Characteristics and outcomes of family practice patients with COVID-19: A case series from Montreal

Abstract

Background: The clinical history and outcomes of COVID-19 among people not hospitalized is not yet well characterized. To better inform clinical evaluation, we set out to characterize the natural history of COVID-19 in primary health care. Methods: Case series of all patients rostered to physicians at a university-affiliated Family Medicine clinic. Cases met the Center for Disease Control (CDC) definition of COVID-19 disease. Results: 89 patients meeting CDC criteria for COVID-19 disease were documented from March 1 to May 21, 2020. Their average age was 55.6 (range 6 to 95) years, and all but one was symptomatic. 57 cases (64%) had a polymerase chain reaction (PCR) test for COVID-19, of whom 77.2% tested positive. 30 cases (33.7%) reported contact with a confirmed or probable case of COVID-19. Based on the Charlson Comorbidity Index, 28 (31.5%) cases had no comorbid conditions. The median number of days from symptom onset to first PCR test was 6 days [Interquartile range 2.3 to 11 days]. The median duration of fever was 3.5 days [Interquartile range 1 to 7 days]. 24 cases (27%) visited the Emergency Department (ED) and 10 were admitted to hospital. The median number of days between symptom onset and first ED visit was 8 days [Interquartile range 3.5 to 27 days]. Conclusions: At the start of this pandemic, the implementation of basic public health measures such as diagnostic testing and contact tracing were delayed. If we are to improve our control over the spread of COVID-19, we will need to substantially reduce the time from symptom onset to diagnostic testing, and subsequent contact tracing. To minimize unnecessary ED visits, we propose a testable strategy for Family Medicine to engage with COVID-19 patients in the acute phase of their illness.