COVID-19 Pandemic
Acute symptoms and return of pre-Covid19 health among vaccinated adults with a SARS-CoV2 infection between 2022-2024 Katie R. Mollan* Katie Mollan Ning Zhang Jessica R. Keys Danyu Lin Becky Straub David Wohl William Fischer
Background: Acute Covid19 symptom experiences and predictors of rapid return to health among non-hospitalized adults remain of great interest. We investigated host and disease-associated predictors of return to pre-Covid19 health.
Methods: The VISION study is a prospective observational cohort of adults in North Carolina who tested SARS-CoV2 positive ≤7 days before online study enrollment (accrual period: Oct 2022-Mar 2024). This analysis includes adults who enrolled 0-7 days after symptom onset and were previously vaccinated; unvaccinated adults were excluded due to sample size limitations. Self-reported Covid19 symptoms and return of pre-Covid19 health were collected daily for 14 days. We estimated the probability of experiencing pre-Covid19 health at days 5-14 after symptom onset using a logistic regression model fit with generalized estimating equations; days since symptom onset was fit via 9 indicators. In our model, we accounted for age (restricted cubic spline), biological sex, race-ethnicity, comorbidities, body mass index, vaccine recency (≤6 vs. >6 months ago), prior infection (0, 1+), and oral SARS-CoV2 medication use.
Results: 2,545 vaccinated adults were eligible for analysis. At baseline, median (IQR) age was 47 (36, 62) years, 74% were women, 43% had prior infection(s), and 58% were vaccinated more than 6 months ago. Within 5 days of symptom onset, 52% started nirmatrelvir-ritonavir or molnupiravir. Return to pre-Covid19 health was reported by 19.6% (95% CI: 18.1-21.1%) at day 7 and 45.1% (43.1-47.0%) at day 14 after symptom onset. Key predictors of pre-Covid19 health during the acute period included days since symptom onset, age, sex, prior infection, and vaccine recency (Figure).
Conclusions: Most vaccinated adults had not returned to pre-Covid19 health at 14 days after Covid19 symptom onset. During the acute phase of Covid19, those with hybrid immunity (i.e., both vaccination and prior infection) were more likely to have return of pre-Covid19 health.
