Control of the SARS-CoV-2 epidemic requires rapid identification and isolation of infected
individuals and their contacts. Community testing in England (Pillar 2) by polymerase chain
reaction (PCR) is reserved for those reporting at least one of four ‘classic’ COVID-19 symptoms
(loss or change of sense of smell, loss or change of sense of taste, fever, new continuous cough). 1
Detection of positive cases in the community might be improved by including additional
symptoms and their combinations. We used data from the REal-time Assessment of Community
Transmission-1 (REACT-1) study to investigate symptom profiles for PCR positivity at different
ages. Among rounds 2–7 (June to December 2020), an age-stratified, variable selection approach
stably selected chills (all ages), headache (5–17 years), appetite loss (18–54 and 55+ years) and
muscle aches (18–54 years) as jointly and positively predictive of PCR positivity together with
the classic four symptoms. Between round 7 (November to December 2020) and round 8
(January 2021) when new variant B.1.1.7 predominated, only loss or change of sense of smell
(more predictive in round 7) and (borderline) new persistent cough (more predictive in round 8)
differed between cases. At any level of PCR testing, triage based on the symptoms identified
here would result in more cases detected than the current approach .