Institute of Global Health and Infectious Diseases, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America.
Department of Family Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America.
PLoS One. 2021 Dec 10;16(12):e0260879. doi: 10.1371/journal.pone.0260879. eCollection 2021.
Symptoms associated with SARS-CoV-2 infection remain incompletely understood, especially among ambulatory, non-hospitalized individuals. With host factors, symptoms predictive of SARS-CoV-2 could be used to guide testing and intervention strategies.
Between March 16 and September 3, 2020, we examined the characteristics and symptoms reported by individuals presenting to a large outpatient testing program in the Southeastern US for nasopharyngeal SARS-CoV-2 RNA RT-PCR testing. Using self-reported symptoms, demographic characteristics, and exposure and travel histories, we identified the variables associated with testing positive using modified Poisson regression.
Among 20,177 tested individuals, the proportion positive was 9.4% (95% CI, 9.0-9.8) and was higher for men, younger individuals, and racial/ethnic minorities (all P<0.05); the positivity proportion was higher for Hispanics (26.9%; 95% CI. 24.9-29.0) compared to Blacks (8.6%; 95% CI, 7.6-9.7) or Whites (5.8%; 95% CI, 5.4-6.3). Individuals reporting contact with a COVID-19 case had the highest positivity proportion (22.8%; 95% CI, 21.5-24.1). Among the subset of 8,522 symptomatic adults who presented for testing after May 1, when complete symptom assessments were performed, SARS-CoV-2 RNA PCR was detected in 1,116 (13.1%). Of the reported symptoms, loss of taste or smell was most strongly associated with SARS-CoV-2 RNA detection with an adjusted risk ratio of 3.88 (95% CI, 3.46-4.35). The presence of chills, fever, cough, aches, headache, fatigue and nasal congestion also significantly increased the risk of detecting SARS-CoV-2 RNA, while diarrhea or nausea/vomiting, although not uncommon, were significantly more common in those with a negative test result. Symptom combinations were frequent with 67.9% experiencing ≥4 symptoms, including 19.8% with ≥8 symptoms; report of greater than three symptoms increased the risk of SARS-CoV-2 RNA detection.
In a large outpatient population in the Southeastern US, several symptoms, most notably loss of taste or smell, and greater symptom burden were associated with detection of SARS-CoV-2 RNA. Persons of color and those with who were a contact of a COVID-19 case were also more likely to test positive. These findings suggest that, given limited SARS-CoV-2 testing capacity, symptom presentation and host characteristics can be used to guide testing and intervention prioritization.
与 SARS-CoV-2 感染相关的症状仍不完全清楚，尤其是在非住院的门诊患者中。宿主因素可能会影响 SARS-CoV-2 的症状预测，从而指导检测和干预策略。
2020 年 3 月 16 日至 9 月 3 日期间，我们研究了在美国东南部一家大型门诊检测计划中接受鼻咽 SARS-CoV-2 RNA RT-PCR 检测的个体报告的特征和症状。使用自我报告的症状、人口统计学特征、接触和旅行史，我们使用修正泊松回归确定与检测阳性相关的变量。
在 20177 名接受检测的个体中，阳性比例为 9.4%（95%CI，9.0-9.8），男性、年轻个体和少数族裔（均 P<0.05）的阳性比例较高；与黑人（8.6%，95%CI，7.6-9.7）或白人（5.8%，95%CI，5.4-6.3）相比，西班牙裔（26.9%；95%CI，24.9-29.0）的阳性比例更高。报告与 COVID-19 病例接触的个体的阳性比例最高（22.8%；95%CI，21.5-24.1）。在 5 月 1 日之后，即完成完整症状评估后，有 8522 名有症状的成年人就诊接受检测，其中 1116 名（13.1%）检测到 SARS-CoV-2 RNA PCR。在所报告的症状中，味觉或嗅觉丧失与 SARS-CoV-2 RNA 检测的相关性最强，调整后的风险比为 3.88（95%CI，3.46-4.35）。发冷、发热、咳嗽、疼痛、头痛、疲劳和鼻塞也显著增加了检测到 SARS-CoV-2 RNA 的风险，而腹泻或恶心/呕吐虽然并不常见，但在检测结果为阴性的个体中更为常见。症状组合很常见，67.9%的个体出现≥4 种症状，包括 19.8%的个体出现≥8 种症状；报告出现三种以上症状会增加 SARS-CoV-2 RNA 检测的风险。
在美国东南部的一家大型门诊人群中，一些症状，尤其是味觉或嗅觉丧失，以及更多的症状负担与 SARS-CoV-2 RNA 的检测相关。有色人种和与 COVID-19 病例有接触的人也更有可能检测呈阳性。这些发现表明，鉴于 SARS-CoV-2 检测能力有限，症状表现和宿主特征可用于指导检测和干预重点。
