Validity of Clinical Symptoms Score to Discriminate Patients with COVID-19 from Common Cold Out-Patients in General Practitioner Clinics in Japan.

Shiro Sonoda,Takeo Fujiwara,Yasunari Miyazaki,Yusuke Matsuyama,Jin Kuramochi

doi:10.3390/jcm10040854

Abstract

Objective: Coronavirus disease 2019 (COVID-19) has spread worldwide, including Japan. However, little is known about the clinical symptoms which discriminate between COVID-19 and non-COVID-19 among outpatients in general practitioner clinics, which is important for efficient case detection. The aim of this study was to investigate the clinical symptoms to discriminate between COVID-19 and non-COVID-19 cases among outpatients in general practitioner clinics during the second wave of the COVID-19 pandemic in Japan in August 2020. Methods: The records of 360 patients who visited a clinic with suspicion of infectious disease and underwent COVID-19 PCR test between 1 and 14 August 2020 were used. The patients filled out a questionnaire on possible clinical symptoms and transmission routes. Multivariate logistic regression was used to investigate the association between clinical symptoms and COVID-19 status. Results: COVID-19-positive patients were 17 (4.7%). Multiple logistic regression analyses showed that anosmia (odds ratio (OR), 25.94 95% confidence interval (CI), 7.15–94.14; p < 0.001), headache (OR, 3.31 95% confidence interval (CI), 0.98–11.20; p = 0.054), sputum production (OR, 3.32 CI, 1.01–10.90; p = 0.048) and history of visiting an izakaya or bar (OR, 4.23 CI, 0.99–18.03; p = 0.051) were marginally significantly associated withbeing COVID-19 positive. This model showed moderate predictive power (area under receiver operating characteristic curve = 0.870 CI, 0.761 to 0.971). Conclusions: We found that anosmia, headache, sputum production, history of visiting an izakaya or bar were associated with COVID-19, which can be used to detect patients with COVID-19 in out-patient clinics in Japan. The findings of this study need to be verified in other clinics and hospitals in Japan and other countries with universal healthcare coverages.

Highlights

Since December 2019, the severe acute respiratory syndrome coronavirus-2 (SARSCoV-2), a novel coronavirus which emerged in Wuhan, China, has spread worldwide leading the World Health Organization to declare a pandemic
The factors that contribute to the severity of COVID-19 are gradually being clarified [6], the factors which discriminate between COVID-19 and non-COVID-19 among outpatients with symptoms of common cold are not clear
Patients aged 20 to 59 accounted for 72.5% (261) of the sample, and there were 17 patients with COVID-19 (4.7%) whose clinical spectrum was 14 moderate, 2 moderate and 1 severe illness based on Coronavirus Disease 2019 (COVID-19) Treatment Guidelines by National Institutes of Health

Summary

Introduction

Since December 2019, the severe acute respiratory syndrome coronavirus-2 (SARSCoV-2), a novel coronavirus which emerged in Wuhan, China, has spread worldwide leading the World Health Organization to declare a pandemic. The factors that contribute to the severity of COVID-19 are gradually being clarified [6], the factors which discriminate between COVID-19 and non-COVID-19 among outpatients with symptoms of common cold are not clear. Such a discrimination is difficult, because COVID-19 is suggested to have high transmissibility after and before symptom onset [7], and most patients with COVID-19 are classified as mildly symptomatic or asymptomatic [8]

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