Study identifies symptom clusters likely to lead to respiratory support

Dry cough, fever, shortness of breath, fatigue – all have been identified as known COVID-19 symptoms.

Add to that list headaches, loss of smell (anosmia), muscle pain, sore throat, hoarseness and new symptoms that seem to be discovered each week.

But a new study has found that no one symptom is indicative of having COVID-19; rather, symptoms come in six different ‘clusters’ and these clusters may be used to predict the seriousness of cases and the resulting necessary treatments.

This includes which patients are more at risk and would most likely need respiratory support.

Researchers analysed data from more than 2600 COVID-19 positive patients in the US, the UK and Sweden and who had regularly logged their symptoms on the Zoe COVID symptom tracker in March and April.

They identified six clusters of symptoms:

Cluster 1 (‘flulike’ with no fever)
Headache, loss of smell, muscle pains, cough, sore throat, chest pain, no fever

Cluster 2 (‘flulike’ with fever)
Headache, loss of smell, cough, sore throat, hoarseness, fever, loss of appetite

Cluster 3 (gastrointestinal)
Headache, loss of smell, loss of appetite, diarrhoea, sore throat, chest pain, no cough

Cluster 4 (severe level one, fatigue)
Headache, loss of smell, cough, fever, hoarseness, chest pain, fatigue

Cluster 5 (severe level two, confusion)
Headache, loss of smell, loss of appetite, cough, fever, hoarseness, sore throat, chest pain, fatigue, confusion, muscle pain

Cluster 6 (severe level three, abdominal and respiratory)
Headache, loss of smell, loss of appetite, cough, fever, hoarseness, sore throat, chest pain, fatigue, confusion, muscle pain, shortness of breath, diarrhoea, abdominal pain

According to a statement on the Zoe app, continuous cough, fever and loss of smell are considered the three key symptoms of COVID-19.

However, analysis shows that people also experience symptoms such as headaches, muscle pains, fatigue, diarrhoea, confusion, loss of appetite, shortness of breath and more.

“The progression and outcomes also vary significantly between people, ranging from mild flu-like symptoms or a simple rash to severe or fatal disease,” says a Zoe app statement.

Patients with clusters six (19.8 per cent), five (9.9 per cent) and four (8.6 per cent) were most likely to require respiratory supports from ventilators or supplemental oxygen.

Cluster one patients (1.5 per cent) were the least likely to need breathing support, followed by cluster three (3.3 per cent) and cluster two (4.4 per cent).

The authors hope the findings could help health professionals monitor at-risk patients, help them plan the required medical resources days before they are required and better manage available resources overall.

“This study helps us to see the different ways COVID can present. It alerts us to symptoms which are particularly worrying in the first few days if someone has a positive test – like confusion, abdominal symptoms and severe fatigue. More importantly, if we did start to monitor the symptoms in the first five days, we could get help to those who are on a more severe disease path earlier, and perhaps prevent them getting really sick,” study co-author Claire Steves told Yahoo Life.

The study has been hailed as a potential game-changer.

“This is the first instance I’ve seen where actual symptoms are correlated with disease severity,” said Linda Anegawa, an internist with virtual primary care platform PlushCare.

“While further research is needed, identifying the six clusters now can start to help doctors risk-stratify patients they are seeing and allocate resources toward those patients who are felt more likely to be severely affected. This is critical since resources are scarce and doctors are spread thin, especially in surge areas.”

The ability to identify clusters that correspond with symptoms “may help patients seek care earlier if they find their symptoms put them into one of the high-risk” categories”, she added.

While the research identifies the patients that may require intensive care, it should also set patients with mild cases at ease, says pulmonary and critical care specialist at the Ohio State University Wexner Medical Center, Matthew Exline.

“A lot of patients, when they’re told they have COVID, there’s obviously a lot of anxiety. Appropriately, we focus on what’s the worst-case scenario – the dangers if you end up on a ventilator, things like that.

“But knowing you’re in a low-risk cluster could help ease that anxiety. Doctors being able to say, ‘Hey, a lot of people with your type of symptoms end up not needing much help’ is reassuring to patients and is very helpful.”

Both researchers admit concern about trying to group patients in clusters, adding that some patients can fluctuate between “multiple symptom clusters or have characteristics of multiple clusters.”

However, both believe the research is helpful and could save lives.

“One of the things that’s really a challenge with COVID research is [that scientists have] so many questions and there’s just a finite number of people to try to answer those questions. By asking willing people to enter their symptoms as it’s happening, you can get a lot of data,” said Mr Exline.

Anegawa agrees.

“In this era where virtual medicine is rapidly growing, health apps are a great way to help patients gather data for their telemedicine visits. In the future, I anticipate apps helping to screen patients with symptoms, again to save time and resources,” she said.

Would you be more likely to use a health tracking app if you knew it could help doctors assess your COVID-19 symptoms?

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Written by Leon Della Bosca

Leon Della Bosca is a voracious reader who loves words. You'll often find him spending time in galleries, writing, designing, painting, drawing, or photographing and documenting street art. He has a publishing and graphic design background and loves movies and music, but then, who doesn’t?
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