Symptoms and symptom clusters associated with SARS-CoV-2 infection in community-based populations: Results from a statewide epidemiological study

Abstract

Background Prior studies examining symptoms of COVID-19 are primarily descriptive and measured among hospitalized individuals. Understanding symptoms of SARS-CoV-2 infection in pre-clinical, community-based populations may improve clinical screening, particularly during flu season. We sought to identify key symptoms and symptom combinations in a community-based population using robust methods. Methods We pooled community-based cohorts of individuals aged 12 and older screened for SARS-CoV-2 infection in April and June 2020 for a statewide prevalence study. Main outcome was SARS-CoV-2 positivity. We calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for individual symptoms as well as symptom combinations. We further employed multivariable logistic regression and exploratory factor analysis (EFA) to examine symptoms and combinations associated with SARS-CoV-2 infection. Results Among 8214 individuals screened, 368 individuals (4.5%) were RT-PCR positive for SARS-CoV-2. Although two-thirds of symptoms were highly specific (>90.0%), most symptoms individually possessed a PPV <50.0%. The individual symptoms most greatly associated with SARS-CoV-2 positivity were fever (OR = 5.34, p<0.001), anosmia (OR = 4.08, p<0.001), ageusia (OR = 2.38, p = 0.006), and cough (OR = 2.86, p<0.001). Results from EFA identified two primary symptom clusters most associated with SARS-CoV-2 infection: (1) ageusia, anosmia, and fever; and (2) shortness of breath, cough, and chest pain. Moreover, being non-white (13.6% vs. 2.3%, p<0.001), Hispanic (27.9% vs. 2.5%, p<0.001), or living in an Urban area (5.4% vs. 3.8%, p<0.001) was associated with infection. Conclusions Symptoms can help distinguish SARS-CoV-2 infection from other respiratory viruses, especially in community or urgent care settings where rapid testing may be limited. Symptoms should further be structured in clinical documentation to support identification of new cases and mitigation of disease spread by public health. These symptoms, derived from asymptomatic as well as mildly infected individuals, can also inform vaccine and therapeutic clinical trials.

Capturing COVID-19–Like Symptoms at Scale Using Banner Ads on an Online News Platform: Pilot Survey Study

“…At time of the survey, Japans epidemic curve had started to flatten, with daily increases in new cases between 3% and 5%, whereas the curve in the United States continued its upward trajectory, with daily increases between 10% and 20% ( Figure 5 [ 26 , 28 ]). On April 30, 2020, the United States reported a daily rate of new infections of 8.26 per 100,000 population.…”

“…First, nearly two-thirds of those reporting at least one symptom reported at least two symptoms. Emerging evidence suggests that symptom combinations may be predictive of COVID-19 infection [ 26 ]. The fact that most individuals reporting COVID-19like symptoms reported more than one symptom provides further evidence that exploring specific phenotypes might be fruitful for future research.…”

“…Second, the constellation of symptoms involving loss of taste or smell with fever appears more often among individuals who reported that they received testing for COVID-19. Several studies report loss of taste and smell as common among COVID-19 patients [ 18 , 26 , 29 ], suggesting that these symptoms cause individuals to seek out medical care or indicate an association with infection. Moreover, those reporting at least one symptom were significantly more likely to report having been tested for COVID-19 than those without symptoms, and those reporting symptoms were significantly associated with testing rates.…”

Capturing COVID-19–Like Symptoms at Scale Using Banner Ads on an Online News Platform: Pilot Survey Study (Preprint)

“…First, nearly two-thirds of those reporting at least one symptom reported at least two symptoms. Emerging evidence suggests that symptom combinations may be predictive of COVID-19 infection [26]. The fact that most individuals reporting COVID-19-like symptoms reported more than one symptom provides further evidence that exploring specific phenotypes might be fruitful for future research.…”

“…At time of the survey, Japan's epidemic curve had started to flatten, with daily increases in new cases between 3% and 5%, whereas the curve in the United States continued its upward trajectory, with daily increases between 10% and 20% (Figure 5 [26,28]). On April 30, 2020, the United States reported a daily rate of new infections of 8.26 per 100,000 population.…”