A symptom diary-based analysis of the disease course of patients with mild coronavirus disease, Germany, 2020
There is limited information on the clinical course of outpatients with mild coronavirus disease (COVID-19). This information is critical to inform public health prevention strategies and to provide predictive guidance to patients, primary care providers, and employers. We retrospectively assessed the daily prevalence of symptoms in 313 COVID-19 outpatients during the first 20 days of illness. Generalized estimating equations were used to assess the probability of symptom occurrence over time. Fatigue (91%), cough (85%), and headache (78%) were the most common symptoms, occurring a median of one day after symptom onset. Neurological symptoms such as loss of taste (66%), anosmia (62%), and dyspnea (51%) occurred much later (median 3-4 days after symptom onset).
Wiegele P, Kabar I, Kerschke L, Froemmel C, Hüsing-KabarA, Schmidt H, et al. Analysis of disease course based on symptom diaries in patients with mild coronavirus disease, Germany, 2020. EmergInfectDis. 2021; 27(5): 1353-1361. https://doi.org/10.3201/eid2705.204507
Commentary
The severity grade of COVID-19 symptoms described in the cohort was described. This grade shows the distribution of maximum symptom intensity according to grade 0-4 within 20 days of onset. According to this, fatigue (57.2%), headache (54.0%), loss of taste (45.3%), loss of smell (41.9%), and myalgia (41.9%) were most frequently reported in severity grades 3-4.
Furthermore, a higher risk of severe taste and odor loss was shown when patients were female, explaining that additional age is negatively related to the severity of olfactory loss. These clinical symptoms seem to increase from the onset and reach a maximum on day 8. Comparing each symptom, cough and headache are reported to be less severe, with a decrease in severity over the course of a week.
