Self-reported symptoms from exposure to Covid-19 provide support to clinical diagnosis, triage and prognosis: An exploratory analysis

Dreyer, Nancy A; Reynolds, Matthew W.; Mack, Christina; Brinkley, Emma; Petruski‐Ivleva, Natalia; Hawaldar, Kalyani; Toovey, Stephen; Morris, Jonathan M.

doi:10.1016/j.tmaid.2020.101909

Cited by 24 publications

(28 citation statements)

References 16 publications

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“…The results also show that all the symptom frequencies reported here (with the exception of rhinorrhea and sneezing) are different between C19+ from C19-users. This agrees with other studies [10] [11] that also reported hyposmia, dysgeusia and fever as significantly increased in C19+ persons. Considering the high relative difference of hyposmia and dysgeusia frequencies for C19+ users, our study suggests that hyposmia and dysgeusia are specific but not sensitive, i.e.…”

Section: Discussionsupporting

confidence: 93%

Symptoms associated with a COVID-19 infection in the general population of Vienna

Munsch¹,

Gruarin²,

Martin³

et al. 2021

Preprint

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Background A large number of studies report COVID-19 symptom frequencies but most studies focus on hospitalized patients. Therefore reported symptom frequencies vary and their applicability to the general population is limited. Here we report COVID-19 symptom frequencies for the general population of a central European country. Methods In a collaboration between the Vienna Social Fund (FSW) and the AI-biotech company Symptoma we report symptom frequencies based on the COVID-19 chatbot of the city government of Vienna and corresponding PCR-test results. Chatbot users answered 13 yes/no questions about symptoms and provided information about age and sex. Subsequently a medically trained professional came to their address to take a sample and PCR results were obtained. Findings Between November 2 and January 5, a total of 3011 persons experiencing flu-like symptoms had a PCR-test by a medical professional at home and completed the chatbot session prior to the test, 816 (27.1%) of them were COVID-19 positive. We compared the symptom frequencies between COVID-19 positive and negative users, and between male and female users. The symptoms (sorted by frequency) of users with positive PCR-test are malaise (81.1%), fatigue (72.9%), headache (64.1%), cough (57.7%), fever (50.7%), sore throat (40.7%), close contact with COVID-19 cases (34.9%), rhinorrhea (31.0%), sneezing (28.4%), dysgeusia (27.1%), hyposmia (26.5%), dyspnea (11.4%) and diarrhea (10.9%). Among these, cough, fever, hyposmia, dysgeusia, malaise, headache, close contact with COVID-19 case and fatigue are significantly (P < 0.01) increased in COVID-19 positive persons while dyspnea, diarrhea and sore throat are significantly (P < 0.01) decreased in COVID-19 positive persons. There was no significant difference for rhinorrhea and sneezing.

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Section: Discussionsupporting

confidence: 93%

Symptoms associated with a COVID-19 infection in the general population of Vienna

Munsch¹,

Gruarin²,

Martin³

et al. 2021

Preprint

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“…Thus, anosmia or dysgeusia may even be regarded as a highly reliable diagnostic marker in very mild cases, as also proposed by other colleagues. 23,24 Of note, we could not find a correlation between the number of symptoms (implying severity) and the level of the neutralisation titre as supported by other recently published data. 25,26 Our data further indicate that in individuals with anosmia/dysgeusia as a sole symptom, the quality and quantity of neutralising/protective antibodies does not differ compared to those with several reported and typical COVID-19 symptoms (fever, cough, dyspnoea).…”

Section: Discussionsupporting

confidence: 85%

A longitudinal seroprevalence study in a large cohort of working adults reveals that neutralising SARS-CoV-2 RBD-specific antibodies persist for at least six months independent of the severity of symptoms

Wagner

Guzek

Ruff

et al. 2020

Preprint

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BackgroundIn spring 2020, at the beginning of the first pandemic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) wave in Europe, we set up an assay system for large-scale testing of virus-specific and protective antibodies including their longevity.MethodsWe analysed the sera of 1655 adult employees for SARS-CoV-2-specific antibodies using the S1 subunit of the spike protein of SARS-CoV-2. Sera containing S1-reactive antibodies were further evaluated for receptor-binding domain (RBD)- and nucleocapsid protein (NCP)-specific antibodies in relation to the neutralisation test (NT) results at 0, three and six months.FindingsWe found immunoglobulin G (IgG) and/or IgA antibodies reactive to the S1 protein in 10.15% (n=168) of the participants. In total, 0.97% (n=16) were positive for S1-IgG, 0.91% (n=15) were S1-IgG-borderline and 8.28% (n=137) exhibited only S1-IgA antibodies. Next, we evaluated the 168 S1-reactive sera for RBD- and NCP specificity: 8.33% (n=14) had detectable RBD-specific and 6.55% (n=11) NCP-specific antibodies. The latter correlated with NTs (kappa coefficient = 0.8660) but started to decline already after 3 months. RBD-specific antibodies correlated best with the NT (kappa = 0.9448) and only these antibodies were stable for up to six months. All participants with virus-neutralising antibodies reported symptoms, of which, anosmia and/or dysgeusia correlated best with the detection of virus-neutralising antibodies.InterpretationRBD-specific antibodies were most reliably detected post infection, independent of the number/severity of symptoms, and correlated best with protective neutralising antibodies at least for six months. They thus qualify best for large-scale seroepidemiological evaluation of both seroprevalence and seroprotection.FundingThis study received funding from the Austrian Ministry of Education, Science and Research within the research framework in relation to the coronavirus disease 2019 pandemic (GZ 2020 0225 104).Key pointsPersistence of SARS-CoV-2 antibodies depends on their specificity. Total RBD-specific antibodies are those that are stable for up to at least six months and correlate best with neutralisation independent of the presence and severity of COVID-19 symptoms.Research in contextEvidence before the studyAt the beginning of the study (early pandemic in April 2020), the SARS-Cov-2 specific seroprevalence was totally unknown. Additionally, S1-specific antibody assays being the first on the market were tested with limited sample size showing a lower sensitivity and specificity at that time. Furthermore, at that time, there were no unambiguous interpretations of antibody test results with regard to immunity/protection against reinfection. It was also not clear whether the detection of different antibody specificities could yield an essential input into the interpretation of the antibody’s qualities. Another open question was how long antibodies of the various specificities as well as antibodies with protective capacities would persist.Added value of this studyWe provide data to confirm the most reliable correlation of RBD-specific antibodies with neutralising antibodies that are stable for at least six months. S1- and NCP-specific antibodies wane more quickly than RBD-specific antibodies, rendering them not as ideal candidates for longitudinal seroprevalence studies. Concerning symptoms, anosmia/dysgeusia was strongly associated with NT-seropositivity and seroprotection in the overall study population.Implications of all the available evidenceOur data suggest that RBD-specific total antibody measurements with assays of high specificity can be used for cross-sectional as well as longitudinal seroepidemiological studies, even in low-prevalence settings. Detection of these antibodies also indicates robust seroprotection for at least six months. Due to the substantial loss of S1- and NCP-specific antibodies within the first months, assays targeting these antigen specificities – in contrast to RBD-specific antibody measurements – are not optimal to assess the duration of seroprotection. Overall, respiratory symptoms alone were not useful in predicting a past infection with SARS-CoV-2. However, anosmia/dysgeusia appeared to be a significant diagnostic marker, in particular for mild COVID-19.

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“…Participants who reported testing positive for COVID-19 within the 14 days preceding enrollment (n=1,518; median [IQR]=7 [4][5][6][7][8][9] days) included 70 (4.6%) individuals who reported taking medication for an autoimmune condition. Participants taking medication for an autoimmune condition were on average older (mean age 46.9 vs 40.9 years), less likely to be Hispanic or Latino (7% vs 16%), and more likely to be female (93% vs 87%) and to report other comorbidities compared to all other participants (Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…Participants reporting use of medications for autoimmune disease reported a median [IQR] of 7 [5][6][7][8][9] symptoms at enrollment, while the median [IQR] number of symptoms for all other participants was 7 [4][5][6][7][8][9]. The median [IQR] severity score at enrollment for those reporting use of medications for autoimmune disease was 12 [7][8][9][10][11][12][13][14][15][16][17] decreased sense of smell or taste at enrollment; among those reporting use of medications for autoimmune disease, a higher proportion reported symptoms at all time points in follow-up, as well as symptoms of greater severity (Figure 1).…”

Section: Resultsmentioning

confidence: 99%

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Identification of a Vulnerable Group for Post-Acute Sequelae of SARS-CoV-2 (PASC): People with Autoimmune Diseases Recover More Slowly from COVID-19

Dreyer¹,

Petruski‐Ivleva²,

Albert³

et al. 2021

IJGM

Self Cite

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Purpose: Evidence is emerging that a significant percentage of COVID-19 cases experience symptom persistence beyond 30 days and go on to develop post-acute sequelae. Our objective was to compare the risk for COVID-19 symptom persistence by self-reported use of medications for autoimmune disease among participants of an on-line COVID-19 registry. Patients and Methods: A community-based online survey collected weekly data on COVID-19 symptom presentation. Participants who completed informed consent online, reported a positive COVID-19 test result within 14 days prior to enrollment and also reported demographics, underlying illnesses, and medication use were included. Symptom presence and severity were evaluated weekly after enrollment and compared between participants reporting use of medications for autoimmune conditions and all others. Logistic regression was used to evaluate the odds of more severe acute illness and symptom persistence approximately 30 days after enrollment. Results: A total of 1,518 COVID-19-positive participants were included. Participants reporting use of medications for autoimmune disease (n=70) were more likely to have experienced symptoms at all time points over a 30-day time period and were more likely to report more severe presentation of COVID-19 during acute illness (adjusted OR (95% CI)=1.32 (0.76-2.29)) compared to those reporting not taking medications for autoimmune disease. At about 30 days after enrollment, users of medications for autoimmune disease were more than twice as likely to report three or more symptoms (adjusted OR (95% CI)=2. 53 (1.21-5.29)). In particular, their risk of persistent shortness of breath and fatigue was elevated (adjusted OR (95% CI)=2.66 (1.15-6.18) and 4.73 (2.17-10.34), respectively). Conclusion: Individuals with underlying autoimmune conditions appear to be particularly vulnerable to post-acute sequelae from COVID-19; early intervention might be considered.

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Self-reported symptoms from exposure to Covid-19 provide support to clinical diagnosis, triage and prognosis: An exploratory analysis

Cited by 24 publications

References 16 publications

Symptoms associated with a COVID-19 infection in the general population of Vienna

Symptoms associated with a COVID-19 infection in the general population of Vienna

A longitudinal seroprevalence study in a large cohort of working adults reveals that neutralising SARS-CoV-2 RBD-specific antibodies persist for at least six months independent of the severity of symptoms

Identification of a Vulnerable Group for Post-Acute Sequelae of SARS-CoV-2 (PASC): People with Autoimmune Diseases Recover More Slowly from COVID-19

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