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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.
BMJ Open. 2021 01 12; 11(1):e042745.BO

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.

Authors+Show Affiliations

Faculdade de Medicina, Universidade de São Caetano do Sul, São Paulo, Brazil. Programa de Oncovirologia, Instituto Nacional de Câncer, Rio de Janeiro, Brazil.Instituto de Medicina Tropical (LIM-52, LIM-46, LIM-49) and Departamento de Moléstias Infecciosas e Parasitarias, Universidade de São Paulo, São Paulo, Brazil.Instituto de Medicina Tropical (LIM-52, LIM-46, LIM-49) and Departamento de Moléstias Infecciosas e Parasitarias, Universidade de São Paulo, São Paulo, Brazil lewisbuss@usp.br.Instituto de Medicina Tropical (LIM-52, LIM-46, LIM-49) and Departamento de Moléstias Infecciosas e Parasitarias, Universidade de São Paulo, São Paulo, Brazil.Faculdade de Medicina, Universidade de São Caetano do Sul, São Paulo, Brazil.Faculdade de Medicina, Universidade de São Caetano do Sul, São Paulo, Brazil.Instituto de Pesquisas Tecnológicas, São Paulo, Brazil.Instituto de Medicina Tropical (LIM-52, LIM-46, LIM-49) and Departamento de Moléstias Infecciosas e Parasitarias, Universidade de São Paulo, São Paulo, Brazil.Instituto de Medicina Tropical (LIM-52, LIM-46, LIM-49) and Departamento de Moléstias Infecciosas e Parasitarias, Universidade de São Paulo, São Paulo, Brazil.Laboratório de Medicina Laboratorial (LIM03), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.Faculdade de Medicina, Universidade de São Caetano do Sul, São Paulo, Brazil.Department of Services and Systems Design, Modular Research System Ltda, São Paulo, Brazil.Instituto de Medicina Tropical (LIM-52, LIM-46, LIM-49) and Departamento de Moléstias Infecciosas e Parasitarias, Universidade de São Paulo, São Paulo, Brazil.Department of Information Technology, Modular Research System Ltda, São Paulo, Brazil.Faculty of Infectious & Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.Faculty of Infectious & Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.Instituto de Medicina Tropical (LIM-52, LIM-46, LIM-49) and Departamento de Moléstias Infecciosas e Parasitarias, Universidade de São Paulo, São Paulo, Brazil.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

33436471

Citation

Leal, Fabio E., et al. "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." BMJ Open, vol. 11, no. 1, 2021, pp. e042745.
Leal FE, Mendes-Correa MC, Buss LF, et al. 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. BMJ Open. 2021;11(1):e042745.
Leal, F. E., Mendes-Correa, M. C., Buss, L. F., Costa, S. F., Bizario, J. C. S., de Souza, S. R. P., Thomaz, O., Tozetto-Mendoza, T. R., Villas-Boas, L. S., de Oliveira-da Silva, L. C., Grespan, R. M. Z., Capuani, L., Buccheri, R., Domingues, H., Alexander, N., Mayaud, P., & Sabino, E. C. (2021). 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. BMJ Open, 11(1), e042745. https://doi.org/10.1136/bmjopen-2020-042745
Leal FE, et al. 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. BMJ Open. 2021 01 12;11(1):e042745. PubMed PMID: 33436471.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Leal,Fabio E, AU - Mendes-Correa,Maria C, AU - Buss,Lewis Fletcher, AU - Costa,Silvia F, AU - Bizario,Joao C S, AU - de Souza,Sonia R P, AU - Thomaz,Osorio, AU - Tozetto-Mendoza,Tania Regina, AU - Villas-Boas,Lucy S, AU - de Oliveira-da Silva,Léa Campos, AU - Grespan,Regina M Z, AU - Capuani,Ligia, AU - Buccheri,Renata, AU - Domingues,Helves, AU - Alexander,Neal, AU - Mayaud,Philippe, AU - Sabino,Ester Cerdeira, Y1 - 2021/01/12/ PY - 2021/1/13/entrez PY - 2021/1/14/pubmed PY - 2021/1/30/medline KW - epidemiology KW - infectious diseases KW - primary care KW - public health SP - e042745 EP - e042745 JF - BMJ open JO - BMJ Open VL - 11 IS - 1 N2 - 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. SN - 2044-6055 UR - https://www.unboundmedicine.com/medline/citation/33436471/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_ L2 - https://bmjopen.bmj.com/lookup/pmidlookup?view=long&pmid=33436471 DB - PRIME DP - Unbound Medicine ER -