Symptom Profiles and Progression in Hospitalized and Nonhospitalized Patients with Coronavirus Disease, Colorado, USA, 2020

Abstract

To improve recognition of coronavirus disease (COVID-19) and inform clinical and public health guidance, we randomly selected 600 COVID-19 case-patients in Colorado. A telephone questionnaire captured symptoms experienced, when symptoms occurred, and how long each lasted. Among 128 hospitalized patients, commonly reported symptoms included fever (84%), fatigue (83%), cough (73%), and dyspnea (72%). Among 236 nonhospitalized patients, commonly reported symptoms included fatigue (90%), fever (83%), cough (83%), and myalgia (74%). The most commonly reported initial symptoms were cough (21%-25%) and fever (20%-25%). In multivariable analysis, vomiting, dyspnea, altered mental status, dehydration, and wheezing were significantly associated with hospitalization, whereas rhinorrhea, headache, sore throat, and anosmia or ageusia were significantly associated with nonhospitalization. General symptoms and upper respiratory symptoms occurred earlier in disease, and anosmia, ageusia, lower respiratory symptoms, and gastrointestinal symptoms occurred later. Symptoms should be considered alongside other epidemiologic factors in clinical and public health decisions regarding potential COVID-19 cases.

Keywords: 2019 novel coronavirus disease; COVID-19; SARS-CoV-2; coronavirus disease; hospitalization; respiratory infections; severe acute respiratory syndrome coronavirus 2; symptom duration; symptom progression; symptoms; viruses; zoonoses.

Figure 1

Coronavirus disease symptoms significantly associated with hospitalization in reduced multivariable model (n = 364 patients), Colorado, March 2020.

Figure 2

Days from coronavirus disease onset to individual symptom onset, by hospitalization status (n = 364 patients), Colorado, March 2020. Symptom progression is shown for hospitalized patients (A) and nonhospitalized patients (B). Lines within boxes indicate median for each symptom, and boxes represent interquartile range. Outliers (defined as >1.5× interquartile range >75th percentile) not shown in figure. SQ, subcutaneous.