Clinical features and natural history of the first 2073 suspected COVID-19 cases in the Corona São Caetano primary care programme: a prospective cohort study. Issue 1 (12th January 2021)

• Record Type: Journal Article
• Authors: Leal, Fabio E; Mendes-Correa, Maria C; Buss, Lewis Fletcher; Costa, Silvia F; Bizario, Joao C S; de Souza, Sonia R P; Thomaz, Osorio; Tozetto-Mendoza, Tania Regina; Villas-Boas, Lucy S; de Oliveira-da Silva, Léa Campos; Grespan, Regina M Z; Capuani, Ligia; Buccheri, Renata; Domingues, Helves; Alexander, Neal; Mayaud, Philippe; Sabino, Ester Cerdeira
• Is Part Of: BMJ open. Volume 11:Issue 1(2021)
• Publication Date: 2021-01-12
• Subjects: primary care -- epidemiology -- infectious diseases -- public health; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2020-042745
• Languages: English
• ISSNs: 2044-6055

Abstract

Abstract : Background: Despite most cases not requiring hospital care, there are limited community-based clinical data on COVID-19. Methods: The Corona São Caetano programme is a primary care initiative providing care to all residents with COVID-19 in São Caetano do Sul, Brazil. It was designed to capture standardised clinical data on community COVID-19 cases. After triage of potentially severe cases, consecutive patients presenting to a multimedia screening platform between 13 April and 13 May 2020 were tested at home with SARS-CoV-2 reverse transcriptase (RT) PCR; positive patients were followed up for 14 days with phone calls every 2 days. RT-PCR-negative patients were offered additional SARS-CoV-2 serology testing to establish their infection status. We describe the clinical, virological and natural history features of this prospective population-based cohort. Findings: Of 2073 suspected COVID-19 cases, 1583 (76.4%) were tested by RT-PCR, of whom 444 (28.0%, 95% CI 25.9 to 30.3) were positive; 604/1136 (53%) RT-PCR-negative patients underwent serology, of whom 52 (8.6%) tested SARS-CoV-2 seropositive. The most common symptoms of confirmed COVID-19 were cough, fatigue, myalgia and headache; whereas self-reported fever (OR 3.0, 95% CI 2.4 to 3.9), anosmia (OR 3.3, 95% CI 2.6 to 4.4) and ageusia (OR 2.9, 95% CI 2.3 to 3.8) were most strongly associated with a positive COVID-19 diagnosis by RT-PCR or serology. RT-PCR cycle thresholds were lower in men, older patients, those with fever and arthralgia and closer to symptom onset. The rates of hospitalisation and death among 444 RT-PCR-positive cases were 6.7% and 0.7%, respectively, with older age and obesity more frequent in the hospitalised group. Conclusion: COVID-19 presents in a similar way to other mild community-acquired respiratory diseases, but the presence of fever, anosmia and ageusia can assist the specific diagnosis. Most patients recovered without requiring hospitalisation with a low fatality rate compared with other hospital-based studies.