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

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

Study: Long COVID in the United States. Image Credit: p.ill.i / ShutterstockStudy: Long COVID in the United States. Image Credit: p.ill.i / Shutterstock

Long-COVID – A Brief 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 most severe pandemics in human history. Unfortunately, a large number of the over 760 million survivors have suffered from persistent COVID-19-like symptoms long after the disease, a condition colloquially referred to as ‘long-COVID.’

Most recent global estimates report over 65 million confirmed long-COVID cases, but given the novelty and lack of public awareness about the condition, this number is almost definitely an underestimate. Research has elucidated that approximately 43% of all COVID-19 patients suffer from one or more long-COVID symptoms. While the disease remains clinically undefined and vague, the World Health Organization (WHO) defines it as 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 United Kingdom and Europe have revealed that Long-COVID symptoms may persist for two years or longer. Patients suffering from the condition are significantly less likely to engage in salaried work, resulting in deficits in the UK and European job markets.

While long-COVID is a novel and poorly understood phenomenon, due in part to it lacking a commonly agreed upon definition, a growing body of research has identified more than 200 symptoms associated with 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.

About the study

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

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

Statistical analyses were mainly descriptive, using the person weight variable (PWEIGHT) for individual weighting against non-response bias. Regression analysis of unweighted data was used to obtain correlations of 1. long-COVID at any time, 2. long-COVID persistence at the time of the survey, and 3. long-COVID with substantial symptoms. All three correlations were coded as binary variables (0,1). Finally, Ordinary Least Squares (OLS) were used to obtain 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 3+ months). Of the 66,349 respondents who reported Long-COVID, 29,839 reported symptoms persisting at 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 people with long-COVID (31%) compared to those who 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 lowest incidence at 11%, while West Virginia reported the highest at 18%. Respondents in the midlife age (47-63) were at higher risk from long-COVID than other age groups. Women were significantly more susceptible to long-COVID compared to men. White Americans reported substantially higher long-COVID prevalence compared to 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 loss of mobility and difficulty in bathing and dressing. Mental impacts included memory loss, reduction in cognitive capacity, and mental health issues such as anxiety and depression. In contrast, participants who survived short COVID reported improvements in well-being, even more so than respondents who never contracted a COVID-19 infection.


The present study investigates the prevalence and impacts of long-COVID in a cohort representative of the American population. Analyses of almost half a million 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).

Journal reference:
Hugo Francisco de Souza

Written by

Hugo Francisco de Souza

Hugo Francisco de Souza is a scientific writer based in Bangalore, Karnataka, India. His academic passions lie in biogeography, evolutionary biology, and herpetology. He is currently pursuing his Ph.D. from the Centre for Ecological Sciences, Indian Institute of Science, where he studies the origins, dispersal, and speciation of wetland-associated snakes. Hugo has received, amongst others, the DST-INSPIRE fellowship for his doctoral research and the Gold Medal from Pondicherry University for academic excellence during his Masters. His research has been published in high-impact peer-reviewed journals, including PLOS Neglected Tropical Diseases and Systematic Biology. When not working or writing, Hugo can be found consuming copious amounts of anime and manga, composing and making music with his bass guitar, shredding trails on his MTB, playing video games (he prefers the term ‘gaming’), or tinkering with all things tech.


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