Symptom burden and quality of life before, during and after a SARS-CoV-2 PCR positive or negative test: results from LIFELINES

Background We aim to study whether and to what extent symptoms are present before, during and after a SARS-CoV-2 infection, and how the symptom burden and quality of life (QoL) compares to those with a negative test. Therefore, this study evaluates the symptom burden and QoL prior, during and after a positive and negative SARS-CoV-2 polymerase chain reaction (PCR) test.
Methods Participants from the prospective Dutch Lifelines COVID-19 Cohort were invited as of April 2020 to fill out weekly, later bi-weekly and monthly, questions about their demographics, COVID-19 diagnosis and severity, QoL, and 28 symptoms. One-way repeated measured ANOVA, McNemar, and chi-square were used to compare symptoms and QoL between time-periods and by test-result.
Findings The study population comprised 996 SARS-CoV-2 PCR positive and 3978 negative participants. Nearly all symptoms were more often reported after a positive test compared to the period before the test (p<0·05), except fever. A higher symptom prevalence after compared to before a test was also found for nearly all symptoms in negative tested participants (p<0·05). Before the test, symptoms were already partly present and reporting of nearly all symptoms before did not differ between positives and negatives (p>0·05). QoL decreased around the test for both positive and negative tested participants, with a larger deterioration for positives.
Interpretation Not all symptoms after a positive SARS-CoV-2 test might be attributable to the infection and  symptoms were also common in participants with a negative SARS-CoV-2 PCR test. 
Funding Y.M.J.G. is supported by Lung Foundation Netherlands grant #4.1.16.085.