The prevalence of symptoms in 24,410 adults infected by the novel coronavirus (SARS-CoV-2; COVID-19): A systematic review and meta-analysis of 148 studies from 9 countries

Abstract

Background To limit the spread of SARS-CoV-2, an evidence-based understanding of the symptoms is critical to inform guidelines for quarantining and testing. The most common features are purported to be fever and a new persistent cough, although the global prevalence of these symptoms remains unclear. The aim of this systematic review is to determine the prevalence of symptoms associated with COVID-19 worldwide. Methods We searched PubMed, Embase, CINAHL, AMED, medRxiv and bioRxiv on 5 th April 2020 for studies of adults (>16 years) with laboratory test confirmed COVID-19. No language or publication status restrictions were applied. Data were independently extracted by two review authors into standardised forms. All datapoints were independently checked by three other review authors. A random-effects model for pooling of binomial data was applied to estimate the prevalence of symptoms, subgrouping estimates by country. I 2 was used to assess inter-study heterogeneity. Results Of 851 unique citations, 148 articles were included which comprised 24,410 adults with confirmed COVID-19 from 9 countries. The most prevalent symptoms were fever (78% [95% CI 75%-81%]; 138 studies, 21,701 patients; I 2 94%), a cough (57% [95% CI 54%-60%]; 138 studies, 21,682 patients; I 2 94%) and fatigue (31% [95% CI 27%-35%]; 78 studies, 13,385 patients; I 2 95%). Overall, 19% of hospitalised patients required non-invasive ventilation (44 studies,

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