Patients presenting for hospital‐based screening for the coronavirus disease 2019: Risk of disease, and healthcare access preferences

Abstract

Objective: Early during the coronavirus disease 2019 (COVID-19) pandemic, Australian EDs experienced an unprecedented surge in patients seeking screening. Understanding what proportion of these patients require testing and who can be safely screened in community-based models of care is critical for workforce and infrastructure planning across the healthcare system, as well as public messaging campaigns. Methods: In this cross-sectional survey, we screened patients presenting to a COVID-19 screening clinic in a tertiary ED. We assessed the proportion of patients who met testing criteria; self-reported symptom severity; reasons why they came to the ED for screening and views on community-based care. Results: We include findings from 1846 patients. Most patients (55.3%) did not meet contemporaneous criteria for testing and most (57.6%) had mild or no (13.4%) symptoms. The main reason for coming to the ED was being referred by a telephone health service (31.3%) and 136 (7.4%) said they tried to contact their general practitioner but could not get an appointment. Only 47 (2.6%) said they thought the disease was too specialised for their general practitioner to manage. Conclusions: While capacity building in acute care facilities is an important part of pandemic planning, it is also important that patients not needing hospital level of care can be assessed and treated elsewhere. We have identified a significant proportion of people at this early stage in the pandemic who have sought healthcare at hospital but who might have been assisted in the community had services been available and public health messaging structured to guide them there.

Knowledge, Attitudes, and Behavior Related to COVID-19 Testing: A Rapid Scoping Review

“…Eight studies [ 21 , 22 , 23 , 24 , 25 , 26 , 27 ] targeted participants of pilot testing programs (e.g., a telehealth system for testing [ 21 ] or the introduction of mass asymptomatic testing on a university campus [ 23 ]). Other target populations included patients or users of a specific health service or clinic [ 21 , 28 , 29 ] or health-related online app [ 30 , 31 ]; age-based populations [ 32 ]; health workers [ 33 , 34 , 35 , 36 , 37 ]; students and/or staff based at universities [ 23 , 24 , 25 , 26 , 27 , 38 ]; employment groups, such as police officers or industry workers [ 39 , 40 ]; and groups deemed especially vulnerable to COVID-19, such as homeless populations [ 41 ], refugee populations [ 42 ], or pregnant women attending clinical settings [ 34 , 35 , 43 ].…”

“…Lateral flow testing is less widely represented in the evidence base and is more likely to feature in articles and preprints based on more recently collected data [ 22 , 38 ]. The characteristics of all studies included in the review are summarized in Table 1 [ 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 …”

“…Studies that explored facilitating factors included research on participants’ knowledge and awareness of testing types and how they work [ 36 , 44 ] and research on people’s identification and interpretation of COVID-19 symptoms, including how this affects test-seeking behavior [ 30 , 45 , 46 , 47 ]. Multiple studies in this research area gathered data on people’s self-reported motivations for undergoing or avoiding testing [ 22 , 23 , 24 , 26 , 27 , 29 , 30 , 32 , 35 , 37 , 38 , 40 , 41 , 42 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 ]. Some of these studies sought to gather data on people’s trust in the government and/or medical systems in relation to COVID-19 testing [ 24 , 41 , 54 , 55 ] or piloted ways to improve people’s levels of trust in testing [ 42 ].…”

Better but Not Well: Disability, Frailty, and Cognitive Impairment One Year after COVID-19 Critical Illness

“…The first wave of the coronavirus disease (COVID-19) pandemic, from December 2019 to August 2020, was responsible for over 24 million confirmed cases worldwide, with approximately 5% of infected adults developing rapidly progressive respiratory failure ( 1 , 2 ). Mortality rates for critically ill patients varied significantly during 2020 across regions, ranging from 15% to 60%, with a global assessment of the in-hospital mortality rate estimated at 28% ( 3 ).…”