Description of symptom course in a telemedicine monitoring clinic for acute symptomatic COVID-19: a retrospective cohort study

  1. James B O'Keefe
  2. Elizabeth J Tong
  3. Ghazala D O'Keefe
  4. David C Tong

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Abstract

Describe the disease course in a cohort of outpatients with COVID-19 and evaluate factors predicting duration of symptoms.

Design

Retrospective cohort study.

Setting

Telemedicine clinic at a large medical system in Atlanta, Georgia.

Participants

337 patients with acute COVID-19. Exclusion criteria included intake visit more than 10 days after symptom onset and hospitalisation prior to intake visit.

Main outcome measures

Symptom duration in days.

Results

Common symptoms at intake visit are upper respiratory (73% cough, 55% loss of smell or taste, 57% sinus congestion, 32% sore throat) and systemic (66% headache, 64% body aches, 53% chills, 30% dizziness, 36% fever). Day of symptom onset was earliest for systemic and upper respiratory symptoms (median onset day 1 for both), followed by lower respiratory symptoms (day 3, 95% CI 2 to 4), with later onset of gastrointestinal symptoms (day 4, 95% CI 3 to 5), when present. Cough had the longest duration when present with median 17 days (95% CI 15 to 21), with 42% not resolved at final visit. Loss of smell or taste had the second longest duration with 14 days (95% CI 12 to 17), with 38% not resolved at final visit. Initial symptom severity is a significant predictor of symptom duration (p<0.01 for multiple symptoms).

Conclusions

COVID-19 illness in outpatients follows a pattern of progression from systemic symptoms to lower respiratory symptoms and persistent symptoms are common across categories. Initial symptom severity is a significant predictor of disease duration for most considered symptoms.

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  1. ScreenIT

    SciScore for 10.1101/2020.06.05.20123471: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Study setting: The study was a retrospective cohort study, conducted at Emory Healthcare, the largest academic health system in Georgia (serving the greater Atlanta metropolitan area), which includes more than 250 provider locations and 120 primary care locations.
    Emory Healthcare
    suggested: (One Mind Biospecimen Bank Listing, RRID:SCR_004193)

    Results from OddPub: Thank you for sharing your data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Strengths and limitations of study: Our data on symptom course in outpatients is robust due to the structure of the VOMC, which was staffed to meet the anticipated “surge” of patients in March-May 2020 and therefore had skilled providers contacting patients and completing full note templates regularly through the course of acute illness. Missing clinical data were minimal (e.g. low risk patients contacted every 48 hours instead of 24 hours), allowing for standard approach to imputation. The primary limitation of this study is that it represents a single-center cohort of patients screened during the early SARS-CoV-2 pandemic. Screening criteria favored the inclusion of working-age individuals in the cohort and our exclusion of hospitalized patients favors younger and healthier patients. We have limited numbers of patients with comorbidities and cannot therefore draw conclusions about the duration of symptoms related to specific conditions (e.g. chronic obstructive pulmonary disease). Another limitation of the structured VOMC cohort data is the time to intake visit. Usual care requires a positive SARS-CoV-2 test prior to enrollment, and delays in testing could attenuate recall of initial symptoms. We therefore limited the study to patients within 10 days of symptom onset and used chart review to verify symptoms reported in the screening process. Discharge timing in the VOMC was a limitation for our follow-up data: the VOMC discharge criteria mirrored the CDC terminology of symp...

    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.
    • No funding statement was detected.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1136/bmjopen-2020-044154
  3. Version published to 10.1101/2020.06.05.20123471v2 on medRxiv
  4. Version published to 10.1101/2020.06.05.20123471v1 on medRxiv