Citation
Thaweethai, Tanayott; Jolley, Sarah E.; Karlson, Elizabeth W.; Levitan, Emily B.; Levy, Bruce; McComsey, Grace A.; McCorkell, Lisa; Nadkarni, Girish N.; Parthasarathy, Sairam; & Singh, Upinder, et al. (2023). Development of a Definition of Postacute Sequelae of SARS-CoV-2 Infection. JAMA, 329(22), 1934-1946. PMCID: PMC10214179Abstract
IMPORTANCE: SARS-CoV-2 infection is associated with persistent, relapsing, or new symptoms or other health effects occurring after acute infection, termed postacute sequelae of SARS-CoV-2 infection (PASC), also known as long COVID. Characterizing PASC requires analysis of prospectively and uniformly collected data from diverse uninfected and infected individuals.OBJECTIVE: To develop a definition of PASC using self-reported symptoms and describe PASC frequencies across cohorts, vaccination status, and number of infections.
DESIGN, SETTING, AND PARTICIPANTS: Prospective observational cohort study of adults with and without SARS-CoV-2 infection at 85 enrolling sites (hospitals, health centers, community organizations) located in 33 states plus Washington, DC, and Puerto Rico. Participants who were enrolled in the RECOVER adult cohort before April 10, 2023, completed a symptom survey 6 months or more after acute symptom onset or test date. Selection included population-based, volunteer, and convenience sampling.
EXPOSURE: SARS-CoV-2 infection.
MAIN OUTCOMES AND MEASURES: PASC and 44 participant-reported symptoms (with severity thresholds).
RESULTS: A total of 9764 participants (89% SARS-CoV-2 infected; 71% female; 16% Hispanic/Latino; 15% non-Hispanic Black; median age, 47 years [IQR, 35-60]) met selection criteria. Adjusted odds ratios were 1.5 or greater (infected vs uninfected participants) for 37 symptoms. Symptoms contributing to PASC score included postexertional malaise, fatigue, brain fog, dizziness, gastrointestinal symptoms, palpitations, changes in sexual desire or capacity, loss of or change in smell or taste, thirst, chronic cough, chest pain, and abnormal movements. Among 2231 participants first infected on or after December 1, 2021, and enrolled within 30 days of infection, 224 (10% [95% CI, 8.8%-11%]) were PASC positive at 6 months.
CONCLUSIONS AND RELEVANCE: A definition of PASC was developed based on symptoms in a prospective cohort study. As a first step to providing a framework for other investigations, iterative refinement that further incorporates other clinical features is needed to support actionable definitions of PASC.
URL
http://dx.doi.org/10.1001/jama.2023.8823Reference Type
Journal ArticleYear Published
2023Journal Title
JAMAAuthor(s)
Thaweethai, TanayottJolley, Sarah E.
Karlson, Elizabeth W.
Levitan, Emily B.
Levy, Bruce
McComsey, Grace A.
McCorkell, Lisa
Nadkarni, Girish N.
Parthasarathy, Sairam
Singh, Upinder
Walker, Tiffany A.
Selvaggi, Caitlin A.
Shinnick, Daniel J.
Schulte, Carolin C. M.
Atchley-Challenner, Rachel
Alba, George A.
Alicic, Radica
Altman, Natasha
Anglin, Khamal
Argueta, Urania
Ashktorab, Hassan
Baslet, Gaston
Bassett, Ingrid V.
Bateman, Lucinda
Bedi, Brahmchetna
Bhattacharyya, Shamik
Bind, Marie-Abele
Blomkalns, Andra L.
Bonilla, Hector
Bush, Patricia A.
Castro, Mario
Chan, James
Charney, Alexander W.
Chen, Peter
Chibnik, Lori B.
Chu, Helen Y.
Clifton, Rebecca G.
Costantine, Maged M.
Cribbs, Sushma K.
Davila Nieves, Sylvia I.
Deeks, Steven G.
Duven, Alexandria
Emery, Ivette F.
Erdmann, Nathan
Erlandson, Kristine M.
Ernst, Kacey C.
Farah-Abraham, Rachael
Farner, Cheryl E.
Feuerriegel, Elen M.
Fleurimont, Judes
Fonseca, Vivian
Franko, Nicholas
Gainer, Vivian
Gander, Jennifer C.
Gardner, Edward M.
Geng, Linda N.
Gibson, Kelly S.
Go, Minjoung
Goldman, Jason D.
Grebe, Halle
Greenway, Frank L.
Habli, Mounira
Hafner, John
Han, Jenny E.
Hanson, Keith A.
Heath, James
Hernandez, Carla
Hess, Rachel
Hodder, Sally L.
Hoffman, Matthew K.
Hoover, Susan E.
Huang, Beatrice
Hughes, Brenna L.
Jagannathan, Prasanna
John, Janice
Jordan, Michael R.
Katz, Stuart D.
Kaufman, Elizabeth S.
Kelly, John D.
Kelly, Sara W.
Kemp, Megan M.
Kirwan, John P.
Klein, Jonathan D.
Knox, Kenneth S.
Krishnan, Jerry A.
Kumar, Andre
Laiyemo, Adeyinka O.
Lambert, Allison A.
Lanca, Margaret
Lee-Iannotti, Joyce K.
Logarbo, Brian P.
Longo, Michele T.
Luciano, Carlos A.
Lutrick, Karen
Maley, Jason H.
Marathe, Jai G.
Marconi, Vincent C.
Marshall, Gailen D.
Martin, Christopher F.
Matusov, Yuri
Mehari, Alem
Mendez-Figueroa, Hector
Mermelstein, Robin
Metz, Torri D.
Morse, Richard
Mosier, Jarrod
Mouchati, Christian
Mullington, Janet
Murphy, Shawn N.
Neuman, Robert B.
Nikolich, Janko Z.
Ofotokun, Ighovwerha
Ojemakinde, Elizabeth
Palatnik, Anna
Palomares, Kristy T. S.
Parimon, Tanyalak
Parry, Samuel
Patterson, Jan E.
Patterson, Thomas F.
Patzer, Rachel E.
Peluso, Michael J.
Pemu, Priscilla
Pettker, Christian M.
Plunkett, Beth A.
Pogreba-Brown, Kristen
Poppas, Athena
Quigley, John G.
Reddy, Uma M.
Reece, Rebecca
Reeder, Harrison T.
Reeves, W. B.
Reiman, Eric M.
Rischard, Franz
Rosand, Jonathan
Rouse, Dwight J
Ruff, Adam
Saade, George R.
Sandoval, Grecio J.
Schlater, Shannon M.
Shepherd, Fitzgerald
Sherif, Zaki A.
Simhan, Hyagriv
Singer, Nora G.
Skupski, Daniel W.
Sowles, Amber
Sparks, Jeffrey A.
Sukhera, Fatima I.
Taylor, Barbara S.
Teunis, Larissa
Thomas, Robert J.
Thorp, John M., Jr.
Thuluvath, Paul
Ticotsky, Amberly
Tita, Alan T. N.
Tuttle, Katherine R.
Urdaneta, Alfredo E.
Valdivieso, Daisy
VanWagoner, Timothy M.
Vasey, Andrew
Verduzco-Gutierrez, Monica
Wallace, Zachary S.
Ward, Honorine D.
Warren, David E.
Weiner, Steven J.
Welch, Shelley
Whiteheart, Sidney W.
Wiley, Zanthia
Wisnivesky, Juan P.
Yee, Lynn M.
Zisis, Sokratis
Horwitz, Leora I.
Foulkes, Andrea S.