Symptoms and Clinical Outcomes of Coronavirus Disease 2019 in the Outpatient Setting

Abstract

Because most cases of coronavirus disease 2019 are not severe, understanding the epidemiology of mild cases has important clinical implications. We aimed to describe the symptom profile and associated outcomes in a virtual outpatient COVID-19 clinic. We conducted a prospective cohort study from March through June 2020. We included 106 patients with positive results for SARS-CoV-2, followed up until they had 2 sequential negative tests. Exploratory regression analyses identified potential prognostic symptoms or risk factors associated with outcomes, including emergency department (ED) visits, hospitalizations, and time to resolution of viral shedding. The mean (range) patient age was 51 (18-86) years, 50% were men, and 36.5% had at least 1 risk factor, most commonly asthma (16%) and diabetes (10%). Most patients (98.1%) had symptomscough (80.4%), fatigue (67.6%), fever (66.0%), headache (49.0%), and ageusia (46.9%). Nine (8.5%) patients were admitted to the ED, 5 (4.7%) were hospitalized, and none died. Asthma (RR = 7.13, P = .001) and being immunocompromised (RR = 3.44, P = .03) were associated with higher risks of adverse outcomes. Asthma (HR = 0.56, P = .04) and early symptoms of ageusia (HR= 0.50, P = .01) or myalgia (HR = 0.63, P = .04) were associated with significantly longer duration of viral shedding. In contrast to reports about severe cases of COVID-19, we found a higher incidence of sinus symptoms, gastrointestinal symptoms, and myalgia and a lower incidence of fever, anosmia, and ageusia among our mild/moderate cases. Asthma and immunocompromised status were associated with adverse outcomes, and asthma and early symptoms of ageusia or myalgia with significantly longer duration of viral shedding. Keywords Clinical epidemiology . Disease management . Infectious disease . Pulmonary diseases . Telemedicine Abbreviations ACE2 Angiotensin-converting enzyme 2 CDC Centers for Disease Control and Prevention COVID-19 Coronavirus disease 2019 CVC COVID-19 virtual clinic ED Emergency department GI Gastrointestinal HR Hazard ratio IQR Interquartile range RR Relative risk RT-PCR Reverse transcription polymerase chain reaction SARS-CoV-2 Severe acute respiratory syndrome coronavirus 2 This article is part of the Topical Collection on Covid-19

Fatigue Symptoms Associated With COVID-19 in Convalescent or Recovered COVID-19 Patients; a Systematic Review and Meta-Analysis

“…Eight had repeated measure designs [ 53 , 56 , 62 , 68 , 69 , 71 , 76 , 81 ]. Where there were multiple assessments of fatigue within a temporal group, we calculated the mean of the fatigue scores or mean of the proportion of patients reporting fatigue.…”

Evaluation of clinical outcomes of patients with mild symptoms of coronavirus disease 2019 (COVID-19) discharged from the emergency department

“…And none of them died. Asthma and immune-compromised were two risk factors with poor prognosis [ 19 ]. In our study, number of male patients was 58.8%, 17.5% were retired, 30.5% were housewives, 2.8% were physicians, and 1.8% were nurses.…”

Clinical characteristics and symptom duration among outpatients with COVID-19

“…While there are numerous studies examining the clinical course of patients with COVID-19 requiring hospitalization or critical care, 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 there is limited data describing the disease course in the outpatient population despite the fact that most patients with COVID-19 do not require hospitalization. 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 Older age and the presence of specific medical conditions have previously been associated with illness severity among adults hospitalized with COVID-19. 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 Both age and specific medical conditions have been associated with greater susceptibility to the disease and prolonged illness in outpatient populations, although data supporting these findings are limited.…”