TY - JOUR
T1 - The Clinical Course of COVID-19 in the Outpatient Setting
T2 - A Prospective Cohort Study
AU - Ambulatory COVID Study Team
AU - Blair, Paul W.
AU - Brown, Diane M.
AU - Jang, Minyoung
AU - Antar, Annukka A.R.
AU - Keruly, Jeanne C.
AU - Bachu, Vismaya S.
AU - Townsend, Jennifer L.
AU - Tornheim, Jeffrey A.
AU - Keller, Sara C.
AU - Sauer, Lauren
AU - Thomas, David L.
AU - Manabe, Yukari C.
AU - Cox, Andrea L.
AU - Heaney, Chris D.
AU - Klein, Sabra L.
AU - Mehta, Shruti H.
AU - Mostafa, Heba
AU - Pekosz, Andy S.
AU - Pisanic, Nora
AU - Smith, L. Leigh
AU - Armstrong, Derek T.
AU - Azamfirei, Razvan
AU - Barnaba, Brittany
AU - Charles, Curtisha
AU - Church, Taylor
AU - Dai, Weiwei
AU - Fuchs, Joelle
AU - Ganesan, Abhinaya
AU - Hardick, Justin
AU - Holden, Jeffrey
AU - Johnstone, Jaylynn R.
AU - Kruczynski, Kate
AU - Kusemiju, Oyinkansola
AU - Lambrou, Anastasia
AU - Li, Lucy
AU - Littlefield, Kirsten
AU - Montana, Manuela Plazas
AU - Park, Han Sol
AU - Payton, Christine B.
AU - Popper, Caroline
AU - Prizzi, Michelle
AU - Reuland, Carolyn J.
AU - Sewell, Thelio
AU - Tuchler, Amanda
AU - Ursin, Rebecca L.
AU - Walch, Samantha N.
N1 - Funding Information:
This work was supported by the Sherrilyn and Ken Fisher Center for Environmental Infectious Diseases Discovery Program and the Johns Hopkins University School of Medicine COVID-19 Research Fund. Y.C.M. received salary support from the National Institutes of Health (grant numbers U54EB007958-12, U5411090366, U54HL143541-02S2, UM1AI068613).
Publisher Copyright:
© 2021 The Author(s).
PY - 2021/2/1
Y1 - 2021/2/1
N2 - Background: Outpatient coronavirus disease 2019 (COVID-19) has been insufficiently characterized. To determine the progression of disease and determinants of hospitalization, we conducted a prospective cohort study. Methods: Outpatient adults with positive reverse transcription polymerase chain reaction results for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were recruited by phone between April 21 and July 23, 2020, after receiving outpatient or emergency department testing within a large health network in Maryland, United States. Symptoms were collected by participants on days 0, 3, 7, 14, 21, and 28, and portable pulse oximeter oxygen saturation (SaO2), heart rate, and temperature were collected for 15 consecutive days. Baseline demographics, comorbid conditions, and vital signs were evaluated for risk of subsequent hospitalization using negative binomial and logistic regression. Results: Among 118 SARS-CoV-2-infected outpatients, the median age (interquartile range [IQR]) was 56.0 (50.0-63.0) years, and 50 (42.4%) were male. Among individuals in the first week of illness (n = 61), the most common symptoms included weakness/fatigue (65.7%), cough (58.8%), headache (45.6%), chills (38.2%), and anosmia (27.9%). Participants returned to their usual health a median (IQR) of 20 (13-38) days from symptom onset, and 66.0% of respondents were at their usual health during the fourth week of illness. Over 28 days, 10.9% presented to the emergency department and 7.6% required hospitalization. The area under the receiver operating characteristics curve for the initial home SaO2 for predicting subsequent hospitalization was 0.86 (95% CI, 0.73-0.99). Conclusions: Symptoms often persisted but uncommonly progressed to hospitalization among outpatients with COVID-19. Home SaO2 may be a helpful tool to stratify risk of hospitalization.
AB - Background: Outpatient coronavirus disease 2019 (COVID-19) has been insufficiently characterized. To determine the progression of disease and determinants of hospitalization, we conducted a prospective cohort study. Methods: Outpatient adults with positive reverse transcription polymerase chain reaction results for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were recruited by phone between April 21 and July 23, 2020, after receiving outpatient or emergency department testing within a large health network in Maryland, United States. Symptoms were collected by participants on days 0, 3, 7, 14, 21, and 28, and portable pulse oximeter oxygen saturation (SaO2), heart rate, and temperature were collected for 15 consecutive days. Baseline demographics, comorbid conditions, and vital signs were evaluated for risk of subsequent hospitalization using negative binomial and logistic regression. Results: Among 118 SARS-CoV-2-infected outpatients, the median age (interquartile range [IQR]) was 56.0 (50.0-63.0) years, and 50 (42.4%) were male. Among individuals in the first week of illness (n = 61), the most common symptoms included weakness/fatigue (65.7%), cough (58.8%), headache (45.6%), chills (38.2%), and anosmia (27.9%). Participants returned to their usual health a median (IQR) of 20 (13-38) days from symptom onset, and 66.0% of respondents were at their usual health during the fourth week of illness. Over 28 days, 10.9% presented to the emergency department and 7.6% required hospitalization. The area under the receiver operating characteristics curve for the initial home SaO2 for predicting subsequent hospitalization was 0.86 (95% CI, 0.73-0.99). Conclusions: Symptoms often persisted but uncommonly progressed to hospitalization among outpatients with COVID-19. Home SaO2 may be a helpful tool to stratify risk of hospitalization.
KW - ambulatory care
KW - coronavirus infections/epidemiology
KW - middle aged
KW - recovery of function
KW - treatment outcome
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U2 - 10.1093/ofid/ofab007
DO - 10.1093/ofid/ofab007
M3 - Review article
C2 - 33614816
AN - SCOPUS:85103455023
SN - 2328-8957
VL - 8
JO - Open Forum Infectious Diseases
JF - Open Forum Infectious Diseases
IS - 2
M1 - ofab007
ER -