Baseline phenotype and 30-day outcomes of people tested for COVID-19: an international network cohort including >3.32 million people tested with real-time PCR and >219,000 tested positive for SARS-CoV-2 in South Korea, Spain and the United States
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Abstract
Early identification of symptoms and comorbidities most predictive of COVID-19 is critical to identify infection, guide policies to effectively contain the pandemic, and improve health systems’ response. Here, we characterised socio-demographics and comorbidity in 3,316,107persons tested and 219,072 persons tested positive for SARS-CoV-2 since January 2020, and their key health outcomes in the month following the first positive test. Routine care data from primary care electronic health records (EHR) from Spain, hospital EHR from the United States (US), and claims data from South Korea and the US were used. The majority of study participants were women aged 18-65 years old. Positive/tested ratio varied greatly geographically (2.2:100 to 31.2:100) and over time (from 50:100 in February-April to 6.8:100 in May-June). Fever, cough and dyspnoea were the most common symptoms at presentation. Between 4%-38% required admission and 1-10.5% died within a month from their first positive test. Observed disparity in testing practices led to variable baseline characteristics and outcomes, both nationally (US) and internationally. Our findings highlight the importance of large scale characterization of COVID-19 international cohorts to inform planning and resource allocation including testing as countries face a second wave.
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SciScore for 10.1101/2020.10.25.20218875: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: All the data partners obtained Institutional Review Board (IRB) approval or exemption, as appropriate, to conduct this study. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing your code and data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Strengths and limitations: Our study has limitations. We analysed data collected during routine care and in actual practice settings for clinical rather than research purposes. It is therefore expected that …
SciScore for 10.1101/2020.10.25.20218875: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: All the data partners obtained Institutional Review Board (IRB) approval or exemption, as appropriate, to conduct this study. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing your code and data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Strengths and limitations: Our study has limitations. We analysed data collected during routine care and in actual practice settings for clinical rather than research purposes. It is therefore expected that some information will be incompletely reported, leading to potential misclassification. The variability observed in testing practices and the similarity in the distribution of important comorbidities, symptoms and demographics in the tested vs tested+ cohorts suggests targeted testing for subjects with severe forms of disease in the first months of the pandemic. The lack of mild infections limits our ability to identify key variables associated with susceptibility to infection. Underreporting of symptoms in EHR is another limitation of the study which can be due to factors such as source of data, testing availability, model of care, and reimbursement policies. We observed wide-spread variation in symptom reporting and a generally lower prevalence of symptoms compared to previous literature. Despite this, our study suggests that symptoms such as cough and fever remain key disease features, predictive of a positive test. We were not able to describe characteristics of the population tested negative for SARS-CoV-2 given the transient state of this population and specifically the difficulties in accurately ascertaining this cohort during a pandemic. However, the majority of the tested population consists of persons who tested negative for SARS-CoV-2 with tested+ cohort compris...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
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