Symptoms and recovery among adult outpatients with and without COVID-19 at 11 healthcare facilities-July 2020, United States

Influenza Other Respir Viruses. 2021 May;15(3):345-351. doi: 10.1111/irv.12832. Epub 2021 Jan 6.


Background: Symptoms of mild COVID-19 illness are non-specific and may persist for prolonged periods. Effects on quality of life of persistent poor physical or mental health associated with COVID-19 are not well understood.

Methods: Adults aged ≥18 years with laboratory-confirmed COVID-19 and matched control patients who tested negative for SARS-CoV-2 infection at outpatient facilities associated with 11 medical centers in the United States were interviewed to assess symptoms, illness duration, and health-related quality of life. Duration of symptoms, health-related quality of life measures, and days of poor physical health by symptoms experienced during illness were compared between case patients and controls using Wilcoxon rank-sum tests. Symptoms associated with COVID-19 case status were evaluated by multivariable logistic regression.

Results: Among 320 participants included, 157 were COVID-19 cases and 163 were SARS-CoV-2 negative controls. Loss of taste or smell was reported by 63% of cases and 6% of controls and was strongly associated with COVID-19 in logistic regression models (adjusted odds ratio [aOR] = 32.4; 95% confidence interval [CI], 12.6-83.1). COVID-19 cases were more likely than controls to have experienced fever, body aches, weakness, or fatigue during illness, and to report ≥1 persistent symptom more than 14 days after symptom onset (50% vs 32%, P < .001). Cases reported significantly more days of poor physical health during the past 14 days than controls (P < .01).

Conclusions: Differentiating COVID-19 from other acute illnesses will require widespread diagnostic testing, especially during influenza seasons. Persistent COVID-19-related symptoms may negatively affect quality of life, even among those initially presenting with mild illness.

Keywords: COVID-19; SARS-CoV-2; anosmia; convalescence; quality of life; recovery; symptoms duration.

MeSH terms

  • Adult
  • COVID-19 / psychology*
  • Case-Control Studies
  • Female
  • Health Facilities
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Outpatients
  • Quality of Life*
  • SARS-CoV-2*