This systematic review and meta analysis describes the prevalence of symptoms associated with COVID-19 worldwide. Findings confirm that fever and cough are the most prevalent symptoms of COVID-19 worldwide. Findings also suggest that the use of symptoms alone to screen adults for SARS-CoV-2 infection is likely to miss a substantial number of infected individuals.

The authors examined 148 unique articles of adults >16 years with laboratory test confirmed COVID-19. All articles were published by April 5, 2020.

They analyzed data from 24,410 adults with confirmed COVID-19 from 9 countries. Main findings included:

• The most prevalent symptoms were fever (78% [95% CI 75%-81%]), cough (57% [95% CI 54%-60%]) and fatigue (31% [95% CI 27%-35%])
• Approximately 1 in 5 test-positive adults were never febrile and fewer than 3 in 5 developed a cough
• Other major symptoms include fatigue (31%), losing the ability to smell (25%), and difficulty in breathing (23%)
• Overall, 19% of hospitalized patients required non-invasive ventilation, 17% required intensive care, 9% required invasive ventilation, and 2% required extra-corporeal membrane oxygenation
• The mortality rate was 7%