Outpatient Management of Oligosymptomatic Patients with Respiratory Infection in the Era of SARS-CoV-2. Experience from Rural German General Practitioners 

Abstract

Background: Covid-19 is causing a pandemic and forces physicians to restructure their daily work. We want to share our experience in the outpatient management of potentially infected patients with colleagues from other countries with special consideration of altered national test strategies during the crisis.Methods: We analysed all patients with respiratory symptoms reporting to our three rural general practioner (GP) offices in North Rhine Westphalia, Germany, from 27.01-20.04.2020 (n=489 from a total of 6090 patients). Patients with respiratory symptoms were examined in a separated isolation area, while the others were allowed to enter the office. We applied the first recommended algorithm of the German Robert Koch Institute (RKI) to test suspected patients and compared our results to an adapted, more liberal version of the RKI, which is currently applied in Germany.Results: Eighty patients (16.36%, mean age: 47.03years+-18.08) were sent to a nasopharyngeal smear. five patients (6.25%) turned out to be positive, four of which had established risk factors for COVID-19. Overall, the most common symptoms were cough (83.75%), sore throat (71.25%), as well as myalgia and fatigue (66.25%). The most common diagnoses were rhinopharyngitis (37.22%) and acute bronchitis (30.27%). A sore throat was more common in positively tested patients (80% vs. 12%). Applying the first RKI test strategy yielded 6.25% of positive tests (n=80), while the more liberal later RKI recommendation would have achieved 1.36% of positive tests from 369 patients. No positive test was missed by applying the conservative strategy. None of our employees called in sick during this period, which emphasizes the efficacy and safety of our screening methods. Conclusion: A clinical distinction between ordinary respiratory infections and COVID-19 is not possible in a low-prevalence population. Our model to prevent unprotected physical contact, screen patients in front of the office with protective equipment, and to examine respiratory infections in separated areas works in the GP setting without overt health risks for employees. Thus, this approach should be used as a GP standard to uphold patient care without major health risks for the personnel. Large multicenter studies are necessary to work out the most suitable test strategy.