Abstract
This prospective observational study evaluated the safety and feasibility of a low threshold testing process in a Triage and Test Center (TTC) during the early course of the coronavirus disease 19 (COVID-19) pandemic. In addition, we aimed to identify clinical predictors for a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) swab result. Patients underwent informal triage, standardized history taking, and physician evaluation, only where indicated. Patients were observed for 30 days. Safety was the primary outcome and was defined as a COVID-19-related 30 day re-presentation rate <5% and mortality rate <1% in patients presenting to the TTC. Feasibility was defined as an overruling of informal triage <5%. Among 4815 presentations, 572 (11.9%) were tested positive for SARS-CoV-2, and 4774 were discharged. Mortality at 30-days was 0.04% (2 patients, one of which related to COVID-19). Fever (OR 2.03 [95% CI 1.70;2.42]), myalgia (OR 1.94 [1.63;2.31]), chills (OR 1.77 [1.44;2.16]), headache (OR 1.61 [1.34;1.94]), cough (OR 1.50 [1.24;1.83]), weakness (OR 1.46 [1.21;1.76]), and confusion (OR 1.39 [1.06;1.80]) were associated with test positivity. Re-presentation rate was 8% overall and 1.4% in COVID-19 related re-presentation (69 of 4774). The overruling rate of informal triage was 1.5%. According to our study, a low-threshold testing process in a TTC appeared to be safe (low re-presentation and low mortality) and is feasible (low overruling of informal triage). A COVID-19 diagnosis based on clinical parameters only does not appear possible.
Highlights
Regular, widespread testing to identify and isolate individuals with coronavirus disease 19 (COVID-19) appears to be crucial to reduce transmission [1,2], but limitations on testing availability has been a challenge during the early phase of COVID-19 pandemic
We evaluated feasibility and safety of a Triage and Test Center for low-threshold testing, to determine patient outcomes, and to identify clinical predictors for a positive nasopharyngeal SARS-CoV-2 swab result
The Test Center (TTC) was located in a church in close vicinity
Summary
Widespread testing to identify and isolate individuals with coronavirus disease 19 (COVID-19) appears to be crucial to reduce transmission [1,2], but limitations on testing availability has been a challenge during the early phase of COVID-19 pandemic. Expecting a high number of patients willing to be tested, we designed a quick and easy walk-in process. This process was based on previous safety data regarding informal triage and physiological reserve (e.g., mobility). In detail, unimpaired mobility, low physician disease severity ratings (PDSR), and normal vital signs are associated with a very favorable prognosis [3,4,5,6,7]. We hypothesized that these principles hold true for a coordinated large-scale testing process. Several similar approaches, such as a drive-thru process in COVID-19 testing have been described, but to date, safety data are lacking [8]
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