Long-Term Symptoms Among Adults Tested for SARS-CoV-2

United States, January 2020-April 2021

Valentine Wanga, PhD; Jennifer R. Chevinsky, MD; Lina V. Dimitrov, MPH; Megan E. Gerdes, MPH; Geoffrey P. Whitfield, PhD; Robert A. Bonacci, MD; Miriam A.M. Nji, MD; Alfonso C. Hernandez-Romieu, MD; Jessica S. Rogers-Brown, PhD; Tim McLeod, MPH; Julie Rushmore, PhD, DVM; Caitlyn Lutfy, MPH; Dena Bushman, MSN, MPH; Emilia Koumans, MD; Sharon Saydah, PhD; Alyson B. Goodman, MD; Sallyann M. Coleman King, MD; Brendan R. Jackson, MD; Jennifer R. Cope, MD


Morbidity and Mortality Weekly Report. 2021;70(36):1235-1241. 

In This Article


In this convenience sample of U.S. adults, the prevalence of long-term symptoms often associated with SARS-CoV-2 infection was higher among respondents who ever received a positive test result than among those who always received a negative test result, and symptoms in these persons tended to persist for >4 weeks. Previous studies have found that nonhospitalized persons with SARS-CoV-2 infection have higher prevalence of some long-term symptoms or conditions than nonhospitalized persons with negative SARS-CoV-2 test results.[2–5] Similarly, in this investigation, more respondents who received a positive test result (65.9%) than those who received a negative test result (42.9%) experienced any long-term symptoms, and approximately one half of these symptoms were more likely to be reported among those who received a positive test result.

Early data on post-COVID conditions primarily came from hospitalized cohorts;[1,6] more recent reports describe post-COVID conditions among nonhospitalized, asymptomatic, or mildly ill patients.[1,7] The prevalence of the most common long-term symptoms among respondents who received a positive test result in this investigation was similar to that in earlier studies.[1,8] Many studies on post-COVID conditions lack comparisons with the general population of adults with negative test results for SARS-CoV-2; however, this investigation included a comparison group, allowing for assessment of background symptom frequencies. Estimating population-level frequency of specific long-term symptoms among the general population and patients infected with SARS-CoV-2 could help health care professionals better understand the types and prevalences of symptoms their patients might experience and could help guide health systems in preparing care management strategies for patients with post-COVID conditions.

Among respondents who initially reported symptoms during the month of their first positive test results, >75% reported persistence of any symptoms >4 weeks, with hair loss, cognitive dysfunction, shortness of breath, and postexertional malaise persisting in approximately one half of respondents. This finding is consistent with findings from other studies reported in a systematic review[1] and provides patient-level perspective on long-term symptoms associated with COVID-19; taken together, these studies highlight the importance of continued monitoring and clinical care for long-term symptoms among patients who have these symptoms early in the course of their illness.

With the increasing availability of COVID-19 vaccines, how vaccination affects post-COVID conditions remains unclear. Compared with respondents who received a negative test result, a higher proportion of those who received a positive test result believed that receiving a COVID-19 vaccine made their long-term symptoms better, and no difference was found in reported beliefs that receiving a vaccine made long-term symptoms worse. Early findings indicate that vaccination is not associated with worsening of post-COVID conditions§§§.[9] However, because no data were collected on the trajectory of long-term symptoms in persons who had not been vaccinated, whether any of the observed changes in symptoms are attributable to vaccination is uncertain. More data are needed to fully understand the effects of COVID-19 vaccines on persons with post-COVID conditions.

The findings in this report are subject to at least six limitations. First, the study used a nonprobability-based sample, which limits its generalizability. Second, responses were self-reported and thus subject to recall bias. Third, new symptoms occurring after the month when the first positive COVID-19 test result was received among those who received a positive test result were not assessed, and the reported symptoms could not be linked directly to SARS-CoV-2. Fourth, because the survey did not ask about symptom duration or severity, differences in duration or severity of long-term symptoms in respondents who received a positive rather than a negative test result could not be assessed. Fifth, respondents who always received a negative test result generally had a longer period in which to report symptoms, potentially inflating prevalence of their health care use and long-term symptoms. Finally, this study could not assess validity of SARS-CoV-2 tests, and some false-positive or false-negative test results might have resulted in misclassification of some respondents.

These findings can help guide public health preparedness efforts, resource needs for care and management of persons with post-COVID conditions, and communication about experiences with vaccination. The findings can also aid efforts to address post-COVID conditions, including helping health care professionals recognize the most common symptoms and optimize care for patients whose symptoms persist. Future research to assess long-term symptoms and risk factors, including disease severity, disease duration, and sociodemographic characteristics, will be important to help guide current and future health care services.