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Introduction There are little data on outcomes of COVID-19 patients with the presence of fever compared to the presence of symptoms. We examined the associations between symptomology, presence of fever, and outcomes of a COVID-19 cohort. Methods Between 23rd January to 30th April 2020, 554 COVID-19 patients were admitted to a tertiary hospital in Singapore. They were allocated into 4 groups based on symptomology and fever – Group 1: asymptomatic and afebrile, Group 2: symptomatic but afebrile, Group 3: febrile but asymptomatic, Group 4: symptomatic and febrile. The primary outcomes were intensive care unit (ICU) admissions and mortality. The composite end-point included ICU admissions, mortality or any COVID-19 related end-organ involvement. Results There were differences in ferritin (p = 0.003), C-reactive protein (CRP) levels (p < 0.001) and lymphopenia (p = 0.033) across all groups, with the most favourable biochemical profile in Group 1, and the least in Group 4. Symptomatic groups (Groups 2 and 4) had higher ICU admissions (1.9% and 6.0%, respectively, p = 0.003) than asymptomatic groups (Groups 1 and 3). Composite end-point was highest in Group 4 (24.0%), followed by Group 3 (8.6%), Group 2 (4.8%) and Group 1 (2.4%) (p < 0.001). The presence of fever (OR 4.096, 95% CI 1.737–9.656, p = 0.001) was associated with the composite end-point after adjusting for age, pulse rate, comorbidities, lymphocyte, ferritin, CRP. Presence of symptoms was not associated with the composite end-point. Conclusion In this COVID-19 cohort, presence of fever was a predictor of adverse outcomes. This has implications on the management of febrile but asymptomatic COVID-19 patients.