ArticlePloS one2026
Assessment of long COVID symptom burden in patients testing positive for SARS-CoV-2 at a nationwide retail pharmacy.
Article in PloS one, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundNumerous grouping and scoring methodologies have been proposed to assess long COVID symptomatology. One approach is to use symptom count as a simple, quantifiable measure of long COVID symptom burden.
methodsThis was a secondary analysis of a nationwide patient-reported outcomes (PRO) study that recruited symptomatic adults testing positive for SARS-CoV-2 at a Retail Pharmacy in the spring of 2023. EQ-5D-5LTM, work productivity and impairment (WPAI), the Patient-Reported Outcomes Measurement Information System (PROMIS®) fatigue, and a long COVID symptom questionnaire were administered at Week 4, Month 3, and Month 6 after testing. Pre-infection EQ-5D-5L, WPAI, PROMIS fatigue were collected via recall. Cronbach's α assessed internal consistency of symptoms. Scree plots determined number of significant factors (symptoms) to retain for analysis. Spearman correlation coefficients were calculated between number of symptoms and EQ-5D-5L, WPAI, PROMIS fatigue scores and their changes from pre-COVID baseline. Categorization of long COVID burden using number of symptoms was proposed based on scores via equipercentile linking.
resultsOf 505 patients, mean age was 46.3 years, 70.7% were female. Cronbach's α was 0.865, denoting good internal consistency of the symptom survey instrument. The scree plot supported use of one factor for the composite 30-symptom list. Number of symptoms correlated strongly with EuroQol Utility Index (r = -0.53), presenteeism (r = 0.51), activity impairment (r = 0.51) and fatigue (r = 0.56). Statistically significant differences in mean number of symptoms were found between patients with versus those without problems in any of the 5 domains of the EQ-5-dimensional descriptive system. Based on linked PRO scores, subjects could be classified into low (≤2), medium (3-9), and high (≥10) symptom burden.
conclusionsNumber of long COVID symptoms correlated with validated PRO measures and identified three symptom-based categories of long COVID burden. Number of symptoms is a valid and internally consistent measure to assess long COVID burden in outpatient settings.
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