Omicron-Associated Changes in Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Symptoms in the United Kingdom

Karina Doris Vihta; Koen B. Pouwels; Tim E.A. Peto; Emma Pritchard; Thomas House; Ruth Studley; Emma Rourke; Duncan Cook; Ian Diamond; Derrick Crook; David A. Clifton; Philippa C. Matthews; Nicole Stoesser; David W. Eyre; Ann Sarah Walker; Tina Thomas; D. Cook; Daniel Ayoubkhani; Russell Black; Antonio Felton; Megan Crees; Joel Jones; Lina Lloyd; Esther Sutherland; D. Crook; Jia Wei; Alison Howarth; George Doherty; James Kavanagh; Kevin K. Chau; Hatch B. Stephanie; Daniel Ebner; Lucas Martins Ferreira; Thomas Christott; Brian D. Marsden; Wanwisa Dejnirattisai; Juthathip Mongkolsapaya; Sarah Cameron; Phoebe Tamblin-Hopper; Magda Wolna; Rachael Brown; Sarah Hoosdally; Richard Cornall; Yvonne Jones; David I. Stuart; Gavin Screaton; Katrina Lythgoe; David Bonsall; Tanya Golubchik; Helen Fryer; John Bell; Kevin Paddon; Tim James; John Newton; Julie Robotham; Paul Birrell; Helena Jordan; Tim Sheppard; Graham Athey; Dan Moody; Leigh Curry; Pamela Brereton; Ian Jarvis; Anna Godsmark; George Morris; Bobby Mallick; Phil Eeles; Jodie Hay; Jessica Lee; White Sean; Tim Evans; Lisa Bloemberg; Katie Allison; Anouska Pandya; Sophie Davis; David I. Conway; Margaret Macleod; Chris Cunningham

doi:10.1093/cid/ciac613

Omicron-Associated Changes in Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Symptoms in the United Kingdom

Karina Doris Vihta, Koen B. Pouwels, Tim E.A. Peto, Emma Pritchard, Thomas House, Ruth Studley, Emma Rourke, Duncan Cook, Ian Diamond, Derrick Crook, David A. Clifton, Philippa C. Matthews, Nicole Stoesser, David W. Eyre, Ann Sarah Walker, Tina Thomas, D. Cook, Daniel Ayoubkhani, Russell Black, Antonio FeltonMegan Crees, Joel Jones, Lina Lloyd, Esther Sutherland, D. Crook, Jia Wei, Alison Howarth, George Doherty, James Kavanagh, Kevin K. Chau, Hatch B. Stephanie, Daniel Ebner, Lucas Martins Ferreira, Thomas Christott, Brian D. Marsden, Wanwisa Dejnirattisai, Juthathip Mongkolsapaya, Sarah Cameron, Phoebe Tamblin-Hopper, Magda Wolna, Rachael Brown, Sarah Hoosdally, Richard Cornall, Yvonne Jones, David I. Stuart, Gavin Screaton, Katrina Lythgoe, David Bonsall, Tanya Golubchik, Helen Fryer, John Bell, Kevin Paddon, Tim James, John Newton, Julie Robotham, Paul Birrell, Helena Jordan, Tim Sheppard, Graham Athey, Dan Moody, Leigh Curry, Pamela Brereton, Ian Jarvis, Anna Godsmark, George Morris, Bobby Mallick, Phil Eeles, Jodie Hay, Jessica Lee, White Sean, Tim Evans, Lisa Bloemberg, Katie Allison, Anouska Pandya, Sophie Davis, David I. Conway, Margaret Macleod, Chris Cunningham

Research output: Contribution to journal › Article › peer-review

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Abstract

Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Delta variant has been replaced by the highly transmissible Omicron BA.1 variant, and subsequently by Omicron BA.2. It is important to understand how these changes in dominant variants affect reported symptoms, while also accounting for symptoms arising from other cocirculating respiratory viruses. Methods: In a nationally representative UK community study, the COVID-19 Infection Survey, we investigated symptoms in polymerase chain reaction (PCR)-positive infection episodes versus PCR-negative study visits over calendar time, by age and vaccination status, comparing periods when the Delta, Omicron BA.1, and BA.2 variants were dominant. Results: Between October 2020 and April 2022, a total of 120 995 SARS-CoV-2 PCR-positive episodes occurred in 115 886 participants, with 70 683 (58%) reporting symptoms. The comparator comprised 4 766 366 PCR-negative study visits (483 894 participants), with symptoms reported at 203 422 visits (4%). Symptom reporting in PCR-positive infections varied over time, with a marked reduction in loss of taste/smell as Omicron BA.1 dominated, which was maintained with BA.2 (44% symptomatic infections reporting loss of taste/45% symptomatic infections reporting loss of smell on 17 October 2021, 16%/13% 2 January 2022, 15%/12% 27 March 2022). Cough, fever, shortness of breath, myalgia, fatigue/weakness, and headache also decreased after Omicron BA.1 dominated, but sore throat increased, the latter to a greater degree than concurrent increases in PCR-negative visits. Fatigue/weakness increased again after BA.2 dominated, although to a similar degree to concurrent increases in PCR-negative visits. Symptoms were consistently more common in adults aged 18-65 years than in children or older adults. Conclusions: Increases in sore throat (also common in the general community), along with a marked reduction in loss of taste/smell, make Omicron harder to detect with symptom-based testing algorithms, with implications for institutional and national testing policies.

Original language	English
Pages (from-to)	E133-E141
Journal	Clinical Infectious Diseases
Volume	76
Issue number	3
DOIs	https://doi.org/10.1093/cid/ciac613
Publication status	Published - 1 Feb 2023
Externally published	Yes

Bibliographical note

Publisher Copyright:
© 2022 The Author(s).

Keywords

Omicron
SARS-CoV-2
symptoms

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1093/cid/ciac613

Cite this

Vihta, K. D., Pouwels, K. B., Peto, T. E. A., Pritchard, E., House, T., Studley, R., Rourke, E., Cook, D., Diamond, I., Crook, D., Clifton, D. A., Matthews, P. C., Stoesser, N., Eyre, D. W., Walker, A. S., Thomas, T., Cook, D., Ayoubkhani, D., Black, R., ... Cunningham, C. (2023). Omicron-Associated Changes in Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Symptoms in the United Kingdom. Clinical Infectious Diseases, 76(3), E133-E141. https://doi.org/10.1093/cid/ciac613

@article{a716eca389f544e3b7a03d1242d504a9,

title = "Omicron-Associated Changes in Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Symptoms in the United Kingdom",

abstract = "Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Delta variant has been replaced by the highly transmissible Omicron BA.1 variant, and subsequently by Omicron BA.2. It is important to understand how these changes in dominant variants affect reported symptoms, while also accounting for symptoms arising from other cocirculating respiratory viruses. Methods: In a nationally representative UK community study, the COVID-19 Infection Survey, we investigated symptoms in polymerase chain reaction (PCR)-positive infection episodes versus PCR-negative study visits over calendar time, by age and vaccination status, comparing periods when the Delta, Omicron BA.1, and BA.2 variants were dominant. Results: Between October 2020 and April 2022, a total of 120 995 SARS-CoV-2 PCR-positive episodes occurred in 115 886 participants, with 70 683 (58%) reporting symptoms. The comparator comprised 4 766 366 PCR-negative study visits (483 894 participants), with symptoms reported at 203 422 visits (4%). Symptom reporting in PCR-positive infections varied over time, with a marked reduction in loss of taste/smell as Omicron BA.1 dominated, which was maintained with BA.2 (44% symptomatic infections reporting loss of taste/45% symptomatic infections reporting loss of smell on 17 October 2021, 16%/13% 2 January 2022, 15%/12% 27 March 2022). Cough, fever, shortness of breath, myalgia, fatigue/weakness, and headache also decreased after Omicron BA.1 dominated, but sore throat increased, the latter to a greater degree than concurrent increases in PCR-negative visits. Fatigue/weakness increased again after BA.2 dominated, although to a similar degree to concurrent increases in PCR-negative visits. Symptoms were consistently more common in adults aged 18-65 years than in children or older adults. Conclusions: Increases in sore throat (also common in the general community), along with a marked reduction in loss of taste/smell, make Omicron harder to detect with symptom-based testing algorithms, with implications for institutional and national testing policies.",

keywords = "Omicron, SARS-CoV-2, symptoms",

author = "Vihta, {Karina Doris} and Pouwels, {Koen B.} and Peto, {Tim E.A.} and Emma Pritchard and Thomas House and Ruth Studley and Emma Rourke and Duncan Cook and Ian Diamond and Derrick Crook and Clifton, {David A.} and Matthews, {Philippa C.} and Nicole Stoesser and Eyre, {David W.} and Walker, {Ann Sarah} and Tina Thomas and D. Cook and Daniel Ayoubkhani and Russell Black and Antonio Felton and Megan Crees and Joel Jones and Lina Lloyd and Esther Sutherland and D. Crook and Jia Wei and Alison Howarth and George Doherty and James Kavanagh and Chau, {Kevin K.} and Stephanie, {Hatch B.} and Daniel Ebner and {Martins Ferreira}, Lucas and Thomas Christott and Marsden, {Brian D.} and Wanwisa Dejnirattisai and Juthathip Mongkolsapaya and Sarah Cameron and Phoebe Tamblin-Hopper and Magda Wolna and Rachael Brown and Sarah Hoosdally and Richard Cornall and Yvonne Jones and Stuart, {David I.} and Gavin Screaton and Katrina Lythgoe and David Bonsall and Tanya Golubchik and Helen Fryer and John Bell and Kevin Paddon and Tim James and John Newton and Julie Robotham and Paul Birrell and Helena Jordan and Tim Sheppard and Graham Athey and Dan Moody and Leigh Curry and Pamela Brereton and Ian Jarvis and Anna Godsmark and George Morris and Bobby Mallick and Phil Eeles and Jodie Hay and Jessica Lee and White Sean and Tim Evans and Lisa Bloemberg and Katie Allison and Anouska Pandya and Sophie Davis and Conway, {David I.} and Margaret Macleod and Chris Cunningham",

note = "Publisher Copyright: {\textcopyright} 2022 The Author(s).",

year = "2023",

month = feb,

day = "1",

doi = "10.1093/cid/ciac613",

language = "English",

volume = "76",

pages = "E133--E141",

journal = "Clinical Infectious Diseases",

issn = "1058-4838",

publisher = "Oxford University Press",

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Vihta, KD, Pouwels, KB, Peto, TEA, Pritchard, E, House, T, Studley, R, Rourke, E, Cook, D, Diamond, I, Crook, D, Clifton, DA, Matthews, PC, Stoesser, N, Eyre, DW, Walker, AS, Thomas, T, Cook, D, Ayoubkhani, D, Black, R, Felton, A, Crees, M, Jones, J, Lloyd, L, Sutherland, E, Crook, D, Wei, J, Howarth, A, Doherty, G, Kavanagh, J, Chau, KK, Stephanie, HB, Ebner, D, Martins Ferreira, L, Christott, T, Marsden, BD, Dejnirattisai, W, Mongkolsapaya, J, Cameron, S, Tamblin-Hopper, P, Wolna, M, Brown, R, Hoosdally, S, Cornall, R, Jones, Y, Stuart, DI, Screaton, G, Lythgoe, K, Bonsall, D, Golubchik, T, Fryer, H, Bell, J, Paddon, K, James, T, Newton, J , Robotham, J , Birrell, P, Jordan, H, Sheppard, T, Athey, G, Moody, D, Curry, L, Brereton, P, Jarvis, I, Godsmark, A, Morris, G, Mallick, B, Eeles, P, Hay, J, Lee, J, Sean, W, Evans, T, Bloemberg, L, Allison, K, Pandya, A, Davis, S, Conway, DI, Macleod, M & Cunningham, C 2023, 'Omicron-Associated Changes in Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Symptoms in the United Kingdom', Clinical Infectious Diseases, vol. 76, no. 3, pp. E133-E141. https://doi.org/10.1093/cid/ciac613

TY - JOUR

T1 - Omicron-Associated Changes in Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Symptoms in the United Kingdom

AU - Vihta, Karina Doris

AU - Pouwels, Koen B.

AU - Peto, Tim E.A.

AU - Pritchard, Emma

AU - House, Thomas

AU - Studley, Ruth

AU - Rourke, Emma

AU - Cook, Duncan

AU - Diamond, Ian

AU - Crook, Derrick

AU - Clifton, David A.

AU - Matthews, Philippa C.

AU - Stoesser, Nicole

AU - Eyre, David W.

AU - Walker, Ann Sarah

AU - Thomas, Tina

AU - Cook, D.

AU - Ayoubkhani, Daniel

AU - Black, Russell

AU - Felton, Antonio

AU - Crees, Megan

AU - Jones, Joel

AU - Lloyd, Lina

AU - Sutherland, Esther

AU - Crook, D.

AU - Wei, Jia

AU - Howarth, Alison

AU - Doherty, George

AU - Kavanagh, James

AU - Chau, Kevin K.

AU - Stephanie, Hatch B.

AU - Ebner, Daniel

AU - Martins Ferreira, Lucas

AU - Christott, Thomas

AU - Marsden, Brian D.

AU - Dejnirattisai, Wanwisa

AU - Mongkolsapaya, Juthathip

AU - Cameron, Sarah

AU - Tamblin-Hopper, Phoebe

AU - Wolna, Magda

AU - Brown, Rachael

AU - Hoosdally, Sarah

AU - Cornall, Richard

AU - Jones, Yvonne

AU - Stuart, David I.

AU - Screaton, Gavin

AU - Lythgoe, Katrina

AU - Bonsall, David

AU - Golubchik, Tanya

AU - Fryer, Helen

AU - Bell, John

AU - Paddon, Kevin

AU - James, Tim

AU - Newton, John

AU - Robotham, Julie

AU - Birrell, Paul

AU - Jordan, Helena

AU - Sheppard, Tim

AU - Athey, Graham

AU - Moody, Dan

AU - Curry, Leigh

AU - Brereton, Pamela

AU - Jarvis, Ian

AU - Godsmark, Anna

AU - Morris, George

AU - Mallick, Bobby

AU - Eeles, Phil

AU - Hay, Jodie

AU - Lee, Jessica

AU - Sean, White

AU - Evans, Tim

AU - Bloemberg, Lisa

AU - Allison, Katie

AU - Pandya, Anouska

AU - Davis, Sophie

AU - Conway, David I.

AU - Macleod, Margaret

AU - Cunningham, Chris

PY - 2023/2/1

Y1 - 2023/2/1

N2 - Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Delta variant has been replaced by the highly transmissible Omicron BA.1 variant, and subsequently by Omicron BA.2. It is important to understand how these changes in dominant variants affect reported symptoms, while also accounting for symptoms arising from other cocirculating respiratory viruses. Methods: In a nationally representative UK community study, the COVID-19 Infection Survey, we investigated symptoms in polymerase chain reaction (PCR)-positive infection episodes versus PCR-negative study visits over calendar time, by age and vaccination status, comparing periods when the Delta, Omicron BA.1, and BA.2 variants were dominant. Results: Between October 2020 and April 2022, a total of 120 995 SARS-CoV-2 PCR-positive episodes occurred in 115 886 participants, with 70 683 (58%) reporting symptoms. The comparator comprised 4 766 366 PCR-negative study visits (483 894 participants), with symptoms reported at 203 422 visits (4%). Symptom reporting in PCR-positive infections varied over time, with a marked reduction in loss of taste/smell as Omicron BA.1 dominated, which was maintained with BA.2 (44% symptomatic infections reporting loss of taste/45% symptomatic infections reporting loss of smell on 17 October 2021, 16%/13% 2 January 2022, 15%/12% 27 March 2022). Cough, fever, shortness of breath, myalgia, fatigue/weakness, and headache also decreased after Omicron BA.1 dominated, but sore throat increased, the latter to a greater degree than concurrent increases in PCR-negative visits. Fatigue/weakness increased again after BA.2 dominated, although to a similar degree to concurrent increases in PCR-negative visits. Symptoms were consistently more common in adults aged 18-65 years than in children or older adults. Conclusions: Increases in sore throat (also common in the general community), along with a marked reduction in loss of taste/smell, make Omicron harder to detect with symptom-based testing algorithms, with implications for institutional and national testing policies.

AB - Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Delta variant has been replaced by the highly transmissible Omicron BA.1 variant, and subsequently by Omicron BA.2. It is important to understand how these changes in dominant variants affect reported symptoms, while also accounting for symptoms arising from other cocirculating respiratory viruses. Methods: In a nationally representative UK community study, the COVID-19 Infection Survey, we investigated symptoms in polymerase chain reaction (PCR)-positive infection episodes versus PCR-negative study visits over calendar time, by age and vaccination status, comparing periods when the Delta, Omicron BA.1, and BA.2 variants were dominant. Results: Between October 2020 and April 2022, a total of 120 995 SARS-CoV-2 PCR-positive episodes occurred in 115 886 participants, with 70 683 (58%) reporting symptoms. The comparator comprised 4 766 366 PCR-negative study visits (483 894 participants), with symptoms reported at 203 422 visits (4%). Symptom reporting in PCR-positive infections varied over time, with a marked reduction in loss of taste/smell as Omicron BA.1 dominated, which was maintained with BA.2 (44% symptomatic infections reporting loss of taste/45% symptomatic infections reporting loss of smell on 17 October 2021, 16%/13% 2 January 2022, 15%/12% 27 March 2022). Cough, fever, shortness of breath, myalgia, fatigue/weakness, and headache also decreased after Omicron BA.1 dominated, but sore throat increased, the latter to a greater degree than concurrent increases in PCR-negative visits. Fatigue/weakness increased again after BA.2 dominated, although to a similar degree to concurrent increases in PCR-negative visits. Symptoms were consistently more common in adults aged 18-65 years than in children or older adults. Conclusions: Increases in sore throat (also common in the general community), along with a marked reduction in loss of taste/smell, make Omicron harder to detect with symptom-based testing algorithms, with implications for institutional and national testing policies.

KW - Omicron

KW - SARS-CoV-2

KW - symptoms

UR - http://www.scopus.com/inward/record.url?scp=85151166208&partnerID=8YFLogxK

U2 - 10.1093/cid/ciac613

DO - 10.1093/cid/ciac613

M3 - Article

C2 - 35917440

AN - SCOPUS:85151166208

SN - 1058-4838

VL - 76

SP - E133-E141

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

IS - 3

ER -

Omicron-Associated Changes in Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Symptoms in the United Kingdom

Abstract

Bibliographical note

Keywords

UN SDGs

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