About a quarter of U.S. adults who had COVID-19 during the past four years endured persistent symptoms lasting at least three months following their infection. But the prevalence of long COVID varied significantly by state, with California having a relatively low incidence compared to the national average, according to a report released Friday by the U.S. Centers for Disease Control and Prevention.

Long COVID encompasses over 200 symptoms that can last for months or even years after a coronavirus infection, including extreme fatigue, brain fog, heart palpitations, sexual dysfunction or digestive disorders.

The CDC’s breakdown of long COVID hotspots revealed a clear correlation between areas with higher rates of persistent symptoms and those with the greatest skepticism about the pandemic, per research from the National Institutes of Health.