COVID-19 in Great Britain: epidemiological and clinical characteristics of the first few hundred (FF100) cases: a descriptive case series and case control analysis

Abstract

Objectives: Following detection of the first virologically-confirmed cases of COVID-19 in Great Britain, an enhanced surveillance study was initiated by Public Health England to describe the clinical presentation, course of disease and identify risk factors for infection of the first few hundred cases. Methods: Information was collected on the first COVID-19 cases according to the First Few X WHO protocol. Case-control analyses of the sensitivity, specificity and predictive value of symptoms and risk factors for infection were conducted. Point prevalences of underlying health conditions among the UK general population were presented. Findings: The majority of FF100 cases were imported (51.4%), of which the majority had recent travel to Italy (71.4%). 24.7% were secondary cases acquired mainly through household contact (40.4%). Children had lower odds of COVID-19 infection compared with the general population. The clinical presentation of cases was dominated by cough, fever and fatigue. Non-linear relationships with age were observed for fever, and sensitivity and specificity of symptoms varied by age. Conditions associated with higher odds of COVID-19 infection (after adjusting for age and sex) were chronic heart disease, immunosuppression and multimorbidity. Conclusion: This study presents the first epidemiological and clinical summary of COVID-19 cases in Great Britain. The FFX study design enabled systematic data collection. The study was able to characterize the risk factors for infection with population prevalence estimates setting these relative risks into a public health context. It also provides important evidence for generating case definitions to support public health risk assessment, clinical triage and diagnostic algorithms.

Factors associated with COVID-19-related death using OpenSAFELY

“…These findings largely concur with other data, including the UK international severe acute respiratory and emerging infection consortium (ISARIC) study of hospitalized UK patients with COVID-19-which indicated an increased risk of death with cardiac, pulmonary and kidney disease, malignancy, obesity and dementia 6 -and a large Chinese study that, although lacking correction for age, suggested that cardiovascular disease, hypertension, diabetes, respiratory disease and cancers are associated with increased mortality 5 . Our results showing that severe asthma is associated with a higher risk are notable, as early data suggested that asthma was under-represented in patients with COVID-19 who were hospitalized or had severe outcomes 17,18 .…”

“…Codelists for particular underlying conditions and medicines were compiled from a variety of sources. These include British National Formulary (BNF) codes from OpenPrescribing.net, published codelists for asthma [37][38][39] , immunosuppression [40][41][42] , psoriasis 43 , systemic lupus erythematosus 44 , rheumatoid arthritis 45,46 and cancer 47,48 , and Read Code 2 lists designed specifically to describe groups who are at increased risk of influenza infection 18 . Read Code 2 lists were added to with SNOMED codes and cross-checked against NHS Quality and Outcomes Framework (QOF) registers, then translated into CTV3 with manual curation.…”

COVID-19 and associations with frailty and multimorbidity: a prospective analysis of UK Biobank participants

“…Importantly, our results suggest that people living with frailty and multimorbidity are no more likely to require a hospital admission due to COVID-19 compared to other conditions resulting in similar disease severity. Therefore, the reported high rates of COVID-19 diagnoses and mortality in those with multiple health conditions and those who are characterised as frail [4][5][6]8] are likely due to the highly contagious nature of COVID-19, and potential susceptibility to severe sequelae, rather than a specific propensity to contracting the disease. The routine assessment of frailty during the COVID-19 pandemic has been frequently advocated, to facilitate appropriate management and resource allocation [9,11,32].…”

“…The identification of risk factors for contracting COVID-19 is crucial, to inform public health policy and to facilitate the appropriate distribution of healthcare resources. Preliminary data from Asia, Europe and the United States suggest that the majority of individuals with COVID-19 are aged > 50 years, with most deaths occurring in those aged > 60 years [4][5][6][7][8]. Multimorbidity has also been associated with COVID-19 disease, the need for ventilatory support and higher rates of mortality [4][5][6]8].…”

“…Preliminary data from Asia, Europe and the United States suggest that the majority of individuals with COVID-19 are aged > 50 years, with most deaths occurring in those aged > 60 years [4][5][6][7][8]. Multimorbidity has also been associated with COVID-19 disease, the need for ventilatory support and higher rates of mortality [4][5][6]8]. As a result, COVID-19 patients have frequently been described within the academic discourse as "frail", with this term being used in its more colloquial sense [9][10][11].…”