Abstract
BackgroundAssessment of possible infection with SARS‐CoV‐2, the novel coronavirus responsible for COVID‐19 illness, has been a major activity of infection services since the first reports of cases in December 2019.ObjectivesWe report a series of 68 patients assessed at a Regional Infection Unit in the UK.MethodsBetween 29 January 2020 and 24 February 2020, demographic, clinical, epidemiological and laboratory data were collected. We compared clinical features between patients not requiring admission for clinical reasons or antimicrobials with those assessed as needing either admission or antimicrobial treatment.ResultsPatients assessed were aged from 0 to 76 years; 36/68 were female. Peaks of clinical assessments coincided with updates to the case definition for suspected COVID‐19. Microbiological diagnoses included SARS‐CoV‐2, mycoplasma pneumonia, influenza A, non‐SARS/MERS coronaviruses and rhinovirus/enterovirus. Nine of sixty‐eight received antimicrobials, 15/68 were admitted, 5 due to inability to self‐isolate. Patients requiring admission on clinical grounds or antimicrobials (14/68) were more likely to have fever or raised respiratory rate compared to those not requiring admission or antimicrobials.ConclusionsThe majority of patients had mild illness, which did not require clinical intervention. This finding supports a community testing approach, supported by clinicians able to review more unwell patients. Extensions of the epidemiological criteria for the case definition of suspected COVID‐19 lead to increased screening intensity; strategies must be in place to accommodate this in time for forthcoming changes as the epidemic develops.
Highlights
SARS-CoV-2 is a recently named novel coronavirus responsible for the outbreak of respiratory disease named COVID-19, arising in Wuhan, China, in December 20191-3
With the change in case definition to include those returning from SE Asia, the number of cases markedly increased from an initial mean of 0.9 cases / day to 3.3 / day. 15 / 68 patients (23%) were admitted to the unit, with the remaining patients being managed in an ambulatory manner
We have presented our experience of testing for SARS-CoV-2 at a UK university teaching hospital
Summary
SARS-CoV-2 is a recently named novel coronavirus responsible for the outbreak of respiratory disease named COVID-19, arising in Wuhan, China, in December 20191-3. In the UK, public health and clinical services have been working to identify suspected cases according to a national case definition and to arrange testing, predominantly by real-time PCR of nose and throat swabs. During the 2009 H1N1 influenza pandemic when a syndromic management strategy with presumptive treatment and self-isolation was used, initial clinical diagnoses of influenza were reported to delay diagnoses of a number of diseases including primary HIV infection[7] and Plasmodium falciparum malaria[8], and scoring systems were developed it remains difficult to distinguish between viral and bacterial pneumonia on clinical grounds[9]. Many mild respiratory viral infections were managed as influenza[10], with significant resource implications, both for healthcare services and patients
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