PLOS MEDICINE RESEARCH ARTICLE
Predictive symptoms for COVID-19 in the community: REACT-1 study of over 1 million people Joshua Elliott ID1,2,3☯, Matthew Whitaker ID1,2☯, Barbara Bodinier ID1,2☯, Oliver Eales ID4,5, Steven Riley4,5, Helen Ward ID1,6,7, Graham Cooke ID6,7,8, Ara Darzi ID6,7,9, Marc ChadeauHyam ID1,2,10‡*, Paul Elliott ID1,2,6,7,10,11‡*
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OPEN ACCESS Citation: Elliott J, Whitaker M, Bodinier B, Eales O, Riley S, Ward H, et al. (2021) Predictive symptoms for COVID-19 in the community: REACT-1 study of over 1 million people. PLoS Med 18(9): e1003777. https://doi.org/10.1371/journal.pmed.1003777 Academic Editor: Mirjam E. E. Kretzschmar, Universitair Medisch Centrum Utrecht, NETHERLANDS Received: May 10, 2021 Accepted: August 20, 2021 Published: September 28, 2021 Peer Review History: PLOS recognizes the benefits of transparency in the peer review process; therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. The editorial history of this article is available here: https://doi.org/10.1371/journal.pmed.1003777 Copyright: © 2021 Elliott et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: Access to REACT-1 data is restricted to protect participants’ anonymity. Researchers wishing to inquire about access to data should email react.access@imperial.ac.uk.
1 Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom, 2 MRC Centre for Environment and Health, Imperial College London, London, United Kingdom, 3 Royal Surrey NHS Foundation Trust, Guildford, United Kingdom, 4 MRC Centre for Global infectious Disease Analysis, Imperial College London, London, United Kingdom, 5 Abdul Latif Jameel Institute for Disease and Emergency Analytics, Imperial College London, London, United Kingdom, 6 Imperial College Healthcare NHS Trust, London, United Kingdom, 7 National Institute for Health Research Imperial Biomedical Research Centre, London, United Kingdom, 8 Department of Infectious Disease, Imperial College London, London, United Kingdom, 9 Institute of Global Health Innovation, Imperial College London, London, United Kingdom, 10 Health Data Research UK London, Imperial College London, London, United Kingdom, 11 UK Dementia Research Institute, Imperial College London, London, United Kingdom ☯ These authors contributed equally to this work. ‡ These authors are joint senior authors on this work. * m.chadeau@imperial.ac.uk (MCH); p.elliott@imperial.ac.uk (PE)
Abstract Background Rapid detection, isolation, and contact tracing of community COVID-19 cases are essential measures to limit the community spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We aimed to identify a parsimonious set of symptoms that jointly predict COVID-19 and investigated whether predictive symptoms differ between the B.1.1.7 (Alpha) lineage (predominating as of April 2021 in the US, UK, and elsewhere) and wild type.
Methods and findings We obtained throat and nose swabs with valid SARS-CoV-2 PCR test results from 1,147,370 volunteers aged 5 years and above (6,450 positive cases) in the REal-time Assessment of Community Transmission-1 (REACT-1) study. This study involved repeated community-based random surveys of prevalence in England (study rounds 2 to 8, June 2020 to January 2021, response rates 22%–27%). Participants were asked about symptoms occurring in the week prior to testing. Viral genome sequencing was carried out for PCR-positive samples with N-gene cycle threshold value < 34 (N = 1,079) in round 8 (January 2021). In univariate analysis, all 26 surveyed symptoms were associated with PCR positivity compared with non-symptomatic people. Stability selection (1,000 penalized logistic regression models with 50% subsampling) among people reporting at least 1 symptom identified 7 symptoms as jointly and positively predictive of PCR positivity in rounds 2–7 (June to December 2020): loss or change of sense of smell, loss or change of sense of taste, fever,
PLOS Medicine | https://doi.org/10.1371/journal.pmed.1003777 September 28, 2021
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