Abstract
BackgroundThe clinical history and outcomes of coronavirus disease 2019 among people not hospitalized is not yet well characterized. To better inform clinical evaluation, we set out to characterize the natural history of coronavirus disease 2019 in primary health care.MethodsCase series of all patients rostered to physicians at a university-affiliated Family Medicine clinic. Cases met the Centers for Disease Control and Prevention definition of coronavirus disease 2019 from March 1 to May 21 2020.ResultsIn total, 89 patients meeting Centers for Disease Control and Prevention criteria for coronavirus disease 2019 were documented. Their average age was 55.6 years (range 6–95 years), and all but one was symptomatic. Fifty-seven cases (64%) had a polymerase chain reaction test for coronavirus disease 2019, of whom 77.2% tested positive. Thirty cases (33.7%) reported contact with a confirmed or probable case of coronavirus disease 2019. Based on the Charlson Comorbidity Index, 28 cases (31.5%) had no comorbid conditions. The median number of days from symptom onset to first polymerase chain reaction test was 6 days (interquartile range 2.3–11 days). The median duration of fever was 3.5 days (interquartile range 1–7 days). Twenty-four cases (27%) visited the Emergency Department, and 10 were admitted to hospital. The median number of days between symptom onset and first Emergency Department visit was 8 days (interquartile range 3.5–27 days).ConclusionsAt the start of this pandemic, the implementation of basic measures such as diagnostic testing was delayed. If we are to improve our control over the spread of coronavirus disease 2019, we will need to substantially reduce the time from symptom onset to diagnostic testing, and subsequent contact tracing. To minimize unnecessary Emergency Department visits, we propose a testable strategy for Family Medicine to engage with coronavirus disease 2019 patients in the acute phase of their illness.
Highlights
The clinical history and outcomes of coronavirus disease 2019 among people not hospitalized is not yet well characterized
While there are no specific clinical features that can reliably distinguish COVID-19 from other viral respiratory infections, the preferred diagnostic test for COVID-19 is done through nucleic acid amplification testing (NAAT) with polymerase chain reaction (PCR) from samples collected by nasopharyngeal swabs
Among cases who were tested, we were interested in knowing the following: how soon cases went to get PCR testing following onset of symptoms, how many days it took for cases to become negative based on a follow-up PCR test, and how many days of fever cases experienced during their illness
Summary
The clinical history and outcomes of coronavirus disease 2019 among people not hospitalized is not yet well characterized. To better inform clinical evaluation, we set out to characterize the natural history of coronavirus disease 2019 in primary health care. The novel coronavirus arose in late 2019, but soon became a worldwide threat as new cases emerged at rapid rates. The first cases of COVID-19 in the Canadian province of Quebec were identified at the end of February 2020. On March 13 2020, a state of health emergency was declared. As of April 8 2020, Quebec adopted a case definition for COVID-19 [5]. In the first wave, during which this study was conducted, the earliest data showed that the overall number of daily deaths in Quebec was 1 on March 18 2020, compared with 61 deaths on May 21 2020. In Quebec, the city of Montreal suffered the highest rates of mortality [6]
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