Longitudinal symptom dynamics of COVID-19 infection

  1. Barak Mizrahi
  2. Smadar Shilo
  3. Hagai Rossman
  4. Nir Kalkstein
  5. Karni Marcus
  6. Yael Barer
  7. Ayya Keshet
  8. Na’ama Shamir-Stein
  9. Varda Shalev
  10. Anat Ekka Zohar
  11. Gabriel Chodick
  12. Eran Segal

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Abstract

As the COVID-19 pandemic progresses, obtaining information on symptoms dynamics is of essence. Here, we extracted data from primary-care electronic health records and nationwide distributed surveys to assess the longitudinal dynamics of symptoms prior to and throughout SARS-CoV-2 infection. Information was available for 206,377 individuals, including 2471 positive cases. The two datasources were discordant, with survey data capturing most of the symptoms more sensitively. The most prevalent symptoms included fever, cough and fatigue. Loss of taste and smell 3 weeks prior to testing, either self-reported or recorded by physicians, were the most discriminative symptoms for COVID-19. Additional discriminative symptoms included self-reported headache and fatigue and a documentation of syncope, rhinorrhea and fever. Children had a significantly shorter disease duration. Several symptoms were reported weeks after recovery. By a unique integration of two datasources, our study shed light on the longitudinal course of symptoms experienced by cases in primary care.

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  1. Version published to 10.1038/s41467-020-20053-y
  2. ScreenIT

    SciScore for 10.1101/2020.07.13.20151795: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: Thank you for sharing your code and data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our study also has several limitations. First, the testing policy for COVID-19 in Israel has changed throughout the study period 18. In the majority of the time, individuals had to present with fever or respiratory symptoms, as well as an appropriate epidemiological context, in order to be tested. This may have a strong effect on the prevalence of these symptoms in individuals who were tested compared to those who were not. In addition, both of our data sources may introduce biases to the data and therefore were analysed separately by us. Data which is based on the voluntary self reported symptoms of participants is bound to suffer from selection bias. The fact that the survey was distributed to all the members of MHS by the HMO itself may decrease this bias. Data originating from EHR may also suffer from biases related to processes within the healthcare system 29 and a bias toward patients with more severe conditions. In conclusion, this study we analysed the clinical course of outpatients COVID-19 cases. The study provides additional information on the natural history of mostly mild cases of COVID-19 and may alert physicians for the possibility of the infection and direct the need for testing and self isolation

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  3. Version published to 10.1101/2020.07.13.20151795 on medRxiv