2 MethodsĪ convenience sample of non-hospitalized adults with a first positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) PCR test within the previous 48 h from the Johns Hopkins Health System and their household contacts were prospectively enrolled between 21 April 2020 and 28 October 2021 ( Supplementary Figure 1) ( 7). Here, we examine the association between time to viral RNA clearance from the upper respiratory tract (URT) during acute COVID-19 and specific clinical symptoms of long COVID at 90 or more days from acute COVID-19 illness onset in a cohort of people diagnosed with symptomatic COVID-19 in the outpatient setting. However, few longitudinal studies with well-characterized viral dynamics in the acute phase have assessed the relationship between viral persistence and long COVID symptoms, especially in people with mild to moderate acute COVID-19 who represent typical disease severity in the general population. Viral antigen persistence in tissues may be one mechanism of long COVID ( 5, 6). Among the most common and debilitating symptoms are pain and a lack of mental clarity or problems with concentration, also called “brain fog” ( 3, 4). adults who ever had COVID-19 experienced long COVID symptoms lasting 3 months or longer ( 2). The United States Census Household Pulse Survey of December 2022 estimates that 28% of U.S.

The incidence of long coronavirus disease (COVID) is substantial, even in people who did not require hospitalization for acute COVID-19 ( 1). This work suggests that host-pathogen interactions during the first few weeks after acute COVID-19 onset have an impact on long COVID risk months later. This finding provides evidence that delayed immune clearance of SARS-CoV-2 antigen or greater amount or duration of viral antigen burden in the upper respiratory tract during acute COVID-19 are directly linked to long COVID. The acute viral RNA decay trajectories of participants who did and did not later go on to experience brain fog 90+ days after acute COVID-19 onset were distinct.ĭiscussion: This work indicates that at least two long COVID symptoms - brain fog and muscle pain – at 90+ days from acute COVID-19 onset are specifically associated with prolonged time to clearance of SARS-CoV-2 RNA from the upper respiratory tract during acute COVID-19. Participants reporting higher severity brain fog or muscle pain at 90+ days after acute COVID-19 onset were less likely to have cleared SARS-CoV-2 RNA within 28 days. Results: Self-reported brain fog and muscle pain at 90+ days after acute COVID-19 onset were negatively associated with viral RNA clearance within 28 days of acute COVID-19 onset with adjustment for age, sex, BMI ≥ 25, and COVID vaccination status prior to COVID-19 (brain fog: aRR 0.46, 95% CI 0.22-0.95 muscle pain: aRR 0.28, 95% CI 0.08-0.94). Time from acute COVID-19 illness onset to SARS-CoV-2 RNA clearance greater or less than 28 days was tested for association with the presence or absence of each of 49 long COVID symptoms at 90+ days from acute COVID-19 symptom onset. Each participant indicated the presence and severity of 49 long COVID symptoms at 1-, 3-, 6-, 12-, and 18-months post-COVID-19 diagnosis. Samples were assayed for SARS-CoV-2 using RT-PCR and additional SARS-CoV-2 test results were abstracted from the clinical record. Methods: Seventy-three non-hospitalized adult participants were enrolled within approximately 48 hours of their first positive SARS-CoV-2 RT-PCR test, and mid-turbinate nasal and saliva samples were collected up to 9 times within the first 45 days after enrollment. The role of early viral kinetics in the subsequent development of long COVID is largely unknown, especially in individuals who were not hospitalized for acute COVID-19. Introduction: The incidence of long COVID is substantial, even in people with mild to moderate acute COVID-19.

Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States 3Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Henry M.2Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, United States.1Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States.Antar 1*, Tong Yu 1, Zoe O Demko 1, Chen Hu 2, Jeffrey A.

Brain fog covid vaccine