The predictive role of symptoms in COVID-19 diagnostic models: A longitudinal insight.
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Bird Olivia, Galiza Eva P, Baxter David Neil, Boffito Marta, Browne Duncan, Burns Fiona, Chadwick David R, Clark Rebecca, Cosgrove Catherine A, Galloway James, Goodman Anna L, Heer Amardeep, Higham Andrew, Iyengar Shalini, Jeanes Christopher, Kalra Philip A, Kyriakidou Christina, Bradley Judy M, Munthali Chigomezgo, Minassian Angela M, McGill Fiona, Moore Patrick, Munsoor Imrozia, Nicholls Helen, Osanlou Orod, Packham Jonathan, Pretswell Carol H, San Francisco Ramos Alberto, Saralaya Dinesh, Sheridan Ray P, Smith Richard, Soiza Roy L, Swift Pauline A, Thomson Emma C, Turner Jeremy, Viljoen Marianne Elizabeth, Heath Paul T, Chis Ster Irina
Аннотация
To investigate the symptoms of SARS-CoV-2 infection, their dynamics and their discriminatory power for the disease using longitudinally, prospectively collected information reported at the time of their occurrence. We have analysed data from a large phase 3 clinical UK COVID-19 vaccine trial. The alpha variant was the predominant strain. Participants were assessed for SARS-CoV-2 infection via nasal/throat PCR at recruitment, vaccination appointments, and when symptomatic. Statistical techniques were implemented to infer estimates representative of the UK population, accounting for multiple symptomatic episodes associated with one individual. An optimal diagnostic model for SARS-CoV-2 infection was derived. The 4-month prevalence of SARS-CoV-2 was 2.1%; increasing to 19.4% (16.0%-22.7%) in participants reporting loss of appetite and 31.9% (27.1%-36.8%) in those with anosmia/ageusia. The model identified anosmia and/or ageusia, fever, congestion, and cough to be significantly associated with SARS-CoV-2 infection. Symptoms' dynamics were vastly different in the two groups; after a slow start peaking later and lasting longer in PCR+ participants, whilst exhibiting a consistent decline in PCR- participants, with, on average, fewer than 3 days of symptoms reported. Anosmia/ageusia peaked late in confirmed SARS-CoV-2 infection (day 12), indicating a low discrimination power for early disease diagnosis.