Association of Initial SARS-CoV-2 Test Positivity With Patient-Reported Well-being 3 Months After a Symptomatic Illness
Authors: Wisk Lauren E. , Gottlieb Michael A. , Spatz Erica S. , Yu Huihui , Wang Ralph C. , Slovis Benjamin H. , Saydah Sharon , Plumb Ian D. , O’Laughlin Kelli N. , Montoy Juan Carlos C. , McDonald Samuel A. , Lin Zhenqiu , Lin Jin-Mann S. , Koo Katherine , Idris Ahamed H. , Huebinger Ryan M. , Hill Mandy J. , Gentile Nicole L. , Chang Anna Marie , Anderson Jill , Hota Bala , Venkatesh Arjun K. , Weinstein Robert A. , Elmore Joann G. , Nichol Graham ,   INSPIRE Group, Santangelo Michelle , Ulrich Andrew , Li Shu-Xia , Kinsman Jeremiah , Krumholz Harlan , Dorney Jocelyn , Stephens Kari A , Black Kari , Morse Dana , Morse Sophie , Fernandes Anoushka , Sharma Abhishek , Stober Tracy , Geyer Rachel E , Lyon Victoria , Adams Karen , Willis Michael , Ruiz Luis , Park Jasmine , Malone Kerry , Shughart Hailey , Schaeffer Kevin W , Shughart Lindsey A , Arab Abir I , Grau Dylan T , Patel Ashini , Watts Phillip B , Kelly Morgan , Hunt Alaina , Hannikainen Paavali , Chalfin Melanie , Cheng David , Miao Jessica , Shutty Carly , Chavez Summer , Kane Arun , Marella Prasen , Gallegos Guillermo D , Martin Katherine R , L'Hommedieu Michelle , Chandler Christopher W , Diaz Roldan Kate , Villegas Nicole , Moreno Raul , Eguchi Megan , Rodriguez Robert , Kemball Robin , Chan Virginia , Chavez Cecilia L , Wong Angela , Hall Aron J , Briggs-Hagen Melissa 
Published: December 2022

Importance

Long-term sequelae after symptomatic SARS-CoV-2 infection may impact well-being, yet existing data primarily focus on discrete symptoms and/or health care use.

Objective

To compare patient-reported outcomes of physical, mental, and social well-being among adults with symptomatic illness who received a positive vs negative test result for SARS-CoV-2 infection.

Design, Setting, and Participants

This cohort study was a planned interim analysis of an ongoing multicenter prospective longitudinal registry study (the Innovative Support for Patients With SARS-CoV-2 Infections Registry [INSPIRE]). Participants were enrolled from December 11, 2020, to September 10, 2021, and comprised adults (aged ≥18 years) with acute symptoms suggestive of SARS-CoV-2 infection at the time of receipt of a SARS-CoV-2 test approved by the US Food and Drug Administration. The analysis included the first 1000 participants who completed baseline and 3-month follow-up surveys consisting of questions from the 29-item Patient-Reported Outcomes Measurement Information System (PROMIS-29; 7 subscales, including physical function, anxiety, depression, fatigue, social participation, sleep disturbance, and pain interference) and the PROMIS Short Form–Cognitive Function 8a scale, for which population-normed T scores were reported.

Exposures

SARS-CoV-2 status (positive or negative test result) at enrollment.

Main Outcomes and Measures

Mean PROMIS scores for participants with positive COVID-19 tests vs negative COVID-19 tests were compared descriptively and using multivariable regression analysis.

Results

Among 1000 participants, 722 (72.2%) received a positive COVID-19 result and 278 (27.8%) received a negative result; 406 of 998 participants (40.7%) were aged 18 to 34 years, 644 of 972 (66.3%) were female, 833 of 984 (84.7%) were non-Hispanic, and 685 of 974 (70.3%) were White. A total of 282 of 712 participants (39.6%) in the COVID-19–positive group and 147 of 275 participants (53.5%) in the COVID-19–negative group reported persistently poor physical, mental, or social well-being at 3-month follow-up. After adjustment, improvements in well-being were statistically and clinically greater for participants in the COVID-19–positive group vs the COVID-19–negative group only for social participation (β = 3.32; 95% CI, 1.84-4.80; P &amp;lt; .001); changes in other well-being domains were not clinically different between groups. Improvements in well-being in the COVID-19–positive group were concentrated among participants aged 18 to 34 years (eg, social participation: β = 3.90; 95% CI, 1.75-6.05; P &amp;lt; .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 &amp;lt; .001).

Conclusions and Relevance

In this study, participants in both the COVID-19–positive and COVID-19–negative groups reported persistently poor physical, mental, or social well-being at 3-month follow-up. Although some individuals had clinically meaningful improvements over time, many reported moderate to severe impairments in well-being 3 months later. These results highlight the importance of including a control group of participants with negative COVID-19 results for comparison when examining the sequelae of COVID-19.