Clinical characteristics and risk factors for coronavirus disease 2019 (COVID-19) among patients under investigation in Thailand.

Jackrapong Bruminhent,Nattanon Ruangsubvilai,Jeff Nabhindhakara,Atiporn Ingsathit,Sasisopin Kiertiburanakul,Muhammad Adrish

doi:10.1371/journal.pone.0239250

Jackrapong Bruminhent, Nattanon Ruangsubvilai + Show 4 more

Open Access

https://doi.org/10.1371/journal.pone.0239250

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Journal: PloS one	Publication Date: Sep 15, 2020
Citations: 19	License type: CC BY 4.0

Affiliation: Ramathibodi Hospital, Mahidol University

Abstract

To manage coronavirus disease 2019 (COVID-19), a national health authority has implemented a case definition of patients under investigation (PUIs) to guide clinicians' diagnoses. We aimed to determine characteristics among all PUIs and those with and without COVID-19. We retrospectively reviewed clinical characteristics and risk factors for laboratory-confirmed COVID-19 cases among PUIs at a tertiary care center in Bangkok, Thailand, between March 23 and April 7, 2020. Reverse transcription-polymerase chain reaction for SARS-CoV-2 RNA was performed. There were 405 evaluable PUIs; 157 (38.8%) were men, with a mean age ± SD of 36.2 ± 12.6 years. The majority (68.9%) reported no comorbidities. There were 53 (13.1%) confirmed COVID-19 cases. The most common symptoms among those were cough (73.6%), fever (58.5%), sore throat (39.6%), and muscle pain (37.4%). Among these patients, diagnoses were upper respiratory tract infection (69.8%), viral syndrome (15.1%), pneumonia (11.3%), and asymptomatic infection (3.8%). Multivariate analysis identified close contact with an index case (OR, 3.49; 95%CI, 1.49-8.15; P = 0.004), visiting high-risk places (OR, 1.92; 95%CI, 1.03-3.56; P = 0.039), productive cough (OR, 2.03; 95%CI, 1.05-3.92; P = 0.034), and no medical coverage (OR, 3.91; 95%CI, 1.35-11.32; P = 0.012) as independent risk factors for COVID-19 among the PUIs. The majority had favorable outcomes, though one (1.9%) died from severe pneumonia. COVID-19 was identified in 13% of PUIs defined per a national health authority's case definition. History of contact with a COVID-19 patient, visiting a high-risk place, having no medical coverage, and productive cough may identify individuals at risk of COVID-19 in Thailand.

Highlights

Multivariate analysis identified close contact with an index case (OR, 3.49; 95%confidence interval (CI), 1.49–8.15; P = 0.004), visiting high-risk places (OR, 1.92; 95%CI, 1.03–3.56; P = 0.039), productive cough (OR, 2.03; 95%CI, 1.05–3.92; P = 0.034), and no medical coverage (OR, 3.91; 95%CI, 1.35–11.32; P = 0.012) as independent risk factors for COVID-19 among the patients under investigation (PUIs)
Apart from close contact with an infected case and visiting high-risk places, we found that having no medical coverage and presenting with productive cough were predictors of being diagnosed with COVID-19 among PUIs
Chen et al reported that half of patients with a history of exposure to the seafood market suspected to be the sources of the virus, and close contact with a COVID19-infected individual, were major risk factors among people who lived in Wuhan, Hubei, China during the initial outbreak [14]