The Clinical Course of COVID-19 in the Outpatient Setting: A Prospective Cohort Study
Author:
Blair Paul W12ORCID, Brown Diane M1, Jang Minyoung1, Antar Annukka A R1, Keruly Jeanne C1, Bachu Vismaya S1, Townsend Jennifer L1, Tornheim Jeffrey A1, Keller Sara C1, Sauer Lauren3, Thomas David L1, Manabe Yukari C1, Cox Andrea L, Heaney Chris D, Klein Sabra L, Mehta Shruti H, Mostafa Heba, Pekosz Andy S, Pisanic Nora, Smith L Leigh, Armstrong Derek T, Azamfirei Razvan, Barnaba Brittany, Charles Curtisha, Church Taylor, Dai Weiwei, Fuchs Joelle, Ganesan Abhinaya, Hardick Justin, Holden Jeffrey, Johnstone Jaylynn R, Kruczynski Kate, Kusemiju Oyinkansola, Lambrou Anastasia, Li Lucy, Littlefield Kirsten, Montana Manuela Plazas, Park Han-Sol, Payton Christine B, Popper Caroline, Prizzi Michelle, Reuland Carolyn J, Sewell Thelio, Tuchler Amanda, Ursin Rebecca L, Walch Samantha N,
Affiliation:
1. Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA 2. Austere Environments Consortium for Enhanced Sepsis Outcomes, Henry M. Jackson Foundation, Bethesda, Maryland, USA 3. Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Abstract
AbstractBackgroundOutpatient coronavirus disease 2019 (COVID-19) has been insufficiently characterized. To determine the progression of disease and determinants of hospitalization, we conducted a prospective cohort study.MethodsOutpatient adults with positive reverse transcription polymerase chain reaction results for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were recruited by phone between April 21 and July 23, 2020, after receiving outpatient or emergency department testing within a large health network in Maryland, United States. Symptoms were collected by participants on days 0, 3, 7, 14, 21, and 28, and portable pulse oximeter oxygen saturation (SaO2), heart rate, and temperature were collected for 15 consecutive days. Baseline demographics, comorbid conditions, and vital signs were evaluated for risk of subsequent hospitalization using negative binomial and logistic regression.ResultsAmong 118 SARS-CoV-2-infected outpatients, the median age (interquartile range [IQR]) was 56.0 (50.0–63.0) years, and 50 (42.4%) were male. Among individuals in the first week of illness (n = 61), the most common symptoms included weakness/fatigue (65.7%), cough (58.8%), headache (45.6%), chills (38.2%), and anosmia (27.9%). Participants returned to their usual health a median (IQR) of 20 (13–38) days from symptom onset, and 66.0% of respondents were at their usual health during the fourth week of illness. Over 28 days, 10.9% presented to the emergency department and 7.6% required hospitalization. The area under the receiver operating characteristics curve for the initial home SaO2 for predicting subsequent hospitalization was 0.86 (95% CI, 0.73–0.99).ConclusionsSymptoms often persisted but uncommonly progressed to hospitalization among outpatients with COVID-19. Home SaO2 may be a helpful tool to stratify risk of hospitalization.
Funder
National Institutes of Health
Publisher
Oxford University Press (OUP)
Subject
Infectious Diseases,Oncology
Cited by
52 articles.
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