Long COVID and associated outcomes following COVID-19 reinfections: Insights from an International Patient-Led Survey

Long COVID and associated outcomes following COVID-19 reinfections: Insights from an International Patient-Led Survey | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Long COVID and associated outcomes following COVID-19 reinfections: Insights from an International Patient-Led Survey Letícia Soares, Gina Assaf, Lisa McCorkell, Hannah Davis, Alison K. Cohen, and 11 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4909082/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: COVID-19 reinfections are common worldwide. Long COVID is a serious infection-associated chronic condition and a major public health concern. Using a patient-centered approach, we characterized the association between reinfections and Long COVID. Methods: We developed and disseminated internationally a patient-centered online survey examining the outcomes of COVID-19 reinfections. The survey incorporated validated instruments on fatigue, post-exertional malaise, and physical function with questions about COVID-19 infection history, vaccination, and Long COVID symptoms, including symptoms related to immune and reproductive health. We tested whether the likelihood of Long COVID and related outcomes increases with COVID-19 infection numbers. Results: Here we show that reinfections increase the likelihood of reporting Long COVID, which increased 2.1-fold from one to two infections. Among 3,382 participants, 22% reported never having had COVID-19, 42% experienced it once, and 35% reported reinfections. Relative to those who did not report infections or experienced COVID-19 once, reinfections were associated with increased likelihood of severe fatigue, post-exertional malaise, decreased physical function, poorer immune health, symptom exacerbation before menstruation, and multiple other Long COVID symptoms. While vaccinations and boosters prior to infection are associated with lower likelihood of Long COVID, reinfections diminish their protective effect. The probability of reporting Long COVID remission is generally low (11.5%-6.5%). Conclusions: COVID-19 reinfections are associated with higher likelihood of Long COVID and related outcomes. These findings underscore the need for robust public health measures for COVID-19 infection prevention and the importance of considering reinfections in Long COVID research and clinical practice. Health sciences/Medical research/Epidemiology Health sciences/Diseases/Infectious diseases/Viral infection Health sciences/Health care/Public health/Epidemiology Health sciences/Diseases Health sciences/Health care/Public health Full Text Additional Declarations Yes there is potential Competing Interest. LS has received honoraria from consulting for Evidera Inc. in 2024. Supplementary Files SupplementalMaterial1rmMethods.pdf SupplementalMaterial2rmDescriptiveResults.pdf SupplementalMaterial3rmLongCOVIDmodels.pdf SupplementalMaterial4rminstrumentscales.pdf Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4909082","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":346790945,"identity":"8f657842-c65d-4c15-993a-ecdec8fb3f12","order_by":0,"name":"Letícia Soares","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+ElEQVRIiWNgGAWjYBACPiA+wGAA59sAMWPjAXxa2BiYUbSkgbQ0ENSCDA6DSfxa2PsPHvhRYGcv39787MOHP+ft1rYfBtpSYxONUwvPYYaDPQbJiRvOHDOeObPtdvK2M4lALcfSchtwaZFIBjrGgDnBQCLBmJm34Xay2QGgFsaGw7i1yD8Gaam3l5+R/pn5z59zyWbnHxLQIsEM0nKYseFGjjEzA9sBO7MbhGzhSTYA+uU40C9nihl725ITzG4AbUnA4xd+9oOPP/z4Uw0MsfbNDD/+2NmbnU9/+OBDjQ1OLRggEawygVjlIGBPiuJRMApGwSgYGQAAHzRhZIX57AsAAAAASUVORK5CYII=","orcid":"https://orcid.org/0000-0002-6933-8048","institution":"Patient-Led Research Collaborative, Calabasas, CA, USA","correspondingAuthor":true,"prefix":"","firstName":"Letícia","middleName":"","lastName":"Soares","suffix":""},{"id":346790946,"identity":"2ceb9f17-977d-49a3-b1d8-21c9247dba96","order_by":1,"name":"Gina Assaf","email":"","orcid":"","institution":"Patient-Led Research Collaborative, Calabasas, CA, USA","correspondingAuthor":false,"prefix":"","firstName":"Gina","middleName":"","lastName":"Assaf","suffix":""},{"id":346790947,"identity":"cd314d10-8d46-43ac-962b-b9c375a0c7c9","order_by":2,"name":"Lisa McCorkell","email":"","orcid":"https://orcid.org/0000-0002-3261-6737","institution":"Patient-Led Research Collaborative, Calabasas, CA, USA","correspondingAuthor":false,"prefix":"","firstName":"Lisa","middleName":"","lastName":"McCorkell","suffix":""},{"id":346790948,"identity":"e94a81d9-57c3-47f5-b4cd-1e3d30d0a5cc","order_by":3,"name":"Hannah Davis","email":"","orcid":"","institution":"Patient-Led Research Collaborative, Calabasas, CA, USA","correspondingAuthor":false,"prefix":"","firstName":"Hannah","middleName":"","lastName":"Davis","suffix":""},{"id":346790949,"identity":"886b9002-18a5-4740-9ebc-c1d62c13c0b5","order_by":4,"name":"Alison K. 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Long COVID is a serious infection-associated chronic condition and a major public health concern. Using a patient-centered approach, we characterized the association between reinfections and Long COVID.\r\n\r\nMethods:\r\nWe developed and disseminated internationally a patient-centered online survey examining the outcomes of COVID-19 reinfections. The survey incorporated validated instruments on fatigue, post-exertional malaise, and physical function with questions about COVID-19 infection history, vaccination, and Long COVID symptoms, including symptoms related to immune and reproductive health. We tested whether the likelihood of Long COVID and related outcomes increases with COVID-19 infection numbers. \r\n\r\nResults:\r\nHere we show that reinfections increase the likelihood of reporting Long COVID, which increased 2.1-fold from one to two infections. Among 3,382 participants, 22% reported never having had COVID-19, 42% experienced it once, and 35% reported reinfections. Relative to those who did not report infections or experienced COVID-19 once, reinfections were associated with increased likelihood of severe fatigue, post-exertional malaise, decreased physical function, poorer immune health, symptom exacerbation before menstruation, and multiple other Long COVID symptoms. While vaccinations and boosters prior to infection are associated with lower likelihood of Long COVID, reinfections diminish their protective effect. The probability of reporting Long COVID remission is generally low (11.5%-6.5%). \r\n\r\nConclusions:\r\nCOVID-19 reinfections are associated with higher likelihood of Long COVID and related outcomes. These findings underscore the need for robust public health measures for COVID-19 infection prevention and the importance of considering reinfections in Long COVID research and clinical practice.","manuscriptTitle":"Long COVID and associated outcomes following COVID-19 reinfections: Insights from an International Patient-Led Survey","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-09-24 20:42:40","doi":"10.21203/rs.3.rs-4909082/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"56bec400-fbf0-4450-a7ed-ef30c652455c","owner":[],"postedDate":"September 24th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":36777853,"name":"Health sciences/Medical research/Epidemiology"},{"id":36777854,"name":"Health sciences/Diseases/Infectious diseases/Viral infection"},{"id":36777855,"name":"Health sciences/Health care/Public health/Epidemiology"},{"id":36777856,"name":"Health sciences/Diseases"},{"id":36777857,"name":"Health sciences/Health care/Public health"}],"tags":[],"updatedAt":"2024-12-19T18:20:19+00:00","versionOfRecord":[],"versionCreatedAt":"2024-09-24 20:42:40","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4909082","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4909082","identity":"rs-4909082","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}