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Research ArticleOriginal Research

High Prevalence of Both Previous Infection with SARS-CoV-2 and Persistent Symptoms

Mark H. Ebell, David Forgacs, Ye Shen, Ted M. Ross, Cassie Hulme, Michelle Bentivegna, Hannah B. Hanley, Alexandria M. Jefferson and Lauren Hainess
The Journal of the American Board of Family Medicine May 2022, 35 (3) 570-578; DOI: https://doi.org/10.3122/jabfm.2022.03.210348
Mark H. Ebell
From University of Georgia, College of Public Health, Department of Epidemiology and Biostatistics (MHE, YS, CH, MB, LH); University of Georgia, College of Veterinary Medicine, Center for Vaccines and Immunology (DF, TMR, HBH, AMJ); University of Georgia, College of Veterinary Medicine, Department of Infectious Diseases (TMR).
MD, MS
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David Forgacs
From University of Georgia, College of Public Health, Department of Epidemiology and Biostatistics (MHE, YS, CH, MB, LH); University of Georgia, College of Veterinary Medicine, Center for Vaccines and Immunology (DF, TMR, HBH, AMJ); University of Georgia, College of Veterinary Medicine, Department of Infectious Diseases (TMR).
PhD
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Ye Shen
From University of Georgia, College of Public Health, Department of Epidemiology and Biostatistics (MHE, YS, CH, MB, LH); University of Georgia, College of Veterinary Medicine, Center for Vaccines and Immunology (DF, TMR, HBH, AMJ); University of Georgia, College of Veterinary Medicine, Department of Infectious Diseases (TMR).
PhD
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Ted M. Ross
From University of Georgia, College of Public Health, Department of Epidemiology and Biostatistics (MHE, YS, CH, MB, LH); University of Georgia, College of Veterinary Medicine, Center for Vaccines and Immunology (DF, TMR, HBH, AMJ); University of Georgia, College of Veterinary Medicine, Department of Infectious Diseases (TMR).
PhD
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Cassie Hulme
From University of Georgia, College of Public Health, Department of Epidemiology and Biostatistics (MHE, YS, CH, MB, LH); University of Georgia, College of Veterinary Medicine, Center for Vaccines and Immunology (DF, TMR, HBH, AMJ); University of Georgia, College of Veterinary Medicine, Department of Infectious Diseases (TMR).
MPH
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Michelle Bentivegna
From University of Georgia, College of Public Health, Department of Epidemiology and Biostatistics (MHE, YS, CH, MB, LH); University of Georgia, College of Veterinary Medicine, Center for Vaccines and Immunology (DF, TMR, HBH, AMJ); University of Georgia, College of Veterinary Medicine, Department of Infectious Diseases (TMR).
MPH
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Hannah B. Hanley
From University of Georgia, College of Public Health, Department of Epidemiology and Biostatistics (MHE, YS, CH, MB, LH); University of Georgia, College of Veterinary Medicine, Center for Vaccines and Immunology (DF, TMR, HBH, AMJ); University of Georgia, College of Veterinary Medicine, Department of Infectious Diseases (TMR).
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Alexandria M. Jefferson
From University of Georgia, College of Public Health, Department of Epidemiology and Biostatistics (MHE, YS, CH, MB, LH); University of Georgia, College of Veterinary Medicine, Center for Vaccines and Immunology (DF, TMR, HBH, AMJ); University of Georgia, College of Veterinary Medicine, Department of Infectious Diseases (TMR).
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Lauren Hainess
From University of Georgia, College of Public Health, Department of Epidemiology and Biostatistics (MHE, YS, CH, MB, LH); University of Georgia, College of Veterinary Medicine, Center for Vaccines and Immunology (DF, TMR, HBH, AMJ); University of Georgia, College of Veterinary Medicine, Department of Infectious Diseases (TMR).
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Article Figures & Data

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    Appendix Figure 1.

    Receiver Operating Characteristic (ROC) Curve and Dot Plot for Saliva Assay.

Tables

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    Table 1.

    Characteristics of Study Participants with Both Valid Antibody Result and Completed Survey (n = 428)

    Antibody Result (> 61.85 ng/mL)
    Total (n = 428)Positive (n = 145)Negative (n = 283)
    Age
        Mean (SD)20.6 (2.28)20.4 (2.20)20.7 (2.32)
    Sex
        Male133 (31.1%)54 (37.2%)79 (27.9%)
        Female294 (68.7%)91 (62.8%)203 (71.7%)
        Other1 (0.2%)0 (0%)1 (0.4%)
    Race
        Alaska Native/Native American1 (0.2%)0 (0%)1 (0.4%)
        Asian/Pacific Islander21 (4.9%)10 (6.9%)11 (3.9%)
        Black/African American21 (4.9%)4 (2.8%)17 (6.0%)
        White365 (85.3%)125 (86.2%)240 (84.8%)
        Multiracial18 (4.2%)5 (3.4%)13 (4.6%)
        Not Reported2 (0.5%)1 (0.7%1 (0.4%)
    Year in School
        Undergraduate Year 1/2177 (41.4%)64 (44.1%)113 (39.9%)
        Undergraduate Year 3/4/5216 (50.5%)70 (48.3%)146 (51.6%)
        Graduate or Professional35 (8.2%)11 (7.6%)24 (8.5%)
    Housing
        UGA Dormitory117 (27.3%)43 (29.7%)74 (26.1%)
        Fraternity/Sorority House42 (9.8%)13 (9.0%)29 (10.2%)
        Apartment/Condo185 (43.2%)59 (40.7%)126 (44.5%)
        Living at Home with Parents/Guardians21 (4.9%)8 (5.5%)13 (4.6%)
        Rental or Other Home63 (14.7%)22 (15.2%)41 (14.5%)
    Number Sharing Household
        0–2 Roommates197 (46.0%)77 (53.1%)120 (42.4%)
        >2 Roommates217 (50.7%)64 (44.1%)153 (54.1%)
        Missing14 (3.3%)4 (2.8%)10 (3.5%)
    Mask-Wearing Off Campus
        Almost Always230 (53.7%)78 (53.8%)152 (53.7%)
        Sometimes148 (34.6%)53 (36.6%)95 (33.6%)
        Rarely or Never49 (11.4%)14 (9.7%)35 (12.4%)
    Number of Parties/Bars Attended During Fall Semester
        0–1 Time180 (42.1%)53 (36.6%)127 (44.9%)
        2–5 Times109 (25.5%)35 (24.1%)74 (26.1%)
        6–10 Times50 (11.7%)18 (12.4%)32 (11.3%)
        11 or More Times89 (20.8%)39 (26.9%)50 (17.7%)
    At Least One Roommate Positive
        Yes195 (45.6%)79 (54.5%)116 (41.0%)
        No228 (53.3%)63 (43.4%)165 (58.3%)
        Missing5 (1.2%)3 (2.1%)2 (0.7%)
    • Abbreviations: SD, standard deviation.

    • View popup
    Table 2.

    Results of Logistic Regression with Presence of Antibodies (> 61.85 ng/mL) as the Dependent Variable

    Risk FactorUnivariate OR (95% CI)Adjusted OR (95% CI)P*
    Age (years)0.95 (0.87–1.05)0.97 (0.84–1.13)0.698
    Male sex1.53 (1.00–2.34)1.66 (1.03–2.67)0.036
    Non-White race0.93 (0.47–1.82)1.05 (0.49–2.26)0.896
    Year in School
        Undergraduate year 1/2RefRef
        Undergraduate year 3/4/50.85 (0.56-1.29)0.92 (0.46 – 1.82)0.803
        Graduate0.81 (0.37-1.76)0.62 (0.18 – 2.17)0.453
    Housing
        DormitoryRefRef
        Greek0.77 (0.36-1.64)1.08 (0.38 – 3.04)0.884
        Apartment0.81 (0.50–1.31)1.57 (0.70 – 3.50)0.273
        At Home1.06 (0.41-2.76)2.68 (0.87 – 8.22)0.085
        Rental Home0.92 (0.49-1.75)2.24 (0.82 – 6.11)0.117
    Mask-Wearing Off Campus
        Almost alwaysRefRef
        Sometimes1.09 (0.70–1.68)1.01 (0.61 – 1.67)0.968
        Rarely or Never0.78 (0.40–1.53)0.56 (0.26 - −1.20)0.134
    Number of Parties/Bars Attended During Fall Semester
        0–1RefRef
        2–51.13 (0.68–1.89)1.11 (0.63–1.99)0.708
        6–101.35 (0.70–2.61)1.19 (0.55–2.55)0.658
        11+1.87 (1.10–3.17)1.65 (0.86–3.15)0.130
    At Least One Roommate Positive1.78 (1.19–2.68)1.92 (1.18–3.12)0.009
    Number Sharing Housing >20.65 (0.43–0.98)0.41 (0.23–0.72)0.002
    • ↵* For adjusted multiple variable logistic regression.

    • Abbreviations: OR, odds ratio; CI, confidence interval.

    • View popup
    Table 3.

    Characteristics of Participants with Previous Confirmed COVID-19 Infection

    Confirmed COVID-19 (n = 140)
    Symptoms
        Yes122 (87.1%)
        No18 (12.9%)
    Persistent Symptoms
        Yes14 (10.0%)
        No126 (90.0%)
    Number of Days with Persistent Symptoms (n = 14)
        Mean (SD)132 (22.5)
        Median [Min, Max]131 [12, 253]
    • Abbreviations: SD, standard deviation.

    • View popup
    Appendix Table 1.

    Sensitivity and Specificity of Different Antibody Titer Cutoffs for the Diagnosis of Previous Infection With SARS-CoV-2

    Antibody TiterSensitivity (%)95% CISpecificity (%)95% CI
    > 22.9010070.09%–100.0%11.110.5699%–43.50%
    > 39.1610070.09%–100.0%22.223.948%–54.74%
    > 43.2210070.09%–100.0%33.3312.06%–64.58%
    > 44.6210070.09%–100.0%44.4418.88%–73.33%
    > 46.3488.8956.50%–99.43%44.4418.88%–73.33%
    > 49.0688.8956.50%–99.43%55.5626.67%–81.12%
    > 53.9588.8956.50%–99.43%66.6735.42%–87.94%
    > 58.5788.8956.50%–99.43%77.7845.26%–96.05%
    > 61.8588.8956.50%–99.43%88.8956.50%–99.43%
    > 64.4577.7845.26%–96.05%88.8956.50%–99.43%
    > 68.2177.7845.26%–96.05%10070.09%–100.0%
    > 72.8266.6735.42%–87.94%10070.09%–100.0%
    > 77.3255.5626.67%–81.12%10070.09%–100.0%
    > 95.5944.4418.88%–73.33%10070.09%–100.0%
    > 140.633.3312.06%–64.58%10070.09%–100.0%
    > 220.422.223.948%–54.74%10070.09%–100.0%
    > 319.411.110.5699%–43.50%10070.09%–100.0%
    • Abbreviations: CI, Confidence interval.

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The Journal of the American Board of Family Medicine: 35 (3)
The Journal of the American Board of Family Medicine
Vol. 35, Issue 3
May/June 2022
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High Prevalence of Both Previous Infection with SARS-CoV-2 and Persistent Symptoms
Mark H. Ebell, David Forgacs, Ye Shen, Ted M. Ross, Cassie Hulme, Michelle Bentivegna, Hannah B. Hanley, Alexandria M. Jefferson, Lauren Hainess
The Journal of the American Board of Family Medicine May 2022, 35 (3) 570-578; DOI: 10.3122/jabfm.2022.03.210348

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High Prevalence of Both Previous Infection with SARS-CoV-2 and Persistent Symptoms
Mark H. Ebell, David Forgacs, Ye Shen, Ted M. Ross, Cassie Hulme, Michelle Bentivegna, Hannah B. Hanley, Alexandria M. Jefferson, Lauren Hainess
The Journal of the American Board of Family Medicine May 2022, 35 (3) 570-578; DOI: 10.3122/jabfm.2022.03.210348
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