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Association Between Pre–COVID-19 Symptoms and Illness Duration
TAKE-HOME MESSAGE
- This case–control study found that patients with upper respiratory symptoms (sneezing, rhinorrhea, etc) and underlying comorbidities (such as allergic rhinitis or lung disease) for several weeks prior to a new SARS-CoV-2 infection were more prone to a longer duration of COVID-19 symptoms. These individuals with baseline respiratory symptoms prior to infection tended to be younger and female.
- Although baseline respiratory symptoms correlated with long COVID, it should be noted that the majority of individuals with post-COVID symptoms were asymptomatic prior to infection. This study implies that, in individuals experiencing symptoms even prior to SARS-CoV-2 infection, other etiologies of disease aside from long COVID should be considered.
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND
Some individuals experience prolonged illness after acute coronavirus disease 2019 (COVID-19). We assessed whether pre-infection symptoms affected post-acute COVID illness duration.
METHODS
Survival analysis was performed in adults (n=23 452) with community-managed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection prospectively self-logging data through the ZOE COVID Symptom Study app, at least weekly, from 8 weeks before to 12 weeks after COVID-19 onset, conditioned on presence versus absence of baseline symptoms (4-8 weeks before COVID-19). A case-control study was performed in 1350 individuals with long illness (≥8 weeks, including 906 individuals (67.1%) with illness ≥12 weeks), matched 1:1 (for age, sex, body mass index, testing week, prior infection, vaccination, smoking, index of multiple deprivation) with 1350 individuals with short illness (<4 weeks). Baseline symptoms were compared between the two groups, and against post-COVID symptoms.
RESULTS
Individuals reporting baseline symptoms had longer COVID-related symptom duration (median 15 days versus 10 days for individuals without baseline symptoms) with baseline fatigue nearly doubling duration. Two-thirds (910 (67.4%) of 1350) of individuals with long illness were asymptomatic beforehand. However, 440 (32.6%) had baseline symptoms, versus 255 (18.9%) of 1350 individuals with short illness (p<0.0001). Baseline symptoms doubled the odds ratio for long illness (2.14, 95% CI 1.78-2.57). Prior comorbidities were more common in individuals with long versus short illness. In individuals with long illness, baseline symptomatic (versus asymptomatic) individuals were more likely to be female, younger, and have prior comorbidities; and baseline and post-acute symptoms, and symptom burden, correlated strongly.
CONCLUSIONS
Individuals experiencing symptoms before COVID-19 had longer illness duration and increased odds of long illness. However, many individuals with long illness were well before SARS-CoV-2 infection.
Additional Info
Symptoms before and after COVID-19: a population and case-control study using prospective data
Eur. Respir. J. 2024 Jul 18;64(1)2301853, CH Sudre, M Antonelli, NJ Cheetham, E Molteni, LS Canas, V Bowyer, B Murray, K Rjoob, M Modat, J Capdevila Pujol, C Hu, J Wolf, TD Spector, A Hammers, CJ Steves, S Ourselin, EL DuncanFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.