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The prevalence of symptoms in 24,410 adults infected by the novel coronavirus (SARS-CoV-2; COVID-19): A systematic review and meta-analysis of 148 studies from 9 countries

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  • Michael C Grant
  • Luke Geoghegan
  • Marc Arbyn
  • Zakaria Mohammed
  • Luke McGuinness
  • Emily L Clarke
  • Ryckie G Wade

Abstract

Background: To limit the spread of SARS-CoV-2, an evidence-based understanding of the symptoms is critical to inform guidelines for quarantining and testing. The most common features are purported to be fever and a new persistent cough, although the global prevalence of these symptoms remains unclear. The aim of this systematic review is to determine the prevalence of symptoms associated with COVID-19 worldwide. Methods: We searched PubMed, Embase, CINAHL, AMED, medRxiv and bioRxiv on 5th April 2020 for studies of adults (>16 years) with laboratory test confirmed COVID-19. No language or publication status restrictions were applied. Data were independently extracted by two review authors into standardised forms. All datapoints were independently checked by three other review authors. A random-effects model for pooling of binomial data was applied to estimate the prevalence of symptoms, subgrouping estimates by country. I2 was used to assess inter-study heterogeneity. Results: Of 851 unique citations, 148 articles were included which comprised 24,410 adults with confirmed COVID-19 from 9 countries. The most prevalent symptoms were fever (78% [95% CI 75%-81%]; 138 studies, 21,701 patients; I2 94%), a cough (57% [95% CI 54%-60%]; 138 studies, 21,682 patients; I2 94%) and fatigue (31% [95% CI 27%-35%]; 78 studies, 13,385 patients; I2 95%). Overall, 19% of hospitalised patients required non-invasive ventilation (44 studies, 6,513 patients), 17% required intensive care (33 studies, 7504 patients), 9% required invasive ventilation (45 studies, 6933 patients) and 2% required extra-corporeal membrane oxygenation (12 studies, 1,486 patients). The mortality rate was 7% (73 studies, 10,402 patients). Conclusions: We confirm that fever and cough are the most prevalent symptoms of adults infected by SARS-CoV-2. However, there is a large proportion of infected adults which symptoms-alone do not identify.

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  • Michael C Grant & Luke Geoghegan & Marc Arbyn & Zakaria Mohammed & Luke McGuinness & Emily L Clarke & Ryckie G Wade, 2020. "The prevalence of symptoms in 24,410 adults infected by the novel coronavirus (SARS-CoV-2; COVID-19): A systematic review and meta-analysis of 148 studies from 9 countries," PLOS ONE, Public Library of Science, vol. 15(6), pages 1-19, June.
    • Handle: RePEc:plo:pone00:0234765
    DOI: 10.1371/journal.pone.0234765
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    References listed on IDEAS

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    1. Janine Huisman & Jeroen Smits, 2017. "Duration and quality of the peer review process: the author’s perspective," Scientometrics, Springer;Akadémiai Kiadó, vol. 113(1), pages 633-650, October.
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    1. Nikola Anđelić & Sandi Baressi Šegota & Ivan Lorencin & Zdravko Jurilj & Tijana Šušteršič & Anđela Blagojević & Alen Protić & Tomislav Ćabov & Nenad Filipović & Zlatan Car, 2021. "Estimation of COVID-19 Epidemiology Curve of the United States Using Genetic Programming Algorithm," IJERPH, MDPI, vol. 18(3), pages 1-26, January.
    2. Najeeb Ullah & Khurshid Ahmad Khan & Javeid Iqbal & Asim Rana & Bilal Bin Younis & Mohsin Asif & Aijaz Zeeshan Khan Chachar & Falak shan, 2020. "Efficacy of Remdesivir in Covid-19 Patients; Multicenter Study in Lahore," International Journal of Sciences, Office ijSciences, vol. 9(11), pages 31-34, November.
    3. Oliver Viera-Segura & Natali Vega-Magaña & Mariel García-Chagollán & Marcela Peña-Rodríguez & Germán Muñoz-Sánchez & Ahtziri Socorro Carranza-Aranda & Iris Monserrat Llamas-Covarrubias & Moisés Ramos-, 2021. "A Comprehensive Descriptive Epidemiological and Clinical Analysis of SARS-CoV-2 in West-Mexico during COVID-19 Pandemic 2020," IJERPH, MDPI, vol. 18(20), pages 1-13, October.
    4. Caterina Alacevich & Inna Thalmann & Catia Nicodemo & Simon Lusignan & Stavros Petrou, 2023. "Symptomatic SARS-CoV-2 Episodes and Health-Related Quality of Life," Applied Health Economics and Health Policy, Springer, vol. 21(5), pages 761-771, September.
    5. Nguyen, My, 2020. "Mask Mandates and COVID-19 Related Symptoms in the US," MPRA Paper 109992, University Library of Munich, Germany.
    6. Carol Nash, 2020. "Report on Digital Literacy in Academic Meetings during the 2020 COVID-19 Lockdown," Challenges, MDPI, vol. 11(2), pages 1-24, September.
    7. Matthew Whitaker & Joshua Elliott & Barbara Bodinier & Wendy Barclay & Helen Ward & Graham Cooke & Christl A. Donnelly & Marc Chadeau-Hyam & Paul Elliott, 2022. "Variant-specific symptoms of COVID-19 in a study of 1,542,510 adults in England," Nature Communications, Nature, vol. 13(1), pages 1-10, December.
    8. Laurent Gerbaud & Candy Guiguet-Auclair & Franck Breysse & Joséphine Odoul & Lemlih Ouchchane & Jonathan Peterschmitt & Camille Dezfouli-Desfer & Vincent Breton, 2020. "Hospital and Population-Based Evidence for COVID-19 Early Circulation in the East of France," IJERPH, MDPI, vol. 17(19), pages 1-17, September.
    9. Abbasi-Kangevari, Mohsen & Ghanbari, Ali & Malekpour, Mohammad-Reza & Ghamari, Seyyed-Hadi & Azadnajafabad, Sina & Saeedi Moghaddam, Sahar & Keykhaei, Mohammad & Haghshenas, Rosa & Golestani, Ali & Ra, 2023. "Exploring the clinical benefit of ventilation therapy across various patient groups with COVID-19 using real-world data," Open Access Publications from Kiel Institute for the World Economy 273506, Kiel Institute for the World Economy (IfW Kiel).
    10. Erika Christina Gouveia e Silva & Ana Carolina Basso Schmitt & Caroline Gil de Godoy & Danielle Brancolini de Oliveira & Clarice Tanaka & Carlos Toufen & Carlos Roberto Ribeiro de Carvalho & Celso R. , 2023. "Risk Factors for the Impairment of Ambulation in Older People Hospitalized with COVID-19: A Retrospective Cohort Study," IJERPH, MDPI, vol. 20(22), pages 1-10, November.
    11. Bo Zhao & Fanlei Kong & Myo Nyein Aung & Motoyuki Yuasa & Eun Woo Nam, 2020. "Novel Coronavirus (COVID-19) Knowledge, Precaution Practice, and Associated Depression Symptoms among University Students in Korea, China, and Japan," IJERPH, MDPI, vol. 17(18), pages 1-17, September.
    12. Arthur Eumann Mesas & Iván Cavero-Redondo & Celia Álvarez-Bueno & Marcos Aparecido Sarriá Cabrera & Selma Maffei de Andrade & Irene Sequí-Dominguez & Vicente Martínez-Vizcaíno, 2020. "Predictors of in-hospital COVID-19 mortality: A comprehensive systematic review and meta-analysis exploring differences by age, sex and health conditions," PLOS ONE, Public Library of Science, vol. 15(11), pages 1-23, November.
    13. Marcin Januszewski & Laura Ziuzia-Januszewska & Alicja A. Jakimiuk & Waldemar Wierzba & Anna Gluszko & Joanna Zytynska-Daniluk & Artur J. Jakimiuk, 2021. "Is the Course of COVID-19 Different during Pregnancy? A Retrospective Comparative Study," IJERPH, MDPI, vol. 18(22), pages 1-15, November.

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