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Symptoms and symptom clusters associated with SARS-CoV-2 infection in community-based populations: Results from a statewide epidemiological study.
PLoS One. 2021; 16(3):e0241875.Plos

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.

Authors+Show Affiliations

Department of Epidemiology, IU Fairbanks School of Public Health, Indianapolis, Indiana, United States of America. Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, United States of America.Department of Medicine, IU School of Medicine, Indianapolis, Indiana, United States of America. Center for Global Health, Indiana University, Indianapolis, Indiana, United States of America.Department of Biostatistics, IU Fairbanks School of Public Health, Indianapolis, Indiana, United States of America.Department of Epidemiology, IU Fairbanks School of Public Health, Indianapolis, Indiana, United States of America.Department of Biostatistics, IU Fairbanks School of Public Health, Indianapolis, Indiana, United States of America.Department of Health Policy and Management, IU Fairbanks School of Public Health, Indianapolis, Indiana, United States of America. Department of Family Medicine, IU School of Medicine, Indianapolis, Indiana, United States of America.Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, United States of America. Department of Health Policy and Management, IU Fairbanks School of Public Health, Indianapolis, Indiana, United States of America.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

33760821

Citation

Dixon, Brian E., et al. "Symptoms and Symptom Clusters Associated With SARS-CoV-2 Infection in Community-based Populations: Results From a Statewide Epidemiological Study." PloS One, vol. 16, no. 3, 2021, pp. e0241875.
Dixon BE, Wools-Kaloustian KK, Fadel WF, et al. Symptoms and symptom clusters associated with SARS-CoV-2 infection in community-based populations: Results from a statewide epidemiological study. PLoS One. 2021;16(3):e0241875.
Dixon, B. E., Wools-Kaloustian, K. K., Fadel, W. F., Duszynski, T. J., Yiannoutsos, C., Halverson, P. K., & Menachemi, N. (2021). Symptoms and symptom clusters associated with SARS-CoV-2 infection in community-based populations: Results from a statewide epidemiological study. PloS One, 16(3), e0241875. https://doi.org/10.1371/journal.pone.0241875
Dixon BE, et al. Symptoms and Symptom Clusters Associated With SARS-CoV-2 Infection in Community-based Populations: Results From a Statewide Epidemiological Study. PLoS One. 2021;16(3):e0241875. PubMed PMID: 33760821.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Symptoms and symptom clusters associated with SARS-CoV-2 infection in community-based populations: Results from a statewide epidemiological study. AU - Dixon,Brian E, AU - Wools-Kaloustian,Kara K, AU - Fadel,William F, AU - Duszynski,Thomas J, AU - Yiannoutsos,Constantin, AU - Halverson,Paul K, AU - Menachemi,Nir, Y1 - 2021/03/24/ PY - 2020/10/26/received PY - 2021/02/26/accepted PY - 2021/3/24/entrez PY - 2021/3/25/pubmed PY - 2021/4/22/medline SP - e0241875 EP - e0241875 JF - PloS one JO - PLoS One VL - 16 IS - 3 N2 - 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. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/33760821/Symptoms_and_symptom_clusters_associated_with_SARS_CoV_2_infection_in_community_based_populations:_Results_from_a_statewide_epidemiological_study_ L2 - https://dx.plos.org/10.1371/journal.pone.0241875 DB - PRIME DP - Unbound Medicine ER -