Differential diagnosis of COVID-19 and influenza

Abstract

This study uses two existing data sources to examine how patients’ symptoms can be used to differentiate COVID-19 from other respiratory diseases. One dataset consisted of 839,288 laboratory-confirmed, symptomatic, COVID-19 positive cases reported to the Centers for Disease Control and Prevention (CDC) from March 1, 2019, to September 30, 2020. The second dataset provided the controls and included 1,814 laboratory-confirmed influenza positive, symptomatic cases, and 812 cases with symptomatic influenza-like-illnesses. The controls were reported to the Influenza Research Database of the National Institute of Allergy and Infectious Diseases (NIAID) between January 1, 2000, and December 30, 2018. Data were analyzed using case-control study design. The comparisons were done using 45 scenarios, with each scenario making different assumptions regarding prevalence of COVID-19 (2%, 4%, and 6%), influenza (0.01%, 3%, 6%, 9%, 12%) and influenza-like-illnesses (1%, 3.5% and 7%). For each scenario, a logistic regression model was used to predict COVID-19 from 2 demographic variables (age, gender) and 10 symptoms (cough, fever, chills, diarrhea, nausea and vomiting, shortness of breath, runny nose, sore throat, myalgia, and headache). The 5-fold cross-validated Area under the Receiver Operating Curves (AROC) was used to report the accuracy of these regression models. The value of various symptoms in differentiating COVID-19 from influenza depended on a variety of factors, including (1) prevalence of pathogens that cause COVID-19, influenza, and influenza-like-illness; (2) age of the patient, and (3) presence of other symptoms. The model that relied on 5-way combination of symptoms and demographic variables, age and gender, had a cross-validated AROC of 90%, suggesting that it could accurately differentiate influenza from COVID-19. This model, however, is too complex to be used in clinical practice without relying on computer-based decision aid. Study results encourage development of web-based, stand-alone, artificial Intelligence model that can interview patients and help clinicians make quarantine and triage decisions.

A Detailed Overview of SARS-CoV-2 Omicron: Its Sub-Variants, Mutations and Pathophysiology, Clinical Characteristics, Immunological Landscape, Immune Escape, and Therapies

“…The number of individuals with oxygen supports was also smaller than it was during the previous waves due to other SARS-CoV-2 variants, specifically Delta [ 67 ]. The clinical characteristics of the SARS-CoV-2 Omicron variant are different from those of all of the previous variants [ 68 , 69 , 70 , 71 ]. The most common symptoms are a cough, runny nose, congestion, and fatigue ( Figure 5 B) [ 71 ].…”

“…The clinical characteristics of the SARS-CoV-2 Omicron variant are different from those of all of the previous variants [ 68 , 69 , 70 , 71 ]. The most common symptoms are a cough, runny nose, congestion, and fatigue ( Figure 5 B) [ 71 ]. The loss of smell and taste, fever, dizziness, headache, runny nose, hair loss, and blisters on the feet were more adequately prevented during the Delta outbreak than they were during the Omicron outbreak.…”

“…A sore throat and a hoarse voice were more prevalent during the Omicron outbreak. Individuals infected with Omicron are less likely to show at least one of the three classic symptoms of COVID-19: the loss of smell, a fever, and a persistent cough, which associated with individuals infected with the Delta variant [ 71 ]. A study showed that acute symptoms prevailed for a more extended period in patients affected during the Delta outbreak (average of 8.89 days) than they did during Omicron outbreak (average of 6.87 days).…”

Order of Occurrence of COVID-19 Symptoms

“…There is confusion about what symptoms should be screened to identify COVID-19, and how to differentiate COVID-19 from other diseases. Early on, fever and difficulty breathing were identified as signature symptoms of COVID-19; however, these are also present in a range of other respiratory illnesses 5. COVID-19 is now considered a systemic disease with multiple manifestations, including many nonrespiratory symptoms 6,7.…”

Combined Symptom Screening and At-Home Tests for COVID-19

“…Clinical diagnosis of coronavirus disease-2019 (COVID-19) from its symptoms is fraught with difficulty. Simple clinical rules for differential diagnosis of COVID-19 from respiratory diseases do not exist 9. Furthermore, COVID-19 is a systemic disease, with many different types of symptoms, and clinicians would need to rule out a variety of diseases including neurological and gastrointestinal diseases with similar symptoms 10.…”