Journal Article

COVID-19 symptoms predictive of healthcare workers’ SARS-CoV-2 PCR results

Lan, Fan-Yun, Osgood, Rebecca, Christophi, Costas A., Kales, Stefanos N., Filler, Robert, Mathew, Soni, Bruno-Murtha, Lou Ann, Buley, Jane, Iliaki, Eirini, Fernandez-Montero, Alejandro

2020

Overview

Coronavirus 2019 disease (COVID-19) is caused by the virus SARS-CoV-2, transmissible both person-to-person and from contaminated surfaces. Early COVID-19 detection among healthcare workers (HCWs) is crucial for protecting patients and the healthcare workforce. Because of limited testing capacity, symptom-based screening may prioritize testing and increase diagnostic accuracy. We performed a retrospective study of HCWs undergoing both COVID-19 telephonic symptom screening and nasopharyngeal SARS-CoV-2 assays during the period, March 9-April 15, 2020. HCWs with negative assays but progressive symptoms were re-tested for SARS-CoV-2. Among 592 HCWs tested, 83 (14%) had an initial positive SARS-CoV-2 assay. Fifty-nine of 61 HCWs (97%) who were asymptomatic or reported only sore throat/nasal congestion had negative SARS-CoV-2 assays (P = 0.006). HCWs reporting three or more symptoms had an increased multivariate-adjusted odds of having positive assays, 1.95 (95% CI: 1.10-3.64), which increased to 2.61 (95% CI: 1.50-4.45) for six or more symptoms. The multivariate-adjusted odds of a positive assay were also increased for HCWs reporting fever and a measured temperature ≥ 37.5°C (3.49 (95% CI: 1.95-6.21)), and those with myalgias (1.83 (95% CI: 1.04-3.23)). Anosmia/ageusia (i.e. loss of smell/loss of taste) was reported less frequently (16%) than other symptoms by HCWs with positive assays, but was associated with more than a seven-fold multivariate-adjusted odds of a positive test: OR = 7.21 (95% CI: 2.95-17.67). Of 509 HCWs with initial negative SARS-CoV-2 assays, nine had symptom progression and positive re-tests, yielding an estimated negative predictive value of 98.2% (95% CI: 96.8-99.0%) for the exclusion of clinically relevant COVID-19. Symptom and temperature reports are useful screening tools for predicting SARS-CoV-2 assay results in HCWs. Anosmia/ageusia, fever, and myalgia were the strongest independent predictors of positive assays. The absence of symptoms or symptoms limited to nasal congestion/sore throat were associated with negative assays.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Adult / Ageusia - virology / Anosmia / Assaying / Asymptomatic / Asymptomatic Infections / Betacoronavirus / Biology and Life Sciences / Body Temperature / Clinical Laboratory Techniques / Congestion / Coronavirus Infections - diagnosis / Coronavirus Infections - physiopathology / Coronaviruses / COVID-19 / COVID-19 Testing / Diagnosis / Diagnostic systems / Diagnostic tests / Disease prevention / Disease transmission / Environmental health / Female / Fever / Fever - virology / Health aspects / Health care / Health Personnel / Health services / Hospitals / Humans / Identification and classification / Infections / Infectious diseases / Laboratories / Logistic Models / Male / Medical personnel / Medical schools / Medicine / Medicine and Health Sciences / Middle Aged / Multivariate Analysis / Myalgia / Myalgia - virology / Nasopharynx - virology / Occupational health / Olfaction / Olfaction disorders / Olfaction Disorders - virology / Pandemics / Pharyngitis / Pharyngitis - virology / Pneumonia, Viral - diagnosis / Pneumonia, Viral - physiopathology / Polymerase Chain Reaction / Principal Component Analysis / Principal components analysis / Public health / Research and Analysis Methods / Retrospective Studies / SARS-CoV-2 / Severe acute respiratory syndrome / Severe acute respiratory syndrome coronavirus 2 / Signs and symptoms / Smell / Taste disorders / Temperature / Viral diseases / Viruses