{"doi":"10.1093/ofid/ofab090","title":"Acute Symptoms of Mild to Moderate COVID-19 Are Highly Heterogeneous Across Individuals and Over Time","abstract":"BACKGROUND: The symptoms of coronavirus disease 2019 (COVID-19) appear to be heterogenous, and the typical course of these symptoms is unknown. Our objectives were to characterize the common trajectories of COVID-19 symptoms and to assess how symptom course predicts other symptom changes as well as clinical deterioration. METHODS: One hundred sixty-two participants with acute COVID-19 responded to surveys up to 31 times for up to 17 days. Several statistical methods were used to characterize the temporal dynamics of these symptoms. Because 9 participants showed clinical deterioration, we explored whether these participants showed any differences in symptom profiles. RESULTS: Trajectories varied greatly between individuals, with many having persistently severe symptoms or developing new symptoms several days after being diagnosed. A typical trajectory was for a symptom to improve at a decremental rate, with most symptoms still persisting to some degree at the end of the reporting period. The pattern of symptoms over time suggested a fluctuating course for many patients. Participants who showed clinical deterioration were more likely to present with higher reports of severity of cough and diarrhea. CONCLUSIONS: The course of symptoms during the initial weeks of COVID-19 is highly heterogeneous and is neither predictable nor easily characterized using typical survey methods. This has implications for clinical care and early-treatment clinical trials. Additional research is needed to determine whether the decelerating improvement pattern seen in our data is related to the phenomenon of patients reporting long-term symptoms and whether higher symptoms of diarrhea in early illness presages deterioration.","journal":"Open Forum Infectious Diseases","year":2021,"id":166593,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":33,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.6369,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":673796,"name":"Madelyn Frumkin","orcid":"0000-0002-3122-4483","position":1,"is_corresponding":false},{"id":686394,"name":"Angela M. Reiersen","orcid":"0000-0003-3203-4590","position":2,"is_corresponding":false},{"id":253971,"name":"Eric J. Lenze","orcid":"0000-0002-0471-9368","position":3,"is_corresponding":false},{"id":827,"name":"Michael S. Avidan","orcid":"0000-0001-6248-044X","position":4,"is_corresponding":false},{"id":45786,"name":"Jack Miller","orcid":null,"position":5,"is_corresponding":false},{"id":231285,"name":"Jay F. Piccirillo","orcid":"0000-0002-4062-1747","position":6,"is_corresponding":false},{"id":353714,"name":"Charles F. Zorumski","orcid":"0000-0002-9704-5154","position":7,"is_corresponding":false},{"id":692370,"name":"Caline Mattar","orcid":"0000-0001-8603-2916","position":8,"is_corresponding":false},{"id":456781,"name":"Thomas L. Rodebaugh","orcid":"0000-0001-6814-7795","position":0,"is_corresponding":true}],"reference_count":20,"raw_metadata":null,"created_at":"2026-07-18T23:45:49.644768Z","pmid":"33796601","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}