Outcomes of COVID-19 Among High-Risk Individuals: A Study Comparing Febrile and Afebrile Presentation

Fever is one of the most frequent symptoms of coronavirus disease 2019 (COVID-19) and clinicians are faced with a practice question on whether fever is a risk for progression of disease especially in persons with risk factors for severe illness. We studied if a difference exists in the clinical course and outcome between febrile and afebrile (symptomatic) presentation.

Patients aged > 18 years with confirmed COVID-19 with at least one risk factor for severe illness were studied. Enrolment was done from a home COVID-19 care cohort between May 2020 and March 2022. Participants were divided into febrile and afebrile groups and further divided into six sub-groups based on their comorbidities (diabetes mellitus, hypertension, chronic lung disease, chronic kidney disease, liver disease and others) using a pre-specified inclusion method. Severity of illness was classified as non-hypoxic or hypoxic and clinical course was monitored.

A total of 3,752 patients were studied, of whom 965 (25.7%) had severe illness and 117 (3.1%) died. Persons with obesity (P < 0.001), chronic kidney disease (P = 0.003) and chronic liver disease (P = 0.02) more frequently had presentation without fever. No significant difference in hypoxia (P = 0.35) or mortality (P = 0.50) was observed between febrile (n = 1,240) and afebrile (n = 2,512) presentation.

Fever in COVID-19 was not associated with severe illness or mortality. The overall and risk factor specific mortality observed in our study is substantially low, probably due to lesser bias in selection of study participants or due to ethnicity of study population.