Abstract
BackgroundCOVID-19 studies are primarily from the inpatient setting, skewing towards severe disease. Race and comorbidities predict hospitalization, however, ambulatory presentation of milder COVID-19 disease and characteristics associated with progression to severe disease is not well-understood.MethodsWe conducted a retrospective chart review including all COVID-19 positive cases from Stanford Health Care (SHC) in March 2020 to assess demographics, comorbidities and symptoms in relationship to: 1) their access point of testing (outpatient, inpatient, and emergency room (ER)) and 2) development of severe disease.ResultsTwo hundred fifty-seven patients tested positive: 127 (49%), 96 (37%), and 34 (13%) at outpatient, ER and inpatient, respectively. Overall, 61% were age < 55; age > 75 was rarer in outpatient setting (11%) than ER (14%) or inpatient (24%). Most patients presented with cough (86%), fever/chills (76%), or fatigue (63%). 65% of inpatients reported shortness of breath compared to 30–32% of outpatients and ER patients. Ethnic/minority patients had a significantly higher risk of developing severe disease (Asian OR = 4.8 [1.6–14.2], Hispanic OR = 3.6 [1.1–11.9]). Medicare-insured patients were marginally more likely (OR = 4.0 [0.9–17.8]). Other factors associated with developing severe disease included kidney disease (OR = 6.1 [1.0–38.1]), cardiovascular disease (OR = 4.7 [1.0–22.1], shortness of breath (OR = 5.4 [2.3–12.6]) and GI symptoms (OR = 3.3 [1.4–7.7]; hypertension without concomitant CVD or kidney disease was marginally significant (OR = 2.3 [0.8–6.5]).ConclusionsEarly widespread symptomatic testing for COVID-19 in Silicon Valley included many less severely ill patients. Thorough manual review of symptomatology reconfirms the heterogeneity of COVID-19 symptoms, and challenges in using clinical characteristics to predict decline. We re-demonstrate that socio-demographics are consistently associated with severity.
Highlights
COVID-19 studies are primarily from the inpatient setting, skewing towards severe disease
Other factors associated with developing severe disease included kidney disease (OR = 6.1 [1.0–38.1]), cardiovascular disease (OR = 4.7 [1.0–22.1], shortness of breath (OR = 5.4 [2.3–12.6]) and GI symptoms
Thorough manual review of symptomatology reconfirms the heterogeneity of COVID-19 symptoms, and challenges in using clinical characteristics to predict decline
Summary
COVID-19 studies are primarily from the inpatient setting, skewing towards severe disease. Data on COVID-19 symptoms is primarily from the inpatient setting and skews towards the more severely ill, leaving many knowledge gaps around characteristics of the disease in the ambulatory population. As community spread of COVID19 has exponentially increased and testing has scaled up, race and ethnicity have consistently been found to predict hospitalization and mortality [1, 3, 4]. The complexities underlying these health disparities are uncertain, and undoubtedly include a mix of social, economic, access, and behavioral factors [3]. Certain comorbidities (including diabetes, heart disease, chronic kidney disease, and obesity) are known to strongly predict COVID-19 hospitalization [5]; most of these comorbidities have disparate prevalence by race/ethnicity, but are not alone sufficient to explain racial/ethnic disparities in COVID-19’s impacts
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