Could self-reported symptoms be predictors of RT-PCR positivity in suspected COVID-19 cases? The Libya experience/Les symptomes auto-declares pourraient-ils constituer des facteurs predictifs d'une positivite au test RT-PCR chez les cas suspects de COVID-19 ? L'experience de la Libye

• Published in: Eastern Mediterranean health journal Vol. 28; no. 9; pp. 664 - 672
• Main Authors: Ghiadi, Amira El, Eddali, Omnia, Ashur, Sana, Sabei, Laila
• Format: Journal Article
• Language: English
• Published: World Health Organization 01.09.2022
• Subjects: Health surveys; Methods; Polymerase chain reaction; Pulmonary manifestations of general diseases; Surveys; Libya
• ISSN: 1020-3397
• DOI: 10.26719/emhj.22.061

Background: COVID-19 has symptoms similar to several other respiratory and non-respiratory diseases, which makes differentiating them a challenging task and could lead to unnecessary use of realtime reverse transcriptase polymerase chain reaction (RT-PCR) resources. Aims: The study aimed to assess self-reported symptoms as predictors for RT-PCR positivity in suspected COVID-19 cases. Methods: This was a cross-sectional study. We retrospectively reviewed the database of COVID-19 care centres in the eastern district of Tripoli, Libya, from May to December 2020. Presenting symptoms and RT-PCR test data were extracted. Results: Of the 4593 subjects, 923 (20.1%) had positive RT-PCR result. Sensitivity for COVID-19 disease diagnosis was very low ([less than or equal to] 18.2%) for all symptoms, except for myalgia (82.1%). Specificity was high for all symptoms (90.7-99.8%), except for myalgia (11.0%). Loss of taste and smell had the highest positive likelihood ratio (LR) for RT-PCR positivity (LR+ = 3.59, 95% CI: 2.95-4.37). In the multiple logistic regression, three symptoms maintained significant contribution to RT-PCR positivity; these were loss of taste and smell (odds ratio (OR) = 3.90, 95% CI: 3.04-4.99), sore throat (OR = 1.50, 95% CI: 1.02-2.19), and myalgia (OR = 0.65, 95% CI: 0.49-0.85). Other significant predictors were history of contact with a COVID-19 case (OR = 0.50, 95% CI: 0.39-0.62), and being female (OR = 1.33, 95% CI: 1.15-1.55). Conclusion: The findings of this study do not support the use of self-reported symptoms for the confirmation of COVID-19 disease in suspected cases because of their poor diagnostic properties. Keywords: COVID-19, self-reported symptoms, predictors, sensitivity, specificity, respiratory disease, PCR Contexte : La COVID-19 presente des symptomes similaires a ceux de plusieurs autres maladies respiratoires et non respiratoires, ce qui rend leur differenciation difficile et pourrait entrainer un recours inutile aux ressources de l'amplification en chaine par polymerase en temps reel (RT-PCR). Objectifs : L'etude visait a evaluer les symptomes auto-declares en tant que facteurs predictifs de la positivite au test RT-PCR chez les cas suspects de COVID-19. Methodes : Il s'agissait d'une etude transversale. Nous avons examine retrospectivement la base de donnees des centres de soins COVID-19 dans le district oriental de Tripoli en Libye, de mai a decembre 2020. Les symptomes qui se sont presentes et les donnees du test RT-PCR ont ete extraits. Resultats : Neuf cent vingt-trois sujets (20,1 %) sur 4593 presentaient un resultat positif a la RT-PCR. La sensibilite du diagnostic de la COVID-19 etait tres faible ([less than or equal to] 18,2 %) pour tous les symptomes, a l'exception de la myalgie (82,1 %). La specificite etait elevee pour tous les symptomes (90,7-99,8 %), sauf pour la myalgie (11,0 %). La perte du gout et de l'odorat presentait le rapport de vraisemblance (RV) positif le plus eleve pour la positivite a la RT-PCR (RV+ = 3,59, IC a 95 % : 2,95-4,37). A la regression logistique multiple, trois symptomes ont maintenu une contribution significative a la positivite de la RT-PCR ; il s'agissait de la perte du gout et de l'odorat (OR = 3,90, IC a 95 % : 3,04-4,99), des maux de gorge (OR = 1,50, IC a 95 % : 1,02-2,19), et de la myalgie (OR = 0,65, IC a 95 % : 0,49-0,85). Les autres facteurs predictifs significatifs etaient les contacts precedents avec un cas de COVID-19 (OR = 0,50, IC a 95 % : 0,39-0,62), et l'appartenance au sexe feminin (OR = 1,33, IC a 95 % : 1,15-1,55). Conclusion : Les resultats de la presente etude ne soutiennent pas l'utilisation des symptomes auto-declares pour la confirmation de la presence de COVID-19 chez les cas suspects, en raison de leurs mauvaises proprietes diagnostiques.