Clinical spectrum of coronavirus disease 2019 in Iceland: population based cohort study

Abstract

Objective To characterise the symptoms of coronavirus disease 2019 (covid-19). Design Population based cohort study. Setting Iceland. Participants All individuals who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse transcription polymerase chain reaction (RT-PCR) between 17 March and 30 April 2020. Cases were identified by three testing strategies: targeted testing guided by clinical suspicion, open invitation population screening based on self referral, and random population screening. All identified cases were enrolled in a telehealth monitoring service, and symptoms were systematically monitored from diagnosis to recovery. Main outcome measures Occurrence of one or more of 19 predefined symptoms during follow-up. Results Among 1564 people positive for SARS-CoV-2, the most common presenting symptoms were myalgia (55%), headache (51%), and non-productive cough (49%). At the time of diagnosis, 83 (5.3%) individuals reported no symptoms, of whom 49 (59%) remained asymptomatic during follow-up. At diagnosis, 216 (14%) and 349 (22%) people did not meet the case definition of the Centers for Disease Control and Prevention and the World Health Organization, respectively. Most (67%) of the SARS-CoV-2-positive patients had mild symptoms throughout the course of their disease. Conclusion In the setting of broad access to RT-PCR testing, most SARS-CoV-2-positive people were found to have mild symptoms. Fever and dyspnoea were less common than previously reported. A substantial proportion of SARS-CoV-2-positive people did not meet recommended case definitions at the time of diagnosis.

Serologic Screening for Coronavirus Disease 2019 in Patients With Glomerular Disease

“…A combined analysis of all cases (identified either by PCR or serological testing) showed that the majority of patients had mild or asymptomatic disease, 19% required hospital admission (but subsequently recovered and were discharged), and the overall case fatality rate was 7% (substantially lower than the 30% mortality reported for the PCR-proven group). This provides a more Icelandic epidemiological study reported that, out of 1797 patients identified with SARS-CoV-2 infection (with a similar male:female ratio and average age to our patient cohort), 5.6% were hospitalised, 1.5% required admission to ITU and 0.6% died 1 . Further work is now needed to understand the role of different immunosuppressive treatments, the underlying disease for which they are prescribed, and co-morbidities, in determining COVID-19 outcome.…”

“…No epidemiological studies examining COVID-19 disease severity in the general population in London have been published for direct comparison. However, a recently published, large Icelandic epidemiological study reported that, out of 1797 patients identified with SARS-CoV-2 infection (with a similar male:female ratio and average age to our patient cohort), 5.6% were hospitalised, 1.5% required admission to ITU and 0.6% died 1 . Further work is now needed to understand the role of different immunosuppressive treatments, the underlying disease for which they are prescribed, and co-morbidities, in determining COVID-19 outcome.…”

SARS-CoV-2 persistence is associated with antigen-specific CD8 T-cell responses

“…In contrast to previous studies, which have focused on the fraction of infected who are severely ill [ 4 , [6] , [7] , [8] , [9] , 21 ], our cohort consisted mainly of non-hospitalized individuals, which also represents the majority of COVID-19 cases [ 22 , 23 ]. Thus, the data presented here is representative for the general population and the results have high external validity.…”

Efficacy and safety of CT-P59 plus standard of care: a phase 2/3 randomized, double-blind, placebo-controlled trial in outpatients with mild-to-moderate SARS-CoV-2 infection

“…The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic represents an ongoing global health crisis of unprecedented scale [1][2][3] . While most patients experience asymptomatic or mild-tomoderate disease, some progress to experience more severe symptoms and may require hospitalization 4,5 .…”