Clinical features and natural history of the first 2073 suspected COVID-19 cases in the Corona São Caetano primary care programme: a prospective cohort study
Philippe Mayaud,
Ester Cerdeira Sabino,
Fabio E Leal,
Maria C Mendes-Correa,
Lewis Fletcher Buss,
Silvia F Costa,
Joao C S Bizario,
Sonia R P de Souza,
Osorio Thomaz,
Tania Regina Tozetto-Mendoza,
Lucy S Villas-Boas,
Léa Campos de Oliveira-da Silva,
Regina M Z Grespan,
Ligia Capuani,
Renata Buccheri,
Helves Domingues,
Neal Alexander
Affiliations
Philippe Mayaud
Faculty of Infectious & Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
Ester Cerdeira Sabino
Department of Infectious and Parasitic Diseases, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
Fabio E Leal
Faculdade de Medicina, Universidade de São Caetano do Sul, São Paulo, Brazil
Maria C Mendes-Correa
Instituto de Medicina Tropical (LIM-52, LIM-46, LIM-49) and Departamento de Moléstias Infecciosas e Parasitarias, Universidade de São Paulo, São Paulo, Brazil
Lewis Fletcher Buss
Instituto de Medicina Tropical (LIM-52, LIM-46, LIM-49) and Departamento de Moléstias Infecciosas e Parasitarias, Universidade de São Paulo, São Paulo, Brazil
Silvia F Costa
Instituto de Medicina Tropical (LIM-52, LIM-46, LIM-49) and Departamento de Moléstias Infecciosas e Parasitarias, Universidade de São Paulo, São Paulo, Brazil
Joao C S Bizario
Faculdade de Medicina, Universidade de São Caetano do Sul, São Paulo, Brazil
Sonia R P de Souza
Faculdade de Medicina, Universidade de São Caetano do Sul, São Paulo, Brazil
Osorio Thomaz
Instituto de Pesquisas Tecnológicas, São Paulo, Brazil
Tania Regina Tozetto-Mendoza
Instituto de Medicina Tropical (LIM-52, LIM-46, LIM-49) and Departamento de Moléstias Infecciosas e Parasitarias, Universidade de São Paulo, São Paulo, Brazil
Lucy S Villas-Boas
Instituto de Medicina Tropical (LIM-52, LIM-46, LIM-49) and Departamento de Moléstias Infecciosas e Parasitarias, Universidade de São Paulo, São Paulo, Brazil
Léa Campos de Oliveira-da Silva
Laboratório de Medicina Laboratorial (LIM03), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
Regina M Z Grespan
Faculdade de Medicina, Universidade de São Caetano do Sul, São Paulo, Brazil
Ligia Capuani
Department of Services and Systems Design, Modular Research System Ltda, São Paulo, Brazil
Renata Buccheri
Instituto de Medicina Tropical (LIM-52, LIM-46, LIM-49) and Departamento de Moléstias Infecciosas e Parasitarias, Universidade de São Paulo, São Paulo, Brazil
Helves Domingues
Department of Information Technology, Modular Research System Ltda, São Paulo, Brazil
Neal Alexander
Faculty of Infectious & Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
Background Despite most cases not requiring hospital care, there are limited community-based clinical data on COVID-19.Methods The Corona São Caetano programme is a primary care initiative providing care to all residents with COVID-19 in São Caetano do Sul, Brazil. It was designed to capture standardised clinical data on community COVID-19 cases. After triage of potentially severe cases, consecutive patients presenting to a multimedia screening platform between 13 April and 13 May 2020 were tested at home with SARS-CoV-2 reverse transcriptase (RT) PCR; positive patients were followed up for 14 days with phone calls every 2 days. RT-PCR-negative patients were offered additional SARS-CoV-2 serology testing to establish their infection status. We describe the clinical, virological and natural history features of this prospective population-based cohort.Findings Of 2073 suspected COVID-19 cases, 1583 (76.4%) were tested by RT-PCR, of whom 444 (28.0%, 95% CI 25.9 to 30.3) were positive; 604/1136 (53%) RT-PCR-negative patients underwent serology, of whom 52 (8.6%) tested SARS-CoV-2 seropositive. The most common symptoms of confirmed COVID-19 were cough, fatigue, myalgia and headache; whereas self-reported fever (OR 3.0, 95% CI 2.4 to 3.9), anosmia (OR 3.3, 95% CI 2.6 to 4.4) and ageusia (OR 2.9, 95% CI 2.3 to 3.8) were most strongly associated with a positive COVID-19 diagnosis by RT-PCR or serology. RT-PCR cycle thresholds were lower in men, older patients, those with fever and arthralgia and closer to symptom onset. The rates of hospitalisation and death among 444 RT-PCR-positive cases were 6.7% and 0.7%, respectively, with older age and obesity more frequent in the hospitalised group.Conclusion COVID-19 presents in a similar way to other mild community-acquired respiratory diseases, but the presence of fever, anosmia and ageusia can assist the specific diagnosis. Most patients recovered without requiring hospitalisation with a low fatality rate compared with other hospital-based studies.
