Abstract
Patients with strong clinical features of COVID-19 with negative real time polymerase chain reaction (RT-PCR) SARS-CoV-2 testing are not currently included in official statistics. The scale, characteristics and clinical relevance of this group are not well described. We performed a retrospective cohort study in two large London hospitals to characterize the demographic, clinical, and hospitalization outcome characteristics of swab-negative clinical COVID-19 patients. We found 1 in 5 patients with a negative swab and clinical suspicion of COVID-19 received a clinical diagnosis of COVID-19 within clinical documentation, discharge summary or death certificate. We compared this group to a similar swab positive cohort and found similar demographic composition, symptomology and laboratory findings. Swab-negative clinical COVID-19 patients had better outcomes, with shorter length of hospital stay, reduced need for > 60% supplementary oxygen and reduced mortality. Patients with strong clinical features of COVID-19 that are swab-negative are a common clinical challenge. Health systems must recognize and plan for the management of swab-negative patients in their COVID-19 clinical management, infection control policies and epidemiological assessments.
Highlights
As of 15th December 2020, the World Health Organization (WHO) has reported 70 million confirmed cases of COVID-19 globally with 1.6 million confirmed d eaths[1]
20% (94/456) of swab-negative cases were identified as swab-negative clinical COVID-19. 98% (92/94) of these cases fulfilled Public Health England (PHE) criteria for patients eligible to be swabbed for SARS-CoV-2 compared to Scientific Reports | (2021) 11:2455 |
We find one in five symptomatic patients admitted to the medical department who had a negative SARS-CoV-2 swab received a clinical diagnosis of COVID-19 despite negative testing
Summary
As of 15th December 2020, the World Health Organization (WHO) has reported 70 million confirmed cases of COVID-19 globally with 1.6 million confirmed d eaths[1]. Epidemiological evaluations in many countries including the UK, focus on patients with positive real-time polymerase chain reaction (RT-PCR) testing[4]. This places a significant importance on the diagnostic accuracy of laboratory testing. Several case reports describe patients with clinical features of COVID-19 but negative upper respiratory tract swabs who later have positive confirmatory testing on induced sputum or bronchial lavage[6,7,8]. Some patients with strong features of COVID-19 receive a clinical diagnosis of COVID19 despite a negative swab result This clinical approach is being further recognized in the admission criteria of some clinical trials who permit recruitment of these p atients[10]. Our study aims to assess the real-world prevalence and characteristics of clinically diagnosed swab-negative COVID-19, including factors associated with swab-negative disease, and whether their outcomes differ to swab-positive patients
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