Predictive value of clinical symptoms for COVID-19 diagnosis in young adults

Abstract

Objective: Assessment of predictive values of clinical symptoms for COVID-19 diagnosis in young adults. Participants: Nonresidential university students (ages 18–25) participating in surveillance testing and mandatory symptom survey between 9/9/2020 and 11/25/2020. Methods: Retrospective study of test results and symptom survey data. Results: Among 6,489 individuals, 288 (4.4%) tested positive for COVID-19, 90 (31.3%) of whom reported symptoms. COVID-19 prevalence among individuals reporting and not reporting symptoms was 17.2% and 3.3%, respectively. The four symptoms with highest positive predictive values (PPVs) were smell/taste loss (PPV = 38.5%), chills (PPV = 31.5%), muscle/joint pain (PPV = 26.0%), and fever (PPV = 25.9%). Conclusions: Institutions should emphasize COVID-19 risk for highly predictive symptoms in public health messaging to inform individuals on when to seek testing or self-isolation. However, low COVID-19 diagnostic accuracy of clinical symptoms and the high pre-symptomatic/asymptomatic rate (69%) highlight the limitations of voluntary testing strategies employed by higher education institutions during the original strain of SARS-CoV-2.

Keywords:

• COVID-19
• SARS-CoV-2
• symptoms
• young adults
• university

Acknowledgments

We thank the Clemson University administrators, medical staff, housing staff, and all other testing providers who helped implement and manage SARS-CoV-2 testing. We thank Clemson University’s Computing & Information Technology department for their assistance in collecting, managing, and distributing test result data.

Authors’ contributions

Rennert, Kunkel, and Sivaraj had full access to the data in the study and assume responsibility for the integrity of the data analysis. Rennert, Kunkel, Colenda contributed to concept and design. Kunkel, Rennert, and Sivaraj contributed to acquisition, analysis, or interpretation of the data. Kunkel, Rennert, and Stuenkel contributed to drafting of the manuscript. All authors contributed to critical revision of the manuscript for important intellectual content. Kunkel, Rennert, Sivaraj, and Stuenkel contributed to statistical analysis. Rennert contributed to administrative, technical, or material support.

Disclosure Statement

The authors have no conflicts of interest to report. The authors confirm that the research presented in this article met the ethical guidelines, including adherence to the legal requirements of the United States of America and received approval from the Institutional Review Board of Clemson University.

Role of funder

The funder had no role in the development of this study; data collection, analysis, and interpretation; manuscript preparation and review; and the decision to submit the manuscript for publication.

Additional information

Funding

Rennert and Kunkel received salary support from Clemson University for public health consulting and modeling during the conduct of this study (project #1502934). Sivaraj and Stuenkel acknowledge financial support (graduate assistantship) from Clemson University during the conduct of this study. Christopher C Colenda reports personal fees from Colenda Consulting, LLC for public health consulting to Clemson University in 2020.