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

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 (77% [95% CI 74%-80%]; 138 studies, 21,701 patients; I² 94%), dry cough (58% [95% CI 54%-61%]; 136 studies, 17,380 patients; I² 93%) and fatigue (31% [95% CI 27%-35%]; 78 studies, 13,385 patients; I² 95%). Overall, 17% of hospitalised patients required non-invasive ventilation (34 studies, 7519 patients), 17% required intensive care (34 studies, 7519 patients), 9% required invasive ventilation (25 studies, 6933 patients) and 2% required extra-corporeal membrane oxygenation (73 studies, 10,402 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.

Funding Statement: Ryckie Wade is a Doctoral Research Fellow funded by the National Institute for Health Research (NIHR, DRF-2018-11-ST2-028). Luke McGuinness is supported by an NIHR Doctoral Research Fellowship (DRF-2018-11-ST2-048). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. Marc Arbyn was supported by the VALCOR project (Sciensano, Brussels, Begium).

Declaration of Interests: The authors stated that there are no conflicts of interest.