Symptom Diary–Based Analysis of Disease Course Among Patients With Mild Coronavirus Disease, Germany, 2020

Patricia Nicole Wiegele; Iyad Kabar; Laura Kerschke; Christopher Froemmel; Anna Hüsing-Kabar; Hartmut Schmidt; Elena Vorona; Richard Vollenberg; Phil-Robin Tepasse


Emerging Infectious Diseases. 2021;27(5):1353-1361. 

In This Article

Abstract and Introduction


Limited information is available on the clinical course of outpatients with mild coronavirus disease (COVID-19). This information is critically important to inform public health prevention strategies and to provide anticipatory guidance to patients, primary care providers, and employers. We retrospectively assessed the daily prevalence of symptoms in 313 COVID-19 outpatients for the first 20 days of illness. Generalized estimating equations were used to assess the probability of symptom occurrence over time. Fatigue (91%), cough (85%), and headache (78%) were the most common symptoms and occurred a median of 1 day from symptom onset. Neurologic symptoms, such as loss of taste (66%) and anosmia (62%), and dyspnea (51%) occurred considerably later (median 3–4 days after symptom onset). Symptoms of COVID-19 are similar to those of other respiratory pathogens, so symptomatic patients should be tested more frequently for severe acute respiratory syndrome coronavirus 2 during influenza season to prevent further spread of COVID-19.


Coronavirus disease (COVID-19) is a highly contagious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).[1] SARS-CoV-2 was first identified in December 2019 in Wuhan, China, and quickly spread across the world.[2] At the beginning of the COVID-19 pandemic, studies mainly focused on the epidemiologic and clinical characteristics of hospitalized and critically ill patients.[3–6] Fever, cough, and dyspnea were identified as the most common symptoms in critically ill patients.[7,8] Chemosensory symptoms, including loss of taste and smell, were highly prevalent in mildly ill patients and thus more common in COVID-19 than in other respiratory viral diseases.[9,10] Male sex, older age, obesity, and underlying conditions such as diabetes and cardiovascular disease are risk factors for severe or fatal disease.[11–13] As the pandemic has spread worldwide, the numbers of COVID-19 outpatients with mild clinical manifestations have increased steadily, and such patients currently represent ≈80% of all confirmed cases.[14] To prevent further spread of SARS-CoV-2, detecting such cases early is essential because both asymptomatic and oligosymptomatic patients can transmit the virus.[15] To help in early identification of mild SARS-CoV-2 infections, we investigated symptom prevalence and severity on a daily basis in COVID-19 patients with a mild disease course.