Identifying High-Risk COVID Patients Through Early Symptoms, Contributing Factors Before Testing

^{By Julie Gould}

As an epidemiologist, Nancy A Dreyer, chief scientific officer and senior vice president, Real World Solutions, IQVIA Cambridge, MA has history working with infectious diseases—COVID-19 is her third pandemic. She began her work with H5N1 influenza A, commonly known as the avian flu, which was highly lethal with a case-fatality rate of close to 90%—with a median of 9 days from first symptom to death.

“I helped create the world’s largest patient registry by reviewing hospital records from bird flu cases throughout southeast Asia,” she explained. “We discovered that a medication that was approved for seasonal influenza quadrupled the likelihood of surviving avian influenza, a very exciting finding. Later I worked H1N1 influenza by studying vaccine safety.”

As cases of the coronavirus continue to rise in the US and globally, there is increasing need to find more efficient ways to identify at-risk populations and find potential solutions to protect people from symptom onset. In a recent study, Ms Dreyer and coresearchers identified factors that could imply COVID-19 positivity and help facilitate diagnosis and triage without testing, as well as better predict who is most at-risk of developing serious infections. We spoke with Ms Dreyer about their research’s progress.

Please describe your study and its findings. What results have you found? Were any of the outcomes particularly surprising?

In April 2020, I worked with IQVIA and launched a study of symptom severity and progression among people who believe they have been exposed to COVID-19 (www.helpstopCOVID19.com). Active in the US and UK, more than 20,000 people have joined this study. Nearly all participants still live in their communities and most have not sought medical care for COVID.

The main focus of this research has been to identify characteristics that put people at high risk of developing serious infections from COVID-19, as well as what factors, if any, protect against symptom onset or help people recover more quickly. We are exploring the roles of prescription and non-prescription medications, vitamins and other supplements, as well as occupation and underlying medical conditions. We just added new questions about COVID-19 vaccines that will allow us to compare the safety and effectiveness of different vaccines and also to compare the health experience of those who have been vaccinated with those who have not. 

Our preliminary work has shown that people who have these 3 symptoms—loss of sense of taste and smell and a fever—are six times more likely to test positive for COVID-19, offering a quick way to identify probable COVID-19 in the absence of testing. We also found that obesity and pre-existing pulmonary disease were the strongest risk factors for experiencing moderate to severe dyspnea, but that having diabetes, hypertension or autoimmune disease did not appear to increase such risk. Additionally, there was no evidence for a marked increased risk among people who reported underlying cancer.

Do you and your co-investigators intend to expand upon this research?

Now we are starting to explore symptom duration and resolution to identify the characteristics of people who are at high risk of prolonged serious symptoms, and to see if we can find any medications and/or supplements that may promote faster symptom resolution.  

Is there anything else pertaining to your research and findings that you would like to add?

Hopefully this research will build confidence in these new vaccines and will help put this pandemic in the rear-view mirror.

Reference:
Dreyer NA, Reynolds M, DeFilippo Mack C, et al. Self-reported symptoms from exposure to Covid-19 provide support to clinical diagnosis, triage and prognosis: An exploratory analysis [published online ahead of print, 2020 Nov 3]. Travel Med Infect Dis. 2020;38:101909. doi:10.1016/j.tmaid.2020.101909