Study estimates 18 million Americans have long-standing COVID

In a recent study published on medRxiv*preprint server, researchers assessed the prevalence, risk factors, and impact of post-coronavirus disease (COVID) (PCC) or long COVID conditions on daily activities among adults residing in the United States (United States).

PCC or long COVID refers to a diagnosis of new, recurrent, or ongoing clinical findings or symptoms ≥ 4 weeks after COVID 2019 (COVID-19). In the United States, estimates of the prevalence of PCC have been made based on non-population-based sources such as EHRs (electronic health records), cohort studies, and cross-sectional studies with convenience sampling. Additionally, data on PCC risk factors and its effect on daily activities are limited.

Study: The epidemiology of long COVID in American adults two years after the start of the American SARS-CoV-2 pandemic. Image Credit: Dmitry Demidovich/Shutterstock

About the study

In the present population-based, cross-sectional study, researchers assessed the risk factors and prevalence of CCP and the impact of CCP on routine activities in American adults.

A population-based survey was conducted in Spanish and English between June 30 and July 2, 2022 among 3,042 American adults. The prevalence of PCC was estimated by sociodemographic variables, with data adjustments for age and sex, based on questions developed by the UK Office of National Statistics. Potentially eligible individual samples were drawn from 60,126,257 and 105,469,157 landline and mobile numbers, respectively. Additionally, online opt-in panel samples were taken across the country.

Current and previous COVID-19 status was assessed. The prevalence of exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) through July 2022 was estimated to meet current case definitions of COVID-19 or provide affirmative answers for the acquisition of COVID-19 by July 15, 2022. Participants self-reported if they experienced symptoms of PCC such as difficulty concentrating, shortness of breath, and fatigue.

Respondents with ongoing COVID-19 were selected based on their self-reported responses of ≥ 1 positive COVID-19 test report based on healthcare provider-based diagnosis, rapid test for SARS-CoV-2 at home or the presence of COVID-19 symptoms with known close contact with SARS-CoV-2 positive individuals. Additionally, respondents with a history of COVID-19 (prior to June 15, 2022) were identified based on self-reported responses of a positive COVID-19 test report based on a healthcare provider-based diagnosis , the most recently acquired SARS-CoV-2 infection, and a rapid home SARS-CoV-2 test.

The impact of CCP on routine activities was assessed based on participants’ responses such as “not at all; ” Yes a bit ; or yes, a lot.” Respondents were asked about co-morbidities such as diabetes, cancer, obesity, lung diseases such as chronic obstructive pulmonary disease (COPD), liver disorders, cardiovascular disorders, hypertension, organ transplantation and immunosuppressive conditions.

Data was also obtained on participants’ vaccination status. Logarithmic binomial modeling was used to analyze, and standardized prevalence and sex and age-adjusted prevalence ratios (aPR) were estimated. Additionally, a sensitivity analysis was performed based on retrospective selection modeling for gender, age, ethnicity, comorbidities, vaccination status, and insurance.


In the final sample, 62%, 32%, and 6.0% of survey respondents registered from landlines, mobiles, and the online registration panel, respectively, with an overall response rate of 7 .2% for all modalities. Of those with PCC, 44%, 27%, and 29% reported having acquired SARS-CoV-2 infections most recently within the previous six months, six months to one year, and more than two months ago. ‘a year.

A total of 222 respondents (of 3,042, 7.3%) reported PCC, of ​​which 25% said their daily activities were “a lot” affected and 29% had contracted COVID-19 before more than a year. Participants who reported a significant impact of the CCP on their daily lives were over the age of 50 (34%), were non-Hispanic white (34%), and were either unemployed (36%) or earned less than 60 000 (vs. >60,000, 33%, aPR: 2.2).

The standardized prevalence of CCP was highest among respondents ages 25-34 (10%), 35-44 (9.0%), females (9.4%), non-Hispanic whites (8 .7%), with comorbidities (10%), jobs (8.9%), providing an income varying between $20,001 and $60,000 (8.8%) or between $60,001 and $100,000 ( 8.5%).

Gender- and age-adjusted modeling showed that PCC was more prevalent among female respondents (aPR: 1.8), with comorbidities (aPR: 1.6) who were employed (vs. unemployed, aPR: 1.3) and insurance (vs. unknown or no insurance). mutual, tAP: 1.9), and who had not received (vs. had received boosters, tap: 1.7) or were not vaccinated (vs. booster doses administered, tap: 1.4) . In the sensitivity analysis, the effect sizes remained unchanged or were strengthened.

The prevalence of exposure to SARS-CoV-2 in July 2022 was 53%. The sex- and age-standardized prevalence of SARS-CoV-2 exposure was highest in people aged 25-34 years (66%) and decreased with age. In addition, the standardized prevalence of SARS-CoV-2 exposure was higher in Hispanic men (61%) (57%) with comorbidities (60%).

Overall, the study results highlighted the huge PCC burden and considerable variability in the prevalence of SARS-CoV-2. Population-based surveys are essential for CCP surveillance as a complement to ongoing CCP surveillance.

Using a representative sample of the adult population living in the United States, we estimate that approximately 18.5 million adults, or 7.3% (95% CI: 6.1-8.5%) of the US adult population, suffered from long-lasting COVID (symptoms persisting for more than four weeks after the most recent SARS-CoV-2 infection that has not been explained by anything else) during the 2-week study period in June-July 2022.

*Important Notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be considered conclusive, guide clinical practice/health-related behaviors, or treated as established information.

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