COVID | Free Full-Text | Symptoms Predicting SARS-CoV-2 Test Results in Resident Physicians and Fellows in New York City
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In this study of residents and fellows from a large healthcare center in New York City, we found that self-reported symptoms-based screening alone can accurately predict a positive SARS-CoV-2 test result. Among a wide list of symptoms associated with SARS-CoV-2 infection examined, loss of smell, myalgia, loss of taste, cough and fever were found to be top predictors of a positive SARS-CoV-2 test result. Inclusion in the prediction models of sociodemographic (sex, age, race) and occupational risk factors previously shown to increase risk of SARS-CoV-2 infection did not substantially change results, but slightly increased prediction accuracy, suggesting that the combination of symptoms with other potentially known risk factors could further optimize screening of SARS-CoV-2 infection of physician trainees in healthcare settings with remote screening and/or limited testing capacity.
A previous population-based prospective cohort study in Spain using a machine learning approach noted olfactory dysfunction, gustatory dysfunction, fever, dry cough and asthenia (weakness) to be strong predictors of a positive SARS-CoV-2 RT-PCR result; but no association between dyspnea, rhinorrhea and sore throat and a positive test result [24]. Another study analyzed about 42 prospective SARS-CoV-2 studies and also demonstrated that anosmia, ageusia, fatigue, fever and cough were associated with higher odds for SARS-CoV-2 infection [25]. Moreover, they noted that combining symptoms with other sociodemographic (age, gender, etc.) or community risk factors (e.g., travel history) may slightly improve the sensitivity of the prediction model [25]. In our study of young HCWs we observed similar findings, in addition to shortness of breath (dyspnea) and runny nose (rhinorrhea) that were significantly associated with SARS-CoV-2 infection. A meta-analysis of HCW studies also found the occurrence of lack of smell, fever and myalgia to be associated with higher odds of SARS-CoV-2 infection in symptomatic patients, and no significant association for fatigue and sore throat [26]. However, our results demonstrated association between fatigue and a positive SARS-CoV-2 infection in addition to lack of smell, fever and myalgia. We did not find sore throat or pharyngitis to be associated with a SARS-CoV-2 infection, which is in agreement with prior evidence [24,25,26,27]. This previous meta-analysis only analyzed the abovementioned five symptoms in association with SARS-CoV-2 infection due to limited data available on symptoms reported in previous studies [26]. One previous study in the UK and USA of 18,401 participants that used smartphone-based apps for symptoms screening also found loss of smell, loss of taste, high temperature, persistent cough and loss of appetite as the top predictors of SARS-CoV-2 infection [9]. In our study, we did not assess loss of appetite, but we identified loss of smell, loss of taste, fever and cough as top predictors of a positive SARS-CoV-2 test in physician trainees. Additionally, results from a few other recent symptom-based COVID-19 screening studies further support our findings that loss of smell, loss of taste, fever, cough and myalgia are important predictors of SARS-CoV-2 infection [11,24,27].
Findings from our study remained robust in sensitivity analyses of a subset of 186 trainees with prospective, real-time data on symptoms reported prior to laboratory-confirmed SARS-CoV-2 test results available from the EHS COVID-19 registry data and, therefore, reverse causation bias is unlikely. Furthermore, we found perfect agreement (100%) between self-reports of SARS-CoV-2 test results and laboratory-confirmed SARS-CoV-2 test results in physician trainees with no evidence of recall bias in survey responses during the study period. Our study sample had a similar age range and race and specialty distributions compared to the total population of eligible residents and fellows for the present study, and therefore results should be more broadly representative of the origin cohort of trainees [5]. Study limitations include the lack of data on loss of appetite previously reported as a potentially important predictor of SARS-CoV-2 infection [9]. We further assessed symptoms predicting a positive SARS-CoV-2 test result during the first COVID-19 wave and prior to vaccination campaigns. Other factors related to SARS-CoV-2 infection such as specific variants or vaccination status might impact the prediction of a positive SARS-CoV-2 test result. Further research is needed to validate our findings in recent waves with new SARS-CoV-2 variants and after vaccination.
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