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Meta-Analysis
. 2020 Jun 23;15(6):e0234765.
doi: 10.1371/journal.pone.0234765. eCollection 2020.

The prevalence of symptoms in 24,410 adults infected by the novel coronavirus (SARS-CoV-2; COVID-19): A systematic review and meta-analysis of 148 studies from 9 countries

Michael C Grant  1 , Luke Geoghegan  2 , Marc Arbyn  3 , Zakaria Mohammed  4   5 , Luke McGuinness  6   7 , Emily L Clarke  8   9 , Ryckie G Wade  4   5
Affiliations
Meta-Analysis

The prevalence of symptoms in 24,410 adults infected by the novel coronavirus (SARS-CoV-2; COVID-19): A systematic review and meta-analysis of 148 studies from 9 countries

Michael C Grant et al. PLoS One. .

Abstract

Background: To limit the spread of SARS-CoV-2, an evidence-based understanding of the symptoms is critical to inform guidelines for quarantining and testing. The most common features are purported to be fever and a new persistent cough, although the global prevalence of these symptoms remains unclear. The aim of this systematic review is to determine the prevalence of symptoms associated with COVID-19 worldwide.

Methods: We searched PubMed, Embase, CINAHL, AMED, medRxiv and bioRxiv on 5th April 2020 for studies of adults (>16 years) with laboratory test confirmed COVID-19. No language or publication status restrictions were applied. Data were independently extracted by two review authors into standardised forms. All datapoints were independently checked by three other review authors. A random-effects model for pooling of binomial data was applied to estimate the prevalence of symptoms, subgrouping estimates by country. I2 was used to assess inter-study heterogeneity.

Results: Of 851 unique citations, 148 articles were included which comprised 24,410 adults with confirmed COVID-19 from 9 countries. The most prevalent symptoms were fever (78% [95% CI 75%-81%]; 138 studies, 21,701 patients; I2 94%), a cough (57% [95% CI 54%-60%]; 138 studies, 21,682 patients; I2 94%) and fatigue (31% [95% CI 27%-35%]; 78 studies, 13,385 patients; I2 95%). Overall, 19% of hospitalised patients required non-invasive ventilation (44 studies, 6,513 patients), 17% required intensive care (33 studies, 7504 patients), 9% required invasive ventilation (45 studies, 6933 patients) and 2% required extra-corporeal membrane oxygenation (12 studies, 1,486 patients). The mortality rate was 7% (73 studies, 10,402 patients).

Conclusions: We confirm that fever and cough are the most prevalent symptoms of adults infected by SARS-CoV-2. However, there is a large proportion of infected adults which symptoms-alone do not identify.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Study flow chart.
Fig 2
Fig 2. Forest plot of the prevalence of fever in adults with laboratory test confirmed COVID-19.
The diamonds are summary estimates from each country.
Fig 3
Fig 3. Forest plot of the prevalence of cough (dry or productive) in adults with laboratory test confirmed COVID-19.
The diamonds are summary estimates from each country.
See this image and copyright information in PMC

References

    1. Coronavirus disease 2019 (COVID-19) Situation Report– 81. World Heal. Organ. 2020.
    1. Jefferson T, Del Mar C, Dooley L, Ferroni E, Al-Ansary LA, Bawazeer GA, et al. Physical interventions to interrupt or reduce the spread of respiratory viruses: systematic review. BMJ. 2009;339:b3675–b3675. 10.1136/bmj.b3675 - DOI - PMC - PubMed
    1. Jefferson T, Del Mar CB, Dooley L, Ferroni E, Al-Ansary LA, Bawazeer GA, et al. Physical interventions to interrupt or reduce the spread of respiratory viruses. Cochrane Database Syst Rev. 2011; - PMC - PubMed
    1. Ahmed F, Zviedrite N, Uzicanin A. Effectiveness of workplace social distancing measures in reducing influenza transmission: A systematic review. BMC Public Health. BMC Public Health; 2018;18:1–13. - PMC - PubMed
    1. Livingston E, Bucher K, Rekito A. Coronavirus Disease 2019 and Influenza 2019–2020. JAMA. 2020;323:1122 10.1001/jama.2020.2633 - DOI - PubMed

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