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

Research output: Contribution to journalArticlepeer-review


BACKGROUND: Some individuals experience prolonged illness after acute COVID-19. We assessed whether pre-infection symptoms affected post-COVID illness duration.

METHODS: Survival analysis was performed in adults (n=23 452) with community-managed SARC-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, 906 [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 post-COVID symptom duration (from 10 to 15 days) with baseline fatigue nearly doubling duration. Two-thirds (910 of 1350 [67.4%]) 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 increased the odds ratio for long illness (2.14 [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 have longer illness duration and increased odds of long illness. However, many individuals with long illness are well before SARS-CoV-2 infection.

Original languageEnglish
JournalEuropean Respiratory Journal
Publication statusE-pub ahead of print - 4 Apr 2024


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