Sudre Carole H, Keshet Ayya, Graham Mark S, Joshi Amit D, Shilo Smadar, Rossman Hagai, Murray Benjamin, Molteni Erika, Klaser Kerstin, Canas Liane D, Antonelli Michela, Modat Marc, Capdevila Pujol Joan, Ganesh Sajaysurya, Wolf Jonathan, Meir Tomer, Chan Andrew T, Steves Claire J, Spector Tim D, Brownstein John S, Segal Eran, Ourselin Sebastien, Astley Christina M
MRC Unit for Lifelong health and Ageing at UCL, Department of Population Science and Experimental Medicine, University College London, London, UK.
Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK.
medRxiv. 2020 Dec 16:2020.12.15.20248096. doi: 10.1101/2020.12.15.20248096.
Multiple participatory surveillance platforms were developed across the world in response to the COVID-19 pandemic, providing a real-time understanding of community-wide COVID-19 epidemiology. During this time, testing criteria broadened and healthcare policies matured. We sought to test whether there were consistent associations of symptoms with SARS-CoV-2 test status across three national surveillance platforms, during periods of testing and policy changes, and whether inconsistencies could better inform our understanding and future studies as the COVID-19 pandemic progresses.
Four months (1st April 2020 to 31st July 2020) of observation through three volunteer COVID-19 digital surveillance platforms targeting communities in three countries (Israel, United Kingdom, and United States). Logistic regression of self-reported symptom on self-reported SARS-CoV-2 test status (or test access), adjusted for age and sex, in each of the study cohorts. Odds ratios over time were compared to known changes in testing policies and fluctuations in COVID-19 incidence.
Anosmia/ageusia was the strongest, most consistent symptom associated with a positive COVID-19 test, based on 658,325 tests (5% positive) from over 10 million respondents in three digital surveillance platforms using longitudinal and cross-sectional survey methodologies. During higher-incidence periods with broader testing criteria, core COVID-19 symptoms were more strongly associated with test status. Lower incidence periods had, overall, larger confidence intervals.
The strong association of anosmia/ageusia with self-reported SARS-CoV-2 test positivity is omnipresent, supporting its validity as a reliable COVID-19 signal, regardless of the participatory surveillance platform or testing policy. This analysis highlights that precise effect estimates, as well as an understanding of test access patterns to interpret differences, are best done only when incidence is high. These findings strongly support the need for testing access to be as open as possible both for real-time epidemiologic investigation and public health utility.
NIH, NIHR, Alzheimer's Society, Wellcome Trust.
为应对新冠疫情，全球开发了多个参与式监测平台，以实时了解社区范围内的新冠流行病学情况。在此期间，检测标准放宽，医疗政策逐渐成熟。我们试图检验在三个国家监测平台上，在检测和政策变化期间，症状与新冠病毒检测状态之间是否存在一致的关联，以及随着新冠疫情的发展，这些不一致是否能更好地增进我们的理解并为未来研究提供信息。
通过针对三个国家（以色列、英国和美国）社区的三个新冠病毒志愿者数字监测平台进行了四个月（2020年4月1日至2020年7月31日）的观察。在每个研究队列中，对自我报告的症状与自我报告的新冠病毒检测状态（或检测机会）进行逻辑回归分析，并对年龄和性别进行调整。将随时间变化的优势比与已知的检测政策变化和新冠发病率波动进行比较。
基于三个数字监测平台上超过1000万受访者的658325次检测（5%呈阳性），使用纵向和横断面调查方法，嗅觉丧失/味觉丧失是与新冠病毒检测呈阳性最强烈、最一致相关的症状。在检测标准更宽松的高发病期，新冠核心症状与检测状态的关联更强。总体而言，低发病期的置信区间更大。
嗅觉丧失/味觉丧失与自我报告的新冠病毒检测阳性之间的强烈关联普遍存在，支持其作为可靠的新冠信号的有效性，无论参与式监测平台或检测政策如何。该分析强调，只有在发病率高时，才能最好地进行精确的效应估计以及对检测机会模式的理解，以解释差异。这些发现有力地支持了为实时流行病学调查和公共卫生效用，检测机会应尽可能开放的必要性。
美国国立卫生研究院、英国国家卫生研究院、阿尔茨海默病协会、惠康信托基金会。
