Symptoms of COVID-19 outpatients in the United States

Matthew F Pullen, Caleb P Skipper, Katherine Huppler Hullsiek, Ananta S Bangdiwala, Katelyn A. Pastick, Elizabeth C. Okafor, Sarah M Lofgren, Radha Rajasingham, Nicole S Engen, Alison L Galdys, Darlisha A Williams, Mahsa Abassi, David R. Boulware

Research output: Contribution to journalArticlepeer-review

37 Scopus citations


Background. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a novel pathogen causing the current worldwide coronavirus disease 2019 (COVID-19) pandemic. Due to insufficient diagnostic testing in the United States, there is a need for clinical decision-making algorithms to guide testing prioritization. Methods. We recruited participants nationwide for a randomized clinical trial. We categorized participants into 3 groups: (1) those with confirmed SARS-CoV-2 infection, (2) those with probable SARS-CoV-2 infection (pending test or not tested but with a confirmed COVID-19 contact), and (3) those with possible SARS-CoV-2 infection (pending test or not tested and with a contact for whom testing was pending or not performed). We compared the frequency of self-reported symptoms in each group and categorized those reporting symptoms in early infection (0-2 days), midinfection (3-5 days), and late infection (<5 days). Results. Among 1252 symptomatic persons screened, 316 had confirmed, 393 had probable, and 543 had possible SARS-CoV-2 infection. In early infection, those with confirmed and probable SARS-CoV-2 infection shared similar symptom profiles, with fever most likely in confirmed cases (P = .002). Confirmed cases did not show any statistically significant differences compared with unconfirmed cases in symptom frequency at any time point. The most commonly reported symptoms in those with confirmed infection were cough (82%), fever (67%), fatigue (62%), and headache (60%), with only 52% reporting both fever and cough. Conclusions. Symptomatic persons with probable SARS-CoV-2 infection present similarly to those with confirmed SARSCoV- 2 infection. There was no pattern of symptom frequency over time.

Original languageEnglish (US)
Article numberofaa271
JournalOpen Forum Infectious Diseases
Issue number7
StatePublished - Jul 1 2020

Bibliographical note

Funding Information:
This work was supported by Jan and David Baszucki, Steve Kirsch, the Alliance of Minnesota Chinese Organizations, the Minnesota Chinese Chamber of Commerce, and the University of Minnesota. Personnel were supported through the Doris Duke Charitable Foundation through a grant supporting the Doris Duke International Clinical Research Fellows Program at the University of Minnesota. Katelyn Pastick and Elizabeth Okafor are Doris Duke International Clinical Research Fellows. Sarah Lofgren is supported by the National Institute of Mental Health (K23MH121220). Caleb Skipper is supported by the Fogarty International Center (D43TW009345). Drs. Radha Rajasingham and Matthew Pullen are supported by the National Institute of Allergy and Infectious Disease (K23AI138851, T32AI055433).

Publisher Copyright:
© The Author(s) 2020.


  • COVID-19
  • Coronavirus
  • SARS-CoV-2


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