Matthews Zachary K, Cybulski Daniel J, Frankel Dianne N, Kieffer John W, Casey Theresa M, Osuna Angela B, Yun Heather C, Marcus Joseph E
Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
Division of Infectious Diseases, Department of Medicine, Brooke Army Medical Center, JBSA-Fort Sam Houston, TX 78234, USA.
Mil Med. 2024 May 18;189(5-6):1196-1200. doi: 10.1093/milmed/usad138.
Symptomatic Coronavirus Disease 2019 (COVID-19) screening has been a cornerstone of case identification during the pandemic. Despite the myriad of COVID-19 symptoms, symptom screens have primarily focused on symptoms of influenza-like illnesses such as fever, cough, and dyspnea. It is unknown how well these symptoms identify cases in a young, healthy military population. This study aims to evaluate the utility of symptom-based screening in identifying COVID-19 through three different COVID-19 waves.
A convenience sample of 600 military trainees who arrived at Joint Base San Antonio-Lackland in 2021 and 2022 were included. Two hundred trainees with symptomatic COVID-19 before the emergence of the Delta variant (February-April 2021), when Delta variant was predominant (June-August 2021), and when Omicron was the predominant variant (January 2022) had their presenting symptoms compared. At each time point, the sensitivity of a screen for influenza-like illness symptoms was calculated.
Of the 600 symptomatic active duty service members who tested positive for COVID-19, the most common symptoms were sore throat (n = 385, 64%), headache (n = 334, 56%), and cough (n = 314, 52%). Although sore throat was the most prominent symptom during Delta (n = 140, 70%) and Omicron (n = 153, 77%), headache was the most common before Delta (n = 93, 47%). There were significant differences in symptoms by vaccination status; for example, ageusia was more common in patients who were not completely vaccinated (3% vs. 0%, P = .01). Overall, screening for fever, cough, or dyspnea had a 65% sensitivity with its lowest sensitivity in the pre-Delta cases (54%) and highest sensitivity in Omicron cases (78%).
In this descriptive cross-sectional study evaluating symptomatic military members with COVID-19, symptom prevalence varied based on predominant circulating COVID-19 variant as well as patients' vaccination status. As screening strategies evolve with the pandemic, changing symptom prevalence should be considered.
2019年冠状病毒病（COVID-19）症状筛查一直是疫情期间病例识别的基石。尽管COVID-19症状众多，但症状筛查主要集中在流感样疾病的症状上，如发热、咳嗽和呼吸困难。目前尚不清楚这些症状在年轻、健康的军人人群中识别病例的效果如何。本研究旨在通过三个不同的COVID-19流行阶段评估基于症状的筛查在识别COVID-19方面的效用。
纳入了2021年和2022年抵达圣安东尼奥-拉克兰联合基地的600名军事训练学员的便利样本。比较了200名在德尔塔变异株出现之前（2021年2月至4月）、德尔塔变异株占主导时（2021年6月至8月）以及奥密克戎成为主要变异株时（2022年1月）出现症状的COVID-19学员的症状表现。在每个时间点，计算流感样疾病症状筛查的敏感性。
在600名COVID-19检测呈阳性的有症状现役军人中，最常见的症状是喉咙痛（n = 385，64%）、头痛（n = 334，56%）和咳嗽（n = 314，52%）。尽管喉咙痛在德尔塔（n = 140，70%）和奥密克戎（n = 153，77%）期间是最突出的症状，但头痛在德尔塔之前是最常见的（n = 93，47%）。症状因疫苗接种状况而异；例如，味觉丧失在未完全接种疫苗的患者中更常见（3%对0%，P = 0.01）。总体而言，对发热、咳嗽或呼吸困难进行筛查的敏感性为65%，在德尔塔变异株出现之前的病例中敏感性最低（54%），在奥密克戎病例中敏感性最高（78%）。
在这项评估有症状COVID-19军人的描述性横断面研究中，症状患病率因主要流行的COVID-19变异株以及患者的疫苗接种状况而异。随着疫情期间筛查策略的演变，应考虑症状患病率的变化。
