Postacute Sequelae of SARS-CoV-2 in University Setting

Megan Landry; Sydney Bornstein; Nitasha Nagaraj; Gary A. Sardon Jr.; Amanda Castel; Amita Vyas; Karen McDonnell; Mira Agneshwar; Alyson Wilkinson; Lynn Goldman


Emerging Infectious Diseases. 2023;29(3):519-527. 

In This Article

Abstract and Introduction


Postacute sequelae of SARS-CoV-2 infection, commonly known as long COVID, is estimated to affect 10% to 80% of COVID-19 survivors. We examined the prevalence and predictors of long COVID from a sample of 1,338 COVID-19 cases among university members in Washington, DC, USA, during July 2021−March 2022. Cases were followed up after 30 days of the initial positive result with confidential electronic surveys including questions about long COVID. The prevalence of long COVID was 36%. Long COVID was more prevalent among those who had underlying conditions, who were not fully vaccinated, who were female, who were former/current smokers, who experienced acute COVID-19 symptoms, who reported higher symptom counts, who sought medical care, or who received antibody treatment. Understanding long COVID among university members is imperative to support persons who have ongoing symptoms and to strengthen existing services or make referrals to other services, such as mental health, exercise programs, or long-term health studies.


It is estimated that 1 in 3 Americans who have SARS-CoV-2 infection will experience symptoms related to postacute sequelae of SARS-CoV-2,[1] also referred to as long COVID (other terms include long-haul coronavirus disease, post–-COVID-19 conditions, or chronic COVID-19).[2] The length of time that a person must experience symptoms to be considered to have long COVID is not universally accepted; definitions range from 28 days to 6 months after acute SARS-CoV-2 infection.[3–7] A recent World Health Organization working group used a Delphi process to conclude that "a post-COVID-19 condition occurs in individuals with a history of probable or confirmed SARS-CoV-2 infection, usually 3 months from the onset of COVID-19 with symptoms that last for at least 2 months and cannot be explained by an alternative diagnosis".[8]

Regardless of a universally agreed upon length of time a person must experience symptoms to be characterized as long COVID, this sequela has been suggested to be the "next national health disaster",[9] and because of discrepancies in symptoms and long-term effects on quality of life, there seem to be more questions than answers. Although long COVID manifests differently in each person, nearly 50 signs and symptoms have been linked to the condition.[10] The most common signs and symptoms are fatigue, shortness of breath, muscle pain, joint pain, headache, cough, chest pain, altered smell, altered taste, and diarrhea.[11] Other reported signs and symptoms include cognitive impairment (known as brain fog), memory loss, palpitations, anxiety, sore throat, sleep disorders, runny nose, sneezing, hoarseness, ear pain, thoughts of self-harm and suicide, seizures, and bladder incontinence,[8,11] as well as cardiac effects, such as myocardial inflammation.[12]

Although some investigators have reported that long COVID occurs at rates that are independent of symptom severity,[11–13] others have found long COVID is more common among patients hospitalized for COVID-19 or those who experienced moderate-to-severe symptoms.[6,11,14–20] However, long COVID has been observed in patients who were asymptomatic[2] or only experienced mild symptoms, and it has been reported that symptoms can fluctuate or relapse.[7–8,21–23] Furthermore, little is known about long COVID signs and symptoms and predictors on a college campus, where most of the population is young and healthy, but among whom potential complications of long COVID could be detrimental to academic learning and overall quality of life.

Long COVID signs and symptoms might vary by sex, age, and initial illness severity. For example, nervous system symptoms such as headaches and dizziness are more common among women, but men are more likely to have musculoskeletal system symptoms such as pain in the muscles or joints and numbness of the limbs.[24] Younger patients have reported more headaches, abdominal symptoms, and anxiety/depression, and older patients were more likely to have breathing difficulties, cognitive symptoms, pain, and fatigue.[19]

Aside from the medical illness long COVID poses, persistent signs and symptoms can negatively affect leisure and work, causing further strain on one's quality of life. Persons who have long COVID frequently experience a substantial reduction or impairment in the ability to engage in preillness levels of occupational, educational, social, or personal activities that persist for >6 months.[14] They might also experience difficulty sticking to daily routines, dealing with stress, getting household tasks done, and caring for/supporting others.[25] Abnormal scores on mental and cognitive health questionnaires have also been observed among patients who have long COVID.[7] Our study builds on the existing knowledge base by examining the prevalence and predictors of long COVID among a sample of university members, including students, faculty, and staff, who tested positive for COVID-19 over an 18-month period.