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Self-Reported Symptoms of SARS-CoV-2 Infection in a Nonhospitalized Population in Italy: Cross-Sectional Study of the EPICOVID19 Web-Based Survey.
JMIR Public Health Surveill. 2020 09 18; 6(3):e21866.JP

Abstract

BACKGROUND

Understanding the occurrence of symptoms resembling those of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a large nonhospitalized population at the peak of the epidemic in Italy is of paramount importance; however, data are currently scarce.

OBJECTIVE

The aims of this study were to evaluate the association of self-reported symptoms with SARS-CoV-2 nasopharyngeal swab (NPS) test results in nonhospitalized individuals and to estimate the occurrence of symptoms associated with coronavirus disease (COVID-19) in a larger nontested population.

METHODS

EPICOVID19 is a self-administered cross-sectional voluntary web-based survey of adults throughout Italy who completed an anonymous questionnaire in the period of April 13 to 21, 2020. The associations between symptoms potentially related to SARS-CoV-2 infection and NPS results were calculated as adjusted odds ratios (aORs) with 95% CIs by multiple logistic regression analysis controlling for age, sex, education, smoking habits, and number of comorbidities. Thereafter, for each symptom and for combinations of the symptoms, we calculated the sensitivity, specificity, accuracy, and areas under the curve (AUCs) in a receiver operating characteristic (ROC) analysis to estimate the occurrence of COVID-19-like infection in the nontested population.

RESULTS

A total of 171,310 people responded to the survey, of whom 102,543 (59.9%) were women; mean age 47.4 years. Out of the 4785 respondents with known NPS test results, 4392 were not hospitalized. Among the 4392 nonhospitalized respondents, those with positive NPS tests (856, 19.5%) most frequently reported myalgia (527, 61.6%), olfactory and taste disorders (507, 59.2%), cough (466, 54.4%), and fever (444, 51.9%), whereas 7.7% were asymptomatic. Multiple regression analysis showed that olfactory and taste disorders (aOR 10.3, 95% CI 8.4-12.7), fever (aOR 2.5, 95% CI 2.0-3.1), myalgia (aOR 1.5, 95% CI 1.2-1.8), and cough (aOR 1.3, 95% CI 1.0-1.6) were associated with NPS positivity. Having two to four of these symptoms increased the aOR from 7.4 (95% CI 5.6-9.7) to 35.5 (95% CI 24.6-52.2). The combination of the four symptoms showed an AUC of 0.810 (95% CI 0.795-0.825) in classifying positive NPS test results and then was applied to the nonhospitalized and nontested sample (n=165,782). We found that 7739 to 20,103 of these 165,782 respondents (4.4% to 12.1%) had experienced symptoms suggestive of COVID-19 infection.

CONCLUSIONS

Our results suggest that self-reported symptoms are reliable indicators of SARS-CoV-2 infection in a pandemic context. A nonnegligible number of symptomatic respondents (up to 12.1%) were undiagnosed and potentially contributed to the spread of the infection.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04471701; https://clinicaltrials.gov/ct2/show/NCT04471701.

Authors+Show Affiliations

Epidemiology Unit, Institute of Biomedical Technologies, National Research Council, Segrate (MI), Italy.Epidemiology Unit, Institute of Biomedical Technologies, National Research Council, Segrate (MI), Italy.Department of Environmental Epidemiology and Disease Registries, Institute of Clinical Physiology, National Research Council, Pisa, Italy.Infectious Diseases Unit, Department of Biomedical and Clinical Sciences L. Sacco, University of Milan, Milan, Italy.Infectious Diseases Unit, Department of Biomedical and Clinical Sciences L. Sacco, University of Milan, Milan, Italy.Infectious Diseases Unit, Department of Biomedical and Clinical Sciences L. Sacco, University of Milan, Milan, Italy.Infectious Diseases Unit, Department of Biomedical and Clinical Sciences L. Sacco, University of Milan, Milan, Italy.Aging Branch, Neuroscience Institute, National Research Council, Padoa, Italy.Aging Branch, Neuroscience Institute, National Research Council, Padoa, Italy. Geriatric Unit, Department of Medicine (DIMED), University of Padova, Padoa, Italy.Aging Branch, Neuroscience Institute, National Research Council, Padoa, Italy.Epidemiology and Health Research Laboratory, Institute of Clinical Physiology, National Research Council, Pisa, Italy.Epidemiology and Health Research Laboratory, Institute of Clinical Physiology, National Research Council, Pisa, Italy.Epidemiology and Health Research Laboratory, Institute of Clinical Physiology, National Research Council, Pisa, Italy.Epidemiology Unit, Institute of Biomedical Technologies, National Research Council, Segrate (MI), Italy.Epidemiology Unit, Institute of Biomedical Technologies, National Research Council, Segrate (MI), Italy.Epidemiology Unit, Institute of Biomedical Technologies, National Research Council, Segrate (MI), Italy.Division of Infectious Diseases, Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy.Infectious Diseases Clinic, Department of System Medicine, Tor Vergata University of Rome, Rome, Italy.Public Health and Infectious Disease Department, Sapienza University, Rome, Italy.Unit of Geriatrics, Department of Medicine, Biomedical Campus of Rome, Rome, Italy.Infectious Diseases Unit, Department of Biomedical and Clinical Sciences L. Sacco, University of Milan, Milan, Italy.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32650305

Citation

Adorni, Fulvio, et al. "Self-Reported Symptoms of SARS-CoV-2 Infection in a Nonhospitalized Population in Italy: Cross-Sectional Study of the EPICOVID19 Web-Based Survey." JMIR Public Health and Surveillance, vol. 6, no. 3, 2020, pp. e21866.
Adorni F, Prinelli F, Bianchi F, et al. Self-Reported Symptoms of SARS-CoV-2 Infection in a Nonhospitalized Population in Italy: Cross-Sectional Study of the EPICOVID19 Web-Based Survey. JMIR Public Health Surveill. 2020;6(3):e21866.
Adorni, F., Prinelli, F., Bianchi, F., Giacomelli, A., Pagani, G., Bernacchia, D., Rusconi, S., Maggi, S., Trevisan, C., Noale, M., Molinaro, S., Bastiani, L., Fortunato, L., Jesuthasan, N., Sojic, A., Pettenati, C., Tavio, M., Andreoni, M., Mastroianni, C., ... Galli, M. (2020). Self-Reported Symptoms of SARS-CoV-2 Infection in a Nonhospitalized Population in Italy: Cross-Sectional Study of the EPICOVID19 Web-Based Survey. JMIR Public Health and Surveillance, 6(3), e21866. https://doi.org/10.2196/21866
Adorni F, et al. Self-Reported Symptoms of SARS-CoV-2 Infection in a Nonhospitalized Population in Italy: Cross-Sectional Study of the EPICOVID19 Web-Based Survey. JMIR Public Health Surveill. 2020 09 18;6(3):e21866. PubMed PMID: 32650305.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Self-Reported Symptoms of SARS-CoV-2 Infection in a Nonhospitalized Population in Italy: Cross-Sectional Study of the EPICOVID19 Web-Based Survey. AU - Adorni,Fulvio, AU - Prinelli,Federica, AU - Bianchi,Fabrizio, AU - Giacomelli,Andrea, AU - Pagani,Gabriele, AU - Bernacchia,Dario, AU - Rusconi,Stefano, AU - Maggi,Stefania, AU - Trevisan,Caterina, AU - Noale,Marianna, AU - Molinaro,Sabrina, AU - Bastiani,Luca, AU - Fortunato,Loredana, AU - Jesuthasan,Nithiya, AU - Sojic,Aleksandra, AU - Pettenati,Carla, AU - Tavio,Marcello, AU - Andreoni,Massimo, AU - Mastroianni,Claudio, AU - Antonelli Incalzi,Raffaele, AU - Galli,Massimo, Y1 - 2020/09/18/ PY - 2020/06/27/received PY - 2020/07/10/accepted PY - 2020/07/09/revised PY - 2020/7/11/pubmed PY - 2020/10/3/medline PY - 2020/7/11/entrez KW - COVID-19 KW - SARS-CoV-2 KW - cross-sectional KW - nasopharyngeal swab testing KW - self-reported symptom KW - voluntary respondents KW - web-based survey SP - e21866 EP - e21866 JF - JMIR public health and surveillance JO - JMIR Public Health Surveill VL - 6 IS - 3 N2 - BACKGROUND: Understanding the occurrence of symptoms resembling those of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a large nonhospitalized population at the peak of the epidemic in Italy is of paramount importance; however, data are currently scarce. OBJECTIVE: The aims of this study were to evaluate the association of self-reported symptoms with SARS-CoV-2 nasopharyngeal swab (NPS) test results in nonhospitalized individuals and to estimate the occurrence of symptoms associated with coronavirus disease (COVID-19) in a larger nontested population. METHODS: EPICOVID19 is a self-administered cross-sectional voluntary web-based survey of adults throughout Italy who completed an anonymous questionnaire in the period of April 13 to 21, 2020. The associations between symptoms potentially related to SARS-CoV-2 infection and NPS results were calculated as adjusted odds ratios (aORs) with 95% CIs by multiple logistic regression analysis controlling for age, sex, education, smoking habits, and number of comorbidities. Thereafter, for each symptom and for combinations of the symptoms, we calculated the sensitivity, specificity, accuracy, and areas under the curve (AUCs) in a receiver operating characteristic (ROC) analysis to estimate the occurrence of COVID-19-like infection in the nontested population. RESULTS: A total of 171,310 people responded to the survey, of whom 102,543 (59.9%) were women; mean age 47.4 years. Out of the 4785 respondents with known NPS test results, 4392 were not hospitalized. Among the 4392 nonhospitalized respondents, those with positive NPS tests (856, 19.5%) most frequently reported myalgia (527, 61.6%), olfactory and taste disorders (507, 59.2%), cough (466, 54.4%), and fever (444, 51.9%), whereas 7.7% were asymptomatic. Multiple regression analysis showed that olfactory and taste disorders (aOR 10.3, 95% CI 8.4-12.7), fever (aOR 2.5, 95% CI 2.0-3.1), myalgia (aOR 1.5, 95% CI 1.2-1.8), and cough (aOR 1.3, 95% CI 1.0-1.6) were associated with NPS positivity. Having two to four of these symptoms increased the aOR from 7.4 (95% CI 5.6-9.7) to 35.5 (95% CI 24.6-52.2). The combination of the four symptoms showed an AUC of 0.810 (95% CI 0.795-0.825) in classifying positive NPS test results and then was applied to the nonhospitalized and nontested sample (n=165,782). We found that 7739 to 20,103 of these 165,782 respondents (4.4% to 12.1%) had experienced symptoms suggestive of COVID-19 infection. CONCLUSIONS: Our results suggest that self-reported symptoms are reliable indicators of SARS-CoV-2 infection in a pandemic context. A nonnegligible number of symptomatic respondents (up to 12.1%) were undiagnosed and potentially contributed to the spread of the infection. TRIAL REGISTRATION: ClinicalTrials.gov NCT04471701; https://clinicaltrials.gov/ct2/show/NCT04471701. SN - 2369-2960 UR - https://www.unboundmedicine.com/medline/citation/32650305/Self_Reported_Symptoms_of_SARS_CoV_2_Infection_in_a_Nonhospitalized_Population_in_Italy:_Cross_Sectional_Study_of_the_EPICOVID19_Web_Based_Survey_ L2 - https://publichealth.jmir.org/2020/3/e21866/ DB - PRIME DP - Unbound Medicine ER -