Links To And Excerpts From Symptom Profiles of a Convenience Sample of Patients with COVID-19 — United States, January–April 2020 Weekly / July 17, 2020 / 69(28);904–908

As I reviewed the article below in preparation for excerpting it, I was reminded that the symptoms of COVID-19 are common to a multitude of other serious diseases.

Therefore, the physician evaluating a patient must consider the possibility of all these other diseases so as not to miss a serious but treatable disease.

So I’m preparing a post, Telemedicine Evaluation Of A Patient With Possible COVID-19 Infection (coming soon). The post will be to remind myself of an approach to the broad differential diagnosis that COVID-19 symptoms can represent.

In this post I link to and excerpt from Symptom Profiles of a Convenience Sample of Patients with COVID-19 — United States, January–April 2020 Morbidity and Mortality Weekly Report (MMWR) July 17, 2020 / 69(28);904–908. [Link To Full Text HTML] [Link To Full Text PDF]

Here are excerpts:

Coronavirus disease 2019 (COVID-19) was first detected
in the United States in January 2020 (1), and by mid-July,
approximately 3.4 million cases had been reported in the
United States (2).

Information about symptoms among U.S. COVID-19 patients is limited, especially among nonhospitalized patients. To better understand symptom profiles of patients with laboratory-confirmed COVID-19 in the United States, CDC used an optional questionnaire to collect detailed information on a convenience sample of COVID-19 patients from participating states.

Symptom data were analyzed by age group, sex, hospitalization status, and symptom onset date relative to expansion of testing guidelines on March 8, 2020 (3).

Among 164 symptomatic patients with known onset during
January 14–April 4, 2020, a total of 158 (96%) reported fever,
cough, or shortness of breath.

Among 57 hospitalized adult patients (aged ≥18 years), 39 (68%) reported all three of these symptoms, compared with 25 (31%) of the 81 nonhospitalized adult patients.

Gastrointestinal (GI) symptoms and other symptoms, such as chills, myalgia, headache, and fatigue, also were commonly reported, especially after expansion of testing guidelines.

To aid prompt recognition of COVID-19, clinicians and public health professionals should be aware that COVID-19 can cause a wide variety of symptoms.

This analysis included only symptomatic persons.

For this report, fever (measured or subjective), cough, or shortness of breath, all of which have been frequently described among COVID-1 patients, were classified as typical signs or symptoms. GI symptoms included nausea, abdominal pain, vomiting, or diarrhea.

Sixteen participating states§ submitted case investigation
forms containing data collected during January 19–June 3,
2020, for 199 COVID-19 patients.

Sufficient symptom data for analysis were available for 164 (85%) patients.

Among the sample of 147 (90%) patients for whom age and hospitalization status were known, 90 (61%) were not hospitalized, including nine (10%) aged <18 years and 81 (90%) aged ≥18 years.

All of the 57 (39%) patients who were hospitalized for clinical management were aged ≥18 years.

Each of the following symptoms was reported by >50% of patients: cough (84%), fever (80%), myalgia (63%), chills (63%), fatigue (62%), headache (59%), and shortness of breath (57%) (Figure).

Approximately half of patients reported one or more GI symptoms; among these, diarrhea was reported most frequently (38%) and vomiting least frequently (13%).

Among adult patients, shortness of breath was more
commonly reported by hospitalized than by nonhospitalized patients (82% versus 38%).

In contrast, new changes in smell and taste and rhinorrhea were reported by a higher percentage of nonhospitalized patients (22% and 51%, respectively) than hospitalized patients (7% and 21%, respectively).

Nearly all of the 164 symptomatic patients (96%) reported
one or more of the typical signs and symptoms of fever, cough,
or shortness of breath; 45% of patients reported all three


Among 164 symptomatic COVID-19 patients, nearly
all experienced fever, cough, or shortness of breath, and
all but four would have met the CSTE clinical case definition. However, a wide variety of other symptoms were also
reported; chills, myalgia, headache, fatigue, and the presence
of at least one GI symptom (most commonly diarrhea) were
each reported by >50% of patients. The occurrence of these
symptoms in patients with COVID-19 has also been reported
elsewhere (5–7).

Symptoms other than fever, cough, and shortness of breath were reported more commonly after testing guidelines were expanded. This change might reflect an expansion of the types of patients eligible for testing and an increased awareness of other COVID-19 symptoms over time, such as changes in smell or taste.

Few differences in symptom profile were notable by age or sex, especially when stratifying by hospitalization status; however, hospitalized patients (many of whom were older) more frequently reported experiencing fever, cough, and shortness of breath.

Clinicians and public health professionals should be aware
that COVID-19 can manifest a range of symptoms. Because
prompt identification of COVID-19 patients is important
to slow the spread of disease, testing should be considered
for patients experiencing 1) fever, cough, or shortness of
breath; 2) symptoms included in the CSTE case definition,
including chills, myalgia, or headache; 3) other symptoms,
including diarrhea or fatigue, especially if reported along with
fever, cough, or shortness of breath; and 4) for asymptomatic
persons, based on clinical or public health judgment (9).
Representative symptom data from U.S. patients across the
spectrum of COVID-19 illness severity, including data on
the timing of symptom development, are needed to inform
clinical case definitions and guidance for symptom screening
or testing criteria.

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