ENE-COVID nationwide serosurvey served to characterize asymptomatic infections and to develop a symptom-based risk score to predict COVID-19

Pérez-Gómez, Beatriz; Pastor-Barriuso, Roberto; Pérez-Olmeda, Mayte; Hernán, Miguel A; Oteo-Iglesias, Jesús; de Larrea, Nerea Fernández; Fernández-García, Aurora; Martín, Mariano; Fernández-Navarro, Pablo; Cruz, Israel; Sanmartín, Jose L; Paniagua, Jose León; Muñoz-Montalvo, Juan F; Blanco, Faustino; Yotti, Raquel; Pollán, Marina

OBJECTIVES: To characterize asymptomatic SARS-CoV-2 infections and develop a symptom-based risk score useful in primary healthcare. STUDY DESIGN AND SETTING: 61,092 community-dwelling participants in a nationwide population-based serosurvey completed a questionnaire on COVID-19 symptoms and received an immunoassay for SARS-CoV-2 IgG antibodies between April 27-June 22, 2020. Standardized prevalence ratios for asymptomatic infection were estimated across participant characteristics. We constructed a symptom-based risk score and evaluated its ability to predict SARS-CoV-2 infection. RESULTS: 28.7% of infections were asymptomatic (95% CI 26.1-31.4%). Standardized asymptomatic prevalence ratios were 1.19 (1.02-1.40) for men versus women, 1.82 (1.33-2.50) and 1.45 (0.96-2.18) for individuals <20 and ≥80 years versus those aged 40-59, 1.27 (1.03-1.55) for smokers versus non-smokers, and 1.91 (1.59-2.29) for individuals without versus with case contact. In symptomatic population, a symptom-based score (weights: severe tiredness=1; absence of sore throat=1; fever=2; anosmia/ageusia=5) reached standardized seroprevalence ratio of 8.71 (7.37-10.3), discrimination index of 0.79 (0.77-0.81), and sensitivity and specificity of 71.4% (68.1-74.4%) and 74.2% (73.1-75.2%) for a score ≥3. CONCLUSION: The presence of anosmia/ageusia, fever with severe tiredness, or fever without sore throat should serve to suspect COVID-19 in areas with active viral circulation. The proportion of asymptomatics in children and adolescents challenges infection control.