Should COVID-19 symptoms be used to cohort patients in the emergency department? A retrospective analysis

Abstract

Objective To determine how cohorting patients based on presenting complaints affects risk of nosocomial infection in crowded Emergency Departments under conditions of high and low prevalence of COVID-19. Methods This was a retrospective analysis of presenting complaints and PCR tests collected during the COVID-19 epidemic from 4 EDs from a large hospital system in Bronx County, NY, from May 1, 2020 to April 30, 2021. Sensitivity, specificity, positive and negative predictive value (PPV, NPV) were calculated for a symptom screen based on the CDC list of COVID-19 symptoms: fever/chills, shortness of breath/dyspnea, cough, muscle or body ache, fatigue, headache, loss of taste or smell, sore throat, nasal congestion/runny nose, nausea, vomiting, and diarrhea. PPV was calculated for varying values of prevalence. Results There were 80,078 visits with PCR tests. The sensitivity of the symptom screen was 64.7% (95% CI: 63.6, 65.8), specificity 65.4% (65.1, 65.8). PPV was 16.8% (16.5, 17.0) and NPV was 94.5% (94.4, 94.7) when the observed prevalence of COVID-19 in the ED over the year was 9.7%. The PPV of fever/chills, cough, body and muscle aches and nasal congestion/runny nose were each approximately 25% across the year, while diarrhea, nausea, vomiting and headache were less predictive, (PPV 4.7%–9.6%) The combinations of fever/chills, cough, muscle/body aches, and shortness of breath had PPVs of 40–50%. The PPV of the screen varied from 3.7% (3.6, 3.8) at 2% prevalence of COVID-19 to 44.3% (44.0, 44.7) at 30% prevalence. Conclusion The proportion of patients with a chief complaint of COVID-19 symptoms and confirmed COVID-19 infection was exceeded by the proportion without actual infection. This was true when prevalence in the ED was as high as 30%. Cohorting of patients based on the CDC's list of COVID-19 symptoms will expose many patients who do not have COVID-19 to risk of nosocomially acquired COVID-19. EDs should not use the CDC list of COVID-19 symptoms as the only strategy to minimize exposure.

Differences in Humanized Care Perceived by Hospitalized Patients from Urban and Rural Areas during the COVID-19 Pandemic: Evidence Collected in Peru

“…To curb the rapid increase of the epidemic, international organizations such as The United Nations recommended isolation and/or confinement, the use of masks, social distancing and permanent hand washing to avoid contagion (Caputo et al, 2021;Casaccia et al, 2021;Mendez-Lopez et al, 2022;Valero Cedeño et al, 2020). In this regard, the clinical manifestations usually presented by COVID-19 disease are: dry cough, fever and fatigue, headaches, sore throat and muscle aches, diarrhea, nasal congestion, conjunctivitis, loss of sense of taste and smell, skin rashes, discoloration of fingers and toes (Bijur et al, 2022;Higginson et al, 2022;Kadirvelu et al, 2022;Pérez Abreu et al, 2020;Tegeler et al, 2022;Wong et al, 2022).…”