Whom Should We Test for COVID-19? Performance of a Symptom and Risk Factor Questionnaire on COVID-19 Test Results and Patient Outcomes in an Immediate Care Setting

Abstract

Introduction: The CDC and Illinois Department of Public Health disseminated risk factor criteria for COVID-19 testing early in the pandemic. The objective of this study is to assess the effectiveness of risk stratifying patients for COVID-19 testing and to identify which risk factors and which other clinical variables were associated with SARS-CoV-2 PCR test positivity. Methods: We conducted an observational cohort study on a sample of symptomatic patients evaluated at an immediate care setting. A risk assessment questionnaire was administered to every patient before clinician evaluation. High-risk patients received SARS-CoV-2 test and low-risk patients were evaluated by a clinician and selectively tested based on clinician judgment. Multivariate analyses tested whether risk factors and additional variables were associated with test positivity. Results: The adjusted odds ratio of testing positive was associated with COVID-19-positive or suspect close contact (aOR 1.56, 95% CI 1.15-2.10), large gathering attendance with a COVID-19-positive individual (aOR 1.92, 95% CI 1.10-3.34), and, with the largest effect size, decreased taste/smell (aOR 2.83, 95% CI 2.01-3.99). Testing positive was associated with ages 45-64 and ≥65 (aOR 1.75, 95% CI 1.25-2.44, and aOR 2.78, 95% CI 1.49-5.16), systolic blood pressures ≤120 (aOR 1.64, 95% CI 1.20-2.24), and, with the largest effect size, temperatures ≥99.0°F (aOR 3.06, 95% CI 2.23-4.20). The rate of positive SARS-CoV-2 test was similar between high-risk and low risk patients (225 [22.2%] vs 50 [19.8%]; P = .41). Discussion: The risk assessment questionnaire was not effective at stratifying patients for testing. Although individual risk factors were associated with SARS-CoV-2 test positivity, the low-risk group had similar positivity rates to the high-risk group. Our observations underscore the need for clinicians to develop clinical experience and share best practices and for systems and payors to support policies, funding, and resources to test all symptomatic patients.

Risk factors of COVID-19 disease confirmed cases in Solok District

“…The result is uniform that gender has nothing to do with COVID-19 [7], [20]. In contrast to other studies, gender and age group have statistically significant values [21]. This can be caused by differences in individual behavior and attitudes towards health protocols, maintaining diet, individual immune systems, clean and healthy lifestyles, and different daily activities [22].…”

The significance of advanced COVID-19 diagnostic testing in pandemic control measures

“…However, most of the early testing protocols had limitations including sensitivity, specificity, and background crossreactivity. Moreover, diagnostic tests were required to be processed at off-site centralized laboratories, requiring a long turnaround time with almost a week needed for results to become available [27][28][29]. Some of these limitations were later improved by newly developed commercial assays that have their limit of detection-analytical sensitivity better defined than previous tests.…”

Home Monitoring for Fever: An Inexpensive Screening Method to Prevent Household Spread of COVID-19

“…There is a broad range of published estimates for a normal oral temperature, however, based on the conclusions of a systematic review of these studies 7 we chose a mean oral temperature of 36.6°C as best reflected the mean normal temperature for all age groups. The definition of what constitutes fever also varies, and among studies examining fever in COVID-19 patients fever cutoffs ranged from >37.2°C 8 to > 38°C 9 . We chose a value of 37.6° midway between these two extremes and 1 °C ° above the chosen normal temperature.…”