{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T00:34:43Z","timestamp":1792802083228,"version":"4.5.0"},"reference-count":26,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2021,9,28]],"date-time":"2021-09-28T00:00:00Z","timestamp":1632787200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"department of health and social care","id":[{"id":"https:\/\/ror.org\/03sbpja79","id-type":"ROR","asserted-by":"crossref"}]},{"DOI":"10.13039\/100010661","name":"horizon 2020 framework programme","doi-asserted-by":"publisher","award":["874627"],"award-info":[{"award-number":["874627"]}],"id":[{"id":"10.13039\/100010661","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000289","name":"Cancer Research UK","doi-asserted-by":"crossref","award":["22184"],"award-info":[{"award-number":["22184"]}],"id":[{"id":"10.13039\/501100000289","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004440","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["UNS32973"],"award-info":[{"award-number":["UNS32973"]}],"id":[{"id":"10.13039\/100004440","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004440","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["200861\/Z\/16\/Z"],"award-info":[{"award-number":["200861\/Z\/16\/Z"]}],"id":[{"id":"10.13039\/100004440","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004440","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["200187\/Z\/15\/Z"],"award-info":[{"award-number":["200187\/Z\/15\/Z"]}],"id":[{"id":"10.13039\/100004440","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Centres for Disease Control and Prevention","award":["US, 442 U01CK0005-01-02"],"award-info":[{"award-number":["US, 442 U01CK0005-01-02"]}]},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MR\/L01341X\/1"],"award-info":[{"award-number":["MR\/L01341X\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MR\/S019669\/1"],"award-info":[{"award-number":["MR\/S019669\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000274","name":"British Heart Foundation","doi-asserted-by":"publisher","award":["RE\/18\/4\/34215"],"award-info":[{"award-number":["RE\/18\/4\/34215"]}],"id":[{"id":"10.13039\/501100000274","id-type":"DOI","asserted-by":"publisher"}]},{"name":"UK Dementia Research Institute at Imperial","award":["MC_PC_17114"],"award-info":[{"award-number":["MC_PC_17114"]}],"id":[{"id":"https:\/\/ror.org\/02wedp412","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Huo Family Foundation","id":[{"id":"https:\/\/ror.org\/02cc3ss06","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosmedicine.org"],"crossmark-restriction":false},"short-container-title":["PLoS Med"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Rapid detection, isolation, and contact tracing of community COVID-19 cases are essential measures to limit the community spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We aimed to identify a parsimonious set of symptoms that jointly predict COVID-19 and investigated whether predictive symptoms differ between the B.1.1.7 (Alpha) lineage (predominating as of April 2021 in the US, UK, and elsewhere) and wild type.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods and findings<\/jats:title>\n                    <jats:p>\n                      We obtained throat and nose swabs with valid SARS-CoV-2 PCR test results from 1,147,370 volunteers aged 5 years and above (6,450 positive cases) in the REal-time Assessment of Community Transmission-1 (REACT-1) study. This study involved repeated community-based random surveys of prevalence in England (study rounds 2 to 8, June 2020 to January 2021, response rates 22%\u201327%). Participants were asked about symptoms occurring in the week prior to testing. Viral genome sequencing was carried out for PCR-positive samples with N-gene cycle threshold value &lt; 34 (\n                      <jats:italic>N<\/jats:italic>\n                      = 1,079) in round 8 (January 2021). In univariate analysis, all 26 surveyed symptoms were associated with PCR positivity compared with non-symptomatic people. Stability selection (1,000 penalized logistic regression models with 50% subsampling) among people reporting at least 1 symptom identified 7 symptoms as jointly and positively predictive of PCR positivity in rounds 2\u20137 (June to December 2020): loss or change of sense of smell, loss or change of sense of taste, fever, new persistent cough, chills, appetite loss, and muscle aches. The resulting model (rounds 2\u20137) predicted PCR positivity in round 8 with area under the curve (AUC) of 0.77. The same 7 symptoms were selected as jointly predictive of B.1.1.7 infection in round 8, although when comparing B.1.1.7 with wild type, new persistent cough and sore throat were more predictive of B.1.1.7 infection while loss or change of sense of smell was more predictive of the wild type. The main limitations of our study are (i) potential participation bias despite random sampling of named individuals from the National Health Service register and weighting designed to achieve a representative sample of the population of England and (ii) the necessary reliance on self-reported symptoms, which may be prone to recall bias and may therefore lead to biased estimates of symptom prevalence in England.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Where testing capacity is limited, it is important to use tests in the most efficient way possible. We identified a set of 7 symptoms that, when considered together, maximize detection of COVID-19 in the community, including infection with the B.1.1.7 lineage.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pmed.1003777","type":"journal-article","created":{"date-parts":[[2021,9,28]],"date-time":"2021-09-28T14:06:45Z","timestamp":1632838005000},"page":"e1003777","update-policy":"https:\/\/doi.org\/10.1371\/journal.pmed.corrections_policy","source":"Crossref","is-referenced-by-count":97,"title":["Predictive symptoms for COVID-19 in the community: REACT-1 study of over 1 million people"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9005-623X","authenticated-orcid":true,"given":"Joshua","family":"Elliott","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1363-6537","authenticated-orcid":true,"given":"Matthew","family":"Whitaker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0781-3624","authenticated-orcid":true,"given":"Barbara","family":"Bodinier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8086-4495","authenticated-orcid":true,"given":"Oliver","family":"Eales","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven","family":"Riley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8238-5036","authenticated-orcid":true,"given":"Helen","family":"Ward","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6475-5056","authenticated-orcid":true,"given":"Graham","family":"Cooke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7815-7989","authenticated-orcid":true,"given":"Ara","family":"Darzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8341-5436","authenticated-orcid":true,"given":"Marc","family":"Chadeau-Hyam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7511-5684","authenticated-orcid":true,"given":"Paul","family":"Elliott","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,9,28]]},"reference":[{"key":"pmed.1003777.ref001","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1377\/hlthaff.2020.01409","article-title":"Increased intensity of PCR testing reduced COVID-19 transmission within countries during the first pandemic wave","volume":"40","author":"RP Rannan-Eliya","year":"2021","journal-title":"Health Aff (Millwood)"},{"key":"pmed.1003777.ref002","volume-title":"Contact tracing in the context of COVID-19","author":"World Health Organization","year":"2021"},{"key":"pmed.1003777.ref003","doi-asserted-by":"crossref","first-page":"2993","DOI":"10.1038\/s41467-021-23276-9","article-title":"Controlling COVID-19 via test-trace-quarantine","volume":"12","author":"CC Kerr","year":"2021","journal-title":"Nat Commun"},{"key":"pmed.1003777.ref004","doi-asserted-by":"crossref","first-page":"e488","DOI":"10.1016\/S2214-109X(20)30074-7","article-title":"Feasibility of controlling COVID-19 outbreaks by isolation of cases and contacts","volume":"8","author":"J Hellewell","year":"2020","journal-title":"Lancet Glob Health"},{"key":"pmed.1003777.ref005","volume-title":"Symptoms of COVID-19","author":"Centers for Disease Control and Prevention","year":"2021"},{"key":"pmed.1003777.ref006","volume-title":"Technical briefing","author":"Public Health England","year":"2021"},{"key":"pmed.1003777.ref007","unstructured":"Cov-Lineages.org. B.1.1.7. Cov-Lineages.org; 2021 [cited 2021 Sep 3]. https:\/\/cov-lineages.org\/global_report_B.1.1.7.html."},{"key":"pmed.1003777.ref008","volume-title":"COVID data tracker","author":"Centers for Disease Control and Prevention","year":"2021"},{"key":"pmed.1003777.ref009","doi-asserted-by":"crossref","first-page":"200","DOI":"10.12688\/wellcomeopenres.16228.1","article-title":"REal-time Assessment of Community Transmission (REACT) of SARS-CoV-2 virus: study protocol","volume":"5","author":"S Riley","year":"2020","journal-title":"Wellcome Open Res"},{"key":"pmed.1003777.ref010","doi-asserted-by":"crossref","DOI":"10.17504\/protocols.io.bp2l6n26rgqe\/v3","volume-title":"nCoV-2019 sequencing protocol v3 (LoCost)","author":"J Quick","year":"2020"},{"key":"pmed.1003777.ref011","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1186\/s13073-021-00839-5","article-title":"CoronaHiT: high-throughput sequencing of SARS-CoV-2 genomes","volume":"13","author":"DJ Baker","year":"2021","journal-title":"Genome Med"},{"key":"pmed.1003777.ref012","volume-title":"nf-core\/viralrecon: assembly and intrahost\/low-frequency variant calling for viral samples","author":"nf-core","year":"2021"},{"key":"pmed.1003777.ref013","unstructured":"GitHub. cov-lineages\/pangolin. Github; 2021 [cited 2021 Jun 22]. https:\/\/github.com\/cov-lineages\/pangolin."},{"key":"pmed.1003777.ref014","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1111\/j.1467-9868.2010.00740.x","article-title":"Stability selection","volume":"72","author":"N Meinshausen","year":"2010","journal-title":"J R Stat Soc Series B Stat Methodol"},{"key":"pmed.1003777.ref015","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1111\/j.1467-9868.2011.01034.x","article-title":"Variable selection with error control: another look at stability selection","volume":"75","author":"RD Shah","year":"2013","journal-title":"J R Stat Soc Series B Stat Methodol"},{"key":"pmed.1003777.ref016","volume-title":"SPI-B: impact of financial and other targeted support on rates of self-isolation or quarantine, 16 September 2020","author":"Scientific Pandemic Influenza Group on Behaviours","year":"2020"},{"key":"pmed.1003777.ref017","volume-title":"Deaths involving COVID-19 by local area and socioeconomic deprivation: deaths occurring between 1 March and 31 May 2020","author":"S Caul","year":"2020"},{"key":"pmed.1003777.ref018","doi-asserted-by":"crossref","first-page":"1037","DOI":"10.1038\/s41591-020-0916-2","article-title":"Real-time tracking of self-reported symptoms to predict potential COVID-19","volume":"26","author":"C Menni","year":"2020","journal-title":"Nat Med"},{"key":"pmed.1003777.ref019","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1038\/s41586-021-03291-y","article-title":"SARS-CoV-2 evolution during treatment of chronic infection","volume":"592","author":"SA Kemp","year":"2021","journal-title":"Nature"},{"key":"pmed.1003777.ref020","doi-asserted-by":"crossref","first-page":"1295","DOI":"10.1016\/j.cell.2020.08.012","article-title":"Deep mutational scanning of SARS-CoV-2 receptor binding domain reveals constraints on folding and ACE2 binding","volume":"182","author":"TN Starr","year":"2020","journal-title":"Cell"},{"key":"pmed.1003777.ref021","doi-asserted-by":"crossref","first-page":"eabg3055","DOI":"10.1126\/science.abg3055","article-title":"Estimated transmissibility and impact of SARS-CoV-2 lineage B.1.1.7 in England","volume":"372","author":"NG Davies","year":"2021","journal-title":"Science"},{"key":"pmed.1003777.ref022","doi-asserted-by":"crossref","first-page":"n579","DOI":"10.1136\/bmj.n579","article-title":"Risk of mortality in patients infected with SARS-CoV-2 variant of concern 202012\/1: matched cohort study","volume":"372","author":"R Challen","year":"2021","journal-title":"BMJ"},{"key":"pmed.1003777.ref023","unstructured":"New and Emerging Respiratory Virus Threats Advisory Group on SARS-CoV-2 variant B.1.1.7. NERVTAG: update note on B.1.1.7 severity, 11 February 2021. London: Scientific Advisory Group for Emergencies; 2021 [cited 2021 Sep 3]. https:\/\/www.gov.uk\/government\/publications\/nervtag-update-note-on-b117-severity-11-february-2021."},{"key":"pmed.1003777.ref024","volume-title":"Coronavirus (COVID-19) infection survey: characteristics of people testing positive for COVID-19 in England, 27 January 2021","author":"Office for National Statistics","year":"2021"},{"key":"pmed.1003777.ref025","doi-asserted-by":"crossref","first-page":"990","DOI":"10.1126\/science.abf0874","article-title":"Resurgence of SARS-CoV-2: detection by community viral surveillance","volume":"372","author":"S Riley","year":"2021","journal-title":"Science"},{"key":"pmed.1003777.ref026","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1038\/s41586-021-03470-x","article-title":"Assessing transmissibility of SARS-CoV-2 lineage B.1.1.7 in England","volume":"593","author":"E Volz","year":"2021","journal-title":"Nature"}],"container-title":["PLOS Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pmed.1003777","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,9]],"date-time":"2023-11-09T11:46:17Z","timestamp":1699530377000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pmed.1003777"}},"subtitle":[],"editor":[{"given":"Mirjam E. E.","family":"Kretzschmar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2021,9,28]]},"references-count":26,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2021,9,28]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pmed.1003777","relation":{"has-preprint":[{"id-type":"doi","id":"10.1101\/2021.02.10.21251480","asserted-by":"object"}]},"ISSN":["1549-1676"],"issn-type":[{"value":"1549-1676","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,28]]}}}