Acute and persistent symptoms in non-hospitalized PCR-confirmed COVID-19 patients

  1. Sofie Bliddal
  2. Karina Banasik
  3. Ole Birger Pedersen
  4. Janna Nissen
  5. Lisa Cantwell
  6. Michael Schwinn
  7. Morten Tulstrup
  8. David Westergaard
  9. Henrik Ullum
  10. Søren Brunak
  11. Niels Tommerup
  12. Bjarke Feenstra
  13. Frank Geller
  14. Sisse Rye Ostrowski
  15. Kirsten Grønbæk
  16. Claus Henrik Nielsen
  17. Susanne Dam Nielsen
  18. Ulla Feldt-Rasmussen

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Abstract

Reports of persistent symptoms after hospitalization with COVID-19 have raised concern of a “long COVID” syndrome. This study aimed at determining the prevalence of and risk factors for acute and persistent symptoms in non-hospitalized patients with polymerase chain reaction (PCR) confirmed COVID-19. We conducted a cohort study of non-hospitalized participants identified via the Danish Civil Registration System with a SARS-CoV-2-positive PCR-test and available biobank samples. Participants received a digital questionnaire on demographics and COVID-19-related symptoms. Persistent symptoms: symptoms > 4 weeks (in sensitivity analyses > 12 weeks). We included 445 participants, of whom 34% were asymptomatic. Most common acute symptoms were fatigue, headache, and sneezing, while fatigue and reduced smell and taste were most severe. Persistent symptoms, most commonly fatigue and memory and concentration difficulties, were reported by 36% of 198 symptomatic participants with follow-up > 4 weeks. Risk factors for persistent symptoms included female sex (women 44% vs. men 24%, odds ratio 2.7, 95% CI 1.4–5.1, p = 0.003) and BMI (odds ratio 1.1, 95% CI 1.0–1.2, p = 0.001). In conclusion, among non-hospitalized PCR-confirmed COVID-19 patients one third were asymptomatic while one third of symptomatic participants had persistent symptoms illustrating the heterogeneity of disease presentation. These findings should be considered in health care planning and policy making related to COVID-19.

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  1. Version published to 10.1038/s41598-021-92045-x
  2. ScreenIT

    SciScore for 10.1101/2021.01.22.21249945: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementConsent: Interested participants could contact a call center between July 27th and August 28th 2020 to receive oral information on the project and provide oral consent prior to receiving a digital link for written consent.
    IRB: Ethics: The study was part of the “Epidemiology and Genetics of COVID-19” study approved by the National Committee on Health Research Ethics (
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variableLogistic regression analyses included as covariates: sex (male-female), age, BMI, smoking status (non-smoker vs. ever smoker), comorbidity (yes-no based on composite scores of self-reported chronic disease), work in the health care sector (yes-no), and time to questionnaire (weeks).

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Although data should be reproduced due to possible limitations of survival or recall bias, these findings should be taken into account in future health care planning and policy making related to COVID-19 prevention, detection, treatment and follow-up.

    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

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2021.01.22.21249945v1 on medRxiv