Journal Article

COVID-19 symptoms at time of testing and association with positivity among outpatients tested for SARS-CoV-2

Napravnik, Sonia, Smedberg, Jason R., Barzin, Amir H., Thompson, Cecilia M., Ruegsegger, Laura, Gilleskie, Matt, Weber, David J., Wohl, David A., Whinna, Herbert C., Davy-Mendez, Thibaut, Miller, Melissa B.

2021

Overview

Symptoms associated with SARS-CoV-2 infection remain incompletely understood, especially among ambulatory, non-hospitalized individuals. With host factors, symptoms predictive of SARS-CoV-2 could be used to guide testing and intervention strategies. Between March 16 and September 3, 2020, we examined the characteristics and symptoms reported by individuals presenting to a large outpatient testing program in the Southeastern US for nasopharyngeal SARS-CoV-2 RNA RT-PCR testing. Using self-reported symptoms, demographic characteristics, and exposure and travel histories, we identified the variables associated with testing positive using modified Poisson regression. Among 20,177 tested individuals, the proportion positive was 9.4% (95% CI, 9.0-9.8) and was higher for men, younger individuals, and racial/ethnic minorities (all P<0.05); the positivity proportion was higher for Hispanics (26.9%; 95% CI. 24.9-29.0) compared to Blacks (8.6%; 95% CI, 7.6-9.7) or Whites (5.8%; 95% CI, 5.4-6.3). Individuals reporting contact with a COVID-19 case had the highest positivity proportion (22.8%; 95% CI, 21.5-24.1). Among the subset of 8,522 symptomatic adults who presented for testing after May 1, when complete symptom assessments were performed, SARS-CoV-2 RNA PCR was detected in 1,116 (13.1%). Of the reported symptoms, loss of taste or smell was most strongly associated with SARS-CoV-2 RNA detection with an adjusted risk ratio of 3.88 (95% CI, 3.46-4.35). The presence of chills, fever, cough, aches, headache, fatigue and nasal congestion also significantly increased the risk of detecting SARS-CoV-2 RNA, while diarrhea or nausea/vomiting, although not uncommon, were significantly more common in those with a negative test result. Symptom combinations were frequent with 67.9% experiencing ≥4 symptoms, including 19.8% with ≥8 symptoms; report of greater than three symptoms increased the risk of SARS-CoV-2 RNA detection. In a large outpatient population in the Southeastern US, several symptoms, most notably loss of taste or smell, and greater symptom burden were associated with detection of SARS-CoV-2 RNA. Persons of color and those with who were a contact of a COVID-19 case were also more likely to test positive. These findings suggest that, given limited SARS-CoV-2 testing capacity, symptom presentation and host characteristics can be used to guide testing and intervention prioritization.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Adolescent / Adult / Asymptomatic / Biology and life sciences / Chills / Coronaviruses / Cough / COVID-19 / COVID-19 - diagnosis / COVID-19 - virology / COVID-19 Testing / Demographic variables / Diarrhea / Ethnicity / Female / Fever / Humans / Infections / Infectious diseases / Influenza / Male / Marginalized groups / Medical examination / Medical laboratories / Medicine / Medicine and health sciences / Middle Aged / Minority & ethnic groups / Nausea / Olfaction / Outpatients / Polymerase chain reaction / Ribonucleic acid / Risk / RNA / RNA, Viral - genetics / SARS-CoV-2 - physiology / Severe acute respiratory syndrome / Severe acute respiratory syndrome coronavirus 2 / Smell / Social Sciences / Statistics / Taste / Underserved populations / Viral diseases / Vomiting / Young Adult