Symptoms before and after COVID-19: a population and case-control study using prospective data

Carole H Sudre; Michela Antonelli; Nathan J Cheetham; Erika Molteni; Liane S Canas; Vicky Bowyer; Ben Murray; Khaled Rjoob; Marc Modat; Joan Capdevila Pujol; Christina Hu; Jonathan Wolf; Tim D Spector; Alexander Hammers; Claire J Steves; Sebastien Ourselin; Emma L Duncan

doi:10.1183/13993003.01853-2023

Symptoms before and after COVID-19: a population and case-control study using prospective data

Carole H Sudre, Michela Antonelli, Nathan J Cheetham, Erika Molteni, Liane S Canas, Vicky Bowyer, Ben Murray, Khaled Rjoob, Marc Modat, Joan Capdevila Pujol, Christina Hu, Jonathan Wolf, Tim D Spector, Alexander Hammers, Claire J Steves, Sebastien Ourselin, Emma L Duncan

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Abstract

Background 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.

Original language	English
Article number	2301853
Journal	European Respiratory Journal
Volume	64
Issue number	1
DOIs	https://doi.org/10.1183/13993003.01853-2023
Publication status	E-pub ahead of print - 4 Apr 2024

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Sudre, C. H., Antonelli, M., Cheetham, N. J., Molteni, E., Canas, L. S., Bowyer, V., Murray, B., Rjoob, K., Modat, M., Capdevila Pujol, J., Hu, C., Wolf, J., Spector, T. D., Hammers, A., Steves, C. J., Ourselin, S., & Duncan, E. L. (2024). Symptoms before and after COVID-19: a population and case-control study using prospective data. European Respiratory Journal, 64(1), Article 2301853. Advance online publication. https://doi.org/10.1183/13993003.01853-2023

@article{efdb9ecdf8f5438f82c538de2b58350e,

title = "Symptoms before and after COVID-19: a population and case-control study using prospective data",

abstract = "Background 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.",

author = "Sudre, {Carole H} and Michela Antonelli and Cheetham, {Nathan J} and Erika Molteni and Canas, {Liane S} and Vicky Bowyer and Ben Murray and Khaled Rjoob and Marc Modat and {Capdevila Pujol}, Joan and Christina Hu and Jonathan Wolf and Spector, {Tim D} and Alexander Hammers and Steves, {Claire J} and Sebastien Ourselin and Duncan, {Emma L}",

note = "Copyright {\textcopyright}The authors 2024. For reproduction rights and permissions contact [email protected].",

year = "2024",

month = apr,

day = "4",

doi = "10.1183/13993003.01853-2023",

language = "English",

volume = "64",

journal = "European Respiratory Journal",

issn = "0903-1936",

publisher = "European Respiratory Society",

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Sudre, CH , Antonelli, M , Cheetham, NJ , Molteni, E, Canas, LS, Bowyer, V, Murray, B, Rjoob, K, Modat, M, Capdevila Pujol, J, Hu, C, Wolf, J, Spector, TD , Hammers, A , Steves, CJ , Ourselin, S & Duncan, EL 2024, 'Symptoms before and after COVID-19: a population and case-control study using prospective data', European Respiratory Journal, vol. 64, no. 1, 2301853. https://doi.org/10.1183/13993003.01853-2023

TY - JOUR

T1 - Symptoms before and after COVID-19

T2 - a population and case-control study using prospective data

AU - Sudre, Carole H

AU - Antonelli, Michela

AU - Cheetham, Nathan J

AU - Molteni, Erika

AU - Canas, Liane S

AU - Bowyer, Vicky

AU - Murray, Ben

AU - Rjoob, Khaled

AU - Modat, Marc

AU - Capdevila Pujol, Joan

AU - Hu, Christina

AU - Wolf, Jonathan

AU - Spector, Tim D

AU - Hammers, Alexander

AU - Steves, Claire J

AU - Ourselin, Sebastien

AU - Duncan, Emma L

PY - 2024/4/4

Y1 - 2024/4/4

N2 - Background 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.

AB - Background 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.

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U2 - 10.1183/13993003.01853-2023

DO - 10.1183/13993003.01853-2023

M3 - Article

C2 - 38575161

SN - 0903-1936

VL - 64

JO - European Respiratory Journal

JF - European Respiratory Journal

IS - 1

M1 - 2301853

ER -

Symptoms before and after COVID-19: a population and case-control study using prospective data

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