Coronavirus (COVID-19): using signs and symptoms to diagnose COVID-19 in primary care

Cochrane Review: Struyf T, Deeks JJ, Dinnes J, Takwoingi Y, Davenport C, Leeflang MMG, Spijker R, Hooft L, Emperador D, Domen J, Tans A, Janssens S, Wickramasinghe D, Lannoy V, Horn SR A, Van den Bruel A. Signs and symptoms to determine if a patient presenting in primary care or hospital outpatient settings has COVID-19. Cochrane Database of Systematic Reviews 2022, Issue 5. Art. No.: CD013665. doi: 10.1002/14651858.CD013665.pub3.¹

On 11 March 2020 the World Health Organization (WHO) declared the novel coronavirus (COVID-19) outbreak a global pandemic.² The increased workload caused by COVID-19 in an already overburdened health care system³ has caused clinicians to search for easy-to-use tools that could be used for diagnosis to avoid work overload.⁴ Symptom and sign evaluation has been suggested as a potentially useful tool. The objective of the Cochrane review summarised here, was to determine the diagnostic accuracy of symptoms and signs for COVID-19 in people presenting to primary care or hospital outpatient settings.¹

From the available evidence neither presence of absence of any one symptom could be relied on to predict the presence of COVID-19. Although some studies are now looking at combinations of symptoms and their ability to predict infection, there is currently not enough studies looking at the same combinations to provide any reliable evidence. Some symptoms may increase the likelihood of COVID-19, such as cough, but if further testing were not carried out on individuals without the presence of cough there would be large numbers of missed cases¹ (Table 1).

Table 1.  Summary of symptoms used to determine if a patient presenting in primary care or hospital outpatients has COVID-19.