Clinical features and natural history of the first 2073 suspected COVID-19 cases in the Corona Sao Caetano primary care programme: a prospective cohort study

Author(s):Show less -

Leal, Fabio E. ^{[1, 2]} ; Mendes-Correa, Maria C. ^{[3, 4]} ; Buss, Lewis Fletcher ^{[3, 4]} ; Costa, Silvia F. ^{[3, 4]} ; Bizario, Joao C. S. ^[1] ; de Souza, Sonia R. P. ^[1] ; Thomaz, Osorio ^[5] ; Tozetto-Mendoza, Tania Regina ^{[3, 4]} ; Villas-Boas, Lucy S. ^{[3, 4]} ; de Oliveira-da Silva, Lea Campos ^[6] ; Grespan, Regina M. Z. ^[1] ; Capuani, Ligia ^[7] ; Buccheri, Renata ^{[3, 4]} ; Domingues, Helves ^[8] ; Alexander, Neal ^[9] ; Mayaud, Philippe ^[9] ; Sabino, Ester Cerdeira ^{[3, 4]}

Affiliation

^[1] Univ Sao Caetano Sul, Fac Med, Sao Paulo - Brazil

^[2] Inst Nacl Canc, Programa Oncovirol, Rio De Janeiro - Brazil

^[3] Univ Sao Paulo, LIM 49, Inst Med Trop LIM 52, LIM 46, Sao Paulo - Brazil

^[4] Univ Sao Paulo, Dept Molestias Infecciosas & Parasitarias, Sao Paulo - Brazil

^[5] Inst Pesquisas Tecnol, Sao Paulo - Brazil

^[6] Univ Sao Paulo, Fac Med, Hosp Clin, Lab Med Lab LIM03, Sao Paulo - Brazil

^[7] Modular Res Syst Ltd, Dept Serv & Syst Design, Sao Paulo - Brazil

^[8] Modular Res Syst Ltd, Dept Informat Technol, Sao Paulo - Brazil

^[9] London Sch Hyg & Trop Med, Fac Infect & Trop Dis, London - England

• Document type: Journal article
• Source: BMJ OPEN; v. 11, n. 1 2021.
• Web of Science Citations: 0

Abstract

Background Despite most cases not requiring hospital care, there are limited community-based clinical data on COVID-19. Methods The Corona Sao Caetano programme is a primary care initiative providing care to all residents with COVID-19 in Sao 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. (AU)

• FAPESP's process: 18/14389-0 - Brazil-UK Centre for Arbovirus Discovery, Diagnosis, Genomics and Epidemiology (CADDE)
• Grantee: Ester Cerdeira Sabino
• Support Opportunities: Research Projects - Thematic Grants