Symptom profiles and accuracy of clinical case definitions for COVID-19 in a community cohort: results from the Virus Watch study

  1. Ellen Fragaszy
  2. Madhumita Shrotri
  3. Cyril Geismar
  4. Anna Aryee
  5. Sarah Beale
  6. Isobel Braithwaite
  7. Thomas Byrne
  8. Max T. Eyre
  9. Wing Lam Erica Fong
  10. Jo Gibbs
  11. Pia Hardelid
  12. Jana Kovar
  13. Vasileios Lampos
  14. Eleni Nastouli
  15. Annalan M.D. Navaratnam
  16. Vincent Nguyen
  17. Parth Patel
  18. Robert W. Aldridge
  19. Andrew Hayward
  20. Virus Watch Collaborative

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Abstract

Background: Understanding symptomatology and accuracy of clinical case definitions for community COVID-19 cases is important for Test, Trace and Isolate (TTI) and future targeting of early antiviral treatment.  

Methods: Community cohort participants prospectively recorded daily symptoms and swab results (mainly undertaken through the UK TTI system).  We compared symptom frequency, severity, timing, and duration in test positive and negative illnesses.  We compared the test performance of the current UK TTI case definition (cough, high temperature, or loss of or altered sense of smell or taste) with a wider definition adding muscle aches, chills, headache, or loss of appetite.    

Results: Among 9706 swabbed illnesses, including 973 SARS-CoV-2 positives, symptoms were more common, severe and longer lasting in swab positive than negative illnesses.  Cough, headache, fatigue, and muscle aches were the most common symptoms in positive illnesses but also common in negative illnesses. Conversely, high temperature, loss or altered sense of smell or taste and loss of appetite were less frequent in positive illnesses, but comparatively even less frequent in negative illnesses.  The current UK definition had 81% sensitivity and 47% specificity versus 93% and 27% respectively for the broader definition. 1.7-fold more illnesses met the broader case definition than the current definition. 

Conclusions: Symptoms alone cannot reliably distinguish COVID-19 from other respiratory illnesses. Adding additional symptoms to case definitions could identify more infections, but with a large increase in the number needing testing and the number of unwell individuals and contacts self-isolating whilst awaiting results.

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  1. Version published to 10.12688/wellcomeopenres.17479.1
  2. Version published to 10.1101/2021.05.14.21257229v2 on medRxiv
  3. ScreenIT

    SciScore for 10.1101/2021.05.14.21257229: (What is this?)

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

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot 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: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

    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.
    • No funding statement was detected.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

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  4. Version published to 10.1101/2021.05.14.21257229v1 on medRxiv