To investigate the symptoms of SARS-CoV-2 infection, their dynamics and their discriminatory power for the disease using longitudinally, prospectively collected information reported at the time of their occurrence. We have analysed data from a large phase 3 clinical UK COVID-19 vaccine trial. The alpha variant was the predominant strain. Participants were assessed for SARS-CoV-2 infection via nasal/throat PCR at recruitment, vaccination appointments, and when symptomatic. Statistical techniques were implemented to infer estimates representative of the UK population, accounting for multiple symptomatic episodes associated with one individual. An optimal diagnostic model for SARS-CoV-2 infection was derived. The 4-month prevalence of SARS-CoV-2 was 2.1%; increasing to 19.4% (16.0%–22.7%) in participants reporting loss of appetite and 31.9% (27.1%–36.8%) in those with anosmia/ageusia. The model identified anosmia and/or ageusia, fever, congestion, and cough to be significantly associated with SARS-CoV-2 infection. Symptoms’ dynamics were vastly different in the two groups; after a slow start peaking later and lasting longer in PCR+ participants, whilst exhibiting a consistent decline in PCR- participants, with, on average, fewer than 3 days of symptoms reported. Anosmia/ageusia peaked late in confirmed SARS-CoV-2 infection (day 12), indicating a low discrimination power for early disease diagnosis.

One of the crucial issues in the evolution of the welfare state is the preferred means of funding and providing social services. In the absence of a federally-funded and centrally-administered child day care programme in the United States, a variety of services and programmes have evolved. Public policy which seeks to encourage service diversity must consider the ability of social service consumers to afford, select or utilize services of quality, or to demand quality from service providers. This study compares child day care services provided under different auspices — public (state and municipal), quasi-public (military), quasi-private (employer-sponsored), non-profit and private proprietary. Consumer ratings of the day care programmes provided under six different auspices are compared to a research assessment of the same six programmes. The data indicate a tendency among consumers to be inattentive regarding the basic elements of care and to overestimate the quality of care. If we accept the view that consumer choice is desirable on procedural grounds (a desirable freedom), then the findings of this study suggest that public policy should strive to enhance the effectiveness of consumer choice.