High prevalence of symptoms among Brazilian subjects with antibodies against SARS-CoV-2: a nationwide household survey

Abstract

ABSTRACTSince the beginning of the pandemic of COVID-19, there has been a widespread assumption that most infected persons are asymptomatic. A frequently-cited early study from China suggested that 86% of all infections were undocumented, which was used as indirect evidence that patients were asymptomatic.Using data from the most recent wave of the EPICOVID19 study, a nationwide household-based survey including 133 cities from all states of Brazil, we estimated the proportion of people with and without antibodies for SARS-CoV-2 who were asymptomatic, which symptoms were most frequently reported, the number of symptoms reported and the association between symptomatology and socio-demographic characteristics. We were able to test 33,205 subjects using a rapid antibody test that was previously validated. Information on symptoms was collected before participants received the test result. Out of 849 (2.7%) participants who tested positive for SARS-CoV-2 antibodies, only 12.1% (95%CI 10.1-14.5) reported no symptoms since the start of the pandemic, compared to 42.2% (95%CI 41.7-42.8) among those who tested negative. The largest difference between the two groups was observed for changes in smell or taste (56.5% versus 9.1%, a 6.2-fold difference). Symptoms change in smell or taste, fever and myalgia were most likely to predict positive test results as suggested by recursive partitioning tree analysis.Among individuals without any of these three symptoms (74.2% of the sample), only 0.8% tested positive, compared to 18.3% of those with both fever and changes in smell or taste. Most subjects with antibodies against SARS-CoV-2 in Brazil are symptomatic, even though most present only mild symptoms.