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Bird O, Galiza EP, Baxter DN, Boffito M, Browne D, Burns F, Chadwick DR, Clark R, Cosgrove CA, Galloway J, Goodman AL, Heer A, Higham A, Iyengar S, Jeanes C, Kalra PA, Kyriakidou C, Bradley JM, Munthali C, Minassian AM, McGill F, Moore P, Munsoor I, Nicholls H, Osanlou O, Packham J, Pretswell CH, San Francisco Ramos A, Saralaya D, Sheridan RP, Smith R, Soiza RL, Swift PA, Thomson EC, Turner J, Viljoen ME, Heath PT, Chis Ster I. The predictive role of symptoms in COVID-19 diagnostic models: A longitudinal insight. Epidemiol Infect 2024; 152:e37. [PMID: 38250791 PMCID: PMC10945957 DOI: 10.1017/s0950268824000037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 12/17/2023] [Accepted: 12/27/2023] [Indexed: 01/23/2024] Open
Abstract
To investigate the symptoms of SARS-CoV-2 infection, their dynamics and their discriminatory power for the disease using longitudinally, prospectively collected information reported at the time of their occurrence. We have analysed data from a large phase 3 clinical UK COVID-19 vaccine trial. The alpha variant was the predominant strain. Participants were assessed for SARS-CoV-2 infection via nasal/throat PCR at recruitment, vaccination appointments, and when symptomatic. Statistical techniques were implemented to infer estimates representative of the UK population, accounting for multiple symptomatic episodes associated with one individual. An optimal diagnostic model for SARS-CoV-2 infection was derived. The 4-month prevalence of SARS-CoV-2 was 2.1%; increasing to 19.4% (16.0%-22.7%) in participants reporting loss of appetite and 31.9% (27.1%-36.8%) in those with anosmia/ageusia. The model identified anosmia and/or ageusia, fever, congestion, and cough to be significantly associated with SARS-CoV-2 infection. Symptoms' dynamics were vastly different in the two groups; after a slow start peaking later and lasting longer in PCR+ participants, whilst exhibiting a consistent decline in PCR- participants, with, on average, fewer than 3 days of symptoms reported. Anosmia/ageusia peaked late in confirmed SARS-CoV-2 infection (day 12), indicating a low discrimination power for early disease diagnosis.
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Affiliation(s)
- Olivia Bird
- Vaccine Institute, St. George’s University of London, St. George’s University Hospitals National Health Service Foundation Trust, London, United Kingdom
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Eva P. Galiza
- Vaccine Institute, St. George’s University of London, St. George’s University Hospitals National Health Service Foundation Trust, London, United Kingdom
| | - David Neil Baxter
- Medical Education, Stockport National Health Service Foundation Trust, Stepping Hill Hospital, Stockport, United Kingdom
| | - Marta Boffito
- Chelsea and Westminster Hospital, National Health Service Foundation Trust, London, United Kingdom
| | - Duncan Browne
- Faculty of Medicine, Imperial College London, London, United Kingdom
- Endocrinology/Diabetes/General Medicine, Royal Cornwall Hospitals National Health Service Trust, Truro, United Kingdom
| | - Fiona Burns
- Faculty of Population Health Sciences, Institute for Global Health, University College London, and Royal Free London National Health Service Foundation Trust, London, United Kingdom
| | - David R. Chadwick
- Centre for Clinical Infection, South Tees Hospitals National Health Service Foundation Trust, James Cook University Hospital, Middlesbrough, United Kingdom
| | | | - Catherine A. Cosgrove
- Vaccine Institute, St. George’s University of London, St. George’s University Hospitals National Health Service Foundation Trust, London, United Kingdom
| | - James Galloway
- Centre for Rheumatic Disease, Kings College London, London, United Kingdom
| | - Anna L. Goodman
- Department of Infectious Diseases, Guy’s and St Thomas’ National Health Service Foundation Trust, London, United Kingdom
- Medical Research Council Clinical Trials Unit, University College London, London, United Kingdom
| | - Amardeep Heer
- Lakeside Healthcare Research, Lakeside Surgeries Corby, Northants, United Kingdom
| | - Andrew Higham
- Gastrointestinal and Liver Services, University Hospitals of Morecambe Bay National Health Service Foundation Trust, Kendal, United Kingdom
| | - Shalini Iyengar
- Accelerated Enrollment Solutions, Synexus Hexham Dedicated Research Site, Hexham General Hospital, Hexham, United Kingdom
| | - Christopher Jeanes
- Department of Microbiology, Norfolk and Norwich University Hospitals National Health Service Foundation Trust, Norfolk, United Kingdom
| | - Philip A. Kalra
- Nephrology, Salford Royal Hospital, Northern Care Alliance National Health Service Foundation Trust, Salford, United Kingdom
| | - Christina Kyriakidou
- Accelerated Enrollment Solutions, Synexus Midlands Dedicated Research Site, Birmingham, United Kingdom
| | - Judy M. Bradley
- Dentistry and Biomedical Sciences, School of Medicine, Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University of Belfast, Belfast, United Kingdom
| | - Chigomezgo Munthali
- Accelerated Enrollment Solutions, Synexus Merseyside Dedicated Research Site, Burlington House, Liverpool, United Kingdom
| | - Angela M. Minassian
- Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Oxford, United Kingdom
- Oxford Health National Health Service Foundation Trust, Warneford Hospital, Oxford, United Kingdom
| | - Fiona McGill
- Department of Microbiology, Leeds Teaching Hospitals National Health Service Trust, Leeds, United Kingdom
| | - Patrick Moore
- The Adam Practice, Dorset, United Kingdom
- University Hospital Southampton National Health Service Foundation Trust, Southampton, United Kingdom
| | - Imrozia Munsoor
- Accelerated Enrollment Solutions, Synexus Glasgow Dedicated Research Site, Glasgow, United Kingdom
| | - Helen Nicholls
- Accelerated Enrollment Solutions, Synexus Wales Dedicated Research Site, Cardiff, United Kingdom
| | - Orod Osanlou
- School of Medical Sciences (Pharmacology/Pharmacy), Bangor University, Wales, United Kingdom
- Clinical Pharmacology and Therapeutics/General Internal Medicine, Betsi Cadwaladr University Health Board, Wales, United Kingdom
| | - Jonathan Packham
- Academic Unit of Population and Lifespan Sciences, University of Nottingham, Nottingham, United Kingdom
- Department of Rheumatology, Haywood Hospital, Midlands Partnership National Health Service Foundation Trust, Stafford, United Kingdom
| | - Carol H. Pretswell
- Accelerated Enrollment Solutions, Synexus Lancashire Dedicated Research Site, Matrix Park Buckshaw Village, Chorley, United Kingdom
| | - Alberto San Francisco Ramos
- Vaccine Institute, St. George’s University of London, St. George’s University Hospitals National Health Service Foundation Trust, London, United Kingdom
| | - Dinesh Saralaya
- National Institute for Health Research, Patient Recruitment Centre, Bradford Teaching Hospitals National Health Service Foundation Trust, Bradford, United Kingdom
| | - Ray P. Sheridan
- Geriatric Medicine, Royal Devon University Healthcare, Exeter, United Kingdom
| | - Richard Smith
- Department of Nephrology, East Suffolk and North Essex National Health Service Foundation Trust, Colchester, United Kingdom
| | - Roy L. Soiza
- Aberdeen Royal Infirmary and Ageing Clinical and Experimental Research Group, University of Aberdeen, Aberdeen, United Kingdom
| | - Pauline A. Swift
- Renal Services, Epsom and St Helier University Hospitals National Health Service Trust, London, United Kingdom
| | - Emma C. Thomson
- School of Infection & Immunity, Medical Research Council-University of Glasgow Centre for Virus Research, and Queen Elizabeth University Hospital, National Health Service Greater Glasgow & Clyde, Glasgow, United Kingdom
| | - Jeremy Turner
- Department of Diabetes and Endocrinology, Norfolk and Norwich University Hospitals National Health Service Foundation Trust, Norfolk, United Kingdom
| | - Marianne Elizabeth Viljoen
- Accelerated Enrollment Solutions, Synexus Manchester Dedicated Research Site, Kilburn House, Manchester, United Kingdom
| | - Paul T. Heath
- Vaccine Institute, St. George’s University of London, St. George’s University Hospitals National Health Service Foundation Trust, London, United Kingdom
| | - Irina Chis Ster
- Institute of Infection and Immunity, George’s University of London, London, United Kingdom
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Tshabane C, Kuonza L, Mdose H, Musekiwa A, Motaze NV. Estimation of shedding time in laboratory-confirmed COVID-19 cases in South Africa: a population-based record linkage study, March-December 2020. Pan Afr Med J 2023; 46:24. [PMID: 38107342 PMCID: PMC10724037 DOI: 10.11604/pamj.2023.46.24.41047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 08/23/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction in South Africa, COVID-19 cases are notifiable and hospitalized cases are reported on a dedicated platform. It is crucial to estimate the duration of SARS-CoV-2 shedding to inform public health interventions. We aimed to estimate viral shedding time among laboratory-confirmed COVID-19 cases in South Africa. Methods we analyzed COVID-19 PCR results from 5 March to 31 December 2020. We included cases with at least 2 consecutive positive PCR tests and a subsequent negative test. We performed multiple linear regression to determine the association between shedding time and predictor variables (age, sex, admission status and province). We included 2752 cases that met the inclusion criteria. Results about 39.9% (1099/2752) of participants were inpatients and 60.1% (1653/2752) were outpatients. The median shedding time was 17 days (range: 1-128). There was no difference in shedding time between males and females and between hospitalized patients and outpatients. Individuals aged 0-4 years had the lowest shedding time (median: 14 days, range: 1-72). After adjusting for age, sex and province, shedding time was shorter for hospitalized patients compared to outpatients (co-efficient: -0.14, CI: -0.24 - -0.03, P-value: 0.014). Six provinces (KwaZulu-Natal, Gauteng, Limpopo, North West, Mpumalanga, and Western Cape) had a significant association with shedding time. Conclusion the duration of viral shedding within our population varies from 1-128 days. Although prolonged shedding might not necessarily indicate infectiousness, individual patient monitoring and management are needed for patients with prolonged shedding. Further studies are required to explore the association between comorbidities and SARS-CoV-2 shedding time.
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Affiliation(s)
- Carroll Tshabane
- South African Field Epidemiology Training Programme, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Lazarus Kuonza
- South African Field Epidemiology Training Programme, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Hetani Mdose
- South African Field Epidemiology Training Programme, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Alfred Musekiwa
- South African Field Epidemiology Training Programme, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Nkengafac Villyen Motaze
- South African Field Epidemiology Training Programme, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa
- Medicine Usage in South Africa, School of Pharmacy, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
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Lionis C, Petelos E, Linardakis M, Diamantakis A, Symvoulakis E, Karkana MN, Kampa M, Pirintsos SA, Sourvinos G, Castanas E. A Mixture of Essential Oils from Three Cretan Aromatic Plants Inhibits SARS-CoV-2 Proliferation: A Proof-of-Concept Intervention Study in Ambulatory Patients. Diseases 2023; 11:105. [PMID: 37606476 PMCID: PMC10443288 DOI: 10.3390/diseases11030105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 08/04/2023] [Accepted: 08/07/2023] [Indexed: 08/23/2023] Open
Abstract
INTRODUCTION The need for effective therapeutic regimens for non-critically ill patients during the COVID-19 pandemic remained largely unmet. Previous work has shown that a combination of three aromatic plants' essential oils (CAPeo) (Thymbra capitata (L.) Cav., Origanum dictamnus L., Salvia fruticose Mill.) has remarkable in vitro antiviral activity. Given its properties, it was urgent to explore its potential in treating mild COVID-19 patients in primary care settings. METHODS A total of 69 adult patients were included in a clinical proof-of-concept (PoC) intervention study. Family physicians implemented the observational study in two arms (intervention group and control group) during three study periods (IG2020, n=13, IG2021/22, n=25, and CG2021/22, n=31). The SARS-CoV-2 infection was confirmed by real-time PCR. The CAPeo mixture was administered daily for 14 days per os in the intervention group, while the control group received usual care. RESULTS The PoC study found that the number and frequency of general symptoms, including general fatigue, weakness, fever, and myalgia, decreased following CAPeo administration. By Day 7, the average presence (number) of symptoms decreased in comparison with Day 1 in IG (4.7 to 1.4) as well as in CG (4.0 to 3.1), representing a significant decrease in the cumulative presence in IC (-3.3 vs. -0.9, p < 0.001; η2 = 0.20) on Day 7 and on Day 14 (-4.2 vs. -2.9, p = 0.027; η2 = 0.08). DISCUSSION/CONCLUSIONS Our findings suggest that CAPeo possesses potent antiviral activity against SARS-CoV-2 in addition tο its effect against influenza A and B and human rhinovirus HRV14 strains. The early and effective impact on alleviating key symptoms of COVID-19 may suggest this mixture can act as a complementary natural agent for patients with mild COVID-19.
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Affiliation(s)
- Christos Lionis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, 71003 Heraklion, Greece; (E.P.); (M.L.); (A.D.); (E.S.); (M.-N.K.)
- Department of Health, Medicine and Care, General Practice, Linköping University, SE-581 85 Linköping, Sweden
| | - Elena Petelos
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, 71003 Heraklion, Greece; (E.P.); (M.L.); (A.D.); (E.S.); (M.-N.K.)
- Department of Health Services Research, CAPHRI-Care and Public Health Research Institute, Maastricht University, 6229 HX Maastricht, The Netherlands
| | - Manolis Linardakis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, 71003 Heraklion, Greece; (E.P.); (M.L.); (A.D.); (E.S.); (M.-N.K.)
| | - Athanasios Diamantakis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, 71003 Heraklion, Greece; (E.P.); (M.L.); (A.D.); (E.S.); (M.-N.K.)
| | - Emmanouil Symvoulakis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, 71003 Heraklion, Greece; (E.P.); (M.L.); (A.D.); (E.S.); (M.-N.K.)
| | - Maria-Nefeli Karkana
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, 71003 Heraklion, Greece; (E.P.); (M.L.); (A.D.); (E.S.); (M.-N.K.)
| | - Marilena Kampa
- Laboratory of Experimental Endocrinology, School of Medicine, University of Crete, 71003 Heraklion, Greece; (M.K.); (E.C.)
| | - Stergios A. Pirintsos
- Department of Biology, School of Sciences and Technology, University of Crete, 71003 Heraklion, Greece;
- Botanical Garden, University of Crete, 71003 Rethymnon, Greece
| | - George Sourvinos
- Laboratory of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion, Greece;
| | - Elias Castanas
- Laboratory of Experimental Endocrinology, School of Medicine, University of Crete, 71003 Heraklion, Greece; (M.K.); (E.C.)
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Occurrence and transmission potential of asymptomatic and presymptomatic SARS-CoV-2 infections: Update of a living systematic review and meta-analysis. PLoS Med 2022; 19:e1003987. [PMID: 35617363 PMCID: PMC9135333 DOI: 10.1371/journal.pmed.1003987] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/13/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Debate about the level of asymptomatic Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection continues. The amount of evidence is increasing and study designs have changed over time. We updated a living systematic review to address 3 questions: (1) Among people who become infected with SARS-CoV-2, what proportion does not experience symptoms at all during their infection? (2) What is the infectiousness of asymptomatic and presymptomatic, compared with symptomatic, SARS-CoV-2 infection? (3) What proportion of SARS-CoV-2 transmission in a population is accounted for by people who are asymptomatic or presymptomatic? METHODS AND FINDINGS The protocol was first published on 1 April 2020 and last updated on 18 June 2021. We searched PubMed, Embase, bioRxiv, and medRxiv, aggregated in a database of SARS-CoV-2 literature, most recently on 6 July 2021. Studies of people with PCR-diagnosed SARS-CoV-2, which documented symptom status at the beginning and end of follow-up, or mathematical modelling studies were included. Studies restricted to people already diagnosed, of single individuals or families, or without sufficient follow-up were excluded. One reviewer extracted data and a second verified the extraction, with disagreement resolved by discussion or a third reviewer. Risk of bias in empirical studies was assessed with a bespoke checklist and modelling studies with a published checklist. All data syntheses were done using random effects models. Review question (1): We included 130 studies. Heterogeneity was high so we did not estimate a mean proportion of asymptomatic infections overall (interquartile range (IQR) 14% to 50%, prediction interval 2% to 90%), or in 84 studies based on screening of defined populations (IQR 20% to 65%, prediction interval 4% to 94%). In 46 studies based on contact or outbreak investigations, the summary proportion asymptomatic was 19% (95% confidence interval (CI) 15% to 25%, prediction interval 2% to 70%). (2) The secondary attack rate in contacts of people with asymptomatic infection compared with symptomatic infection was 0.32 (95% CI 0.16 to 0.64, prediction interval 0.11 to 0.95, 8 studies). (3) In 13 modelling studies fit to data, the proportion of all SARS-CoV-2 transmission from presymptomatic individuals was higher than from asymptomatic individuals. Limitations of the evidence include high heterogeneity and high risks of selection and information bias in studies that were not designed to measure persistently asymptomatic infection, and limited information about variants of concern or in people who have been vaccinated. CONCLUSIONS Based on studies published up to July 2021, most SARS-CoV-2 infections were not persistently asymptomatic, and asymptomatic infections were less infectious than symptomatic infections. Summary estimates from meta-analysis may be misleading when variability between studies is extreme and prediction intervals should be presented. Future studies should determine the asymptomatic proportion of SARS-CoV-2 infections caused by variants of concern and in people with immunity following vaccination or previous infection. Without prospective longitudinal studies with methods that minimise selection and measurement biases, further updates with the study types included in this living systematic review are unlikely to be able to provide a reliable summary estimate of the proportion of asymptomatic infections caused by SARS-CoV-2. REVIEW PROTOCOL Open Science Framework (https://osf.io/9ewys/).
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