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Order of Occurrence of COVID-19 Symptoms
Janusz Wojtusiak1, Wejdan Bagais, Jee Vang
1Departments of Health Administration and Policy (Drs Wojtusiak, Vang, and Alemi and Ms Bagais) and Global and Community Health (Dr Roess), College of Health and Human Services, George Mason University, Fairfax, Virginia.
Background And Objectives:
COVID-19 symptoms change after onset-some show early, others later. This article examines whether the order of occurrence of symptoms can improve diagnosis of COVID-19 before test results are available.
Methods:
In total, 483 individuals who completed a COVID-19 test were recruited through Listservs. Participants then completed an online survey regarding their symptoms and test results. The order of symptoms was set according to (a) whether the participant had a "history of the symptom" due to a prior condition; and (b) whether the symptom "occurred first," or prior to, other symptoms of COVID-19. Two LASSO (Least Absolute Shrinkage and Selection Operator) regression models were developed. The first model, referred to as "time-invariant," used demographics and symptoms but not the order of symptom occurrence. The second model, referred to as "time-sensitive," used the same data set but included the order of symptom occurrence.
Results:
The average cross-validated area under the receiver operating characteristic (AROC) curve for the time-invariant model was 0.784. The time-sensitive model had an AROC curve of 0.799. The difference between the 2 accuracy levels was statistically significant (α < .05).
Conclusion:
The order of symptom occurrence made a statistically significant, but small, improvement in the accuracy of the diagnosis of COVID-19.
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