Self-Assessed Severity as a Determinant of Coronavirus Disease 2019 Symptom Specificity: A Longitudinal Cohort Study

Anna Bershteyn; Angela M Dahl; Tracy Q Dong; Meagan E Deming; Connie L Celum; Helen Y Chu; Angelica C Kottkamp; Alexander L Greninger; Risa M Hoffman; Keith R Jerome; Christine M Johnston; Patricia J Kissinger; Raphael J Landovitz; Miriam K Laufer; Alfred Luk; Kathleen M Neuzil; Michael K Paasche-Orlow; Robert A Pitts; Mark D Schwartz; Helen C Stankiewicz Karita; Lorna E Thorpe; Anna Wald; Crystal Y Zheng; Mark H Wener; Ruanne V Barnabas; Elizabeth R Brown

doi:10.1093/cid/ciac129

Self-Assessed Severity as a Determinant of Coronavirus Disease 2019 Symptom Specificity: A Longitudinal Cohort Study

Clin Infect Dis. 2022 Aug 24;75(1):e1180-e1183. doi: 10.1093/cid/ciac129.

Authors

Anna Bershteyn¹, Angela M Dahl², Tracy Q Dong³, Meagan E Deming⁴, Connie L Celum⁵, Helen Y Chu⁶, Angelica C Kottkamp⁷, Alexander L Greninger^{3

8}, Risa M Hoffman⁹, Keith R Jerome^{3

8}, Christine M Johnston¹⁰, Patricia J Kissinger¹¹, Raphael J Landovitz¹², Miriam K Laufer⁴, Alfred Luk¹³, Kathleen M Neuzil⁴, Michael K Paasche-Orlow¹⁴, Robert A Pitts¹⁵, Mark D Schwartz¹, Helen C Stankiewicz Karita¹⁶, Lorna E Thorpe¹, Anna Wald^{3

8

17}, Crystal Y Zheng¹³, Mark H Wener⁸, Ruanne V Barnabas^{18

19}, Elizabeth R Brown^{2

20}

Affiliations

¹ Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA.
² Department of Biostatistics, University of Washington, Seattle, Washington, USA.
³ Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
⁴ Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA.
⁵ International Clinical Research Center and Department of Global Health, University of Washington, Seattle, Washington, USA.
⁶ Department of Medicine and Department of Epidemiology, University of Washington, Seattle, Washington, USA.
⁷ Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA.
⁸ Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA.
⁹ Department of Medicine and Division of Infectious Diseases, University of California, Los Angeles, California, USA.
¹⁰ Department of Medicine and Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA.
¹¹ Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA.
¹² Center for Clinical AIDS Research & Education, University of California, Los Angeles, California, USA.
¹³ John W. Deming Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA.
¹⁴ Department of Medicine and Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA.
¹⁵ Department of Medicine and Division of Infectious Diseases, NYC Health & Hospitals/Bellevue, New York, New York, USA.
¹⁶ Department of Medicine, University of Washington, Seattle, Washington, USA.
¹⁷ Department of Medicine, Department of Epidemiology, Seattle, Washington, USA.
¹⁸ Department of Global Health and Department of Medicine, University of Washington, Seattle, Washington, USA.
¹⁹ Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USAand.
²⁰ Vaccine and Infectious Disease Division and Public Health Sciences Division, Fred Hutchinson Cancer Research Center, USA.

Abstract

Coronavirus disease 2019 symptom definitions rarely include symptom severity. We collected daily nasal swab samples and symptom diaries from contacts of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) case patients. Requiring ≥1 moderate or severe symptom reduced sensitivity to predict SARS-CoV-2 shedding from 60.0% (95% confidence interval [CI], 52.9%-66.7%) to 31.5% (95% CI, 25.7%- 38.0%) but increased specificity from 77.5% (95% CI, 75.3%-79.5%) to 93.8% (95% CI, 92.7%-94.8%).

Keywords: COVID-19; SARS-CoV-2; screening; severity; symptoms.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

COVID-19 Testing
COVID-19* / diagnosis
Humans
Longitudinal Studies
SARS-CoV-2