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

Abstract

BackgroundDespite most cases not requiring hospital care, there are limited community-based clinical data on COVID-19.MethodsThe 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.FindingsOf 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.ConclusionCOVID-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.

Risk assessment and rationalization of health resource allocation: Lessons from the Brazilian COVID-19 cohort in 2020

“…A similar pattern also manifested itself among the older patients, but less pronouncedly, possibly due to the prevalent accumulation of comorbidities among individuals in these strata. Our results confirmed the association of aging with the demand for healthcare resources and COVID-19-related deaths reported in different Brazilian states, ( Sousa et al, 2020 , Macedo et al, 2020 , Cobre et al, 2020 , Escosteguy et al, 2020 , Moura et al, 2020 , Leal et al, 2021 , Policarpo et al, 2021 , Bastos et al, 2020 ) in population restricted to a clinical condition or not, or even in national population studies, ( Santos et al, 2021 , de Souza et al, 2020 , Nascimento et al, 2020 , Marcolino et al, 2021 , Castro et al, 2021 ) but also reported in studies in Latin America, ( Escalera-Antezana et al, 2020 , Araujo et al, 2020 , Elizondo et al, 2021 , Galindo et al, 2021 , Yacobitti et al, 2021 , Ortiz-Prado et al, 2021 ) and in international cohorts ( Pepe et al, 2021 ). Overall, frailty and the high prevalence of comorbidities made the elderly more susceptible to severe infection by COVID-19.…”

Self‐reported olfactory and gustatory dysfunction and psychophysical testing in screening for COVID‐19: A systematic review and meta‐analysis

“…7-9,16-62 There were 16 case-control studies [21][22][23][26][27][28]32,33,36,44,45,47,53,55,59,62 and 34 cohort studies. [7][8][9][16][17][18][19][20]24,25,[29][30][31]34,35,[37][38][39][40][41][42][43]46,[48][49][50][51][52]54,[56][57][58]60,61 Sample size ranged from 83 to 11,483 patients. Studies originated from 6 continents including Europe, North America, South America, Asia, Australia, and Africa.…”

“…Presence of blinding of RT-PCR test results was adhered to in 22 (44%) of the studies. [7][8][9]19,20,24,28,29,31,34,35,37,38,[40][41][42]48,49,55,[57][58][59] The definition of acute onset (<14-day duration) of OGD was clearly described in 11 studies. 8,20,24,29,32,33,35,39,40,54,60 Further details of included studies are presented in Table S2.…”

“…The pooled estimate from 24 studies 7,16,17,[21][22][23]26,28,30,32,34,36,38,39,43,45,47,50,51,55,57,58,61,62 displayed an overall sensitivity of 44.9% (95% CI, 36.4%-53.8%) and specificity of 91.5% (95% CI, 87.7%-94.3%) for predicting COVID-19 infection. The pooled positive LR (95% CI) was 5.31 (95% CI, 3.99-7.07) and negative LR was 0.60 (95% CI, 0.52-0.69).…”

Exploring the Clinical Utility of Gustatory Dysfunction (GD) as a Triage Symptom Prior to Reverse Transcription Polymerase Chain Reaction (RT-PCR) in the Diagnosis of COVID-19: A Meta-Analysis and Systematic Review

“…Alizadehsani [142] Altman [143] Beltrán-Corbellini [176] Bénézit [34] Bidkar [139] Boudjema [140] Carignan [177] Chas [144] Chen [149] Cho [178] Dawson [179] Dixon [180] Dreyer [150] Elimian [181] Fistera [145] Ganz-Lord [146] Gibbons [151] Gurrola [182] Izquierdo-Domínguez [183] Jeyashree (1) [141] Jeyashree (2) [141] Karni [152] Kempker [184] La Torre [185] Leal [186] Lee [187] Martin-Sanz [188] Martinez-Fierro [189] Moeller [147] Moolla [190] Nakanishi [191] Pérula de Torres [192] Raberahona [148] Riestra-Ayora [193] Rojas-Lechuga [194] Sayin [195] Sbrana [153] Sonoda [196] Trachootham [197] Trubiano [198] Tudrej [199] Villerabel [200] Yan [201] Zayet (1) [202] Zayet (2) [203] Appendix D Specify the methods ...…”