ArticlePloS one2020
U-shaped-aggressiveness of SARS-CoV-2: Period between initial symptoms and clinical progression to COVID-19 suspicion. A population-based cohort study.
Article in PloS one, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.
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Who cites it
2 citing papers in PubMed, 1 synthesis or guideline pooled it.
- A Systematic Review of the Markers of Severity in Acute Respiratory Infections to Inform Primary Care Surveillance.Influenza and other respiratory viruses · 2025Pooled it
- Improving the early identification of COVID-19 pneumonia: a narrative review.BMJ open respiratory research · 2021Review
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5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundEarly identification of different COVID-19 clinical presentations may depict distinct pathophysiological mechanisms and guide management strategies.
objectiveTo determine the aggressiveness of SARS-CoV-2 using symptom progression in COVID-19 patients.
designHistoric cohort study of Mexican patients. Data from January-April 2020 were provided by the Health Ministry.
settingPopulation-based. Patients registered in the Epidemiologic Surveillance System in Mexico.
participantsSubjects who sought medical attention for clinical suspicion of COVID-19. All patients were subjected to RT-PCR testing for SARS-CoV-2. MEASUREMENTS: We measured the Period between initial symptoms and clinical progression to COVID-19 suspicion (PISYCS) and compared it to the primary outcomes (mortality and pneumonia).
results65,500 patients were included. Reported fatalities and pneumonia were 2176 (3.32%), and 11568 (17.66%), respectively. According to the PISYCS, patients were distributed as follows: 14.89% in <24 hours, 43.25% between 1-3 days, 31.87% between 4-7 days and 9.97% >7 days. The distribution for mortality and pneumonia was 5.2% and 22.5% in <24 hours, 2.5% and 14% between 1-3 days, 3.6% and 19.5% between 4-7 days, 4.1% and 20.6% >7 days, respectively (p<0.001). Adjusted-risk of mortality was (OR [95% CI], p-value): <24 hours = 1.75 [1.55-1.98], p<0.001; 1-3 days = 1 (reference value); 4-7 days = 1.53 [1.37-1.70], p<0.001; >7 days = 1.67 [1.44-1.94], p<0.001. For pneumonia: <24 hours = 1.49 [1.39-1.58], p<0.001; 1-3 days = 1; 4-7 days = 1.48 [1.41-1.56], p<0.001; >7 days = 1.57 [1.46-1.69], p<0.001. LIMITATIONS: Using a database fed by large numbers of people carries the risk of data inaccuracy. However, this imprecision is expected to be random and data are consistent with previous studies.
conclusionThe PISYCS shows a U-shaped SARS-CoV-2 aggressiveness pattern. Further studies are needed to corroborate the time-related pathophysiology behind these findings.
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