Loss of smell and taste in combination with other symptoms is a strong predictor of COVID-19 infection

AbstractImportanceA strategy for preventing further spread of the ongoing COVID-19 epidemic is to detect infections and isolate infected individuals without the need of extensive bio-specimen testing.ObjectivesHere we investigate the prevalence of loss of smell and taste among COVID-19 diagnosed individuals and we identify the combination of symptoms, besides loss of smell and taste, most likely to correspond to a positive COVID-19 diagnosis in non-severe cases.DesignCommunity survey.Setting and ParticipantsSubscribers of RADAR COVID-19, an app that was launched for use among the UK general population asking about COVID-19 symptoms.Main ExposureLoss of smell and taste.Main Outcome MeasuresCOVID-19.ResultsBetween 24 and 29 March 2020, 1,573,103 individuals reported their symptoms via the app; 26% reported suffering from one or more symptoms of COVID-19. Of those, n=1702 reported having had a RT-PCR COVID-19 test and gave full report on symptoms including loss of smell and taste; 579 were positive and 1123 negative. In this subset, we find that loss of smell and taste were present in 59% of COVID-19 positive individuals compared to 18% of those negative to the test, yielding an odds ratio (OR) of COVID-19 diagnosis of OR[95%CI]=6.59[5.25; 8.27], P= 1.90×10−59. We also find that a combination of loss of smell and taste, fever, persistent cough, fatigue, diarrhoea, abdominal pain and loss of appetite is predictive of COVID-19 positive test with sensitivity 0.54[0.44; 0.63], specificity 0.86[0.80; 0.90], ROC-AUC 0.77[0.72; 0.82] in the test set, and cross-validation ROC-AUC 0.75[0.72; 0.77]. When applied to the 410,598 individuals reporting symptoms but not formally tested, our model predicted that 13.06%[12.97%;13.15] of these might have been already infected by the virus.Conclusions and RelevanceOur study suggests that loss of taste and smell is a strong predictor of having been infected by the COVID-19 virus. Also, the combination of symptoms that could be used to identify and isolate individuals includes anosmia, fever, persistent cough, diarrhoea, fatigue, abdominal pain and loss of appetite. This is particularly relevant to healthcare and other key workers in constant contact with the public who have not yet been tested for COVID-19.Key pointsWhat is already known on this topicThe spread of COVID-19 can be reduced by identifying and isolating infected individuals but it is not possible to test everyone and priority has been given in most countries to individuals presenting symptoms of the disease.COVID-19 symptoms, such as fever, cough, aches, fatigue are common in many other viral infectionsThere is therefore a need to identify symptom combinations that can rightly pinpoint to infected individualsWhat this study addsAmong individuals showing symptoms severe enough to be given a COVID-19 RT-PCR test in the UK the prevalence of loss of smell (anosmia) was 3-fold higher (59%) in those positive to the test than among those negative to the test (18%).We developed a mathematical model combining symptoms to predict individuals likely to be COVID-19 positive and applied this to over 400,000 individuals in the general population presenting some of the COVID-19 symptoms.We find that ∼13% of those presenting symptoms are likely to have or have had a COVID-19 infection. The proportion was slightly higher in women than in men but is comparable in all age groups, and corresponds to 3.4% of those who filled the app report.

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P23 Tolerability of prednisolone and dexamethasone in children in saudi arabia and the united kingdom

Archives of Disease in Childhood ◽

10.1136/archdischild-2017-314585.32 ◽

2018 ◽

Vol 103 (2) ◽

pp. e2.26-e2

Author(s):

Fahad Aljebab ◽

Mofadhi Alanazi ◽

Imti Choonara ◽

Sharon Conroy

Keyword(s):

Saudi Arabia ◽

Abdominal Pain ◽

Sodium Phosphate ◽

Oral Prednisolone ◽

Phosphate Solution ◽

List Type ◽

Dexamethasone Sodium Phosphate ◽

Significant Difference ◽

Sodium Phosphate Solution ◽

The Uk

BackgroundCorticosteroids are used to treat conditions including acute asthma and croup where they are often given in short-courses. This study evaluated the tolerability and palatability of oral prednisolone and dexamethasone in children in Saudi Arabia (SA) and the UK.MethodsA prospective observational/interview study was performed. Palatability was evaluated by asking patient/parent’s opinions of the taste and acceptability of the medication. Children pointed at the appropriate face on a scale depicting: 1 ‘dislike very much’, 2 ‘dislike a little’, 3 ‘not sure’, 4 ‘like a little’ and 5 ‘like very much’.1 Tolerability, in particular nausea, vomiting and abdominal pain was evaluated by direct questioning of the patient/parents after each administration. Data was collected over three months in each centre. Patients aged 2–18 years treated with oral prednisolone or dexamethasone in hospital were approached to participate.ResultsIn SA, 122 patients (89 asthma, 33 croup), aged 2–10 years (mean=4.3) were recruited: 52 received prednisolone base tablets; 37 prednisolone sodium phosphate syrup; 33 dexamethasone elixir. In the UK, of 133 patients (80 asthma, 53 croup) aged 2–16 years (mean=4.9): 38 received prednisolone base tablets; 42 prednisolone sodium phosphate soluble tablets; 53 dexamethasone sodium phosphate oral solution.SA: Day 1 prednisolone base tablet palatability scores: 1 (88.5%); 2 (11.5%). Day 2 scores: 1 (64.4%); 2 (28.9%); 3 (6.7%). Day 1 prednisolone sodium phosphate solution palatability scores: 1 (48.6%); 2 (40.5%); 3 (10.8%). Day 2 scores: 1 (10.8%); 2 (67.6%); 3 (21.6%). Day 1 dexamethasone elixir palatability scores: 1 (27.3%); 2 (48.5%); 3 (24.2%).UK: Day 1 prednisolone base tablet palatability scores: 1 (76.3%); 2 (13.1%); 3 (5.3%); 4 (5.3%). Day 2 scores: 1 (61.3%); 2 (19.4%); 3 (16.1%); 4 (3.2%). Day 1 prednisolone sodium phosphate soluble tablet palatability scores: 1 (35.7%); 2 (26.2%); 3 (23.8%); 4 (11.9%) 5 (2.4%). Day 2 scores: 1 (16.7%); 2 (58.2%); 3 (16.7%); 4 (4.2%); 5 (4.2%). Day 1 dexamethasone sodium phosphate solution palatability scores: 1 (5.7%); 2 (28.3%); 3 (37.7%); 4 (17%); 5 (11.3%).Dexamethasone sodium phosphate solution had the highest palatability scores (P<706;0.0001). The score was lowest for prednisolone base tablets in both centres (P<0.0001).In SA prednisolone base tablets were associated with more cases of nausea (24 vs 7) and vomiting (5 vs 0) than prednisolone sodium phosphate syrup (p=0.008 and p=0.073 respectively). In the UK vomiting occurred significantly more frequently with prednisolone base tablets (8) than prednisolone sodium phosphate soluble tablets (2) (p=0.041).In both centres dexamethasone was associated with less side effects but with no significant difference between the formulations. Vomiting (1 vs 0), nausea (7 vs 3) and abdominal pain (10 vs 8) occurred more with dexamethasone sodium phosphate solution than dexamethasone elixir (p=1, p=0.53 and p=0.55 respectively).ConclusionsDexamethasone sodium phosphate solution was the most palatable preparation. Prednisolone base tablets were rated the least palatable and were also the least well tolerated. Palatability scores seemed to improve with second doses.ReferenceH. Hames H, Seabrook JA, Matsui D, Rieder MJ, Joubert GI. A palatability study of a flavoured dexamethasone preparation versus prednisolone liquid in children. Can. J. Clin. PharmacolJanuary 2008;15(1):e95–8.

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Growth, reproduction numbers and factors affecting the spread of SARS-CoV-2 novel variants of concern in the UK from October 2020 to July 2021: a modelling analysis

BMJ Open ◽

10.1136/bmjopen-2021-056636 ◽

2021 ◽

Vol 11 (11) ◽

pp. e056636

Author(s):

Thomas Ward ◽

Alex Glaser ◽

Alexander Johnsen ◽

Feng Xu ◽

Ian Hall ◽

...

Keyword(s):

Growth Rate ◽

Exponential Growth ◽

Doubling Time ◽

Reproduction Number ◽

Age Groups ◽

Instantaneous Growth Rate ◽

Rt Pcr ◽

Gene Target ◽

Novel Variants ◽

The Uk

ObjectivesImportations of novel variants of concern (VOC), particularly B.1.617.2, have become the impetus behind recent outbreaks of SARS-CoV-2. Concerns around the impact on vaccine effectiveness, transmissibility and severity are now driving the public health response to these variants. This paper analyses the patterns of growth in hospitalisations and confirmed cases for novel VOCs by age groups, geography and ethnicity in the context of changing behaviour, non-pharmaceutical interventions (NPIs) and the UK vaccination programme. We seek to highlight where strategies have been effective and periods that have facilitated the establishment of new variants.DesignWe have algorithmically linked the most complete testing and hospitalisation data in England to create a data set of confirmed infections and hospitalisations by SARS-CoV-2 genomic variant. We have used these linked data sets to analyse temporal, geographic and demographic distinctions.Setting and participantsThe setting is England from October 2020 to July 2021. Participants included all COVID-19 tests that included RT-PCR CT gene target data or underwent sequencing and hospitalisations that could be linked to these tests.MethodsTo calculate the instantaneous growth rate for VOCs we have developed a generalised additive model fit to multiple splines and varying day of the week effects. We have further modelled the instantaneous reproduction number Rt for the B.1.1.7 and B.1.617.2 variants and included a doubly interval censored model to temporally adjust the confirmed variant cases.ResultsWe observed a clear replacement of the predominant B.1.1.7 by the B.1.617.2 variant without observing sustained exponential growth in other novel variants. Modelled exponential growth of RT PCR gene target triple-positive cases was initially detected in the youngest age groups, although we now observe across all ages a very small doubling time of 10.7 (95% CI 9.1 to 13.2) days and 8 (95% CI 6.9 to 9.1) days for cases and hospitalisations, respectively. We observe that growth in RT PCR gene target triple-positive cases was first detected in the Indian ethnicity group in late February, with a peak of 0.06 (95% CI 0.07 to 0.05) in the instantaneous growth rate, but is now maintained by the white ethnicity groups, observing a doubling time of 6.8 (95% CI 4.9 to 11) days. Rt analysis indicates a reproduction number advantage of 0.45 for B.1.617.2 relative to B.1.1.7, with the Rt value peaking at 1.85 for B.1.617.2.ConclusionsOur results illustrate a clear transmission advantage for the B.1.617.2 variant and the growth in hospitalisations illustrates that this variant is able to maintain exponential growth within age groups that are largely doubly vaccinated. There are concerning signs of intermittent growth in the B.1.351 variant, reaching a 28-day doubling time peak in March 2021, although this variant is presently not showing any evidence of a transmission advantage over B.1.617.2. Step 1b of the UK national lockdown easing was sufficient to precipitate exponential growth in B.1.617.2 cases for most regions and younger adult age groups. The final stages of NPI easing appeared to have a negligible impact on the growth of B.1.617.2 with every region experiencing sustained exponential growth from step 2. Nonetheless, early targeted local NPIs appeared to markedly reduced growth of B.1.617.2. Later localised interventions, at a time of higher prevalence and greater geographic dispersion of this variant, appeared to have a negligible impact on growth.

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Symptom Analysis of Confirmed Covid-19 Patients Managed at Allied Hospitals of Rawalpindi Medical University, Pakistan

Journal of Islamabad Medical & Dental College ◽

10.35787/jimdc.v9i4.607 ◽

1970 ◽

Vol 9 (4) ◽

pp. 235-241

Author(s):

Javeria Malik ◽

Muhammad Khurram ◽

Arsalan Manzoor Mughal ◽

Noman Ahmed Chaudhary ◽

Qaiser Aziz ◽

...

Keyword(s):

Age Groups ◽

Severe Pneumonia ◽

Cross Sectional Study ◽

Upper Respiratory Tract ◽

Shortness Of Breath ◽

Cross Sectional ◽

Duration Of Symptoms ◽

Presenting Symptoms ◽

Persistent Cough ◽

Medical University

Introduction Coronavirus can cause respiratory disease ranging from mild upper respiratory tract illness to severe pneumonia, severe acute respiratory distress syndrome, and death. The purpose of this research was to study the symptoms of confirmed Coronavirus disease (COVID-19) cases and their relationship with gender and age groups. Materials and Methods This observational cross-sectional study was conducted at Rawalpindi Institute of Urology and Transplantation (RIUT) that is the COVID-19 management center of Rawalpindi Medical University, Rawalpindi during the month of March 2020. Consecutive sampling methodology was used, and all real-time polymerase chain reaction (RT-PCR) confirmed patients of COVID-19 were included. Data regarding age, gender, and symptoms with onset was recorded and analyzed. Results Thirty-five patients, 22 (62.9%) males, and 13 (37.1%) females were included. Seven (20%) patients were ≥60 years old, and 12 (34.8%) ≥40 years old. 21 (60%) were symptomatic and the rest of them were asymptomatic. The mean duration of symptoms was 2.8±1.1 days. Fever (13, 61.9%), persistent cough (12, 57.1%), sputum (6, 28.6%), shortness of breath (4, 19%), anorexia (3, 14.3%), fatigue (3, 14.3%), myalgia (1, 4.8%), were presenting symptoms. Cough, anorexia, and fatigue were significantly more frequent in the patients ≥40 of age. Anorexia and fatigue were common in the age groups ≥40 and ≥60 years. Myalgia was significantly frequent in patients aged ≥60 years. Conclusion Fever, persistent cough and shortness of breath are commonest symptoms of COVID 19 patients. COVID-19 can be asymptomatic in many cases.

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Clinical Characteristics of the First 100 Patients of COVID-19 in Tobruk, Libya: A Brief Report from Low-Resource Settings

Disaster Medicine and Public Health Preparedness ◽

10.1017/dmp.2021.123 ◽

2021 ◽

pp. 1-10

Author(s):

Faisal Ismail ◽

Atiya Farag ◽

Soghra Haq ◽

Mohammad Amjad Kamal

Keyword(s):

Rt Pcr ◽

Antibody Testing ◽

Low Resource Settings ◽

Low Resource ◽

Presenting Symptoms ◽

Negative Results ◽

Chest X Ray ◽

Screening Clinic ◽

Loss Of Appetite ◽

Rule Out

ABSTRACT Objective: This study aims to report the clinical features of a cohort of patients with suspected COVID-19 from Tobruk, Libya and reflect upon the diagnosis challenge in low-resource settings. Methods: A descriptive report of the first 100 patients with suspected COVID-19 who have visited the SARS-Cov-2 (Severe Acute Respiratory Syndrome-related Coronavirus-2) (COVID-19) screening clinic at the National Centre for Disease Control (NCDC) in Tobruk, Libya. Results: The most common presenting symptoms were fever (90%), cough (89%), dyspnoea (85%), sore throat (79%), fatigue (78%), headache (64%), loss of smell (52%), loss of taste (53%), loss of appetite (43), nausea and vomiting (26%), diarrhoea (22%), and rhinorrhea (16%). 51% of the patients had lymphocytopenia while 13% had thrombocytopenia. Bilateral infiltrates was the most common radiologic finding on chest X-ray (76%), and COVID-19 IgM and /or IgG antibodies were detected in 80% of the patients, while only 37% of the patients were tested positive by the RT-PCR. Conclusions: The disease continued its spread across the region. Fever, cough and dyspnoea were the main symptoms. 21% of the patients did not have any CXR abnormalities. Initial negative results for either antibody testing or RT-PCR-testing for COVID-19 do not rule out the infection.

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Tracking the mental health of home-carers during the first COVID-19 national lockdown: evidence from a nationally representative UK survey

10.1101/2021.01.25.21250437 ◽

2021 ◽

Author(s):

Elise Whitley ◽

Kelly Reeve ◽

Michaela Benzeval

Keyword(s):

Mental Health ◽

General Population ◽

General Health Questionnaire ◽

Adult Child ◽

Care Recipient ◽

Vulnerable Groups ◽

List Type ◽

Care Burden ◽

Substantial Decline ◽

The Uk

ABSTRACTBackgroundUnpaid carers who look after another member of their household (home-carers) have poorer mental health than the general population. The first COVID-19 national lockdown led to an increasing reliance on home-carers and we investigate the short and longer-term impact of lockdown on their mental health.MethodsData from 9,737 adult participants (aged 16+) from the UK Household Longitudinal Study (Understanding Society) were used to explore changes in 12-item General Health Questionnaire (GHQ-12) score between (a) pre-pandemic (2019) and early lockdown (April 2020) and (b) early and later (July 2020) lockdown.ResultsGHQ-12 scores among home-carers were higher pre-lockdown and increased more than for non-carers from 2019 to April 2020 with further increases for home-carers compared with non-carers between April and July. Compared with respondents caring for a spouse/partner, those caring for a child under 18 had a particularly marked increase in GHQ-12 score between 2019 and April, as did those caring for someone with learning difficulties. Home-carers of children under 18 improved from April to July while those caring for adult children saw a marked worsening of their mental health. Home-carers with greater care burden saw larger increases in GHQ-12 score from 2019 to April and from April to July, and increases through both periods were greater for home-carers who had formal help prior to lockdown but then lost it.ConclusionsThe mental health of home-carers deteriorated more during lockdown than non-carers. Policies that reinstate support for them and their care-recipients will benefit the health of both vulnerable groups.What is already known on this topicCarers have poorer mental health than the general population.Among carers who live with the care recipient (home-carers), some subgroups have poorer mental health than others: female versus male; those who provide more hours of care and have been caring for longer; spousal carers compared with those caring for children (including adult), parents, or other relationships; those caring for individuals whose impairment results in behavioural disturbances, than those who care for individuals with physical or long-term health conditions.What this study addsIn a large representative UK survey, the decline in mental health during lockdown was greater among home-carers than for the general population, and stayed poorer through to July, even as the general population’s mental health recovered slightly.Compared with respondents who were caring for a spouse/partner, those caring for a child under 18 had a particularly marked increase in GHQ-12 score between 2019 and April while those caring for an adult child experienced a substantial decline in their mental health between the beginning and end of the first lockdown (April to July).The increase in GHQ-12 in April from 2019 was highest among those caring for someone with a learning disability and lowest for those caring for someone with a problem related to old age.Home-carers who had a greater care burden, in terms of hours of care provided, or lost formal support during lockdown, had poorer mental health.

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Risk of death among people with rare autoimmune diseases compared to the general population in England during the 2020 COVID-19 pandemic

10.1101/2020.10.09.20210237 ◽

2020 ◽

Cited By ~ 1

Author(s):

Emily Peach ◽

Megan Rutter ◽

Peter Lanyon ◽

Matthew J Grainge ◽

Richard Hubbard ◽

...

Keyword(s):

General Population ◽

Healthcare Services ◽

Mortality Rates ◽

Published Data ◽

List Type ◽

Risk Of Death ◽

Increased Risk ◽

Working Age ◽

Population Mortality ◽

The Uk

AbstractObjectivesTo quantify the risk of death among people with rare autoimmune rheumatic diseases (RAIRD) during the UK 2020 COVID-19 pandemic compared to the general population, and compared to their pre-COVID risk.MethodsWe conducted a cohort study in Hospital Episode Statistics for England 2003 onwards, and linked data from the NHS Personal Demographics Service. We used ONS published data for general population mortality rates.ResultsWe included 168,691 people with a recorded diagnosis of RAIRD alive on 01/03/2020. Their median age was 61.7 (IQR 41.5-75.4) years, and 118,379 (70.2%) were female. Our case ascertainment methods had a positive predictive value of 85%. 1,815 (1.1%) participants died during March and April 2020. The age-standardised mortality rate (ASMR) among people with RAIRD (3669.3, 95% CI 3500.4-3838.1 per 100,000 person-years) was 1.44 (95% CI 1.42-1.45) times higher than the average ASMR during the same months of the previous 5 years, whereas in the general population of England it was 1.38 times higher. Age-specific mortality rates in people with RAIRD compared to the pre-COVID rates were higher from the age of 35 upwards, whereas in the general population the increased risk began from age 55 upwards. Women had a greater increase in mortality rates during COVID-19 compared to men.ConclusionThe risk of all-cause death is more prominently raised during COVID-19 among people with RAIRD than among the general population. We urgently need to quantify how much risk is due to COVID-19 infection and how much is due to disruption to healthcare services.Key messagesPeople with RAIRD had an increased risk of dying during COVID-19 from age 35 years onwards, whereas in the general population it increased from the age of 55 onwards.Women had a greater increase in their risk of death during COVID-19 compared to men.The risk of working age people with RAIRD dying during COVID-19 was similar to that of someone 20 years older in the general population.

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Changes in the incidence, prevalence and mortality of bronchiectasis in the UK from 2004 to 2013: a population-based cohort study

European Respiratory Journal ◽

10.1183/13993003.01033-2015 ◽

2015 ◽

Vol 47 (1) ◽

pp. 186-193 ◽

Cited By ~ 204

Author(s):

Jennifer K. Quint ◽

Elizabeth R.C. Millett ◽

Miland Joshi ◽

Vidya Navaratnam ◽

Sara L. Thomas ◽

...

Keyword(s):

Mortality Rate ◽

General Population ◽

Age Groups ◽

Population Based ◽

Point Prevalence ◽

Practice Research ◽

Clinical Practice Research Datalink ◽

Mortality Figure ◽

The Uk ◽

Incidence Prevalence

There is a paucity of data on incidence, prevalence and mortality associated with non-cystic fibrosis bronchiectasis.Using the Clinical Practice Research Datalink for participants registered between January 1, 2004 and December 31, 2013, we determined incidence, prevalence and mortality associated with bronchiectasis in the UK and investigated changes over time.The incidence and point prevalence of bronchiectasis increased yearly during the study period. Across all age groups, the incidence in women increased from 21.2 per 100 000 person-years in 2004 to 35.2 per 100 000 person-years in 2013 and in men from 18.2 per 100 000 person-years in 2004 to 26.9 per 100 000 person-years in 2013. The point prevalence in women increased from 350.5 per 100 000 in 2004 to 566.1 per 100 000 in 2013 and in men from 301.2 per 100 000 in 2004 to 485.5 per 100 000 in 2013. Comparing morality rates in women and men with bronchiectasis in England and Wales (n=11 862) with mortality rates in the general population from Office of National Statistics data showed that in women the age-adjusted mortality rate for the bronchiectasis population was 1437.7 per 100 000 and for the general population 635.9 per 100 000 (comparative mortality figure of 2.26). In men, the age-adjusted mortality rate for the bronchiectasis population was 1914.6 per 100 000 and for the general population 895.2 per 100 000 (comparative mortality figure of 2.14).Bronchiectasis is surprisingly common and is increasing in incidence and prevalence in the UK, particularly in older age groups. Bronchiectasis is associated with a markedly increased mortality.

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Self-Reported Symptom Study of COVID-19 Chemosensory Dysfunction in Malaysia

10.21203/rs.3.rs-696505/v1 ◽

2021 ◽

Author(s):

Shen-Han Lee ◽

Zhi Xiang Yeoh ◽

Ida Sadja'ah Sachlin ◽

Norzi Gazali ◽

Shahrul Aiman Soelar ◽

...

Keyword(s):

Cross Sectional Study ◽

Rt Pcr ◽

Online Questionnaire ◽

Cross Sectional ◽

Early Symptom ◽

Nasal Blockage ◽

Entire Cohort ◽

Presenting Symptoms ◽

Loss Of Appetite ◽

Chemosensory Function

Abstract Alterations in the three chemosensory modalities – smell, taste, and chemesthesis – have been implicated in Coronavirus Disease 2019 (COVID-19), yet emerging data suggest a wide geographic and ethnic variation in the prevalence of these symptoms. Studies on chemosensory disorders in COVID-19 have predominantly focused on Caucasian populations whereas Asians remain understudied. We conducted a nationwide, multicentre cross-sectional study using an online questionnaire on a cohort of RT-PCR-confirmed adult COVID-19 patients in Malaysia between 6 June to 30 November 2020. The aim of our study was to investigate their presenting symptoms and assess their chemosensory function using self-ratings of perceived smell, taste, chemesthesis, and nasal blockage. In this cohort of 498 patients, 41.4% reported smell and/or taste loss when diagnosed with COVID-19, which was the commonest symptom. Blocked nose, loss of appetite, and gastrointestinal disturbances were independent predictors of smell and/or taste loss on multivariate analysis. Self-ratings of chemosensory function revealed a reduction in smell, taste, and chemesthesis across the entire cohort of patients that was more profound among those reporting smell and/or taste loss as their presenting symptom. Perceived nasal obstruction accounted for only a small proportion of changes in smell and taste, but not for chemesthesis, supporting viral disruption of sensorineural mechanisms as the dominant aetiology of chemosensory dysfunction. Our study suggests that chemosensory dysfunction in COVID-19 may be widespread and more common than previously thought among Asians, and manifest as an early symptom of SARS-CoV-2 infection. This has important implications for our understanding of the infectivity of viral strains, diagnosis, and management of this pandemic. Study Registration: NMRR-20-934-54803 and NCT04390165

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Self-Reported Symptom Study of COVID-19 Chemosensory Dysfunction in Malaysia

10.21203/rs.3.rs-696505/v2 ◽

2021 ◽

Author(s):

Shen-Han Lee ◽

Zhi Xiang Yeoh ◽

Ida Sadja'ah Sachlin ◽

Norzi Gazali ◽

Shahrul Aiman Soelar ◽

...

Keyword(s):

Cross Sectional Study ◽

Ethnic Variation ◽

Rt Pcr ◽

Online Questionnaire ◽

Cross Sectional ◽

Nasal Blockage ◽

Entire Cohort ◽

Presenting Symptoms ◽

Loss Of Appetite ◽

Chemosensory Function

Abstract Alterations in the three chemosensory modalities – smell, taste, and chemesthesis – have been implicated in Coronavirus Disease 2019 (COVID-19), yet emerging data suggest a wide geographic and ethnic variation in the prevalence of these symptoms. Studies on chemosensory disorders in COVID-19 have predominantly focused on Caucasian populations whereas Asians remain understudied. We conducted a nationwide, multicentre cross-sectional study using an online questionnaire on a cohort of RT-PCR-confirmed adult COVID-19 patients in Malaysia between 6 June to 30 November 2020. The aim of our study was to investigate their presenting symptoms and assess their chemosensory function using self-ratings of perceived smell, taste, chemesthesis, and nasal blockage. In this cohort of 498 patients, 41.4% reported smell and/or taste loss when diagnosed with COVID-19, which was the commonest symptom. Blocked nose, loss of appetite, and gastrointestinal disturbances were independent predictors of smell and/or taste loss on multivariate analysis. Self-ratings of chemosensory function revealed a reduction in smell, taste, and chemesthesis across the entire cohort of patients that was more profound among those reporting smell and/or taste loss as their presenting symptom. Perceived nasal obstruction accounted for only a small proportion of changes in smell and taste, but not for chemesthesis, supporting viral disruption of sensorineural mechanisms as the dominant aetiology of chemosensory dysfunction. Our study suggests that chemosensory dysfunction in COVID-19 is more widespread than previously reported among Asians and may be related to the infectivity of viral strains. Study Registration: NMRR-20-934-54803 and NCT04390165

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COVID-19 infection and outcomes in a population-based cohort of 17,173 adults with intellectual disabilities compared with the general population

10.1101/2021.02.08.21250525 ◽

2021 ◽

Author(s):

Angela Henderson ◽

Michael Fleming ◽

Sally-Ann Cooper ◽

Jill Pell ◽

Craig Melville ◽

...

Keyword(s):

At Risk ◽

General Population ◽

Intellectual Disabilities ◽

Age Groups ◽

Case Fatality ◽

Severe Infection ◽

List Type ◽

Elderly Age ◽

All Cause Mortality ◽

Adults With Intellectual Disabilities

AbstractObjectivesTo compare COVID-19 infection, severe infection, mortality, case-fatality, and excess deaths, among adults with intellectual disabilities and those without.DesignRecord-linkage of all adults recorded with intellectual disabilities in Scotland’s Census, 2011, and a 5% sample of other adults, to COVID-19 test results (Electronic Communication of Surveillance in Scotland), hospitalisations (Scottish Morbidity Record 01), and deaths (National Records of Scotland).SettingGeneral population; 24th January 2020 - 15th August 2020ParticipantsSuccessful linkage of 94.8% provided data on 17,173 adults with, and 195,859 without, intellectual disabilities.OutcomesCrude rates of COVID-19 infection, severe infection (hospitalisation/death), mortality, and case fatality; age-, sex- and deprivation-standardised severe infection and mortality ratios; annual all-cause mortality for 2020 and 2015-2019.ResultsAdults with intellectual disabilities had higher rates of COVID-19 infection (957/100,000 versus 513/100,000); severe infection (549/100,000 versus 237/100,000); mortality (259/100,000 versus 114/100,000); and case-fatality (30% versus 24%). Poorer COVID-19 outcomes remained after standardising for age, sex and deprivation: standardised severe infection ratio 2.59 (95% CI 1.80, 3.39) and mortality ratio 3.20 (95% CI 2.16, 4.25). These were higher among 55-64 year olds: 7.12 (95% CI 3.73, 10.50) and 16.16 (95% CI7.69, 24.63) respectively. Among adults with intellectual disabilities, all-cause mortality was only slightly higher in 2020 than the previous five years: standardised mortality ratios 2.49 (95% CI 2.17, 2.81) and 2.38 (95% CI 2.26, 2.49) respectively.ConclusionsAdults with intellectual disabilities were more likely to be infected with COVID-19, and had worse outcomes once infected, particularly those under 65 years. Non-pharmaceutical interventions directed at formal and informal carers are essential to reduce transmission and all adults with intellectual disabilities should be immediately prioritised for vaccination regardless of age.Summary boxWhat is already known on this topicCOVID-19 mortality is higher within multi-occupancy residences.Adults with intellectual disabilities may be at higher risk of COVID-19 mortality than other adults, but there are gaps in the evidence.COVID-19 case-fatality may be no different, or as much as 2.75 times higher in adults with intellectual disabilities compared with other adults.What this study addsCompared with general population adults, adults with intellectual disabilities were almost twice as likely to become infected with COVID-19, 2.3 times as likely to have severe infection, 2.3 times as likely to have COVID-19 mortality, and had 25% higher COVID-19 case-fatality.After standardising for age, sex and deprivation, people with intellectual disabilities were 3.2 times more at risk of covid-19 mortality and 2.6 times more at risk of severe infection relative to those with no intellectual disabilitiesCompared with general population adults, adults with intellectual disabilities had poorer outcomes among non-elderly age-groups particularly those aged 55-65 years, men, and those living in less-deprived neighbourhoods.Non-pharmaceutical initiatives are important for carers and care-provider organisations, and adults with intellectual disabilities should be prioritised in the national rollouts of COVID-19 vaccination programmes, regardless of age, sex, or neighbourhood deprivation.

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