Common symptoms and clinical features of COVID-19 (multiple reviews)
What is this? A large number of studies have reported on the common symptoms and clinical features of COVID-19. These are the subject of many rapid reviews, which are summarised here. More details on the reviews, including citations and links to the full reviews, are available lower down this page.
What was found: At the time of these reviews, fever, cough, fatigue, myalgia (muscle aches and pains) and shortness of breath were the most common clinical features of COVID-19. Several reviews also reported diarrhoea and vomiting.
In the living Cochrane review by Struyf (search done on 27 April 2020), the four categories of clinical features associated with COVID-19 were systemic, respiratory, gastrointestinal and cardiovascular. Overall, the review concluded that individual signs and symptoms generally appeared to have very poor diagnostic properties. Only six symptoms (cough, sore throat, fever, myalgia or arthralgia, fatigue, and headache) had a sensitivity of ≥50%. Fever, myalgia/arthralgia, fatigue and headache had a specificity of >90% and therefore may indicate a substantially increased likelihood of COVID-19 disease.
Several reviews noted that bilateral lung involvement was frequently reported and a combined summary of review of chest CT scans is available here.
Comorbidities were often reported with COVID-19 infection. The most common comorbidities and indicators for more severe course of disease were cerebrovascular disease, cardiovascular disease (in particular hypertension) and diabetes.
At the time of the Cao review (search up to 1 March 2020), almost one-third of COVID-19 patients required intensive care, with acute respiratory distress syndrome (ARDS) being the most frequent clinical presentation. Other severe clinical presentations included acute cardiac injury, acute renal injury, shock and multiple organ dysfunction syndrome (MODS).
Common laboratory findings included non-specific biochemical markers of infection and inflammation, including white blood cell and/or platelet abnormalities, and inflammatory markers. At the time of the Zhu review (search done on 16 March 2020), a range of abnormal biochemical markers including cardiac enzymes, and markers associated with liver function and renal function, had been identified for COVID-19 patients.
The studies included in the He review (search up to 20 May 2020) showed that approximately one in six confirmed COVID-19 cases were asymptomatic, that asymptomatic patients may have abnormal laboratory and imaging findings, and that nearly half developed symptoms later in the infection. In children, the proportion of cases with asymptomatic infection was higher than for other age groups.
What are the reviews:
Citation: Adhikari SP, Meng S, Wu YJ, et al. Epidemiology, causes, clinical manifestation and diagnosis, prevention and control of coronavirus disease (COVID-19) during the early outbreak period: a scoping review. Infectious Diseases of Poverty. 2020 Mar;9(1):29.
In this rapid review, the authors searched for studies on the epidemiology, causes, clinical diagnosis, prevention and control of COVID-19. They restricted their search to articles published in English and Chinese and did their most recent search on 31 January 2020. They included 65 studies, covering epidemiology (19 studies), causes (25), clinical manifestation and diagnosis (9), and prevention and control (12).
Citation: Cao Y, Liu X, Xiong L, et al. Imaging and clinical features of patients with 2019 novel coronavirus SARS‐CoV‐2: a systematic review and meta‐analysis. Journal of Medical Virology. 2020;92(9):1449-59.
In this rapid review, the authors searched for cross-sectional studies and case series on diagnosis and treatment of COVID-19. They restricted their searches to articles published in English and Chinese and searched up to 1 March 2020. They included 31 studies (total: 46,959 patients).
Citation: He J, Guo Y, Mao R, et al. Proportion of asymptomatic coronavirus disease 2019: A systematic review and meta‐analysis. Journal of Medical Virology. 2021;93:820-30.
In this rapid review, the authors searched for observational studies of asymptomatic infection in COVID-19 patients. They did not restrict their searches by language of publication and searched up to 20 May 2020. They included 41 observational studies (total: 50,155 patients).
Citation: Hu Y, Sun J, Dai Z, et al. Prevalence and severity of corona virus disease 2019 (COVID-19): A systematic review. Journal of Clinical Virology 2020;127:104371.
In this rapid review, the authors searched for research into the prevalence and severity of illness for COVID-19 patients. They did not restrict their searches by language of publication and searched for articles published since 1 January 1980 on 10 March 2020. They included 21 studies (total: 47,344 patients), from China (20 studies) and Singapore (1).
Citation: Kaur N, Gupta I, Singh H, et al. Epidemiological and clinical characteristics of 6635 COVID-19 patients: a pooled analysis. SN Comprehensive Clinical Medicine. 2020 Aug;2(8):1048-52.
In this rapid review, the authors searched for studies reporting clinical features and demographic data for COVID-19 patients. They restricted their searches to articles published in English, between 1 December 2019 and 27 April 2020. They included 50 observational studies (total: 6635 patients).
Citation: Koh J, Shah SU, Chua PE, et al. Epidemiological and Clinical Characteristics of Cases During the Early Phase of COVID-19 Pandemic: A Systematic Review and Meta-Analysis. Frontiers in Medicine. 2020;7:295.
In this rapid review, the authors searched for observational studies of epidemiological and clinical characteristics of COVID-19. They restricted their searches to articles published in English or Mandarin between 1 January and 11 February 2020. They included 18 case reports, 8 cross-sectional studies and 3 case series (total: 578 patients). 24 of the studies were conducted in China.
Citation: Pormohammad A, Ghorbani S, Baradaran B, et al. Clinical Characteristics, laboratory findings, radiographic signs and outcomes of 52,251 patients with confirmed covid-19 infection: a systematic review and meta-analysis. Microbial Pathogenesis 2020 Oct;147:104390.
In this rapid review, the authors searched for observational studies reporting clinical features of COVID-19. They did not restrict their searches by language of publication and searched up to 28 February 2020. They included 80 retrospective studies from China (61,742 patients with confirmed COVID-19 infection).
Citation: Struyf T, Deeks JJ, Dinnes J, et al. Signs and symptoms to determine if a patient presenting in primary care or hospital outpatient settings has COVID‐19 disease. Cochrane Database of Systematic Reviews. 2020;(7):CD013665.
In this living Cochrane review, the authors searched the Cochrane COVID-19 Study Register and the University of Bern COVID-19 living evidence database for studies of clinical signs and symptoms for diagnosing COVID-19 disease in primary care or hospital outpatient settings. They did not restrict their searches by language of publication and did the search on 27 April 2020. They included 16 studies (7706 patients) and identified an additional 40 ongoing studies.
Citation: Zhu J, Zhong Z, Ji P, et al. Clinicopathological characteristics of 8697 patients with COVID-19 in China: a meta-analysis. Family Medicine and Community Health. 2020;8(2):e000406.
In this rapid review, the authors searched for cohort studies, cross-sectional studies and case series reporting clinical symptoms or laboratory outcomes in >40 COVID-19 patients. They did not restrict their searches by language of publication and searched for articles published online between 1 January 2020 and 16 March 2020. They included 55 observational studies from China (8697 patients).
Other reviews of this topic:
Citation: Balla M, Merugu GP, Patel M, et al. COVID-19, Modern Pandemic: A Systematic Review From Front-Line Health Care Providers’ Perspective. Journal of Clinical Medicine Research. 2020 Apr;12(4):215-29.
Citation: Grant R, Malik MR, Elkholy A, et al. A review of asymptomatic and sub-clinical Middle East Respiratory Syndrome Coronavirus Infections. Epidemiologic Reviews. 2019;41(1):69-81.
Citation: Htun TP, Sun Y, Chua HL, et al. Clinical features for diagnosis of pneumonia among adults in primary care setting: A systematic and meta-review. Scientific Reports. 2019;9(1):7600.
Citation: Manabe T, Akatsu H, Kotani K, et al. Trends in clinical features of novel coronavirus disease (COVID-19): A systematic review and meta-analysis of studies published from December 2019 to February 2020. Respiratory Investigation. 2020;58(5):409-18.
Citation: Xu P, Sun GD, Li ZZ. Clinical characteristics of two human-to-human transmitted coronaviruses: Corona Virus Disease 2019 vs. Middle East Respiratory Syndrome Coronavirus. European Review for Medical and Pharmacological Sciences. 2020;24(10):5797-809.