Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
[Preprint]. 2021 Feb 8:2020.11.23.20237313.
doi: 10.1101/2020.11.23.20237313.

Optimal symptom combinations to aid COVID-19 case identification: analysis from a community-based, prospective, observational cohort

M Antonelli  1 , J Capdevila  2 , A Chaudhari  3 , J Granerod  3 , L S Canas  1 , M S Graham  1 , K Klaser  1 , M Modat  1 , E Molteni  1 , B Murray  1 , C H Sudre  4   1 , R Davies  2 , A May  2 , L H Nguyen  5   6 , D A Drew  5   6 , A Joshi  5   6 , A T Chan  5   6 , J P Cramer  3 , T Spector  7 , J Wolf  2 , S Ourselin  1 , C J Steves  7 , A E Loeliger  3
Affiliations

Optimal symptom combinations to aid COVID-19 case identification: analysis from a community-based, prospective, observational cohort

M Antonelli et al. medRxiv. .

Update in

Abstract

Objectives: Diagnostic work-up following any COVID-19 associated symptom will lead to extensive testing, potentially overwhelming laboratory capacity whilst primarily yielding negative results. We aimed to identify optimal symptom combinations to capture most cases using fewer tests with implications for COVID-19 vaccine developers across different resource settings and public health.

Methods: UK and US users of the COVID-19 Symptom Study app who reported new-onset symptoms and an RT-PCR test within seven days of symptom onset were included. Sensitivity, specificity, and number of RT-PCR tests needed to identify one case (test per case [TPC]) were calculated for different symptom combinations. A multi-objective evolutionary algorithm was applied to generate combinations with optimal trade-offs between sensitivity and specificity.

Findings: UK and US cohorts included 122,305 (1,202 positives) and 3,162 (79 positive) individuals. Within three days of symptom onset, the COVID-19 specific symptom combination (cough, dyspnoea, fever, anosmia/ageusia) identified 69% of cases requiring 47 TPC. The combination with highest sensitivity (fatigue, anosmia/ageusia, cough, diarrhoea, headache, sore throat) identified 96% cases requiring 96 TPC.

Interpretation: We confirmed the significance of COVID-19 specific symptoms for triggering RT-PCR and identified additional symptom combinations with optimal trade-offs between sensitivity and specificity that maximize case capture given different resource settings.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interests Potential conflicts of interest. JW, RD, JCP, and AM are employees of Zoe Global Ltd. ATC reports grants from Massachusetts Consortium on Pathogen Readiness during the conduct of the study, personal fees from Pfizer Inc., and grants and personal fees from Bayer Pharma; CEPI (authors AC, JG, JPC, AEL) funds clinical trials of COVID-19 vaccines. All other authors declare no competing interests.

Figures

Figure 1.
Figure 1.
Symptom frequency for COVID-19 negative (left) and COVID-19 positive (right) cases
Figure 2.
Figure 2.
Combination of symptoms with highest sensitivity, sensitivity ~ 90%, and specificity ~50%
Figure 3.
Figure 3.
Pareto of optimal subset generated by the multi-objective evolutionary algorithm for three- and seven-day analyses
Figure 4.
Figure 4.
Percentage of a symptom’s appearance in symptom combinations with sensitivity ≥90 %
See this image and copyright information in PMC

References

    1. Hodgson SH, Mansatta K, Mallett G, Harris V, Emary KRW, Pollard AJ. What defines an efficacious COVID-19 vaccine? A review of the challenges assessing the clinical efficacy of vaccines against SARS-CoV-2. Lancet Infect Dis 2020; S1473–3099(20): 30773–8. - PMC - PubMed
    1. Corey L, Mascola JR, Fauci AS, Collins FS. A strategic approach to COVID-19 vaccine R&D. Science 2020; 368(6494):948–950. - PubMed
    1. Polack FP, Thomas SJ, Kitchin N, et al. Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine. New England Journal of Medicine, December 2020, doi = { 10.1056/NEJMoa2034577}. - DOI - PMC - PubMed
    1. Moderna Announces Primary Efficacy Analysis in Phase 3 COVE Study for Its COVID-19 Vaccine: https://investors.modernatx.com/node/10421/pdf [Accessed 9th December 2020].
    1. AZD1222 vaccine met primary efficacy endpoint in preventing COVID-19: https://www.astrazeneca.com/media-centre/press-releases/2020/azd1222hlr.... [Accessed 9th December 2020].

Publication types