U-shaped-aggressiveness of SARS-CoV-2: Period between initial symptoms and clinical progression to COVID-19 suspicion. A population-based cohort study
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Abstract
Early identification of different COVID-19 clinical presentations may depict distinct pathophysiological mechanisms and guide management strategies.
Objective
To determine the aggressiveness of SARS-CoV-2 using symptom progression in COVID-19 patients.
Design
Historic cohort study of Mexican patients. Data from January-April 2020 were provided by the Health Ministry.
Setting
Population-based. Patients registered in the Epidemiologic Surveillance System in Mexico.
Participants
Subjects who sought medical attention for clinical suspicion of COVID-19. All patients were subjected to RT-PCR testing for SARS-CoV-2.
Measurements
We measured the Period between initial symptoms and clinical progression to COVID-19 suspicion (PISYCS) and compared it to the primary outcomes (mortality and pneumonia).
Results
65,500 patients were included. Reported fatalities and pneumonia were 2176 (3.32%), and 11568 (17.66%), respectively. According to the PISYCS, patients were distributed as follows: 14.89% in <24 hours, 43.25% between 1–3 days, 31.87% between 4–7 days and 9.97% >7 days. The distribution for mortality and pneumonia was 5.2% and 22.5% in <24 hours, 2.5% and 14% between 1–3 days, 3.6% and 19.5% between 4–7 days, 4.1% and 20.6% >7 days, respectively (p<0.001). Adjusted-risk of mortality was (OR [95% CI], p-value): <24 hours = 1.75 [1.55–1.98], p<0.001; 1–3 days = 1 (reference value); 4–7 days = 1.53 [1.37–1.70], p<0.001; >7 days = 1.67 [1.44–1.94], p<0.001. For pneumonia: <24 hours = 1.49 [1.39–1.58], p<0.001; 1–3 days = 1; 4–7 days = 1.48 [1.41–1.56], p<0.001; >7 days = 1.57 [1.46–1.69], p<0.001.
Limitations
Using a database fed by large numbers of people carries the risk of data inaccuracy. However, this imprecision is expected to be random and data are consistent with previous studies.
Conclusion
The PISYCS shows a U-shaped SARS-CoV-2 aggressiveness pattern. Further studies are needed to corroborate the time-related pathophysiology behind these findings.
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SciScore for 10.1101/2020.10.28.20221697: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: The Institutional Review Board of Anahuac University (Mexico City, Mexico) approved this study (Protocol approval #202044). Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Software and Algorithms Sentences Resources Statistical significance was set at p<0.05 and performed with SPSS version 25.0 (IBM). SPSSsuggested: (SPSS, RRID:SCR_002865)Results from OddPub: Thank you for sharing your data.
Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.Results…
SciScore for 10.1101/2020.10.28.20221697: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: The Institutional Review Board of Anahuac University (Mexico City, Mexico) approved this study (Protocol approval #202044). Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Software and Algorithms Sentences Resources Statistical significance was set at p<0.05 and performed with SPSS version 25.0 (IBM). SPSSsuggested: (SPSS, RRID:SCR_002865)Results from OddPub: Thank you for sharing your data.
Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.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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