Predictors of incident viral symptoms ascertained in the era of COVID-19
Gregory M Marcus, Jeffrey E Olgin, Noah D Peyser, Eric Vittinghoff, Vivian Yang, Sean Joyce, Robert Avram, Geoffrey H Tison, David Wen, Xochitl Butcher, Helena Eitel, Mark J Pletcher
PLOS ONE, doi:10.1371/journal.pone.0253120
Background In the absence of universal testing, effective therapies, or vaccines, identifying risk factors for viral infection, particularly readily modifiable exposures and behaviors, is required to identify effective strategies against viral infection and transmission.
Methods We conducted a world-wide mobile application-based prospective cohort study available to English speaking adults with a smartphone. We collected self-reported characteristics, exposures, and behaviors, as well as smartphone-based geolocation data. Our main outcome was incident symptoms of viral infection, defined as fevers and chills plus one other symptom previously shown to occur with SARS-CoV-2 infection, determined by daily surveys.
Findings Among 14, 335 participants residing in all 50 US states and 93 different countries followed for a median 21 days (IQR 10-26 days), 424 (3%) developed incident viral symptoms. In pooled multivariable logistic regression models, female biological sex (odds ratio [OR] 1.75, 95% CI 1.39-2.20, p<0.001), anemia (OR 1.45, 95% CI 1.16-1.81, p = 0.001), hypertension (OR 1.35, 95% CI 1.08-1.68, p = 0.007), cigarette smoking in the last 30 days (OR 1.86, p<0.001), any viral symptoms among household members 6-12 days prior (OR 2.06, 95% CI 1.67-2.55, p<0.001), and the maximum number of individuals the participant interacted with within 6 feet in the past 6-12 days (OR 1.15, 95% CI 1.06-1.25, p<0.001) were each associated with a higher risk of developing viral symptoms. Conversely, a higher subjective social status (OR 0.87, 95% CI 0.83-0.93, p<0.001), at least weekly exercise (OR 0.57, 95% CI 0.47-0.70, p<0.001), and sanitizing one's phone (OR 0.79, 95% CI 0.63-0.99, p = 0.037) were each associated with a lower risk of developing viral symptoms.
Supporting information
S1 Table. Proportion of participants completing at least one daily survey per week and the proportion completing weekly surveys. (DOCX)
S2
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'abstract': '<jats:sec id="sec001">\n'
'<jats:title>Background</jats:title>\n'
'<jats:p>In the absence of universal testing, effective therapies, or vaccines, identifying '
'risk factors for viral infection, particularly readily modifiable exposures and behaviors, is '
'required to identify effective strategies against viral infection and transmission.</jats:p>\n'
'</jats:sec>\n'
'<jats:sec id="sec002">\n'
'<jats:title>Methods</jats:title>\n'
'<jats:p>We conducted a world-wide mobile application-based prospective cohort study available '
'to English speaking adults with a smartphone. We collected self-reported characteristics, '
'exposures, and behaviors, as well as smartphone-based geolocation data. Our main outcome was '
'incident symptoms of viral infection, defined as fevers and chills plus one other symptom '
'previously shown to occur with SARS-CoV-2 infection, determined by daily surveys.</jats:p>\n'
'</jats:sec>\n'
'<jats:sec id="sec003">\n'
'<jats:title>Findings</jats:title>\n'
'<jats:p>Among 14, 335 participants residing in all 50 US states and 93 different countries '
'followed for a median 21 days (IQR 10–26 days), 424 (3%) developed incident viral symptoms. '
'In pooled multivariable logistic regression models, female biological sex (odds ratio [OR] '
'1.75, 95% CI 1.39–2.20, p<0.001), anemia (OR 1.45, 95% CI 1.16–1.81, p = 0.001), '
'hypertension (OR 1.35, 95% CI 1.08–1.68, p = 0.007), cigarette smoking in the last 30 days '
'(OR 1.86, 95% CI 1.35–2.55, p<0.001), any viral symptoms among household members 6–12 days '
'prior (OR 2.06, 95% CI 1.67–2.55, p<0.001), and the maximum number of individuals the '
'participant interacted with within 6 feet in the past 6–12 days (OR 1.15, 95% CI 1.06–1.25, '
'p<0.001) were each associated with a higher risk of developing viral symptoms. Conversely, '
'a higher subjective social status (OR 0.87, 95% CI 0.83–0.93, p<0.001), at least weekly '
'exercise (OR 0.57, 95% CI 0.47–0.70, p<0.001), and sanitizing one’s phone (OR 0.79, 95% CI '
'0.63–0.99, p = 0.037) were each associated with a lower risk of developing viral '
'symptoms.</jats:p>\n'
'</jats:sec>\n'
'<jats:sec id="sec004">\n'
'<jats:title>Interpretation</jats:title>\n'
'<jats:p>While several immutable characteristics were associated with the risk of developing '
'viral symptoms, multiple immediately modifiable exposures and habits that influence risk were '
'also observed, potentially identifying readily accessible strategies to mitigate risk in the '
'COVID-19 era.</jats:p>\n'
'</jats:sec>',
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