Matthew J. Gold, OMS-III; Marshall Johnson, OMS-III; Alexandra Mathis, OMS-II; Shaheen Mehrara, OMS-III; ‎Daniel Ruiz, OMS-IV; Caroline Houston, OMS-III; Jonathan Kalenik, OMS-III; Mayra Rodriguez, PhD, MPH

Author Affiliations

‎· Mayra Rodriguez, PhD, MPH, Edward Via College of Osteopathic Medicine – Auburn Campus

‎· Matthew J. Gold, OMS-III, Edward Via College of Osteopathic Medicine – Auburn Campus

‎· Marshall Johnson, OMS-III, Edward Via College of Osteopathic Medicine – Auburn Campus

‎· Alexandra Mathis, OMS-II, Edward Via College of Osteopathic Medicine – Auburn Campus

‎· Shaheen Mehrara, OMS-III, Edward Via College of Osteopathic Medicine – Auburn ‎Campus

· Daniel Ruiz, OMS-IV, Edward Via College of Osteopathic Medicine – Auburn ‎Campus

‎· Caroline Houston, OMS-III, Edward Via College of Osteopathic Medicine – Auburn Campus

‎· Jonathan Kalenik, OMS-III, Edward Via College of Osteopathic Medicine – Auburn Campus ‎

Financial Disclosures

None reported.‎


None reported.‎

Ethical Approval

The following study received IRB approval on 10/25/2021 by Edward Via College of Osteopathic Medicine ‎‎(VCOM) IRB review board. IRB approval number: 1751555-4.‎

Informed Consent

All participants in this study were provided with informed consent prior to being presented with the survey ‎questions used for data collection.‎

Correspondence Address

Address correspondence to Mayra Rodriguez, PhD, MPH, Edward Via College of Osteopathic Medicine – Auburn Campus, 910 S Donahue Rd, Auburn, AL 36832. Email:‎

Author Contributions

Matthew J. Gold, OMS-III; Marshall Johnson, OMS-III; Shaheen Mehrara, OMS-III; Daniel Ruiz, OMS-IV; Jonathan ‎Kalenik, OMS-III; Caroline Houston, OMS-III; Alexandra Mathis, OMS-II; and Mayra Rodriguez, PhD, MPH ‎provided substantial contributions to conception and design, acquisition of data, or analysis and interpretation ‎of data. Matthew J. Gold, OMS-III and Marshall Johnson, OMS-III drafted the article or revised it critically for ‎important intellectual content. Mayra Rodriguez, PHD, MPH gave final approval of the version of the article to ‎be published; and all authors agree to be accountable for all aspects of the work in ensuring that questions ‎related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.‎


We would like to thank Dr. Mayra Rodriguez, Ph.D. for assisting and supporting this study. We also thank the ‎Edward Via College of Osteopathic Medicine (VCOM) for the opportunity to present the abstract of this study at ‎their 5th Annual Research Recognition Day at the VCOM-Auburn campus.‎


Context: There is little known about the lingering side effects of COVID-19 infection, and much of what is known ‎has only been studied in older populations [1-3].‎

Objective: The objectives of this project strive to assess the most common lingering COVID-19 symptoms ‎defined as greater than or equal to 4 weeks post-infection among young adults ages 18-30. In addition, ‎duration of lingering symptoms will be examined between different races, genders, and medical history.‎

Methods: The following study received IRB approval by the VCOM IRB review board on October 25th, 2021 with ‎the IRB approval number: 1751555-4. Participants (n = 138) completed a quantitative survey which included ‎profile questions that were used in a descriptive analysis to evaluate what correlations exist between ‎demographics and lingering COVID-19 symptoms. Measures include the comparison between social factors (i.e., ‎employment status), genders, and race, specifically Hispanics versus non-Hispanics, with the longevity of the ‎lingering COVID-19 symptoms (i.e., anosmia, fatigue, etc.) lasting greater than or equal to 4 weeks.‎

Results: The results revealed the top-five most common lingering symptoms in descending order: anosmia and ‎ageusia (47 respondents), fatigue (17 respondents), chest pain (8 respondents), headaches (7 respondents) and ‎cough (6 respondents). After comparing lingering symptoms between males and females, the data revealed that ‎males may be more likely to experience lingering symptoms compared to females. Interestingly, both males and ‎females reported that fatigue was the most common prominent symptom during initial infection, with anosmia ‎and ageusia still remaining the most common lingering symptoms. When reviewing participants (126 ‎individuals) with any medical history (i.e., allergies, asthma, anxiety, HTN, etc.) and participants (12 individuals) ‎without medical history in the study, it was calculated that participants with any medical history seemed to be ‎more likely to experience lingering COVID-19 symptoms compared to those without medical history. When ‎comparing non-Hispanic and Hispanic responses, 5 Hispanic respondents out of 24 reported anosmia and ‎ageusia lasting 4 weeks or greater compared to 27 non-Hispanic respondents out of 111 also experiencing ‎anosmia and ageusia lasting 4 weeks or greater. Further studies are needed to assess the associations of ‎lingering COVID-19 symptoms between Hispanic status and non-Hispanic status.‎

Conclusion: There are several other comparisons to be included comparing different genders, social factors, etc. ‎This study was certainly limited by being self-surveyed which creates drawbacks to the study, as researchers did ‎not confirm that those who completed a survey met the two criteria (tested positive via PCR or rapid antigen ‎and age requirements 18-30 years old). The largest barrier faced was maintaining IRB compliance while also ‎recruiting an adequate level of participants to meet the study criteria. The researchers held the ethical ‎standard in abiding by IRB conduct.‎


COVID-19 has become notorious for leaving unexplained symptoms months after initial infection. ‎While there have been many studies that look at the “long haul COVID-19 symptoms” [4-6], few focus on the younger ‎population [1-3]. This study breaks down a population between the ages of 18 to 30 even further. Within this ‎age group, the study will analyze the different symptoms and those more likely to experience lingering ‎symptoms between male and female, medical history versus no medical history, the difference in lingering ‎symptoms between Hispanics versus non-Hispanics, and the perception this age group has on key topics that ‎influence transmission. The broad goal of this study is to create data that will help public health officials and ‎providers prepare for lingering symptoms post-COVID-19 and to understand the perception this group has on ‎public health guidelines and efforts to prevent transmission.‎

There is little known about the lingering COVID-19 symptoms among young adults [1-3]. Commonly‎ referred to as “long-haulers”, the population have an array of symptoms that have lasted for weeks, months, ‎and now over a year [4-6]. These “long-haulers” have an average age of 40 years old [5-6]. This study ‎investigates young adults between 18 to 30 years old to analyze the lingering COVID-19 symptoms if present. ‎Currently, there is limited evidence on the medical and psychological effects of the post-infection lingering ‎COVID-19 symptoms concerning the young adult population, as well as between various differentiations ‎between groups of ethnicities and races [7-12].‎

This research began with a baseline of knowledge regarding symptoms of adults older than 30, ‎children younger than 30, and pregnant women who all fell outside of the participants recruited for this project. An ‎analysis published in November of 2020 with 400,000 participants studied the symptoms of pregnant women ‎aging from 15-44 years of age [14]. It resulted in a finding that “pregnant women might be at increased risk for ‎severe illness associated with coronavirus disease 2019” [14]. Another meta-analysis of 213 studies was ‎published in June of 2021 researching the infection and transmission rate in children less than 18 year of age ‎‎[15]. It concluded a “limited number of household transmission” due to children less than 18 years of age, ‎however it failed to outline symptoms of the infected children [15]. Another prospective cohort study of ‎‎258,790 participants published in October of 2021 pooled data on symptoms and duration of children between ‎the ages of 5 to 17 [16]. It resulted with “the most common symptoms being headache (1079 [62·2%] of 1734 ‎children) and fatigue (954 [55·0%] of 1734 children)” [16]. This gave direction for symptoms to address in the ‎current study, however it failed to research participants between the ages of 18-30. Lastly, a prevalence study ‎of 2,299,666 child COVID-19 cases was published in March of 2021 which researched susceptibility of ‎adolescents from the ages of 10 to 24 [17]. It resulted in a “significantly greater” prevalence of COVID-19 ‎diagnosis for adolescents which was “contrary to previous findings that adolescents are less susceptible than ‎older adults” [17]. This directed the project to target specific symptoms in adolescents and target the ‎population aged between 18 to 30 years old.‎ Our psychosocial questionnaire took root after a systematic review of 30 studies was published in July ‎of 2020 [13]. The study resulted in a “COVID-19 vaccination intention during the first year of the pandemic ‎ranging from 27.7% to 93.3%” [13]. This highlighted a perception of hesitancy towards vaccination, which in turn ‎allowed us to target participants from the ages of 18 to 30 regarding this same topic.‎

Our objective was to understand the prevalence of COVID-19 symptoms in young adults during active‎ infection and, of these symptoms, which tend to linger for weeks, months or years post-infection. We strived to ‎compare the difference in prevalence and nature of lingering symptoms based on sex, past medical history, and ‎race. We also intended to assess the psychosocial understanding and general public perception of the COVID-19 ‎pandemic, including vaccinations, masks, legislation and mandates, politics, and media coverage [6-7].‎


The following study received IRB approval by the VCOM IRB review board on October 25th, 2021 with the IRB approval number: 1751555-4. Participants (n=138) ages 18-30 who tested positive for COVID-19 via PCR or ‎rapid antigen testing were asked to complete a survey. The survey asked participants to identify themselves ‎based on age, race, gender identity, education level, employment status, weight, and pre-existing conditions. ‎Questions were asked regarding how and when the participants tested positive for COVID-19, what symptoms ‎they experienced during the initial infection, which of those symptoms lingered beyond the initial infection, ‎whether or not they were vaccinated, and the degree of medical care they received during their illness. ‎Participants were also asked some questions regarding their opinions of government response to the ‎pandemic, media coverage of the pandemic, masking, vaccine mandates, and other social and public health ‎aspects surrounding the COVID-19 pandemic [6-7]. Participants were sourced via social media distribution; ‎researchers advertised the survey on their Facebook, Twitter, Instagram, and Snapchat accounts and asked those aged 18-30 who had tested positive for ‎COVID-19 to respond. No participant was contacted individually. The full-length survey that was provided to ‎participants is included below.


When comparing lingering symptoms between males and females, it has been shown that 4 males out ‎of 35 and 9 females out of 100 experienced lingering symptoms. However, the statistical significance of males ‎to females experiencing lingering symptoms was not significant. The P-Value is 0.345 which shows the ‎difference between genders is not statistically significant. Interestingly, both males and females reported that ‎fatigue, loss of taste and loss of smell were the most prominent symptoms they experienced initially; men ‎reported loss of taste more while women reported fatigue more as their most prominent symptom. ‎Furthermore, anosmia and ageusia still remain the most common lingering symptoms in both groups with most ‎reporting the time of these lingering symptoms to be 2-4 weeks versus 7-14 days of fatigue and 3-5 days of ‎muscle or body aches. There were 100 females and 35 males who participated in the survey (3 participants did ‎not reveal gender) which may have been due to women’s increased level of health consciousness or due to the ‎differences in desire to participate in a study involving one’s health status.‎

When reviewing 126 individuals with any medical history (i.e., allergies, asthma, anxiety, HTN, etc.) ‎and 12 individuals without medical history in the study, it was calculated that participants with any medical ‎history seemed to be more likely to experience lingering COVID-19 symptoms compared to those without ‎medical history. Those with allergies (unspecified) in their past medical history seemed to experience lingering ‎COVID-19 symptoms more than other medical histories. Participants with allergies most commonly reported ‎anosmia and ageusia for lingering symptoms. Another observation, individuals with depression reported ‎anosmia and ageusia most commonly for lingering symptoms as well. Interestingly, when comparing those ‎with asthma (19 respondents) and without asthma (119 respondents), those with asthma may be more likely ‎to experience lingering symptoms compared to those without asthma. Participants with asthma also most ‎commonly reported anosmia and ageusia for lingering symptoms (Figures 1-5).‎

The top-five most common lingering symptoms of young adults were (in descending order): anosmia ‎and ageusia (27 respondents and 20 respondents, respectively), fatigue (17 respondents), chest pain (8 ‎respondents), headaches (7 respondents), and cough (6 respondents) (Figure 6). Interestingly, these symptoms ‎are consistent with previous meta-analyses discussing long-term COVID-19 symptoms and a cross-sectional ‎study emphasizing hyposmia and hypogeusia which showed similar incidence in symptomatology [18-19].‎

When looking at lingering symptoms between Hispanics (24 participants) and non-Hispanics (111‎ participants), 5 Hispanics reported anosmia and ageusia lasting 4 weeks or greater compared to 27 non-‎Hispanics that reported anosmia and ageusia lasting 4 weeks or greater. This is consistent with a study of a ‎population in Mexico reporting anosmia as one of their recovering symptoms [20]. Likewise, when looking at ‎lingering symptoms such as fatigue and headache, 16 non-Hispanic participants experienced fatigue lasting 4 ‎weeks or greater and 6 non-Hispanic participants experienced headache lasting 4 weeks or greater while none ‎of the Hispanic participants experienced fatigue or headache lasting 4 weeks or greater. In this study, younger ‎Hispanics may be less likely to experience lingering symptoms compared to non-Hispanics [9].‎

To understand the psychosocial effects surrounding COVID-19, participants’ responses were recorded and‎ analyzed on multiple topics. Assessing whether respondents would get the COVID-19 booster shot if eligible: ‎‎177 responses revealed 58.12% answered “yes”, while 41.88% of responses answered “no”. Assessing whether ‎vaccines should be mandatory for all eligible citizens: 120 responses revealed 35.0% answered “yes”, while ‎‎65.0% of responses answered “no”. Assessing if respondents felt hesitant towards receiving the COVID-19 ‎vaccine: 73 responses revealed 60.3% did not feel hesitant, 28.8% did feel hesitant, 6.8% felt hesitant towards ‎the vaccine booster but not hesitant towards the vaccine, and 4.1% were hesitant until FDA approval of the ‎vaccine [7, 8,10,13]. The range of hesitancy, between 28.8% feeling hesitant and 60.3% not feeling hesitant, ‎towards intention of vaccination was consistent with previous studies showing a “COVID-19 vaccination ‎intention during the first year of the pandemic ranging from 27.7% to 93.3%” [13].‎


When looking at the results, the study demonstrated that young adults do face lingering symptoms of ‎COVID-19. Many of these symptoms reported by participants of this study have been listed in several other ‎studies, however there seems to be consistency in the young adult population with the general adolescent and ‎adult population [1-2,4-6, 9, 12, 16, 18-20]. It’s also important to note that the results showed that a significant ‎portion of young people do not find it in their interest to receive the booster shot [10]. The self completion ‎surveys set limitations to the study, as researchers did not confirm that those who completed a survey met the ‎prerequisite criteria. The largest barrier faced was to maintain IRB compliance while recruiting an adequate ‎level of participants to meet the study criteria. The IRB refrained the researchers from contacting or answering ‎questions of participants individually. This inability to answer individual questions, such as issues with the link, ‎creates a question of how to maintain ethical standards of recruitment without suppressing an investigator’s ‎ability to seek the appropriate population. This further challenges researchers in following ethical protocol ‎while maintaining engagement with the population in question.‎


Findings in this study demonstrated lingering COVID-19 symptoms that are not usually found in the young‎ population such as chest pain, even among males. Headaches were not as commonly reported as lingering ‎symptoms, but there may be an association more towards the beginning of the COVID-19 illness, as seen in ‎adolescents [16]. This study also demonstrated what was previously known about pre-existing conditions; ‎those with extensive medical histories may be more likely to experience lingering symptoms. Furthermore, it ‎shows there is a long way to go to reach the young population to make them aware of the effectiveness and ‎importance of boosters. We encourage other investigators to further research how the Hispanic population ‎perceived the Coronavirus differently than the general population and the effects it has had in their ‎socioeconomic status. Further research needs to be done on how the most vulnerable populations have been ‎affected by the virus and their perceptions of the vaccine. This guides providers and public health officials in ‎maximizing resources to further prevent wave levels of transmission.‎


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Figure 1


Figure 2


Figure 3


Figure 4


Figure 5


Figures 1-5 demonstrates the breakdown of individuals with past medical history experiencing the top-5 most ‎common lingering (greater than or equal to 1 month) COVID-19 symptoms.‎

Figure 6

Figure 6 reveals the top lingering (greater than or equal to 1 month) COVID-19 symptoms and the total is the ‎amount of participants who reported the pertinent symptom during infection at any point of their illness.‎