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COVID-19 Survivors at Increased Risk for Pulmonary Embolism, Respiratory Symptoms


US adults who survived a COVID-19 infection are more likely than individuals who were not infected with COVID-19 to develop incident conditions attributable to the virus.

Patients who were exposed to and infected by SARS-CoV-2 have twice the risk for developing pulmonary embolism or respiratory conditions, according to the latest Morbidity and Mortality Weekly Report, published May 27, 2022.

The researchers utilized electronic health record (EHR) data from March 2020 to November 2021 for US adults to assess the incidence of 26 conditions attributed to long COVID-19. They used the Cerner Real-World Data national deidentified data set.

“As more persons are exposed to and infected by SARS-CoV-2, reports of patients who experience persistent symptoms or organ dysfunction after acute COVID-19 and develop post-COVID conditions have increased,” the authors explained.

Patients were followed for 30 to 365 days after the index encounter and patients diagnosed with COVID-19 (case-patients) were matched with control patients who had no evidence of COVID-19. The controls had a visit in the same month as the matched case-patients. There were 353,164 case-patients (254,345 patients 18-64 years, and 98,819 patients ≥ 65 years) and 1,640,776 control patients (1,051,588 patients 18-64 years, and 589,188 patients ≥ 65 years).

Patients were followed until they developed 1 or more incident conditions or through October 31, 2021. During the study, 38% of case-patients experienced an incidence vs 16% of control patients.

The researchers found:

  • The highest risk was for pulmonary embolism and respiratory symptoms
  • Respiratory symptoms and musculoskeletal pain were the most common incident conditions in both age groups
  • 45.4% of case-patients 65 years or older experienced an incident condition compared with 18.5% of controls in the same age range
  • 1 in 5 COVID-19 survivors in the 18-64 age group and 1 in 4 in the ≥ 65 age group experienced a condition that could be attributed to COVID-19

There was a total of 26 incident conditions the researchers were evaluating, and they found case-patients aged 65 years or older had higher risks vs controls for all 26 conditions. Case-patients aged 18-64 years had higher risks for 22 incident conditions vs controls. Among patients aged 18-64 years there was no significant difference between case-patients and controls for cerebrovascular disease or mental health conditions.

The researchers identified at least 5 limitations to the study, including that given the timeframe the findings might not be representative of patients infected with recent variants of COVID-19, the findings of incident conditions after COVID-19 infection might be biased toward patients seeking care, and the analysis did not factor in vaccination status or other confounding factors.

“Implementation of COVID-19 prevention strategies, as well as routine assessment for post-COVID conditions among persons who survive COVID-19, is critical to reducing the incidence and impact of post-COVID conditions, particularly among adults aged ≥ 65 years,” they wrote.


Bull-Otterson L, Baca S, Saydah S, et al. Post–COVID conditions among adult COVID-19 survivors aged 18–64 and ≥65 Years — United States, March 2020–November 2021. MMWR Morb Mortal Wkly Rep. 2022;71(21);713–717. doi:http://dx.doi.org/10.15585/mmwr.mm7121e1

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