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

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

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Study flow chart.
Fig 1. Study flow chart.
Fig 2. Forest plot of the prevalence…
Fig 2. Forest plot of the prevalence of fever in adults with laboratory test confirmed COVID-19.
The diamonds are summary estimates from each country.
Fig 3. Forest plot of the prevalence…
Fig 3. Forest plot of the prevalence of cough (dry or productive) in adults with laboratory test confirmed COVID-19.
The diamonds are summary estimates from each country.

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