Background: Return to work or school following acute COVID-19 infection is a key recovery milestone. Understanding when adults resume their occupational activities has important implications for the US economy and public health response. 

Methods: We examined patterns of returning to work/school among adults with symptomatic COVID-19 who tested SARS-CoV-2 positive within 0-7 days of study enrollment participating in the VISION study, a large prospective cohort of North Carolina residents with SARS-CoV-2. Analyses were restricted to participants who enrolled within 0-7 days after symptom onset and reported at study entry that return to work/school was applicable to them. Participants were asked daily via an online questionnaire (study days 1-14) if they were back at work/school. We estimated the probability of returning to work/school using inverse probability censoring weighted Kaplan-Meier curves. To summarize the timing of return to work/school, we compared 10-day restricted mean survival time (average time not returned) by baseline characteristics, including bivariate analyses of: age, sex, race, ethnicity, body mass index, vaccination recency, prior infection, hybrid immunity, and residential urbanicity. 

Results: Among 2,169 eligible participants enrolled October 2022 to March 2024 (Figure 1), the median age was 43 years (IQR: 34, 54); 35% received their last SARS-CoV-2 vaccine ≤6 months ago, and 54% were experiencing their first known SARS-CoV-2 infection. The estimated probabilities of returning to work/school by day 7 and day 10 after symptom onset were 56% (95% CI 54-58%) and 79% (95% CI 77-81%), respectively (Figure 2A). During the first 10 days after symptom onset, unvaccinated adults with no prior infections had the slowest return, with an average of 9.2 (95% CI 9.0-9.4) days out of work/school (Table 1), whereas those with at least one prior infection or vaccination took an average of 6.4 to 7.1 days to return to school/work. The fastest return was observed among those vaccinated and with prior infection(s). 

Conclusions: Return to work or school occurred within two weeks of symptom onset for most adults in NC. However, unvaccinated people and adults without prior infection took longer to return to school/work. 

Background: Socioeconomic status may be a risk factor in determining the outcomes of COVID-19. We investigated whether there is an association between ZIP Code-level income and acute COVID-19 symptom severity. 

Methods: The VISION study is an observational study of >3,000 participants age 18 years and older living in North Carolina. This preliminary analysis focuses on participants who tested positive for COVID-19 within 7 days prior to enrollment. Participants completed daily online symptom diaries for 14 days after study entry.  Mean income for each VISION participant’s ZIP Code was obtained from 2021 IRS data and linked to their symptom data. We evaluated the association of mean ZIP Code income and COVID-19 symptom severity (absent, mild, moderate, severe) using a proportional odds marginal model fit with generalized estimating equations to compare the odds of experiencing greater symptom severity (e.g., moderate/severe vs. absent/mild) across ZIP Code income levels. We adjusted for age, sex, race and ethnicity, smoking status, prior COVID-19 infection, and COVID-19 vaccination status. Qualitative results are presented while final analyses are completed. 

Results: Estimates revealed a notable association between the mean income of a participant’s ZIP Code and their acute COVID-19 symptom severity. This relationship varied over the first 14 days after symptom onset, with differences in severity between income levels more pronounced in the first several days after symptom onset. 

Conclusions: People in NC residing in ZIP Codes with lower mean income have greater odds of higher severity of COVID-19 acute symptoms.

Background The oral antiviral Nirmatrelvir-ritonavir (Paxlovid, NMV/r) is effective in treating COVID-19 when initiated within 5 days of symptom onset and continued for 5 days in high-risk individuals, but the real-world timing of NMV/r initiation and discontinuation have not been well described.

Methods Within a large prospective, observational study of people in North Carolina with acute COVID-19, we characterized patterns in NMV/r use among symptomatic individuals who tested positive for SARS-CoV-2 within 7 days of study entry between October 2022 and March 2024. We presented the probability of initiating NMV/r from 0 to 14 days after symptom onset and the probability of remaining on NMV/r at 0 to 6 days after initiation, using inverse probability censoring weighted Kaplan-Meier curves. Analyses were conducted overall and stratified by age, sex at birth, self-reported race, ethnicity, vaccination recency, prior infection(s), residential urbanicity, and risk for progression to severe disease. The average time to NMV/r initiation and discontinuation were reported by individual characteristics.

Results Among 3,141 symptomatic participants, the median age was 47 (IQR: 35, 61); 39% received their last SARS-CoV-2 vaccine within the prior 6 months, and 57% were experiencing their first known infection. The estimated probability of initiating NMV/r within 5 days of symptom onset was 0.43 (95% CI: 0.41, 0.44). Participants less likely to initiate NMV/r within 5 days included those who were younger (<65 years of age), female, non-white, Hispanic/Latinx, unvaccinated, or had 3+ prior infections (Figure). Among the 1,243 NMV/r recipients, 7.9% did not complete treatment, and the estimated probability of taking >6 days to finish the full course was 0.10 (95% CI: 0.08, 0.12). The probability of premature discontinuation was similar across groups defined by baseline covariates.

Conclusions Unvaccinated and historically marginalized groups were associated with lower NMV/r use.

Background: Acute Covid19 symptom experiences and predictors of rapid return to health among non-hospitalized adults remain of great interest. We investigated host and disease-associated predictors of return to pre-Covid19 health.

Methods: The VISION study is a prospective observational cohort of adults in North Carolina who tested SARS-CoV2 positive ≤7 days before online study enrollment (accrual period: Oct 2022-Mar2024). This analysis includes adults who enrolled 0-7 days after symptom onset and were previously
vaccinated; unvaccinated adults were excluded due to sample size limitations. Self-reported Covid19 symptoms and return of pre-Covid19 health were collected daily for 14 days. We estimated the probability of experiencing pre-Covid19 health at days 5-14 after symptom onset using a logistic
regression model fit with generalized estimating equations; days since symptom onset was fit via 9 indicators. In our model, we accounted for age (restricted cubic spline), biological sex, race-ethnicity, comorbidities, body mass index, vaccine recency (≤6 vs. >6 months ago), prior infection (0, 1+), and oral SARS-CoV2 medication use.

Results: 2,545 vaccinated adults were eligible for analysis. At baseline, median (IQR) age was 47 (36, 62) years, 74% were women, 43% had prior infection(s), and 58% were vaccinated more than 6 months ago. Within 5 days of symptom onset, 52% started nirmatrelvir-ritonavir or molnupiravir. Return to pre-Covid19 health was reported by 19.6% (95% CI: 18.1-21.1%) at day 7 and 45.1% (43.1-47.0%) at day 14 after symptom onset. Key predictors of pre-Covid19 health during the acute period included days since symptom onset, age, sex, prior infection, and vaccine recency (Figure not included in the online summary).

Conclusions: Most vaccinated adults had not returned to pre-Covid19 health at 14 days after
Covid19 symptom onset. During the acute phase of Covid19, those with hybrid immunity (i.e., both
vaccination and prior infection) were more likely to have return of pre-Covid19 health.