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State-by-state snapshot: Long-COVID’s grip varies, with mental health within the crosshairs

In a recent study published within the journal PLOS One, researchers analyzed data from almost 500,000 Americans to research the national-scale effects of long-COVID. Their results reveal that long-term COVID prevalence varies from state to state – Hawaii has the bottom, with 11 % and West Virginia has the best, with 18%. Long-COVID varied by ethnicity, with White Americans more prone to suffer from the condition in comparison with Blacks and Asians. Contracting long-COVID at any time was strongly correlated with adversarial mental health outcomes in contrast to short COVID, which surprisingly resulted in improved reported well-being than no COVID. Physical well-being showed the same trend, with long-COVID patients and survivors reporting difficulty in movement. Vaccination was found to have positive effects on outcomes in each long- and short-COVID cohorts.

Study: Long COVID in america. Image Credit: poor health.i / Shutterstock

Long-COVID – A Temporary History

The coronavirus disease 2019 (COVID-19) pandemic has infected over 771 million people and resulted in almost 7 million deaths since its emergence in December 2019. This makes it one of the severe pandemics in human history. Unfortunately, a lot of the over 760 million survivors have suffered from persistent COVID-19-like symptoms long after the disease, a condition colloquially known as ‘long-COVID.’

Most up-to-date global estimates report over 65 million confirmed long-COVID cases, but given the novelty and lack of public awareness concerning the condition, this number is nearly definitely an underestimate. Research has elucidated that roughly 43% of all COVID-19 patients suffer from a number of long-COVID symptoms. While the disease stays clinically undefined and vague, the World Health Organization (WHO) defines it because the persistence or development of symptoms three months following the initial COVID-19 diagnosis, lasting two months or longer.

Long-COVID presents a severe detriment to human well-being (quality of life) and socioeconomic loss – studies in the UK and Europe have revealed that Long-COVID symptoms may persist for 2 years or longer. Patients affected by the condition are significantly less likely to have interaction in salaried work, leading to deficits within the UK and European job markets.

While long-COVID is a novel and poorly understood phenomenon, due partially to it lacking a commonly agreed upon definition, a growing body of research has identified greater than 200 symptoms related to the disease. Alarmingly, a majority of long-COVID patients report “dozens of symptoms across multiple organ systems.” Physical and cognitive impairments have been reported across studies, but their incidence and prevalence remain unknown.

In regards to the study

In the current study, researchers first review currently available literature on long-COVID, with a concentrate on reported physical and cognitive impairment as a consequence of the condition. They then use an enormous publicly available United States (US) government dataset to research the prevalence of long-COVID across the country.

Data was obtained from the UN Census Bureau’s Household Pulse Survey (HPS). The HPS is a web-based survey designed to gather information on the consequences of COVID-19 on American lives. Previous research has summarized data from HPS sweeps #1 to #44, so the current study used data from sweeps #46 to #53 comprising records from June 2022 to January 2023. The sample size included on this study was 461,550.

Statistical analyses were mainly descriptive, using the person weight variable (PWEIGHT) for individual weighting against non-response bias. Regression evaluation of unweighted data was used to acquire correlations of 1. long-COVID at any time, 2. long-COVID persistence on the time of the survey, and three. long-COVID with substantial symptoms. All three correlations were coded as binary variables (0,1). Finally, Extraordinary Least Squares (OLS) were used to acquire a compound metric for the negative impacts of COVID-19 on the American population.

Study findings

Study analyses reveal that 46.7% of all respondents suffered from a COVID-19 infection, with 14.4% reporting long-COVID (symptoms of three+ months). Of the 66,349 respondents who reported Long-COVID, 29,839 reported symptoms persisting on the time of survey data collection. Of all COVID-19 survivors, 13.3% said that they suffered from “severe symptoms” of long-COVID. Prevalence was substantially higher for individuals with long-COVID (31%) in comparison with those that experienced short COVID (7%).

Alarmingly, 6.9% of participants reporting long-COVID reported debilitation in normal day-to-day activities. long-COVID prevalence across the US varied by State, age, sex, ethnicity/race, and education status. Hawaii reported the bottom incidence at 11%, while West Virginia reported the best at 18%. Respondents within the midlife age (47-63) were at higher risk from long-COVID than other age groups. Women were significantly more prone to long-COVID in comparison with men. White Americans reported substantially higher long-COVID prevalence in comparison with Black and Asian Americans.

Education and vaccination status substantially reduced the probability of contracting long-COVID, corroborating previous research. Linear regression analyses of the impacts of COVID-19 revealed severe negative effects on the physical and mental well-being of participants reporting long-COVID. Physical consequences included lack of mobility and difficulty in bathing and dressing. Mental impacts included memory loss, reduction in cognitive capability, and mental health issues comparable to anxiety and depression. In contrast, participants who survived short COVID reported improvements in well-being, much more so than respondents who never contracted a COVID-19 infection.


The current study investigates the prevalence and impacts of long-COVID in a cohort representative of the American population. Analyses of virtually half 1,000,000 Americans revealed that about 14% of Americans suffer from persisting effects of the condition. Prevalence was found to differ by location, sex (women higher), age (highest risk at midlife), education status (inversely proportional), race/ethnicity (White higher), and vaccination status (reduced long-COVID risk following vaccination).

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