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. 2023 May 23;10(7):ofad275.
doi: 10.1093/ofid/ofad275. eCollection 2023 Jul.

Association Between SARS-CoV-2 Variants and Frequency of Acute Symptoms: Analysis of a Multi-institutional Prospective Cohort Study-December 20, 2020-June 20, 2022

Ralph C Wang  1 , Michael Gottlieb  2 , Juan Carlos C Montoy  1 , Robert M Rodriguez  1 , Huihui Yu  3 , Erica S Spatz  3 , Christopher W Chandler  4 , Joann G Elmore  4   5 , Paavali A Hannikainen  6 , Anna Marie Chang  6 , Mandy Hill  7 , Ryan M Huebinger  7 , Ahamed H Idris  8 , Katherine Koo  9 , Shu-Xia Li  3 , Samuel McDonald  8 , Graham Nichol  10 , Kelli N O'Laughlin  11 , Ian D Plumb  12 , Michelle Santangelo  13 , Sharon Saydah  12 , Kari A Stephens  14 , Arjun K Venkatesh  3   15 , Robert A Weinstein  9 ; Innovative Support for Patients with SARS-CoV-2 Infections Registry (INSPIRE) Group
Collaborators, Affiliations

Association Between SARS-CoV-2 Variants and Frequency of Acute Symptoms: Analysis of a Multi-institutional Prospective Cohort Study-December 20, 2020-June 20, 2022

Ralph C Wang et al. Open Forum Infect Dis. .

Abstract

Background: While prior work examining severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concern focused on hospitalization and death, less is known about differences in clinical presentation. We compared the prevalence of acute symptoms across pre-Delta, Delta, and Omicron.

Methods: We conducted an analysis of the Innovative Support for Patients with SARS-CoV-2 Infections Registry (INSPIRE), a cohort study enrolling symptomatic SARS-CoV-2-positive participants. We determined the association between the pre-Delta, Delta, and Omicron time periods and the prevalence of 21 coronavirus disease 2019 (COVID-19) acute symptoms.

Results: We enrolled 4113 participants from December 2020 to June 2022. Pre-Delta vs Delta vs Omicron participants had increasing sore throat (40.9%, 54.6%, 70.6%; P < .001), cough (50.9%, 63.3%, 66.7%; P < .001), and runny noses (48.9%, 71.3%, 72.9%; P < .001). We observed reductions during Omicron in chest pain (31.1%, 24.2%, 20.9%; P < .001), shortness of breath (42.7%, 29.5%, 27.5%; P < .001), loss of taste (47.1%, 61.8%, 19.2%; P < .001), and loss of smell (47.5%, 55.6%, 20.0%; P < .001). After adjustment, those infected during Omicron had significantly higher odds of sore throat vs pre-Delta (odds ratio [OR], 2.76; 95% CI, 2.26-3.35) and Delta (OR, 1.96; 95% CI, 1.69-2.28).

Conclusions: Participants infected during Omicron were more likely to report symptoms of common respiratory viruses, such as sore throat, and less likely to report loss of smell and taste.

Trial registration: NCT04610515.

Keywords: COVID-19; COVID-19 symptoms; SARS-COV-2; variants of concern.

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Conflict of interest statement

Potential conflicts of interest. Dr. Elmore reports serving as Editor in Chief of Adult Primary Care topics for UpToDate. Dr. Venkatesh reports funding for COVID-19-related studies from the Society of Academic Emergency Medicine Foundation Emerging Infectious Disease and Preparedness Grant, the Agency for Healthcare Research and Quality (R01 HS 28340-01) the Food and Drug Administration (ID: 75F40120C00174), and the Emergency Medicine Health Policy Institute/Emergency Medicine Foundation. Dr. Wang reports funding from CDC for research on N95 respirators. Dr. Gottlieb reports grant funding from the Rush Center for Emerging Infectious Diseases Research Grant, Emergency Medicine Foundation/Council of Residency Directors in Emergency Medicine Education Research Grant, Emergency Medicine: Reviews and Perspectives Medical Education Research Grant, University of Ottawa Department of Medicine Education Grant; and Society of Directors of Research in Medical Education Grant. Dr. Nichol reports the following: Vapotherm Inc, Exeter, NH- Research funding; ZOLL Medical, Chelmsford, MA- Research funding; Abiomed Inc., Danvers, MA- Consultant; CellPhire Inc., Rockville, MD- Consultant; CPR Therapeutics, Putney, VT- Consultant; ZOLL Circulation, San Jose, CA- Consultant; Patent- Method for non-imaging ultrasound to measure blood flow during CPR; Non-provisional patent- Method for modifying cell injury associated with reduced blood flow; Heartbeam Inc., Santa Clara, CA- Consultant; Invero Health, LLC., Montvale, NJ- Consultant; Orixha Inc., Saint Cyr Au Mont d’Or, France- Consultant; Kestra Medical Technologies, Kirkland, WA- Consultant; Medic One Foundation, Seattle, WA- Salary Support via Univ. Washington (UW). Dr. Elmore reports serving as Editor in Chief of Adult Primary Care topics for UpToDate. Dr. Venkatesh reports funding for COVID-19-related studies from the Society of Academic Emergency Medicine Foundation Emerging Infectious Disease and Preparedness Grant, the Agency for Healthcare Research and Quality (R01 HS 28340-01), the Food and Drug Administration (ID: 75F40120C00174), and the Emergency Medicine Health Policy Institute/Emergency Medicine Foundation. Dr. Wang reports funding from CDC for research on N95 respirators. All other authors report no potential conflicts.

Figures

Figure 1.
Figure 1.
SARS-CoV-2 viral variant proportion over time in the United States (12/25/20–6/25/22). Abbreviation: SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.
Figure 2.
Figure 2.
INSPIRE participant flow diagram. Abbreviation: INSPIRE, Innovative Support for Patients with SARS-CoV-2 Infections Registry.
Figure 3.
Figure 3.
Bar chart of acute symptom prevalence and Forest plot of odds ratios for each acute symptom by variant time period (variant was >50% of circulating virus).
See this image and copyright information in PMC

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