Covid-19 care before, during, and beyond the hospital

Rauh, Alicia L; Linder, Jeffrey A.

doi:10.1136/bmj.m2035

Cited by 10 publications

(9 citation statements)

References 13 publications

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“…27 28 If the COVID-19 pandemic continues for the next years the PHC has gained important knowledge and experience on how to manage and optimise the care of their patients during such a serious outbreak. 29 However, due to the methodological design of this study we were not able to explore the possible long-term effects of changing the strategy in PHC which is definitely something future researches must investigate.…”

Section: Discussionmentioning

confidence: 92%

How primary healthcare in Iceland swiftly changed its strategy in response to the COVID-19 pandemic

et al. 2020

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ObjectiveTo describe how the primary healthcare (PHC) in Iceland changed its strategy to handle the COVID-19 pandemic.DesignDescriptive observational study.SettingReykjavik, the capital of Iceland.PopulationThe Reykjavik area has a total of 233 000 inhabitants.Main outcome measuresThe number and the mode of consultations carried out. Drug prescriptions and changes in the 10 most common diagnoses made in PHC. Laboratory tests including COVID-19 tests. Average numbers in March and April 2020 compared with the same months in 2018 and 2019.ResultsPragmatic strategies and new tasks were rapidly applied to the clinical work to meet the foreseen healthcare needs caused by the pandemic. The number of daytime consultations increased by 35% or from 780 to 1051/1000 inhabitants (p<0.001) during the study period. Telephone and web-based consultations increased by 127% (p<0.001). The same tendency was observed in out-of-hours services. The number of consultations in maternity and well-child care decreased only by 4% (p=0.003). Changes were seen in the 10 most common diagnoses. Most noteworthy, apart from a high number of COVID-19 suspected disease, was that immunisation, depression, hypothyroidism and lumbago were not among the top 10 diagnoses during the epidemic period. The number of drug prescriptions increased by 10.3% (from 494 to 545 per 1000 inhabitants, p<0.001). The number of prescriptions from telephone and web-based consultations rose by 55.6%. No changes were observed in antibiotics prescriptions.ConclusionsAs the first point of contact in the COVID-19 pandemic, the PHC in Iceland managed to change its strategy swiftly while preserving traditional maternity and well-child care, indicating a very solid PHC with substantial flexibility in its organisation.

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Section: Discussionmentioning

confidence: 92%

How primary healthcare in Iceland swiftly changed its strategy in response to the COVID-19 pandemic

et al. 2020

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“…Hence, most COVID-19 epidemiological and clinical studies have been hospital-based, 7–9 and therefore tend to include more severe cases whose findings may not be generalizable to the general population. 10 The objectives of this study were to describe the epidemiological indicators of the early phase of the programme rollout; and to describe the clinical, virologic and natural history features (including hospitalization and deaths) of SARS-CoV-2 infection among patients identified in primary care.…”

Section: Introductionmentioning

confidence: 99%

A primary care approach to the COVID-19 pandemic: clinical features and natural history of 2,073 suspected cases in the Corona São Caetano programme, São Paulo, Brazil

Leal

Mendes-Corrêa

Buss

et al. 2020

Preprint

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Background: Despite most cases not requiring hospital care, there are limited community-based clinical data on COVID-19. Methods and findings: The Corona Sao Caetano program is a primary care initiative offering COVID-19 care to all residents of Sao Caetano do Sul, Brazil. After triage of potentially severe cases, consecutive patients presenting between 13th April and 13th May 2020 were tested at home with SARS-CoV-2 reverse transcriptase (RT) PCR; positive patients were followed up for 14 days. RT-PCR-negative patients were offered SARS-CoV-2 serology. We describe the clinical features, virology and natural history of this prospective population-based cohort. Of 2,073 suspected COVID-19 cases, 1,583 (76.4%) were tested by RT-PCR, of whom 444 (28.0%, 95%CI: 25.9% - 30.3%) were positive; 604/1,136 (53%) RT-PCR-negative patients underwent serology, of whom 52 (8.6%) tested SARS-CoV-2 seropositive. The most common symptoms of COVID-19 were cough, fatigue, myalgia and headache; whereas self-reported fever, anosmia, and ageusia were most associated with a positive COVID-19 diagnosis. RT-PCR cycle thresholds were lower in men, older patients, those with fever and arthralgia, and around symptom onset. The rates of hospitalization and death among 444 RT-PCR-positive cases were 6.7% and 0.7%, respectively, with older age and obesity more frequent in the hospitalized group. Conclusions: COVID-19 presents similarly to other mild respiratory disease in primary care. Some symptoms assist the differential diagnosis. Most patients can be managed at home.

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“…3,4 However, it is not yet clear which risk factors should be considered when managing COVID-19 from the healthcare and public health perspective. 5 Therefore, it is important to distinguish the risk factors for infection by SARS-CoV-2 from those for hospitalisation or death due to COVID-19. A UK study using primary care data found that the risk factors for SARS-CoV-2 infection were increasing age, male gender, population density, socioeconomic deprivation, and black ethnicity.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for SARS-CoV-2 infection, hospitalisation, and death in Catalonia, Spain: a population-based cross-sectional study

Villar-García¹,

Vivanco-Hidalgo

Clèries

et al. 2020

Preprint

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OBJECTIVE To identify the different subpopulations that are susceptible for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and hospitalisation or death due to coronavirus disease 2019 (COVID-19) in Catalonia, Spain. DESIGN Cross-sectional study. SETTING Data collected from the Catalan Health Surveillance System (CatSalut) in Catalonia, a region of Spain. PARTICIPANTS Using data collected between 1 March and 1 June 2020, we conducted the following comparative analyses: people infected by SARS-CoV-2 (328 892) vs Catalonia's entire population (7 699 568); COVID-19 cases who required hospitalisation (37 638) vs cases who did not require hospitalisation (291 254); and COVID-19 cases who died during the study period vs cases who did not die during the study period (12 287). MAIN OUTCOME MEASURES Three clinical outcomes related to COVID-19 (infection, hospitalisation, or death). We analysed sociodemographic and environment variables (such as residing in a nursing home) and the presence of previous comorbidities. RESULTS A total of 328 892 cases were considered to be infected with SARS-CoV-2 (4.27% of total population). The main risk factors for the diagnostic were: female gender (risk ratio [RR] =1.49; 95% confidence interval [95% CI] =1.48-1.50), age (45-64 years old; RR=1.02; 95% CI=1.01-1.03), high comorbidity burden (GMA index) (RR=3.03; 95% CI=2.97-3.09), reside in a nursing home (RR=11.82; 95% CI=11.66-11.99), and smoking (RR=1.06; 95% CI=1.05-1.07). During the study period, there were 37 638 (11.4 %) hospitalisations due to COVID-19, and the risk factors were: male gender (RR=1.45; 95% CI=1.43-1.48), age > 65 (RR=2.38; 95% CI=2.28-2.48), very low individual income (RR=1.03; 95% CI=0.97-1.08), and high burden of comorbidities (GMA index) (RR=5.15; 95% CI=4.89-5.42). The individual comorbidities with higher burden were obesity (RR=1.23; 95% CI=1.20-1.25), chronic obstructive pulmonary disease (RR=1.19; 95% CI=1.15-1.22), heart failure (RR=1.19; 95% CI=1.16-1.22), diabetes mellitus (RR=1.07; 95% CI=1.04-1.10), and neuro-psychiatric comorbidities (RR=1.06; 95% CI=1.03-1.10). A total of 12 287 deaths (3.73%) were attributed to COVID-19, and the main risk factors were: male gender (RR=1.73; 95% CI=1.67-1.81), age > 65 (RR=37.45; 95% CI=29.23-47.93), residing in a nursing home (RR=9.22; 95% CI=8.81-9.65), and high burden of comorbidities (GMA index) (RR=5.25; 95% CI=4.60-6.00). The individual comorbidities with higher burden were: heart failure (RR=1.21; 95% CI=1.16-1.22), chronic kidney disease (RR=1.17; 95% CI=1.13-1.22), and diabetes mellitus (RR=1.10; 95% CI=1.06-1.14). These results did not change significantly when we considered only PCR-positive patients. CONCLUSIONS Female gender, age between 45 to 64 years old, high burden of comorbidities, and factors related to environment (nursing home) play a relevant role in SARS-CoV-2 infection and transmission. In addition, we found risk factors for hospitalisation and death due to COVID-19 that had not been described to date, including comorbidity burden, neuro-psychiatric disorders, and very low individual income. This study supports interventions for transmission control beyond stratify-and-shield strategies focused only on protecting those at risk of death. Future COVID-19 studies should examine the role of gender, the burden of comorbidities, and socioeconomic status in disease transmission, and should determine its relationship to workplaces, especially healthcare centres and nursing homes.

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Covid-19 care before, during, and beyond the hospital

Abstract: It’s time to shift the research focus to studies on living with this disease

Cited by 10 publications

References 13 publications

How primary healthcare in Iceland swiftly changed its strategy in response to the COVID-19 pandemic

How primary healthcare in Iceland swiftly changed its strategy in response to the COVID-19 pandemic

A primary care approach to the COVID-19 pandemic: clinical features and natural history of 2,073 suspected cases in the Corona São Caetano programme, São Paulo, Brazil

Risk factors for SARS-CoV-2 infection, hospitalisation, and death in Catalonia, Spain: a population-based cross-sectional study

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