Methods for detecting probable COVID-19 cases from large-scale survey data also reveal probable sex differences in symptom profiles

Abstract

BackgroundDaily symptom reporting collected via web-based symptom survey tools holds the potential to improve disease monitoring. Such screening tools might be able to not only discriminate between states of acute illness and non-illness, but also make use of additional demographic information so as to identify how illnesses may differ across groups, such as biological sex. These capabilities may play an important role in the context of future disease outbreaks.ObjectiveUse data collected via a daily web-based symptom survey tool to develop a Bayesian model that could differentiate between COVID-19 and other illnesses and refine this model to identify illness profiles that differ by biological sex.MethodsWe used daily symptom profiles to plot symptom progressions for COVID-19, influenza (flu), and the common cold. We then built a Bayesian network to discriminate between these three illnesses based on daily symptom reports. We further separated out the COVID-19 cohort into self-reported female and male subgroups to observe any differences in symptoms relating to sex. We identified key symptoms that contributed to a COVID-19 prediction in both males and females using a logistic regression model.ResultsAlthough the Bayesian model performed only moderately well in identifying a COVID-19 diagnosis (71.6% true positive rate), the model showed promise in being able to differentiate between COVID-19, flu, and the common cold, as well as periods of acute illness vs. non-illness. Additionally, COVID-19 symptoms differed between the biological sexes; specifically, fever was a more important symptom in identifying subsequent COVID-19 infection among males than among females.ConclusionWeb-based symptom survey tools hold promise as tools to identify illness and may help with coordinated disease outbreak responses. Incorporating demographic factors such as biological sex into predictive models may elucidate important differences in symptom profiles that hold implications for disease detection.

Variability of temperature measurements recorded by a wearable device by biological sex

“…As researchers themselves reported in anonymous surveys, this resistance to using female subjects, despite policies of inclusion, partially stems from the assumption that including female subjects will increase the heterogeneity of study results by virtue of having ovarian rhythms (estrus or menses, respectively) [ 4 ]. Coupled with the assumption that results from males will generalize to females, this lack of inclusion leads to serious inequalities in female health outcomes and available treatments (e.g., [ 9 – 11 ]).…”

Information theory reveals physiological manifestations of COVID-19 that correlate with symptom density of illness

“…These algorithms are based on the idea that physiology changes during illness, and that these changes, captured by wearable devices, can be used to train machine learning algorithms. However, while some physiological changes are anticipated with most illnesses—such as elevated temperature and heart rate ( Li et al, 2017 ) —it is obvious that not all COVID-19 patients manifest illness in the same way ( Alimohamadi et al, 2020 ; Klein et al, 2022 ). Methods are therefore needed to quantify the extent to which different “manifestations” can be identified.…”