Loss of smell and taste in combination with other symptoms is a strong predictor of COVID-19 infection
Authors: Menni Cristina , Valdes Ana M , Freidin Maxim B , Ganesh Sajaysurya , El-Sayed Moustafa Julia S , Visconti Alessia , Hysi Pirro , Bowyer Ruth C E , Mangino Massimo , Falchi Mario , Wolf Jonathan , Steves Claire J , Spector Tim D 
Published: April 2020

Importance

A strategy for preventing further spread of the ongoing COVID-19 epidemic is to detect infections and isolate infected individuals without the need of extensive bio-specimen testing.

Objectives

Here we investigate the prevalence of loss of smell and taste among COVID-19 diagnosed individuals and we identify the combination of symptoms, besides loss of smell and taste, most likely to correspond to a positive COVID-19 diagnosis in non-severe cases.

Design

Community survey.

Setting and Participants

Subscribers of RADAR COVID-19, an app that was launched for use among the UK general population asking about COVID-19 symptoms.

Main Exposure

Loss of smell and taste.

Main Outcome Measures

COVID-19.

Results

Between 24 and 29 March 2020, 1,573,103 individuals reported their symptoms via the app; 26% reported suffering from one or more symptoms of COVID-19. Of those, n=1702 reported having had a RT-PCR COVID-19 test and gave full report on symptoms including loss of smell and taste; 579 were positive and 1123 negative. In this subset, we find that loss of smell and taste were present in 59% of COVID-19 positive individuals compared to 18% of those negative to the test, yielding an odds ratio (OR) of COVID-19 diagnosis of OR[95%CI]=6.59[5.25; 8.27], P= 1.90×10−59. We also find that a combination of loss of smell and taste, fever, persistent cough, fatigue, diarrhoea, abdominal pain and loss of appetite is predictive of COVID-19 positive test with sensitivity 0.54[0.44; 0.63], specificity 0.86[0.80; 0.90], ROC-AUC 0.77[0.72; 0.82] in the test set, and cross-validation ROC-AUC 0.75[0.72; 0.77]. When applied to the 410,598 individuals reporting symptoms but not formally tested, our model predicted that 13.06%[12.97%;13.15] of these might have been already infected by the virus.

Conclusions and Relevance

Our study suggests that loss of taste and smell is a strong predictor of having been infected by the COVID-19 virus. Also, the combination of symptoms that could be used to identify and isolate individuals includes anosmia, fever, persistent cough, diarrhoea, fatigue, abdominal pain and loss of appetite. This is particularly relevant to healthcare and other key workers in constant contact with the public who have not yet been tested for COVID-19.

Key points

What is already known on this topic

The spread of COVID-19 can be reduced by identifying and isolating infected individuals but it is not possible to test everyone and priority has been given in most countries to individuals presenting symptoms of the disease.

COVID-19 symptoms, such as fever, cough, aches, fatigue are common in many other viral infections

There is therefore a need to identify symptom combinations that can rightly pinpoint to infected individuals

What this study adds

Among individuals showing symptoms severe enough to be given a COVID-19 RT-PCR test in the UK the prevalence of loss of smell (anosmia) was 3-fold higher (59%) in those positive to the test than among those negative to the test (18%).

We developed a mathematical model combining symptoms to predict individuals likely to be COVID-19 positive and applied this to over 400,000 individuals in the general population presenting some of the COVID-19 symptoms.

We find that ∼13% of those presenting symptoms are likely to have or have had a COVID-19 infection. The proportion was slightly higher in women than in men but is comparable in all age groups, and corresponds to 3.4% of those who filled the app report.