A prospective cohort study in non-hospitalized household contacts with SARS-CoV-2 infection: symptom profiles and symptom change over time

Yousaf, Anna R; Duca, Lindsey M; Chu, Victoria; Reses, Hannah E; Fajans, Mark; Rabold, Elizabeth M; Laws, Rebecca L; Gharpure, Radhika; Matanock, Almea; Wadhwa, Ash; Pomeroy, Mary; Njuguna, Henry; Fox, Garrett; Binder, Alison M; Christiansen, Ann; Freeman, Brandi; Gregory, Christopher; Tran, Cuc H; Owusu, Daniel; Ye, Dongni; Dietrich, Elizabeth; Pevzner, Eric; Conners, Erin E; Pray, Ian; Rispens, Jared; Vuong, Jeni; Christensen, Kim; Banks, Michelle; O'Hegarty, Michelle; Mills, Lisa; Lester, Sandra; Thornburg, Natalie J; Lewis, Nathaniel; Dawson, Patrick; Marcenac, Perrine; Salvatore, Phillip; Chancey, Rebecca J; Fields, Victoria; Buono, Sean; Yin, Sherry; Gerber, Susan; Kiphibane, Tair; Dasu, Trivikram; Bhattacharyya, Sanjib; Westergaard, Ryan; Dunn, Angela; Hall, Aron J; Fry, Alicia M; Tate, Jacqueline E; Kirking, Hannah L; Nabity, Scott

BACKGROUND: Improved understanding of SARS-CoV-2 spectrum of disease is essential for clinical and public health interventions. There are limited data on mild or asymptomatic infections, but recognition of these individuals is key as they contribute to viral transmission. We describe the symptom profiles from individuals with mild or asymptomatic SARS-CoV-2 infection. METHODS: From March 22 to April 22, 2020 in Wisconsin and Utah, we enrolled and prospectively observed 198 household contacts exposed to SARS-CoV-2. We collected and tested nasopharyngeal (NP) specimens by RT-PCR two or more times during a 14-day period. Contacts completed daily symptom diaries. We characterized symptom profiles on the date of first positive RT-PCR test and described progression of symptoms over time. RESULTS: We identified 47 contacts, median age 24 (3-75) years, with detectable SARS-CoV-2 by RT-PCR. The most commonly reported symptoms on the day of first positive RT-PCR test were upper respiratory (n=32, 68%) and neurologic (n=30, 64%); fever was not commonly reported (n=9, 19%). Eight (17%) individuals were asymptomatic at the date of first positive RT-PCR collection; two (4%) had preceding symptoms that resolved and six (13%) subsequently developed symptoms. Children less frequently reported lower respiratory symptoms (age <18: 21%, age 18-49: 60%, age 50+ years: 69%; p=0.03). CONCLUSIONS: Household contacts with lab-confirmed SARS-CoV-2 infection reported mild symptoms. When assessed at a single time-point, several contacts appeared to have asymptomatic infection; however, over time all developed symptoms. These findings are important to inform infection control, contact tracing, and community mitigation strategies.