A cohort study of Americans tested for SARS-CoV-2 infection shows that new-onset shortness of breath, heart rhythm abnormalities, and type 2 diabetes were more common 31 to 150 days after testing positive for COVID-19 than among those with negative results.
The research was published today in JAMA Network Open.
A team led by Centers for Disease Control and Prevention (CDC) researchers examined new signs and symptoms among 144,768 nonhospitalized and 23,933 hospitalized people 20 years and older with a positive COVID-19 test, and 1,227,510 nonhospitalized people with a negative test. Among the 338,024 people younger than 20 years, 25,327 nonhospitalized and 1,338 hospitalized people tested positive, and 260,660 nonhospitalized and 50,699 hospitalized patients had a negative test result.
The team followed the cohorts for 150 days after they were tested for COVID-19. They used aggregated electronic health record data from 40 healthcare systems on patients tested from March to December 2020. The team considered a new diagnosis as an emerging sign or symptom that was absent in the 18 months to 7 days before testing.
People in the younger age-group who tested positive for COVID-19 were older (ages 13 to 19) than those with negative results (49% vs 35%). More people aged 20 and or older (18%) and those younger than 20 years (26%) with positive tests were Hispanic in all care settings than those who tested negative (8% and 14%, respectively).
Those with severe COVID-19 prone to new diagnoses
Of people aged 20 years and older with a positive COVID-19 test, shortness of breath (4.5% nonhospitalized, 10.5% hospitalized, 16.6% ventilated), fatigue (4.2% nonhospitalized, 8.0% hospitalized, 19.8% ventilated), and sleep disorders (3.2% nonhospitalized, 5.6% hospitalized, 10.4% ventilated) were the most common new conditions.
Among the under-20 group with a positive test, change in bowel habits (2.3% nonhospitalized, 6.0% hospitalized), fatigue (1.7% nonhospitalized, 3.5% hospitalized), and shortness of breath (1.8% nonhospitalized, 3.9% hospitalized) were the most common diagnoses.
Hospitalized patients with a positive test result were more likely to report shortness of breath than those who tested negative (20 years and older: prevalence ratio [PR], 1.89; 20 years and older: PR, 1.72). Shortness of breath was also more common among outpatients 20 years or older with a positive COVID-19 test than among those with a negative result (PR, 1.09).
Hospitalized patients aged 20 or older who tested positive for COVID-19 were more likely than those with negative results to report new fatigue (PR, 1.35) and type 2 diabetes (PR, 2.03). Among younger hospitalized patients, type 2 diabetes (PR, 2.14) was more common among those testing positive versus negative, but the difference between them was less than 1%.
The rate of new diagnoses in nonhospitalized people 20 years and older with a positive test result was less than 2%. Among older hospitalized people with a positive result, type 2 diabetes (7.2%), anxiety and depression (4.9%), and uncoordinated movements or trouble walking (2.2%) were the most common new diagnoses.
Among older people ventilated with a positive test, the most common diagnoses were type 2 diabetes (16.7%) and anxiety and depression (9.5%). New peripheral nerve disorders (7.2%), uncoordinated movements or trouble walking (7.3%), and neuromuscular disorders (5.7%) were common among ventilated persons in this group, but these conditions were rare among their nonventilated hospitalized and nonhospitalized peers (2.5% or less).
Increased awareness among clinicians needed
Among the younger age-group with a positive test, anxiety and depression (2.6% nonhospitalized, 4.6% hospitalized) were the most common diagnoses.
Type 2 diabetes and severe obesity were more common in people 20 years or older with a positive result than among those who tested negative in all care settings from 18 months to 7 days before COVID-19 testing. Hospitalized people younger than 20 who tested positive had a higher rate of cancer than those who tested negative (10% vs 6%) during that period.
The authors noted that long COVID symptoms, such as shortness of breath, fatigue, muscle weakness, fatigue, and cognitive dysfunction, as well as diagnoses of new-onset neuropsychiatric illnesses and types 2 diabetes, are well documented. This, however, was the first population-based characterization of these conditions in the United States, they said.
Although new symptoms and conditions after COVID-19 recovery are rare, applying rates of these events to the millions of COVID-19 survivors implies that many might experience new symptoms and conditions after recovery from their initial illness, the researchers said.
"In addition, new symptoms can be long-lasting and involve chronic conditions, such as type 2 diabetes," they wrote. "Increasing awareness of new symptoms and conditions among health care professionals and health systems is paramount to meet the needs of patients with prolonged or chronic sequelae of SARS-CoV-2 infection."