COVID-19 test positivity: predictive value of various symptoms in a large community-based testing program in California
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Abstract
Background
Much of the early data on COVID-19 symptomatology was captured in the hospital setting. In a community setting the symptoms most predictive of SARS-CoV-2 positivity may be different. Data from the California sites of a COVID-19 community testing program are presented here.
Methods
Prior to being tested, participants in the Baseline COVID-19 Testing Program completed an online screener, in which they self-reported basic demographics and the presence or absence of 10 symptoms. Both positive and negative COVID-19 RT-PCR tests were linked back to the screener data. A multivariable model of positivity was fit using generalized estimating equations, adjusting for month of testing as a fixed effect and accounting for clustering of data within each test site.
Results
Among 547,018 first-time tests in California in 2020, positivity rates were 3.4%, 9.9%, and 19.8% for participants with no symptoms, 1 symptom, or 2 or more symptoms at the time of screening, respectively. All ten symptoms were individually associated with higher positivity rates, but only six of ten symptoms were associated with higher positivity when adjusting for other symptoms. Major symptoms with highest predictive value were recent loss of taste or smell, fever, and coughing with ORs of 3.27, 1.97, and 1.95, respectively. Shortness of breath and vomiting or diarrhea were negatively associated with positivity adjusting for other symptoms and, absent other symptoms, participants with these symptoms did not have significantly higher positivity rates than asymptomatic participants.
Conclusions
Recent loss of taste and smell should be elevated to a major symptom along with fever and coughing in public health messaging and in our community approach to testing and surveillance, while mild to moderate shortness of breath should be de-emphasized as a sensitive early predictor of COVID-19 positivity.
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SciScore for 10.1101/2021.03.03.21252014: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Software and Algorithms Sentences Resources All tests were performed using RT-PCR at labs operated by Quest, Bioreference Laboratory, LabCorp, Eurofins, or Verily. Questsuggested: (QUEST, RRID:SCR_005210)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:This analysis has several limitations. There is …
SciScore for 10.1101/2021.03.03.21252014: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Software and Algorithms Sentences Resources All tests were performed using RT-PCR at labs operated by Quest, Bioreference Laboratory, LabCorp, Eurofins, or Verily. Questsuggested: (QUEST, RRID:SCR_005210)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:This analysis has several limitations. There is undoubtedly selection bias, both in the exclusion of symptomatic people who choose not to get tested and among people with severe symptoms, who are not tested until hospitalized. The higher proportion of women who are tested, with or without symptoms, is likely a result of this type of selection bias. It is therefore important to note that these results reflect the positivity rates in a community testing program, primarily in adults. Based on previously reported studies and what we know about the course of disease, these data should not be applied to the hospital setting. Furthermore, new or worsening shortness of breath may be a sign of severity of disease or the presence of a different disease and warrants consultation with a physician even though it may not be predictive of COVID-19 positivity. Nonetheless, our data suggest that public education could be improved around early symptoms vs later stage symptoms. Shortness of breath, in particular, has remained one of the three most heavily emphasized symptoms in public health messaging, while recent loss of taste or smell has received less attention. Our data suggest a re-ordering of symptom emphasis, considering excluding shortness of breath and GI symptoms entirely, could be valuable and make it possible to more accurately screen for the disease.
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.
- Thank you for including a protocol registration statement.
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