Presentation and temporal nature of postacute sequelae of SARS-CoV-2 infection in a US national cohort

Mar 11, 2026Brain, behavior, & immunity - health

Symptoms and timing of long-term effects after COVID-19 in a US national group

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Long Covid on OpenScience ↗PubMed ↗DOI ↗

Abstract

At 1 month post-infection, 44% of individuals with a history of SARS-CoV-2 infection reported at least one physical symptom.

47% of infected individuals reported at least one mental health symptom, while 33% reported at least one cognitive symptom.
The prevalence of specific physical, cognitive, and mental health symptoms declined from 1 to 12 months post-infection.
By 12 months, symptom prevalence rates were similar to those of non-infected controls.
Cluster analysis identified persistent symptom groups, including loss of taste and smell, psychosocial symptoms, respiratory and cardiovascular symptoms, and brain fog at 12 months.
Cognitive symptom clusters persisted for up to 6 months post-infection, while mental health clusters were transient.

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BACKGROUND: Postacute Sequelae of SARS-CoV-2 Infection (PASC) is a novel illness emerging from SARS-CoV-2 infection, characterized by the persistence of symptoms beyond resolution of the initial illness. Understanding the phenotypes and trajectory of PASC is critical for diagnosis and development of personalized management approaches for specific PASC syndromes, to ultimately improve quality of life. The aim of this study was to examine the prevalence and duration, and characterize patterns of specific PASC symptoms in a community-based cohort.

METHOD: A non-probabilistic, weighted, cross-sectional survey of 14,964 adults from the US general population from the COVID-19 Outbreak Public Evaluation (COPE) Initiative between March 10, 2022 and June 2, 2022.

RESULTS: At 1-month post-infection, 44% of individuals with a history of SARS-CoV-2 infection reported at least one physical symptom, 47% reported at least one mental health symptom and 33% reported at least one cognitive symptom (14%, 10%, and 17% in controls, respectively). The prevalence of specific physical, cognitive and mental health symptoms declined between 1- and 12-months post-infection, to a prevalence rate similar to non-infected controls by 12 months. Cluster analysis revealed the persistence of symptom groups, with loss of taste and smell, psychosocial symptoms, respiratory and cardiovascular symptoms, and brain fog the most prominent at 12 months. Although cognitive symptom clusters persisted to 6 months post-infection, mental health clusters were transient.

CONCLUSIONS: The prevalence of most common PASC symptoms fell to general population levels within 12 months. Persisting physical and cognitive symptom clusters provide insights into potentially distinct disease pathways, and are essential for guiding clinical management strategies, rehabilitation programs, and public health interventions aimed at mitigating long-term impacts of COVID-19.