Clinical manifestations of COVID-19: An overview of 102 systematic reviews with evidence mapping

Xufei Luo; Meng Lv; Xianzhuo Zhang; Janne Estill; Bo Yang; Ruobing Lei; Mengjuan Ren; Yunlan Liu; Ling Wang; Xiao Liu; Qi Wang; Min Meng; Yaolong Chen; COVID-19 evidence and recommendations working group

doi:10.1111/jebm.12483

Clinical manifestations of COVID-19: An overview of 102 systematic reviews with evidence mapping

J Evid Based Med. 2022 Sep;15(3):201-215. doi: 10.1111/jebm.12483. Epub 2022 Jul 31.

Authors

Xufei Luo¹, Meng Lv^{2

3

4}, Xianzhuo Zhang⁵, Janne Estill^{6

7}, Bo Yang⁸, Ruobing Lei^{2

3

4}, Mengjuan Ren¹, Yunlan Liu¹, Ling Wang¹, Xiao Liu¹, Qi Wang^{9

10}, Min Meng^{2

3

4

11}, Yaolong Chen^{1

2

12

13

14

15

16

17

18

19}; COVID-19 evidence and recommendations working group

Affiliations

¹ School of Public Health, Lanzhou University, Lanzhou, China.
² Chevidence Lab of Child & Adolescent Health, Department of Pediatric Research Institute, Children's Hospital of Chongqing Medical University, Chongqing, China.
³ National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.
⁴ Chongqing Key Laboratory of Pediatrics, Chongqing, China.
⁵ The First School of Clinical Medicine, Lanzhou University, Lanzhou, China.
⁶ Institute of Global Health, University of Geneva, Geneva, Switzerland.
⁷ Institute of Mathematical Statistics and Actuarial Science, University of Bern, Bern, Switzerland.
⁸ Department of Immune Programming and Management, Shapingba District Center for Disease Control and Prevention of Chongqing, Chongqing, China.
⁹ Faculty of Health Sciences, Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.
¹⁰ McMaster Health Forum, McMaster University, Hamilton, Canada.
¹¹ Department of Pharmacy, Gansu Provincial Hospital, Lanzhou, China.
¹² Research Unit of Evidence-Based Evaluation and Guidelines, Chinese Academy of Medical Sciences (2021RU017), School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.
¹³ Institute of Health Data Science, Lanzhou University, Lanzhou, China.
¹⁴ Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.
¹⁵ WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou University, Lanzhou, China.
¹⁶ Guideline International Network Asia, Lanzhou, China.
¹⁷ Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou University, Lanzhou, China.
¹⁸ Lanzhou University GRADE Center, Lanzhou, China.
¹⁹ Lanzhou University, Affiliate of the Cochrane China Network, Lanzhou, China.

Abstract

Objective: Coronavirus disease 2019 (COVID-19) has rapidly spread worldwide, but there is so far no comprehensive analysis of all known symptoms of the disease. Our study aimed to present a comprehensive picture of the clinical symptoms of COVID-19 using an evidence map.

Methods: We systematically searched MEDLINE via PubMed, Web of Science, Embase, and Cochrane library from their inception to March 16, 2021. We included systematic reviews reporting the clinical manifestations of COVID-19 patients. We followed the PRISMA guidelines, and the study selection, data extraction, and quality assessment were done by two individuals independently. We assessed the methodological quality of the studies using AMSTAR. We visually presented the clinical symptoms of COVID-19 and their prevalence.

Results: A total of 102 systematic reviews were included, of which, 68 studies (66.7%) were of high quality, 19 studies (18.6%) of medium quality, and 15 studies (14.7%) of low quality. We identified a total of 74 symptoms including 17 symptoms of the respiratory system, 21 symptoms of the neurological system, 10 symptoms of the gastrointestinal system, 16 cutaneous symptoms, and 10 ocular symptoms. The most common symptoms were fever (67 studies, ranging 16.3%-91.0%, pooled prevalence: 64.6%, 95%CI, 61.3%-67.9%), cough (68 studies, ranging 30.0%-72.2%, pooled prevalence: 53.6%, 95%CI, 52.1%-55.1%), muscle soreness (56 studies, ranging 3.0%-44.0%, pooled prevalence: 18.7%, 95%CI, 16.3%-21.3%), and fatigue (52 studies, ranging 3.3%-58.5%, pooled prevalence: 29.4%, 95%CI, 27.5%-31.3%). The prevalence estimates for COVID-19 symptoms were generally lower in neonates, children and adolescents, and pregnant women than in the general populations.

Conclusion: At least 74 different clinical manifestations are associated with COVID-19. Fever, cough, muscle soreness, and fatigue are the most common, but attention should also be paid to the rare symptoms that can help in the early diagnosis of the disease.

Keywords: COVID-19; SARS-CoV-2; clinical manifestations; evidence map; systematic review.

Publication types

Systematic Review

MeSH terms

Adolescent
COVID-19*
Child
Cough / etiology
Fatigue / etiology
Female
Humans
Infant, Newborn
Myalgia / etiology
Pregnancy
SARS-CoV-2