Association of self-reported COVID-19 infection and SARS-CoV-2 serology results with persistent physical symptoms

1. Persistent physical symptoms during the COVID-19 pandemic was associated with believing to have been infected with SARS-CoV-2, and not associated with laboratory-confirmed infection, apart from persistent anosmia.

Evidence Rating Level: 2 (Good)

Individuals infected with SARS-CoV-2 have a higher risk of persistent physical symptoms, colloquially referred to as “long COVID”. However, it is also possible that these symptoms may have its origin in other causes, as opposed to stemming from COVID-19 infection. This current cross-sectional analysis examined the association between persistent physical symptoms and self-reported belief of COVID-19 infection or serology test results. The hypothesis was that self-belief in having been infected would be associated with persistent symptoms, even when controlling for actual infection. The study population consisted of 26,823 individuals taken from the French CONSTANCES cohort study, consisting of volunteers aged 18 to 69 who responded to annual questionnaires. From May to November 2020, participants received self-sampling serology test kits, and were notified of their results. From December 2020 to January 2021, participants responded to a questionnaire about persistent physical symptoms, including pains and aches, sleep difficulties, sensory symptoms, breathing difficulties, digestive problems, anosmia, and headache. They were also asked if they believed they were infected previously and if this was confirmed by testing, and participants believing they were first infected after serologic testing were excluded. Overall, the prevalence of persistent symptoms ranged from .5% for anosmia to 10.2% for sleep difficulties. 914 participants believed they had a COVID-19 infection before the serology test, 49.6% of which had a positive serology test. After adjustment, a positive belief was associated with greater odds of all symptoms (except for hearing impairment and sleep difficulties) with odds ratios (ORs) ranging from 1.39 (95% CI 1.03-1.86) to 16.37 (95% CI 10.21-26.24). However, a positive serology test was only associated with greater odds for anosmia (OR 2.72, 95% CI 1.66-4.46) and was associated with lower odds for skin problems (OR 0.49, 95% CI 0.29-0.85). There was no significant interaction between belief and serology test, and similar results were present even after adjusting for self-rated health and depressive symptoms. In conclusion, this study showed how, apart from anosmia, persistent physical symptoms during the first months of the COVID-19 pandemic were associated with believing to have been infected, rather than having a lab confirmed infection.

Click to read the study in JAMA Internal Medicine

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