Covid-19 in outpatients—Is fever a useful indicator for SARS-CoV-2 infection?

Anne Schneider; Holger Kirsten; Franziska Lordick; Florian Lordick; Christoph Lübbert; Amrei von Braun

doi:10.1371/journal.pone.0246312

Peer Review History

Original SubmissionJuly 9, 2020
8 Jan 2021 Decision Letter - Chiara Lazzeri, Editor PONE-D-20-20307 Covid-19 in outpatients - is fever a useful indicator for SARS-CoV-2 infection? PLOS ONE Dear Dr. von Braun, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. The topic is quite interesting. However, the main limitation of the present investigation is represented by the small number of patients. we suggest to add some more patients to reach a stronger statistolical power. Please submit your revised manuscript by Feb 22 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. 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Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). 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You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: The authors systematically analyzed the symptoms from outpatients with mild to moderate COVID-19 and found that fever was not a common symptom in mild cases. This study is interesting. However, the following major concerns need to be sorted out before it is accepted. 1.The sample size of confirmed covid-19 was small (n=91). Could you add more confirmed mild cases for statistical analysis? 2.The descriptive bias existed as all these data were obtained by telephone interview. Again, it would be better if the sample size is increased. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. 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Revision 1
13 Jan 2021 Author Response We would like to express our sincere gratitude to the reviewer for their precise review of our manuscript. The comments provided to us are highly appreciated. Kindly find our reply below. Reviewer #1: The authors systematically analyzed the symptoms from outpatients with mild to moderate COVID-19 and found that fever was not a common symptom in mild cases. This study is interesting. However, the following major concerns need to be sorted out before it is accepted. 1.The sample size of confirmed covid-19 was small (n=91). Could you add more confirmed mild cases for statistical analysis? Response: Thank you for your kind introductory sentence. We completely agree that our sample size is not large enough to make binding statements on clinical screening mechanisms for Covid-19. Larger cohort studies will be necessary to identify such mechanisms based on symptom evaluations in all age groups. However, our study does contribute valuable clinical data on mild to moderate cases which continues to be rare compared to data on severely effected patients. In full agreement with the reviewer, we have added this point to the section on study limitations (page 12, lines 262-266): “(…) while our study contributes to filling the gap in research on Covid-19 in young out-patients, larger cohort studies will be necessary to translate these findings into effective clinical screening mechanisms for Covid-19.” We will unfortunately not be able to include more patients into the analysis as our hospital shifted to in-patient care on the wards and the intensive care units only. Unlike during the first months of the pandemic, out-patient care is now fully covered by general practitioners. 2.The descriptive bias existed as all these data were obtained by telephone interview. Again, it would be better if the sample size is increased. Response: Thank you for pointing this out. Yes, follow-up data was obtained by telephone interview as these patients were subject to official quarantine measures and clinical consultations at our hospital were organized only if necessary. The descriptive bias is reflected in the study limitations (page 12, line 262-263): “Main limitations of our study include the fact that our analysis of symptoms is based on self-reporting only, and that underlying medical conditions were not systematically assessed. “ On behalf of all co-authors, I thank you for considering our work in its revised version. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0246312.r002
18 Jan 2021 Decision Letter - Chiara Lazzeri, Editor Covid-19 in outpatients - is fever a useful indicator for SARS-CoV-2 infection? PONE-D-20-20307R1 Dear Dr. von Braun, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Chiara Lazzeri Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0246312.r003
Formally Accepted
26 Jan 2021 Acceptance Letter - Chiara Lazzeri, Editor PONE-D-20-20307R1 Covid-19 in outpatients – is fever a useful indicator for SARS-CoV-2 infection? Dear Dr. von Braun: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Chiara Lazzeri Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0246312.r004

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