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Prevalence and Functional Outcomes of Post-Exertional Malaise among Adults with prior COVID-19: Results from a Representative Survey of New York City Residents

Year: 2026
Type: preprint
Study design: Observational Study
Abstract: Objective To estimate the prevalence of Post-Exertional Malaise (PEM) among adults with prior COVID-19 and associated mental health and disability outcomes. Methods We conducted a cross-sectional analysis of data from a survey of 9,620 adults with prior COVID-19 in New York City, collected May – June 2024. PEM was measured with the DePaul Symptom Questionnaire – Post Exertional Malaise, categorized by symptom duration (< 14 vs. ≥14 hours). Weighted prevalence estimates were stratified by socio-demographic and clinical characteristics. Modified Poisson regression was used to assess the association of PEM with depression, anxiety, and disability. Results The prevalence of PEM symptoms was 20.9% overall and 4.0% with symptom duration ≥ 14 hours, representing over 800,000 New Yorkers affected and over 150,000 who meet a diagnostic criterion for ME/CFS. PEM prevalence was higher among women, transgender and non-binary adults, people of color, and lower educational attainment, chronic comorbidities, or disabilities. PEM was associated with 3 - 4 times higher prevalence of mental health outcomes and 4 - 5 times higher disability scores. Conclusions PEM symptoms were common and strongly associated with disability and adverse mental health. Screening, pathways to care, and supportive policies are needed to mitigate long-term consequences, particularly among marginalized populations.
Source: medRxiv
DOI: 10.64898/2026.08.31.26356614
Language: English
Field: Medicine
Open Access status: green
Award: NEW YORK CITY DEPARTMENT OF HEALTH & MENTAL HYGIENE (NYC DOHMH)STRENGTHENING U.S. PUBLIC HEALTH INFRASTRUCTURE, WORKFORCE, AND DATA SYSTEMSCDC-RFA-OE22-2203 - NEW YORK CITY DEPARTMENT OF HEALTH & MENTAL HYGIENE STRENGTHENING U.S. PUBLIC HEALTH INFRASTRUCTURE, WORKFORCE, AND DATA SYSTEMS CDC-RFA-OE22-2203 PROJECT ABSTRACT SUMMARY NEW YORK CITY FACED SIGNIFICANT PUBLIC HEALTH AND HEALTHCARE SYSTEM IMPACTS FROM THE COVID-19 PANDEMIC, WHICH LAID BARE LONG-STANDING WEAKNESSES AND CREATED NEW CHALLENGES TO THE PUBLIC HEALTH INFRASTRUCTURE. THE PANDEMIC AND ITS MANY IMPACTS REVEALED DISPARITIES AND GAPS IN THE CITY’S PUBLIC HEALTH SYSTEM, WHILE EXACERBATING OTHERS. THE NEW YORK CITY DEPARTMENT OF HEALTH AND MENTAL HYGIENE (NYC DOHMH) PLANS TO IMPROVE ITS SYSTEMS AND OPERATIONS IN ORDER TO MEET THE VARIED AND COMPLEX NEEDS OF NYC’S POPULATION, PARTICULARLY FOLLOWING OVER 2.5 YEARS OF RESPONDING TO COVID-19. DOHMH PLANS TO STRENGTHEN ITS PARTNERSHIPS AND ITS INVESTMENTS IN COMMUNITIES BY HIRING, RETAINING, SUSTAINING, AND TRAINING THE PUBLIC HEALTH WORKFORCE AND BY INVESTING IN KEY, STRATEGIC COMPONENTS OF AGENCY AND CITY INFRASTRUCTURE, INCLUDING DOHMH’S FOUNDATIONAL CAPABILITIES SUCH AS INFORMATION TECHNOLOGY, HUMAN RESOURCES, FINANCIAL MANAGEMENT, COMMUNICATIONS, AND CONTRACT AND PROCUREMENT SERVICES. DOHMH WILL ALSO INVEST IN DATA MODERNIZATION STRATEGICALLY IN ORDER TO EXPAND, IMPROVE, AND ACCELERATE PUBLIC HEALTH SERVICES AND, IN TURN, BETTER ADDRESS PUBLIC HEALTH CONCERNS, INCLUDING COVID-19. DOHMH EXPECTS TO ACHIEVE THE FOLLOWING OUTCOMES: - INCREASED HIRING OF DIVERSE STAFF; INCREASED SIZE AND CAPABILITIES OF THE PUBLIC HEALTH WORKFORCE WITH IMPROVED WAGES AND PROTECTIONS - IMPROVED ORGANIZATIONAL SYSTEMS AND PROCESSES; STRENGTHENED FOUNDATIONAL PUBLIC HEALTH CAPABILITIES - A MORE MODERN AND EFFICIENT DATA ENVIRONMENT; INCREASED DATA INTEROPERABILITY; INCREASED AVAILABILITY AND USE OF PUBLIC HEALTH DATA TO INFORM PROGRAMMING AND INVESTMENTS FINALLY, GIVEN THE EXPEDIENCY WITH WHICH DOHMH PLANS TO RECEIVE AND EXPEND THESE FUNDS, DOHMH WILL UTILIZE A FISCAL AGENT, PUBLIC HEALTH SOLUTIONS, TO RECEIVE, OBLIGATE AND LIQUIDATE GRANT FUNDS ON DOHMH’S BEHALF. THE RELATIONSHIP BETWEEN DOHMH AND PUBLIC HEALTH SOLUTIONS FOR MANAGEMENT OF GRANT FUNDS IN THE AREAS OF EMERGENCY PREPAREDNESS AND RESPONSE HAS RESULTED IN SIGNIFICANT EFFICIENCIES IN THE PROCUREMENT OF GOODS AND SERVICES, INCLUDING RAPID AND COMPLETE SPEND-DOWN OF AWARDS; AND DOHMH LOOKS TO ACHIEVE THE SAME EFFICIENCY IN MANAGEMENT OF THIS AWARD.
OpenAlex ID: W7206202062
Cites: 33
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Related to: 10