Results From a 2021 Multistate Survey

Stacey L Konkle et al. Clin Infect Dis. .

Abstract

Background: Little is known about how symptoms or symptom clusters of post-coronavirus disease 2019 (COVID-19) conditions (PCCs) impact an individual's return to pre-COVID-19 health.

Methods: We used 4 state-level COVID-19 case reporting systems and patient-reported survey data to identify patients with PCCs and associations with an individual's return to pre-COVID-19 health after laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Participants had a positive SARS-CoV-2 test between March 2020 and December 2020. Weighted regression models were used to estimate prevalence of PCCs, identify risk factors associated with developing PCCs, and examine associations between PCC symptom clusters and return to pre-COVID-19 health. Factor analysis was used to identify post-COVID-19 symptom clusters.

Results: Prevalence of PCCs in this population-based sample was 29.9% for persons with SARS-CoV-2 infection during the pre-Delta variant period (March 2020-December 2020); 77.2% of persons who experienced PCCs had not returned to pre-COVID-19 health within 8-60 weeks after infection. Female sex, acute COVID-19 illness severity, and number of preexisting comorbidities were significant risk factors associated with PCCs. Myalgic encephalomyelitis/chronic fatigue syndrome-like symptoms, upper respiratory symptoms, and gastrointestinal symptoms were significantly associated with not returning to pre-COVID-19 health.

Conclusions: Understanding PCC symptom clustering may provide insight into pathophysiology, severity of PCCs, and management for patients who have not returned to their usual state of health after SARS-CoV-2 infection. Tracking PCCs can help measure impacts of COVID-19 vaccination and acute COVID-19-specific treatments on reducing PCCs in the United States.

Keywords: long COVID; post-acute sequelae of SARS-CoV-2 (PASC); post–COVID-19 condition; return to health; symptom clusters.

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