BMC Infectious Diseases (Jan 2021)

Relationship of socio-demographics, comorbidities, symptoms and healthcare access with early COVID-19 presentation and disease severity

  • Laura Vaughan,
  • Darlene Veruttipong,
  • Jonathan G. Shaw,
  • Noemie Levy,
  • Lauren Edwards,
  • Marcy Winget

DOI
https://doi.org/10.1186/s12879-021-05764-x
Journal volume & issue
Vol. 21, no. 1
pp. 1 – 10

Abstract

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Abstract Background COVID-19 studies are primarily from the inpatient setting, skewing towards severe disease. Race and comorbidities predict hospitalization, however, ambulatory presentation of milder COVID-19 disease and characteristics associated with progression to severe disease is not well-understood. Methods We conducted a retrospective chart review including all COVID-19 positive cases from Stanford Health Care (SHC) in March 2020 to assess demographics, comorbidities and symptoms in relationship to: 1) their access point of testing (outpatient, inpatient, and emergency room (ER)) and 2) development of severe disease. Results Two hundred fifty-seven patients tested positive: 127 (49%), 96 (37%), and 34 (13%) at outpatient, ER and inpatient, respectively. Overall, 61% were age 75 was rarer in outpatient setting (11%) than ER (14%) or inpatient (24%). Most patients presented with cough (86%), fever/chills (76%), or fatigue (63%). 65% of inpatients reported shortness of breath compared to 30–32% of outpatients and ER patients. Ethnic/minority patients had a significantly higher risk of developing severe disease (Asian OR = 4.8 [1.6–14.2], Hispanic OR = 3.6 [1.1–11.9]). Medicare-insured patients were marginally more likely (OR = 4.0 [0.9–17.8]). Other factors associated with developing severe disease included kidney disease (OR = 6.1 [1.0–38.1]), cardiovascular disease (OR = 4.7 [1.0–22.1], shortness of breath (OR = 5.4 [2.3–12.6]) and GI symptoms (OR = 3.3 [1.4–7.7]; hypertension without concomitant CVD or kidney disease was marginally significant (OR = 2.3 [0.8–6.5]). Conclusions Early widespread symptomatic testing for COVID-19 in Silicon Valley included many less severely ill patients. Thorough manual review of symptomatology reconfirms the heterogeneity of COVID-19 symptoms, and challenges in using clinical characteristics to predict decline. We re-demonstrate that socio-demographics are consistently associated with severity.

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