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0 0.5 1 1.5 2+ Symp. case 16% Improvement Relative Risk Sleep for COVID-19  Marcus et al.  Prophylaxis Is better sleep beneficial for COVID-19? Prospective study of 14,335 patients in multiple countries (Mar - May 2020) Fewer symptomatic cases with higher quality sleep (p=0.00075) Marcus et al., PLOS ONE, June 2021 Favors good sleep Favors control

Predictors of incident viral symptoms ascertained in the era of COVID-19

Marcus et al., PLOS ONE, doi:10.1371/journal.pone.0253120
Jun 2021  
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Prospective survey based study with 14,335 participants, showing risk of viral symptoms associated with shorter sleep duration.
This study includes sleep and exercise.
risk of symptomatic case, 16.0% lower, OR 0.84, p < 0.001, adjusted per study, per extra hour sleep, multivariable, RR approximated with OR.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Marcus et al., 17 Jun 2021, prospective, multiple countries, peer-reviewed, survey, 12 authors, study period 26 March, 2020 - 3 May, 2020.
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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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