{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T22:15:11Z","timestamp":1780092911536,"version":"3.54.0"},"posted":{"date-parts":[[2021,3,13]]},"group-title":"Infectious Diseases (except HIV\/AIDS)","reference-count":51,"publisher":"openRxiv","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2021,3,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                <jats:sec>\n                  <jats:title>BACKGROUND<\/jats:title>\n                  <jats:p>As the coronavirus disease 2019 (COVID-19) pandemic continues and millions remain vulnerable to infection with severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), attention has turned to characterizing post-acute sequelae of SARS-CoV-2 infection (PASC).<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>From April 21 to December 31, 2020, we assembled a cohort of consecutive volunteers who a) had documented history of SARS-CoV-2 RNA-positivity; b) were \u2265 2 weeks past onset of COVID-19 symptoms or, if asymptomatic, first test for SARS-CoV-2; and c) were able to travel to our site in San Francisco. Participants learned about the study by being identified on medical center-based registries and being notified or by responding to advertisements. At 4-month intervals, we asked participants about physical symptoms that were new or worse compared to the period prior to COVID-19, mental health symptoms and quality of life. We described 4 time periods: 1) acute illness (0-3 weeks), 2) early recovery (3-10 weeks), 3) late recovery 1 (12-20 weeks), and 4) late recovery 2 (28-36 weeks). Blood and oral specimens were collected at each visit.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>We have, to date, enrolled 179 adults. During acute SARS-CoV-2 infection, 10 had been asymptomatic, 125 symptomatic but not hospitalized, and 44 symptomatic and hospitalized. In the acute phase, the most common symptoms were fatigue, fever, myalgia, cough and anosmia\/dysgeusia. During the post-acute phase, fatigue, shortness of breath, concentration problems, headaches, trouble sleeping and anosmia\/dysgeusia were the most commonly reported symptoms, but a variety of others were endorsed by at least some participants. Some experienced symptoms of depression, anxiety, and post-traumatic stress, as well as difficulties with ambulation and performance of usual activities. The median visual analogue scale value rating of general health was lower at 4 and 8 months (80, interquartile range [IQR]: 70-90; and 80, IQR 75-90) compared to prior to COVID-19 (85; IQR 75-90). Biospecimens were collected at nearly 600 participant-visits.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>CONCLUSION<\/jats:title>\n                  <jats:p>Among a cohort of participants enrolled in the post-acute phase of SARS-CoV-2 infection, we found many with persistent physical symptoms through 8 months following onset of COVID-19 with an impact on self-rated overall health. The presence of participants with and without symptoms and ample biological specimens will facilitate study of PASC pathogenesis. Similar evaluations in a population-representative sample will be needed to estimate the population-level prevalence of PASC.<\/jats:p>\n                <\/jats:sec>","DOI":"10.1101\/2021.03.11.21252311","type":"posted-content","created":{"date-parts":[[2021,3,13]],"date-time":"2021-03-13T12:25:10Z","timestamp":1615638310000},"source":"Crossref","is-referenced-by-count":21,"title":["Rapid implementation of a cohort for the study of post-acute sequelae of SARS-CoV-2 infection\/COVID-19"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0585-6230","authenticated-orcid":false,"given":"Michael J.","family":"Peluso","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Daniel","family":"Kelly","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah A.","family":"Goldberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle C.","family":"Davidson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sujata","family":"Mathur","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew S.","family":"Durstenfeld","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew A.","family":"Spinelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Hoh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viva","family":"Tai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily A.","family":"Fehrman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonel","family":"Torres","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanel","family":"Hernandez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meghann C.","family":"Williams","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mireya I.","family":"Arreguin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer A.","family":"Bautista","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynn H.","family":"Ngo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monika","family":"Deswal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sadie E.","family":"Munter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrique O.","family":"Martinez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khamal A.","family":"Anglin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariela D.","family":"Romero","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline","family":"Tavs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paulina R.","family":"Rugart","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica Y.","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah M.","family":"Sans","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria W.","family":"Murray","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Payton K.","family":"Ellis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin C.","family":"Donohue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan A.","family":"Massachi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob O.","family":"Weiss","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irum","family":"Mehdi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesus","family":"Pineda-Ramirez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex F.","family":"Tang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan","family":"Wenger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa","family":"Assenzio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Yuan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa","family":"Krone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel L.","family":"Rutishauser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabel","family":"Rodriguez-Barraquer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryan","family":"Greenhouse","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John A.","family":"Sauceda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Gandhi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priscilla Y.","family":"Hsue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy J.","family":"Henrich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6371-747X","authenticated-orcid":false,"given":"Steven G.","family":"Deeks","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey N.","family":"Martin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"key":"2021031511251526000_2021.03.11.21252311v1.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2002032"},{"key":"2021031511251526000_2021.03.11.21252311v1.2","doi-asserted-by":"crossref","first-page":"2372","DOI":"10.1056\/NEJMc2010419","article-title":"Clinical Characteristics of Covid-19 in New York City","volume":"382","year":"2020","journal-title":"N Engl J Med"},{"key":"2021031511251526000_2021.03.11.21252311v1.3","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.6775"},{"key":"2021031511251526000_2021.03.11.21252311v1.4","unstructured":"Harding L. \u201cWeird as hell\u201d: the Covid-19 patients who have symptoms for months. The Guardian. 2020.http:\/\/www.theguardian.com\/world\/2020\/may\/15\/weird-hell-professor-advent-calendar-covid-19-symptoms-paul-garner (accessed 7 Mar2021)."},{"key":"2021031511251526000_2021.03.11.21252311v1.5","unstructured":"Chuck E , Edwards E. Doctors couldn\u2019t help these COVID-19 patients with their endless symptoms. So they turned to one another. NBC News. 2020.https:\/\/www.nbcnews.com\/health\/health-news\/doctors-couldn-t-help-these-covid-19-patients-their-endless-n1208116 (accessed 7 Mar2021)."},{"key":"2021031511251526000_2021.03.11.21252311v1.6","unstructured":"Horowitz J. Surviving Covid-19 May Not Feel Like Recovery for Some. The New York Times. 2020.https:\/\/www.nytimes.com\/2020\/05\/10\/world\/europe\/coronavirus-italy-recovery.html (accessed 7 Mar2021)."},{"key":"2021031511251526000_2021.03.11.21252311v1.7","unstructured":"Yong E. COVID-19 Can Last for Several Months. The Atlantic 2020.https:\/\/www.theatlantic.com\/health\/archive\/2020\/06\/covid-19-coronavirus-longterm-symptoms-months\/612679\/ (accessed 7 Mar2021)."},{"key":"2021031511251526000_2021.03.11.21252311v1.8","unstructured":"Yong E. Long-Haulers Are Redefining COVID-19. The Atlantic 2020.https:\/\/www.theatlantic.com\/health\/archive\/2020\/08\/long-haulers-covid-19-recognition-support-groups-symptoms\/615382\/ (accessed 7 Mar2021)."},{"key":"2021031511251526000_2021.03.11.21252311v1.9","doi-asserted-by":"crossref","unstructured":"Davis HE , Assaf GS , McCorkell L , Wei H , Low RJ , Re\u2019em Y , et al. Characterizing Long COVID in an International Cohort: 7 Months of Symptoms and Their Impact. medRxiv Published Online First: 2020.https:\/\/www.medrxiv.org\/content\/10.1101\/2020.12.24.20248802v1.full-text","DOI":"10.1101\/2020.12.24.20248802"},{"key":"2021031511251526000_2021.03.11.21252311v1.10","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.12603"},{"key":"2021031511251526000_2021.03.11.21252311v1.11","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)32656-8"},{"key":"2021031511251526000_2021.03.11.21252311v1.12","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6930e1"},{"key":"2021031511251526000_2021.03.11.21252311v1.13","doi-asserted-by":"publisher","DOI":"10.1186\/s12931-020-01385-1"},{"key":"2021031511251526000_2021.03.11.21252311v1.14","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.202004-324OC"},{"key":"2021031511251526000_2021.03.11.21252311v1.15","doi-asserted-by":"crossref","first-page":"100463","DOI":"10.1016\/j.eclinm.2020.100463","article-title":"Follow-up study of the pulmonary function and related physiological characteristics of COVID-19 survivors three months after recovery","volume":"25","year":"2020","journal-title":"EClinicalMedicine"},{"key":"2021031511251526000_2021.03.11.21252311v1.16","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2020.3557"},{"key":"2021031511251526000_2021.03.11.21252311v1.17","doi-asserted-by":"crossref","first-page":"2330","DOI":"10.1016\/j.jcmg.2020.05.004","article-title":"Cardiac Involvement in Patients Recovered From COVID-2019 Identified Using Magnetic Resonance Imaging","volume":"13","year":"2020","journal-title":"JACC Cardiovasc Imaging"},{"key":"2021031511251526000_2021.03.11.21252311v1.18","doi-asserted-by":"crossref","first-page":"ofaa574","DOI":"10.1093\/ofid\/ofaa574","article-title":"Cytokine and Chemokine Levels in Coronavirus Disease 2019 Convalescent Plasma","volume":"8","year":"2021","journal-title":"Open Forum Infect Dis"},{"key":"2021031511251526000_2021.03.11.21252311v1.19","doi-asserted-by":"publisher","DOI":"10.1097\/00006842-200203000-00008"},{"key":"2021031511251526000_2021.03.11.21252311v1.20","doi-asserted-by":"publisher","DOI":"10.3109\/07853890109002087"},{"key":"2021031511251526000_2021.03.11.21252311v1.21","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.166.10.1092"},{"key":"2021031511251526000_2021.03.11.21252311v1.22","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2008.06.026"},{"key":"2021031511251526000_2021.03.11.21252311v1.23","doi-asserted-by":"publisher","DOI":"10.1185\/135525703125002360"},{"key":"2021031511251526000_2021.03.11.21252311v1.24","doi-asserted-by":"publisher","DOI":"10.1002\/jts.22059"},{"key":"2021031511251526000_2021.03.11.21252311v1.25","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1016\/j.psychres.2016.03.014","article-title":"Investigation of abbreviated 4 and 8 item versions of the PTSD Checklist 5","volume":"239","year":"2016","journal-title":"Psychiatry Res"},{"key":"2021031511251526000_2021.03.11.21252311v1.26","unstructured":"COVID-19 Data and Reports. https:\/\/data.sfgov.org\/stories\/s\/fjki-2fab (accessed 7 Mar2021)."},{"key":"2021031511251526000_2021.03.11.21252311v1.27","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmi.2020.09.052"},{"key":"2021031511251526000_2021.03.11.21252311v1.28","doi-asserted-by":"publisher","DOI":"10.1101\/2021.03.03.21251639"},{"key":"2021031511251526000_2021.03.11.21252311v1.29","doi-asserted-by":"publisher","DOI":"10.1101\/2021.02.26.21252308"},{"key":"2021031511251526000_2021.03.11.21252311v1.30","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m1443"},{"key":"2021031511251526000_2021.03.11.21252311v1.31","doi-asserted-by":"publisher","DOI":"10.1038\/s41586-021-03207-w"},{"key":"2021031511251526000_2021.03.11.21252311v1.32","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-020-03218-5"},{"key":"2021031511251526000_2021.03.11.21252311v1.33","doi-asserted-by":"publisher","DOI":"10.1084\/jem.20202135"},{"key":"2021031511251526000_2021.03.11.21252311v1.34","doi-asserted-by":"crossref","first-page":"1281","DOI":"10.1001\/jamacardio.2020.3551","article-title":"Association of Cardiac Infection With SARS-CoV-2 in Confirmed COVID-19 Autopsy Cases","volume":"5","year":"2020","journal-title":"JAMA Cardiol"},{"key":"2021031511251526000_2021.03.11.21252311v1.35","doi-asserted-by":"crossref","first-page":"103104","DOI":"10.1016\/j.ebiom.2020.103104","article-title":"Persistence of viral RNA, pneumocyte syncytia and thrombosis are hallmarks of advanced COVID-19 pathology","volume":"61","year":"2020","journal-title":"EBioMedicine"},{"key":"2021031511251526000_2021.03.11.21252311v1.36","doi-asserted-by":"publisher","DOI":"10.1038\/s41586-020-2588-y"},{"key":"2021031511251526000_2021.03.11.21252311v1.37","doi-asserted-by":"crossref","first-page":"1623","DOI":"10.1038\/s41591-020-1038-6","article-title":"A dynamic COVID-19 immune signature includes associations with poor prognosis","volume":"26","year":"2020","journal-title":"Nat Med"},{"key":"2021031511251526000_2021.03.11.21252311v1.38","doi-asserted-by":"publisher","DOI":"10.1101\/2020.11.13.20231209"},{"key":"2021031511251526000_2021.03.11.21252311v1.39","doi-asserted-by":"publisher","DOI":"10.1126\/scitranslmed.abd3876"},{"key":"2021031511251526000_2021.03.11.21252311v1.40","unstructured":"Gu SX , Tyagi T , Jain K , Gu VW , Lee SH . Thrombocytopathy and endotheliopathy: crucial contributors to COVID-19 thromboinflammation. Nat Rev Published Online First: 2020.https:\/\/www.nature.com\/articles\/s41569-020-00469-1?elqTrackId=1463b6ba0cd94325a79ebd0e5db4310e"},{"key":"2021031511251526000_2021.03.11.21252311v1.41","doi-asserted-by":"crossref","first-page":"e575","DOI":"10.1016\/S2352-3026(20)30216-7","article-title":"Endotheliopathy in COVID-19-associated coagulopathy: evidence from a single-centre, cross-sectional study","volume":"7","year":"2020","journal-title":"The Lancet Haematology"},{"key":"2021031511251526000_2021.03.11.21252311v1.42","doi-asserted-by":"crossref","first-page":"1881","DOI":"10.1161\/CIRCULATIONAHA.120.050907","article-title":"Endotheliopathy Is Induced by Plasma From Critically Ill Patients and Associated With Organ Failure in Severe COVID-19","volume":"142","year":"2020","journal-title":"Circulation"},{"key":"2021031511251526000_2021.03.11.21252311v1.43","doi-asserted-by":"crossref","first-page":"103182","DOI":"10.1016\/j.ebiom.2020.103182","article-title":"SARS-CoV-2 leads to a small vessel endotheliitis in the heart","volume":"63","year":"2021","journal-title":"EBioMedicine"},{"key":"2021031511251526000_2021.03.11.21252311v1.44","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(20)30937-5"},{"key":"2021031511251526000_2021.03.11.21252311v1.45","doi-asserted-by":"publisher","DOI":"10.1101\/2021.01.27.21250559"},{"key":"2021031511251526000_2021.03.11.21252311v1.46","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.1111\/cts.12805","article-title":"Clinical and Autoimmune Characteristics of Severe and Critical Cases of COVID-19","volume":"13","year":"2020","journal-title":"Clin Transl Sci"},{"key":"2021031511251526000_2021.03.11.21252311v1.47","doi-asserted-by":"publisher","DOI":"10.1101\/2021.01.21.21249176"},{"key":"2021031511251526000_2021.03.11.21252311v1.48","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0241536"},{"key":"2021031511251526000_2021.03.11.21252311v1.49","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.0830"},{"key":"2021031511251526000_2021.03.11.21252311v1.50","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciab103"},{"key":"2021031511251526000_2021.03.11.21252311v1.51","doi-asserted-by":"publisher","DOI":"10.1007\/s13365-021-00954-4"}],"container-title":[],"original-title":[],"link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1101\/2021.03.11.21252311","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T14:09:59Z","timestamp":1768486199000},"score":1,"resource":{"primary":{"URL":"http:\/\/medrxiv.org\/lookup\/doi\/10.1101\/2021.03.11.21252311"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,13]]},"references-count":51,"URL":"https:\/\/doi.org\/10.1101\/2021.03.11.21252311","relation":{"is-preprint-of":[{"id-type":"doi","id":"10.1093\/ofid\/ofab640","asserted-by":"subject"}]},"subject":[],"published":{"date-parts":[[2021,3,13]]},"subtype":"preprint"}}