Sensitivity of Symptom-Based Screening for COVID-19 in Active Duty Basic Trainees

Zachary K Matthews; Daniel J Cybulski; Dianne N Frankel; John W Kieffer; Theresa M Casey; Angela B Osuna; Heather C Yun; Joseph E Marcus

doi:10.1093/milmed/usad138

Sensitivity of Symptom-Based Screening for COVID-19 in Active Duty Basic Trainees

Mil Med. 2023 May 16:usad138. doi: 10.1093/milmed/usad138. Online ahead of print.

Authors

Zachary K Matthews¹, Daniel J Cybulski^{1

2}, Dianne N Frankel³, John W Kieffer^{1

4}, Theresa M Casey⁴, Angela B Osuna⁴, Heather C Yun^{1

2}, Joseph E Marcus^{1

2}

Affiliations

¹ Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
² Division of Infectious Diseases, Department of Medicine, Brooke Army Medical Center, JBSA-Fort Sam Houston, TX 78234, USA.
³ HQ USAFRICOM, Office of Comman Surgeon, APO, AE 09751, USA.
⁴ Trainee Health Surveillance, 559 THLS, JBSA-Lackland, TX 78236, USA.

PMID: 37192055
DOI: 10.1093/milmed/usad138

Abstract

Introduction: Symptomatic Coronavirus Disease 2019 (COVID-19) screening has been a cornerstone of case identification during the pandemic. Despite the myriad of COVID-19 symptoms, symptom screens have primarily focused on symptoms of influenza-like illnesses such as fever, cough, and dyspnea. It is unknown how well these symptoms identify cases in a young, healthy military population. This study aims to evaluate the utility of symptom-based screening in identifying COVID-19 through three different COVID-19 waves.

Materials and methods: A convenience sample of 600 military trainees who arrived at Joint Base San Antonio-Lackland in 2021 and 2022 were included. Two hundred trainees with symptomatic COVID-19 before the emergence of the Delta variant (February-April 2021), when Delta variant was predominant (June-August 2021), and when Omicron was the predominant variant (January 2022) had their presenting symptoms compared. At each time point, the sensitivity of a screen for influenza-like illness symptoms was calculated.

Results: Of the 600 symptomatic active duty service members who tested positive for COVID-19, the most common symptoms were sore throat (n = 385, 64%), headache (n = 334, 56%), and cough (n = 314, 52%). Although sore throat was the most prominent symptom during Delta (n = 140, 70%) and Omicron (n = 153, 77%), headache was the most common before Delta (n = 93, 47%). There were significant differences in symptoms by vaccination status; for example, ageusia was more common in patients who were not completely vaccinated (3% vs. 0%, P = .01). Overall, screening for fever, cough, or dyspnea had a 65% sensitivity with its lowest sensitivity in the pre-Delta cases (54%) and highest sensitivity in Omicron cases (78%).

Conclusions: In this descriptive cross-sectional study evaluating symptomatic military members with COVID-19, symptom prevalence varied based on predominant circulating COVID-19 variant as well as patients' vaccination status. As screening strategies evolve with the pandemic, changing symptom prevalence should be considered.

Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2023. This work is written by (a) US Government employee(s) and is in the public domain in the US.