Characteristics of Emergency Department Patients With COVID‐19 at a Single Site in Northern California: Clinical Observations and Public Health Implications

Abstract

a novel coronavirus disease (COVID-19) emerged in Wuhan, China, and spread globally, resulting in the first World Health Organization (WHO)-classified pandemic in over a decade. 1 As of April 2020, the United States has the most confirmed COVID-19 cases worldwide, but public health interventions and testing availability have varied across the country. 2Santa Clara County, California, has a population density of approximately 1,400 people per square mile and a high median household income ($116,178/year) and is part of the San Francisco Bay Area. 3 It was one of the first counties where COVID-19 was detected in the United States, with its first case (on January 31, 2020) being the seventh case nationwide. 4 The San Francisco Bay Area was also the first region in the United States to implement "shelter in place" orders on March 16, 2020, which consisted of widespread school and business closures and social distancing measures including prohibition of all nonessential travel and gatherings. 4 The objective of this study was to describe the demographics, clinical characteristics, and outcomes of emergency department (ED) patients who tested positive for COVID-19 at a medical center in Santa Clara County with the aim of identifying clinical patterns and assessing possible effects of local public health measures.This was an observational, cross-sectional study of ED patients with a laboratory-confirmed diagnosis of COVID-19 at a single academic hospital (Stanford Health Care). Our ED is a tertiary care, Level I trauma center that treated approximately 56,000 adults and 23,000 children in 2019. The hospital has 86 intensive care unit (ICU) beds.A novel polymerase chain reaction (PCR) laboratory test to diagnose COVID-19 was developed at the Stanford Clinical Virology Laboratory and approved for clinical use by the Food and Drug Administration (FDA). It utilizes a nasopharyngeal swab specimen that is collected by a health care provider, preserved in viral transport medium, and tested via reverse-transcriptase-PCR (RT-PCR). The test screens for the presence of RNA encoding an envelope protein of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative virus of COVID-19, and is followed by a confirmatory test for the SARS-CoV-2 RNA polymerase. 5

Emergency Medicine in the Time of COVID

“…We also applaud efforts in researching ways to deliver healthcare in different patient-provider interaction settings during pandemics such as in the area of telemedicine. Furthermore, we agree with Duanmu et al that developing robust databases on COVID-19 patients presenting to the ER will allow us to effectively make better data-informed decisions [37]. Publications on COVID-19 should be founded in scientific inquiry, not politics, and should not be locked behind paywalls.…”

SARS-CoV-2 and Obesity: “CoVesity” - A Pandemic Within A Pandemic

“…One study used the Edmonton Obesity Staging System (EOSS) to classify its participants, noting that it is a better predictor of all-cause mortality in patients with obesity, as compared to BMI. All patients were reported to have an EOSS of 2-3 (14). Three of the studies were policy statements from national and international organizations for bariatric surgery, and hence deserved mention.…”

“…This makes obese and diabetic individuals particularly vulnerable to severe lung infection and may explain the development of associated pulmonary brosis (34). Moreover, lowgrade systemic in ammation and end-organ damage seen in obese individuals are associated with the development of insulin resistance, type 2 diabetes, hypertension, atherosclerosis, dyslipidemia and asthma-well-known co-morbidities that negatively affect the outcomes of patients with COVID-19 (14).…”

Exploring the clinical association between neurological symptoms and COVID-19 pandemic outbreak: a systematic review of current literature

“…1. Nineteen studies [4,7,8,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] and 12,157 patients with laboratory-confirmed COVID-19 infection were included in our study.…”