{"doi":"10.1093/ofid/ofab556","title":"COVID-19 Outcomes Among US Military Health System Beneficiaries Include Complications Across Multiple Organ Systems and Substantial Functional Impairment","abstract":"BACKGROUND: We evaluated clinical outcomes, functional burden, and complications 1 month after coronavirus disease 2019 (COVID-19) infection in a prospective US Military Health System (MHS) cohort of active duty, retiree, and dependent populations using serial patient-reported outcome surveys and electronic medical record (EMR) review. METHODS: MHS beneficiaries presenting at 9 sites across the United States with a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test, a COVID-19-like illness, or a high-risk SARS-CoV-2 exposure were eligible for enrollment. Medical history and clinical outcomes were collected through structured interviews and International Classification of Diseases-based EMR review. Risk factors associated with hospitalization were determined by multivariate logistic regression. RESULTS: A total of 1202 participants were enrolled. There were 1070 laboratory-confirmed SARS-CoV-2 cases and 132 SARS-CoV-2-negative participants. In the first month post-symptom onset among the SARS-CoV-2-positive cases, there were 212 hospitalizations, 80% requiring oxygen, 20 ICU admissions, and 10 deaths. Risk factors for COVID-19-associated hospitalization included race (increased for Asian, Black, and Hispanic compared with non-Hispanic White), age (age 45-64 and 65+ compared with <45), and obesity (BMI≥30 compared with BMI<30). Over 2% of survey respondents reported the need for supplemental oxygen, and 31% had not returned to normal daily activities at 1 month post-symptom onset. CONCLUSIONS: Older age, reporting Asian, Black, or Hispanic race/ethnicity, and obesity are associated with SARS-CoV-2 hospitalization. A proportion of acute SARS-CoV-2 infections require long-term oxygen therapy; the impact of SARS-CoV-2 infection on short-term functional status was substantial. A significant number of MHS beneficiaries had not yet returned to normal activities by 1 month.","journal":"Open Forum Infectious Diseases","year":2021,"id":168218,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":31,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.7779,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":650258,"name":"Simon Pollett","orcid":"0000-0003-2643-4213","position":1,"is_corresponding":false},{"id":527807,"name":"Charlotte Lanteri","orcid":null,"position":2,"is_corresponding":false},{"id":272088,"name":"Eugene V. Millar","orcid":"0000-0002-2019-6480","position":3,"is_corresponding":false},{"id":696869,"name":"Anthony C Fries","orcid":"0000-0001-7556-1353","position":4,"is_corresponding":false},{"id":404704,"name":"Ryan C. Maves","orcid":"0000-0001-6234-6160","position":5,"is_corresponding":false},{"id":670645,"name":"Gregory Utz","orcid":"0000-0003-4575-4060","position":6,"is_corresponding":false},{"id":426930,"name":"Tahaniyat Lalani","orcid":"0000-0002-9361-2991","position":7,"is_corresponding":false},{"id":690026,"name":"Alfred G. Smith","orcid":null,"position":8,"is_corresponding":false},{"id":689161,"name":"Rupal Mody","orcid":"0000-0003-3862-4495","position":9,"is_corresponding":false},{"id":588939,"name":"Anuradha Ganesan","orcid":"0000-0001-6214-9677","position":10,"is_corresponding":false},{"id":514704,"name":"Rhonda E Colombo","orcid":"0000-0003-0154-1928","position":11,"is_corresponding":false},{"id":670630,"name":"Christopher Colombo","orcid":"0000-0001-5499-3368","position":12,"is_corresponding":false},{"id":670628,"name":"David A Lindholm","orcid":"0000-0001-5428-7404","position":13,"is_corresponding":false},{"id":391920,"name":"Cristian Madar","orcid":null,"position":14,"is_corresponding":false},{"id":689177,"name":"Sharon Chi","orcid":"0000-0002-6081-5696","position":15,"is_corresponding":false},{"id":671512,"name":"Nikhil Huprikar","orcid":null,"position":16,"is_corresponding":false},{"id":670634,"name":"Derek Larson","orcid":"0000-0002-6147-7182","position":17,"is_corresponding":false},{"id":689162,"name":"Samantha Bazan","orcid":"0000-0002-9812-5164","position":18,"is_corresponding":false},{"id":558489,"name":"Caroline English","orcid":null,"position":19,"is_corresponding":false},{"id":650850,"name":"Edward Parmelee","orcid":null,"position":20,"is_corresponding":false},{"id":559650,"name":"Katrin Mende","orcid":null,"position":21,"is_corresponding":false},{"id":533696,"name":"Eric D. Laing","orcid":"0000-0002-5574-2584","position":22,"is_corresponding":false},{"id":533697,"name":"Christopher C. Broder","orcid":"0000-0001-5382-0510","position":23,"is_corresponding":false},{"id":391331,"name":"Paul W. Blair","orcid":"0000-0002-3817-5987","position":24,"is_corresponding":false},{"id":670631,"name":"Josh Chenoweth","orcid":"0009-0003-9693-5010","position":25,"is_corresponding":false},{"id":272091,"name":"Mark P. Simons","orcid":"0000-0002-4316-9709","position":26,"is_corresponding":false},{"id":426929,"name":"David R. Tribble","orcid":"0000-0003-3077-9505","position":27,"is_corresponding":false},{"id":404703,"name":"Brian K. Agan","orcid":"0000-0002-5114-1669","position":28,"is_corresponding":false},{"id":103453,"name":"Timothy Burgess","orcid":"0000-0003-1247-8370","position":29,"is_corresponding":false},{"id":671513,"name":"EPICC COVID-19 Cohort Study Group","orcid":null,"position":30,"is_corresponding":false},{"id":689163,"name":"John D. Cowden","orcid":"0000-0002-2288-5140","position":31,"is_corresponding":false},{"id":514706,"name":"Ana E Markelz","orcid":"0009-0006-4473-3902","position":33,"is_corresponding":false},{"id":689165,"name":"T. Allen Merritt","orcid":"0000-0002-7950-4425","position":35,"is_corresponding":false},{"id":696870,"name":"Robert Walter","orcid":"0000-0002-0376-2073","position":36,"is_corresponding":false},{"id":696871,"name":"Trevor Wellington","orcid":"0000-0001-9797-3092","position":37,"is_corresponding":false},{"id":671521,"name":"S Bazan","orcid":null,"position":38,"is_corresponding":false},{"id":671523,"name":"N Dimascio-Johnson","orcid":null,"position":39,"is_corresponding":false},{"id":670633,"name":"Evan Ewers","orcid":"0000-0002-1384-9973","position":40,"is_corresponding":false},{"id":690038,"name":"K Gallagher","orcid":null,"position":41,"is_corresponding":false},{"id":671524,"name":"M Odom","orcid":null,"position":43,"is_corresponding":false},{"id":690028,"name":"Ann Rutt","orcid":null,"position":44,"is_corresponding":false},{"id":696872,"name":"David J. Clark","orcid":"0000-0003-3677-0034","position":47,"is_corresponding":false},{"id":670635,"name":"Susan Chambers","orcid":"0000-0002-8931-3294","position":48,"is_corresponding":false},{"id":555607,"name":"Christopher P. Conlon","orcid":"0000-0002-3531-2464","position":51,"is_corresponding":false},{"id":671526,"name":"K Everson","orcid":null,"position":52,"is_corresponding":false},{"id":671527,"name":"P Faestel","orcid":null,"position":53,"is_corresponding":false},{"id":608899,"name":"Trevor S. Ferguson","orcid":"0000-0002-2393-1452","position":54,"is_corresponding":false},{"id":262611,"name":"Leo I. Gordon","orcid":"0000-0003-1666-7064","position":55,"is_corresponding":false},{"id":689169,"name":"Sarah Grogan","orcid":"0000-0002-7510-765X","position":56,"is_corresponding":false},{"id":690041,"name":"S. Bertrán de Lis","orcid":null,"position":57,"is_corresponding":false},{"id":671531,"name":"C Mount","orcid":null,"position":58,"is_corresponding":false},{"id":671532,"name":"D Musfeldt","orcid":null,"position":59,"is_corresponding":false},{"id":690042,"name":"D Odineal","orcid":null,"position":60,"is_corresponding":false},{"id":689171,"name":"Rebecca Sainato","orcid":"0000-0002-3798-9989","position":61,"is_corresponding":false},{"id":690044,"name":"Carin Schofield","orcid":null,"position":62,"is_corresponding":false},{"id":689172,"name":"Caroline Skinner","orcid":"0000-0001-7321-5940","position":63,"is_corresponding":false},{"id":689173,"name":"Michal Stein","orcid":"0000-0002-0765-7326","position":64,"is_corresponding":false},{"id":690045,"name":"Mary E. Switzer","orcid":null,"position":65,"is_corresponding":false},{"id":671538,"name":"M Timlin","orcid":null,"position":66,"is_corresponding":false},{"id":697457,"name":"S Wood","orcid":null,"position":67,"is_corresponding":false},{"id":59340,"name":"Rebecca M. Carpenter","orcid":null,"position":68,"is_corresponding":false},{"id":690047,"name":"L Kim","orcid":null,"position":69,"is_corresponding":false},{"id":514705,"name":"Karl Kronmann","orcid":"0000-0003-1783-7061","position":70,"is_corresponding":false},{"id":697458,"name":"T Lee","orcid":null,"position":72,"is_corresponding":false},{"id":689174,"name":"Adrian D. Smith","orcid":"0000-0003-0036-1490","position":73,"is_corresponding":false},{"id":690049,"name":"Tyler Warkentien","orcid":null,"position":74,"is_corresponding":false},{"id":670640,"name":"John Arnold","orcid":"0000-0002-8623-8057","position":75,"is_corresponding":false},{"id":670641,"name":"Catherine M Berjohn","orcid":"0000-0001-5655-8183","position":76,"is_corresponding":false},{"id":689176,"name":"S. Cammarata","orcid":"0000-0002-9000-0973","position":77,"is_corresponding":false},{"id":128646,"name":"S. Ali Husain","orcid":"0000-0002-1823-0117","position":78,"is_corresponding":false},{"id":670643,"name":"Aoife Lane","orcid":"0000-0001-9991-554X","position":79,"is_corresponding":false},{"id":670644,"name":"Scott Parrish","orcid":"0000-0002-5135-922X","position":81,"is_corresponding":false},{"id":671546,"name":"E Filan","orcid":null,"position":84,"is_corresponding":false},{"id":671547,"name":"K Fong","orcid":null,"position":85,"is_corresponding":false},{"id":671548,"name":"Timothy S. Horseman","orcid":null,"position":86,"is_corresponding":false},{"id":696873,"name":"Milissa U. Jones","orcid":"0009-0009-1798-2753","position":87,"is_corresponding":false},{"id":671549,"name":"A Kanis","orcid":null,"position":88,"is_corresponding":false},{"id":671550,"name":"A Kayatani","orcid":null,"position":89,"is_corresponding":false},{"id":670647,"name":"William Londeree","orcid":"0000-0001-7395-9800","position":90,"is_corresponding":false},{"id":328805,"name":"Joanna Masel","orcid":"0000-0002-7398-2127","position":92,"is_corresponding":false},{"id":269636,"name":"Melissa McMahon","orcid":null,"position":93,"is_corresponding":false},{"id":696874,"name":"G Murphy","orcid":"0000-0001-9653-2527","position":94,"is_corresponding":false},{"id":671553,"name":"Viseth Ngauy","orcid":null,"position":95,"is_corresponding":false},{"id":20994,"name":"Peter Schmidt","orcid":"0000-0002-8358-830X","position":96,"is_corresponding":false},{"id":697459,"name":"E Schoenman","orcid":null,"position":97,"is_corresponding":false},{"id":697460,"name":"Catherine Uyehara","orcid":null,"position":98,"is_corresponding":false},{"id":697461,"name":"R Villacorta Lyew","orcid":null,"position":99,"is_corresponding":false},{"id":536243,"name":"Stephanie A Richard","orcid":"0000-0002-0530-384X","position":0,"is_corresponding":true}],"reference_count":31,"raw_metadata":null,"created_at":"2026-07-18T23:46:02.603031Z","pmid":"34909439","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}