Adults with and Without COVID-19 Report Similar Negative Effects on Wellbeing 3 Months After Illness

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Adults with post–COVID-19 conditions, most frequently referred to as long COVID, experienced similar negative effects on their mental, physical, and social wellbeing as those reported by COVID-19-negative persons with preexisting conditions 3 months after a symptomatic illness, according to new research.

The 1000-participant study published in JAMA Network Open found that approximately 40% of participants in the COVID-19-positive arm and 54% of those in the COVID-19-negative group reported moderate-to-severe residual symptoms 3 months after enrolling in the multisite study.

“Many diseases, including COVID, can lead to symptoms negatively impacting one’s sense of well-being lasting months after initial infection, which is what we saw here,” said lead author Lauren Wisk, PhD, assistant professor of medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California at Los Angeles (UCLA), in a UCLA Health press release. “Because these changes look similar for COVID-negative and COVID-positive participants, this suggests the experience of the pandemic itself, and related stress, may be playing a role in slowing peoples’ recovery from any illness.”

Between December 11, 2020, and September 10, 2021, Wisk and colleagues enrolled persons aged ≥18 years with acute symptoms suggestive of SARS-CoV-2 infection from the US Centers for Disease Control and Prevention-funded Innovative Support for Patients With SARS-CoV-2 Infections Registry (INSPIRE) study. INSPIRE is an ongoing multicenter prospective longitudinal registry study enrolling persons with acute symptoms suggestive of COVID-19 in 8 sites across the US.

The current analysis included the first 1000 persons who completed baseline and 3-month follow-up surveys consisting of questions from the 29-item Patient-Reported Outcomes Measurement Information System (PROMIS-29) and the PROMIS Short Form–Cognitive Function 8a scale, for which population-normed T scores were reported. PROMIS-29 consists of 7 subscales, including physical function, anxiety, depression, fatigue, social participation, sleep disturbance, and pain interference, according to researchers.

Among the final study population, 40.7% were aged 18-34 years, 66.3% were women, 84.7% were non-Hispanic, 70.3% identified as White, 51.5% were married or living with a partner, and 67.6% were privately insured.

Results

Researchers observed that among the total study population, 722 (72.2%) participants received a positive COVID-19 result and 278 (27.8%) received a negative result. Overall, 39.6% of participants who were COVID-19-positive and 53.5% of the COVID-19-negative group described moderate-to-severe decrements in their physical, mental, or social wellbeing at 3 months after enrollment.

After adjustment, improvements in wellbeing were statistically and clinically greater for adults in the COVID-19-positive group compared with those in the COVID-19-negative group only for social participation (β=3.32; 95% CI, 1.84-4.80; P<.001); changes in other well-being domains were not clinically different between groups, noted investigators.

Improvements in wellbeing among adults who were COVID-19-positive were concentrated among those aged 18 to 34 years (eg, social participation: β=3.90; 95% CI, 1.75-6.05; P<.001) and those who presented for COVID-19 testing in an ambulatory setting (eg, social participation: β=4.16; 95% CI, 2.12-6.20; P<.001).

“We found that, as far as well-being is concerned, COVID-positive and COVID-negative groups look more similar than different, but both still have worse well-being scores than the general population,” said Wisk.

A limitation to the study was the lack of clarity regarding which heterogeneous acute condition (eg, bacterial pneumonia, respiratory syncytial virus, or streptococcal pharyngitis) participants with symptomatic illness who tested negative may have been experiencing at the time of enrollment, making it difficult to hypothesize whether COVID-19–negative participants would be expected to have more severe or less severe patient-reported outcomes across time. Also, while the team aimed to recruit a diverse population, the population sample may have been biased due to the requirement for access to a verifiable COVID-19 test, existing electronic health record system, and internet-enabled devices to administer study components. The participants were recruited through September 2021, so the results may be inapplicable to subsequent COVID-19 variants.

With that said, these results underscore the importance of comparing persons who are COVID-19-positive and negative to analyze the impact of SARS-CoV-2 infection on the general population.

“Researchers and doctors now have a better understanding of well-being outcomes related to COVID-19 as a result of this study,” said cosenior author Joann Elmore, MD, MPH, assistant professor of medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, UCLA, in the press release. “The findings highlight the potential widespread impact of the pandemic on our overall health, including the lesser-tracked emotional, social, and mental aspects, alongside the highly recognized physical effects.”

Reference: Wisk LE, Gottlieb MA, Spatz ES, et al. Association of initial SARS-CoV-2 test positivity with patient-reported well-being 3 months after a symptomatic illness. JAMA Netw Open. 2022;5:e2244486. doi:10.1001/jamanetworkopen.2022.44486