Persistent symptoms and risk factors predicting prolonged time to symptom-free after SARS‑CoV‑2 infection: an analysis of the baseline examination of the German COVIDOM/NAPKON-POP cohort

Research output: Contribution to journalResearch articleContributedpeer-review


  • NAPKON Study Group - (Author)
  • Department of internal Medicine 3
  • Chair of Solid State Electronics
  • Ludwig Maximilian University of Munich
  • Otto von Guericke University Magdeburg
  • University Hospital Schleswig-Holstein Campus Kiel
  • Goethe University Frankfurt a.M.
  • University of Würzburg
  • University Hospital Hamburg Eppendorf
  • Kiel University
  • Institute of Social Pediatrics and Adolescent Medicine
  • Jena University Hospital
  • International Epidemiology Institute
  • Martin Luther University Halle-Wittenberg
  • University of Cologne
  • University Hospital of Würzburg
  • TUD Dresden University of Technology


PURPOSE: We aimed to assess symptoms in patients after SARS-CoV-2 infection and to identify factors predicting prolonged time to symptom-free.

METHODS: COVIDOM/NAPKON-POP is a population-based prospective cohort of adults whose first on-site visits were scheduled ≥ 6 months after a positive SARS-CoV-2 PCR test. Retrospective data including self-reported symptoms and time to symptom-free were collected during the survey before a site visit. In the survival analyses, being symptom-free served as the event and time to be symptom-free as the time variable. Data were visualized with Kaplan-Meier curves, differences were tested with log-rank tests. A stratified Cox proportional hazard model was used to estimate adjusted hazard ratios (aHRs) of predictors, with aHR < 1 indicating a longer time to symptom-free.

RESULTS: Of 1175 symptomatic participants included in the present analysis, 636 (54.1%) reported persistent symptoms after 280 days (SD 68) post infection. 25% of participants were free from symptoms after 18 days [quartiles: 14, 21]. Factors associated with prolonged time to symptom-free were age 49-59 years compared to < 49 years (aHR 0.70, 95% CI 0.56-0.87), female sex (aHR 0.78, 95% CI 0.65-0.93), lower educational level (aHR 0.77, 95% CI 0.64-0.93), living with a partner (aHR 0.81, 95% CI 0.66-0.99), low resilience (aHR 0.65, 95% CI 0.47-0.90), steroid treatment (aHR 0.22, 95% CI 0.05-0.90) and no medication (aHR 0.74, 95% CI 0.62-0.89) during acute infection.

CONCLUSION: In the studied population, COVID-19 symptoms had resolved in one-quarter of participants within 18 days, and in 34.5% within 28 days. Over half of the participants reported COVID-19-related symptoms 9 months after infection. Symptom persistence was predominantly determined by participant's characteristics that are difficult to modify.


Original languageEnglish
Pages (from-to)1679-1694
Number of pages16
Issue number6
Publication statusPublished - Dec 2023

External IDs

PubMedCentral PMC10212223
Scopus 85160410082



  • Adult, Humans, Female, Middle Aged, COVID-19/diagnosis, SARS-CoV-2, Prospective Studies, Retrospective Studies, Risk Factors