Elucidating symptoms of COVID-19 illness in the Arizona CoVHORT: a longitudinal cohort study

  1. Sana M Khan
  2. Leslie V Farland
  3. Collin J Catalfamo
  4. Erika Austhof
  5. Melanie L Bell
  6. Zhao Chen
  7. Felina Cordova-Marks
  8. Kacey C Ernst
  9. Pamela Garcia-Filion
  10. Kelly M Heslin
  11. Joshua Hoskinson
  12. Megan L Jehn
  13. Emily C S Joseph
  14. Connor P Kelley
  15. Yann Klimentidis
  16. Stephanie Russo Carroll
  17. Lindsay N Kohler
  18. Kristen Pogreba-Brown
  19. Elizabeth T Jacobs

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Abstract

To elucidate the symptoms of laboratory-confirmed COVID-19 cases as compared with laboratory-confirmed negative individuals and to the untested general population among all participants who reported symptoms within a large prospective cohort study.

Setting and design

This work was conducted within the framework of the Arizona CoVHORT, a longitudinal prospective cohort study conducted among Arizona residents.

Participants

Eligible participants were any individual living in Arizona and were recruited from across Arizona via COVID-19 case investigations, participation in testing studies and a postcard mailing effort.

Primary and secondary outcome measures

The primary outcome measure was a comparison of the type and frequency of symptoms between COVID-19-positive cases, tested but negative individuals and the general untested population who reported experiencing symptoms consistent with COVID-19.

Results

Of the 1335 laboratory-confirmed COVID-19 cases, 180 (13.5%) reported having no symptoms. Of those that did report symptoms, the most commonly reported were fatigue (82.2%), headache (74.6%), aches, pains or sore muscles (66.3%), loss of taste or smell (62.8) and cough (61.9%). In adjusted logistic regression models, COVID-19-positive participants were more likely than negative participants to experience loss of taste and smell (OR 12.1; 95% CI 9.6 to 15.2), bone or nerve pain (OR 3.0; 95% CI 2.2 to 4.1), headache (OR 2.6; 95% CI 2.2 to 3.2), nausea (OR 2.4; 95% CI 1.9 to 3.1) or diarrhoea (OR 2.1; 95% CI 1.7 to 2.6). Fatigue (82.9) and headache (74.9) had the highest sensitivities among symptoms, while loss of taste or smell (87.2) and bone or nerve pain (92.9) had the high specificities among significant symptoms associated with COVID-19.

Conclusion

When comparing confirmed COVID-19 cases with either confirmed negative or untested participants, the pattern of symptoms that discriminates SARS-CoV-2 infection from those arising from other potential circulating pathogens may differ from general reports of symptoms among cases alone.

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  1. Version published to 10.1136/bmjopen-2021-053403
  2. ScreenIT

    SciScore for 10.1101/2021.03.20.21254040: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    RandomizationTo recruit the population-based comparison group, a total of 17,500 postcards were mailed to a simple random sample of Pima, Yuma, and Pinal counties beginning in July 2020.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    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:
    However, limitations of the work must also be considered. Although we have laboratory-confirmed negative participants, we cannot know the COVID-19 status of the untested participants. It is possible that some had already been infected but were asymptomatic or exhibited few symptoms. This would likely attenuate any associations between exposure and outcomes in this study. Additionally, there may be differences in the source population for cases as compared to the laboratory-negative participants and untested participants due to the differences in recruitment strategies for these populations. For example, while postcards were mailed to a random selection of households, it is possible Latinx participants were less likely to respond to this method than direct recruitment as cases during routine case follow-up. This could bias the association between being COVID-19-positive and Latinx away from the null. However, our race/ethnicity profile among cases is approximately similar to the overall distribution of cases throughout Arizona, suggesting a representative sample. Therefore, bias would potentially come from differential responses to other recruitment methods. In conclusion, the findings of this analysis from the Arizona CoVHORT study show variation in several individual characteristics between COVID-19-positive participants, negative participants, and the untested population, which will be studied in future publications to assess the contributors to these observations. In addit...

    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 10.1101/2021.03.20.21254040 on medRxiv