Large Review Identifies Most Common Symptoms of COVID-19

These days, pharmacists are constantly fielding questions on whether certain symptoms are likely to be indicative of COVID-19 infection. A new review provides some guidance on how to answer. Find out what symptoms are most commonly seen with novel coronavirus infections, based on reports from more than 24,000 patients in nine countries.

SHEFFIELD, UK – While dozens of journal articles have discussed possible symptoms of COVID-19, a few are much more likely and demonstrate the need for testing and/or quarantine, according to a new review.

Pharmacists should know that persistent cough and fever are the most prevalent symptoms associated with novel coronavirus, according to a report in the online journal PLoS ONE

University of Sheffield researchers and colleagues point out that other major symptoms include fatigue, losing the ability to smell and difficulty in breathing.

Interestingly, according to the authors, their study confirms the list of symptoms listed by the World Health Organization at the start of the pandemic.

Researchers pulled together data from 148 separate studies to identify the common symptoms experienced by more than 24,000 patients from nine countries, including the UK, China and the United States.

Of the 24,410 cases reviewed, the study found:

  • 78% had a fever, although countries varied, with as few as 32% having fever in Korea.
  • 57%, with a high of 76% reporting a cough in the Netherlands vs. 18% in Korea.
  • 31% said they had suffered fatigue.
  • 25% lost the ability to smell.
  • 23% reported difficulty breathing.

Variation in the prevalence of symptoms between countries probably is explained by difference in data collection, according to the researchers.

“We confirm that fever and cough are the most prevalent symptoms of adults infected by SARS-CoV-2,” the authors write. “However, there is a large proportion of infected adults which symptoms-alone do not identify.”

"This is important because it ensures that people who are symptomatic can be quarantined, so they are not infecting others,” explained co-author Ryckie Wade, MBBS MClinEd MSc, of the Leeds Institute of Medical Research, supervised the research. "The study gives confidence to the fact that we have been right in identifying the main symptoms and it can help determine who should get tested."

The survey also provides some indication of severity. Of patients needing hospital treatment, 17% needed non-invasive help with their breathing; 19% had to be admitted to an intensive care unit, 9% required invasive ventilation and 2% needed extra-corporeal membrane oxygenation.

For the review, researchers searched PubMed, Embase, CINAHL, AMED, medRxiv and bioRxiv on April 5, 2020, for studies of patients 16 and older with laboratory test confirmed COVID-19. Data were independently extracted by two review authors into standardized forms. Of 851 unique citations, 148 articles were included involving more than 24,000 patients from nine countries.

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