Characteristics and Outcomes of COVID-19 Infection from an Urban Ambulatory COVID-19 Clinic—Guidance for Outpatient Clinicians in Triaging Patients

Barbhaya, Dweep; Franco, Stephanie; Gandhi, Kejal; Arya, Radhika; Neupane, Rabin; Foroughi, Negar; Oluigbo, Nnenna; Fishbein, Dawn; Tran, Jennifer

doi:10.1177/21501327211017016

Cited by 4 publications

(5 citation statements)

References 14 publications

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“…The results of the CCC in this current report was similar to the adult COVID-19 Clinic in Washington DC, in that sore throat was an infrequent presenting symptom of COVID-19. 5 In this report no change in symptoms based on the duration of time since the positive PCR was observed. Initial symptoms, such as fever, myalgia, headache is the result of viral replication which is followed by an inflammatory response.…”

Section: Discussionmentioning

confidence: 47%

“…The Washington DC Clinic patients were similar gender distribution to the CCC in this current report; however, the mean age was 7 years older since the Washington DC Clinic provided care only for adults, and the Black/African patients constituted 49.7% compared to 6.3% in the CCC. 5 In addition, the Washington DC data was reported for a 3-month period during a period of high SARS-Cov-2 prevalence versus our 10-month reporting period during which there was variable SARS-CoV-2 prevalence. During the published study periods, New York, Washington DC, and Minnesota experienced peak COVID-19 numbers in April 2020 (3386, 7 day average cases/day), May 2020 (194, 7 day average cases/day), and November 2020 (195, 7 day average cases/day) respectively.…”

Section: Discussionmentioning

confidence: 91%

“…The results of the CCC in this current report was similar to the adult COVID-19 Clinic in Washington DC, in that sore throat was an infrequent presenting symptom of COVID-19. 5…”

Section: Discussionmentioning

confidence: 99%

“…This rate compares to 2% deaths CCF Clinic and 0.4% death rate at the COVID-19 Clinic in Washington DC. 4,5 The low death rate may be due to the highly triaged patient population seen with sicker patients being advised to be seen in the ED, predominately white population and/ or differences in co-morbidities.…”

Section: Discussionmentioning

confidence: 99%

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COVID-19 Care Clinic in a Medical Center: Lessons Learned

Tulledge–Scheitel

Billings

Fischer

et al. 2021

J Prim Care Community Health

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Objective: The purpose of this report is to describe the elements of a Covid-19 Care Clinic (CCC), patient demographics, and outcomes. Methods: Descriptive statistics were used to describe demographics, clinical characteristics, and outcomes. This report is based on 4934 unique patients seen in the CCC who provided research authorization within a 10-month period of time (April 1, 2020-January 31, 2021). The CCC infection control processes consisted of a rooming process that mitigated SARS-COV-2 transmission, preparing examination rooms, using PPE by staff, in room lab drawing, and escorting services to minimize the time in clinic. Results: Of the 4934 unique patients seen (age range newborn-102 years), 76.8% were tested for COVID-19. Of those tested, 11.8% were positive for SARS-CoV-2. Ninety-two percent of the patients with the reason for the visit documented had COVID-19 type symptoms. Cough, shortness of breath, and chest pain were the most common presenting symptom in those with COVID-19. At the time of the visit in the CCC, 5.8% of the patients were actively contagious. Thirty days after being seen in the CCC, 9.1% of the patients were seen in the emergency department (ED) and 0.2% died. During the 10-month period there were no known occupationally related COVID-19 infections. Conclusion: The COVID-19 Care Clinic provided face-to-face access for all ages with COVID-19 type symptoms. A minority of patients had COVID-19 who were seen in the clinic. The clinic provided an additional venue of care outside of the ED. The infectious control measures employed were highly effective in protecting the staff. Lessons learned allow for decentralization of COVID-19 symptom care to the primary care practices employing the infection control measures.

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Section: Discussionmentioning

confidence: 47%

Section: Discussionmentioning

confidence: 91%

“…The results of the CCC in this current report was similar to the adult COVID-19 Clinic in Washington DC, in that sore throat was an infrequent presenting symptom of COVID-19. 5…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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COVID-19 Care Clinic in a Medical Center: Lessons Learned

Tulledge–Scheitel

Billings

Fischer

et al. 2021

J Prim Care Community Health

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“…COVID-19 inflammation could potentiate glycation stress, forming toxic metabolites that accelerate inflammation and oxidative stress, leading to cellular protein damage [25]. Compounding this could be the inadequate food supply secondary to symptoms such as dysgeusia, anorexia/vomiting, and diarrhea [26].…”

Section: Serum Proteinmentioning

confidence: 99%

The Predictive Score for Patients Hospitalized With COVID-19 in Resource-Limited Settings

Philip¹,

David²,

Mathew³

et al. 2022

Cureus

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Background and aimsThe second wave of coronavirus disease 2019 (COVID-19) has been devastating in India and many developing countries. The mortality reported has been 40% higher than in the first wave, overwhelming the nation's health infrastructure. Despite a better understanding of the disease and established treatment protocols including steroids and heparin, the second wave was disastrous. Subsequent waves have the potential to further cripple healthcare deliveries, also affecting non-COVID-19 care across many developing economies. It is then important to identify and triage high-risk patients to best use the limited resources. Routine tests such as neutrophil and monocyte counts have been identified but have not been successfully validated uniformly, and their utility is still being understood in COVID-19.Various predictive models that are available require online resources and calculators and additionally await validation across all populations. These, although useful, might not be available or accessible across all institutions. It is then important to identify easy-to-use scores that utilize tests done routinely.In identifying with this goal, we did a retrospective review of the institutional database to identify potential predictors of intensive care unit (ICU) admission and mortality in patients hospitalized during the second wave who accessed healthcare at our academic setup. ResultsThree predictors of mortality and four predictors of ICU admission were identified. Absolute neutrophil count was a common predictor of both ICU admission and mortality but with two separate cut points. An absolute neutrophil count of >4,200 predicted need for ICU admission (odds ratio (OR): 3.1 (95% confidence interval (CI): 2.0, 4.8)), and >7,200 predicted mortality (adjusted OR: 4.2 (95% CI: 1.9, 9.4)). We observed that a blood urea level greater than 45 was predictive of needing ICU care (adjusted OR: 8.0 (95% CI: 3.7, 17.6)). In our dataset, serum ferritin of >500 was predictive of ICU admission (adjusted OR: 2.7 (95% CI: 1.2, 5.9)). We noted a right shift of partial pressure (p50 is the oxygen tension at which hemoglobin is 50% saturated) (p50c) in SARS-CoV-2 as a predictor of ICU care (OR: 2.6 (95% CI: 1.7, 3.9)) when partial pressure is >26.5. In our analysis, a serum protein of less than 7 g/dL (OR: 2.8 (95% CI: 1.7, 4.4)) was a predictive variable for ICU admission. An LDH value of >675 was predictive of severity with a need for ICU admission (OR: 9.2 (95% CI: 5.4, 15.5)) in our series. We then assigned a score to each of the predictive variables based on the adjusted odds ratio. ConclusionWe identified a set of easy-to-use predictive variables and scores to recognize the subset of patients hospitalized with COVID-19 with the highest risk of death or clinical worsening requiring ICU care.

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