Epidemiology, Clinical Characteristics, and Outcomes of a Large Cohort of COVID-19 Outpatients in Michigan

• Main Authors: Halalau A, Odish F, Imam Z, Sharrak A, Brickner E, Lee PB, Foglesong A, Michel A, Gill I, Qu L, Abbas AE, Carpenter CF
• Format: Article
• Language: English
• Published: Dove Medical Press 2021-04-01
• Series: International Journal of General Medicine
• Subjects: covid-19; infectious disease; epidemiology; sars-cov-2; demographics; outpatient
• Online Access: https://www.dovepress.com/epidemiology-clinical-characteristics-and-outcomes-of-a-large-cohort-o-peer-reviewed-fulltext-article-IJGM

Alexandra Halalau,1,2 Fadi Odish,3 Zaid Imam,4 Aryana Sharrak,2 Evan Brickner,2 Paul Bumki Lee,2 Adam Foglesong,1 Adrian Michel,1 Inayat Gill,1 Lihua Qu,2,5 Amr E Abbas,2,6 Christopher F Carpenter1,2,7 1Internal Medicine Department, Beaumont Health, Royal Oak, MI, USA; 2Oakland University William Beaumont School of Medicine, Rochester, MI, USA; 3Section of Gastroenterology and Hepatology, Department of Internal Medicine, Wright State University, Dayton, OH, USA; 4Division of Gastroenterology and Hepatology, Department of Internal Medicine, Beaumont Health, Royal Oak, MI, USA; 5Outcome Research Department, Research Institute Beaumont Health, Royal Oak, MI, USA; 6Cardiovascular Department, Beaumont Health, Royal Oak, MI, USA; 7Infectious Disease Section, Beaumont Health, Royal Oak, MI, USACorrespondence: Alexandra HalalauWilliam Beaumont Hospital, 3601 W 13 Mile Road, Royal Oak, MI, 48073, USATel [phone]Email [e-mail]: Most outpatients with coronavirus disease 2019 (COVID-19) do not initially demonstrate severe features requiring hospitalization. Understanding this population’s epidemiological and clinical characteristics to allow outcome anticipation is crucial in healthcare resource allocation.Methods: Retrospective, multicenter (8 hospitals) study reporting on 821 patients diagnosed with COVID-19 by real-time reverse transcriptase–polymerase chain reaction assay of nasopharyngeal swabs and discharged home to self-isolate after evaluation in emergency departments (EDs) within Beaumont Health System in March, 2020. Outcomes were collected through April 14, 2020, with a minimum of 12 day follow-up and included subsequent ED visit, admission status, and mortality.Results: Of the 821 patients, mean age was 49.3 years (SD 15.7), 46.8% were male and 55.1% were African-American. Cough was the most frequent symptom in 78.2% of patients with a median duration of 3 days (IQR 2– 7), and other symptoms included fever 62.1%, rhinorrhea or nasal congestion 35.1% and dyspnea 31.2%. ACEI/ARBs usage was reported in 28.7% patients and 34.0% had diabetes mellitus. Return to the ED for re-evaluation was reported in 19.2% of patients from whom 54.4% were admitted. The patients eventually admitted to the hospital were older (mean age 54.4 vs 48.7 years, p=0.002), had higher BMI (35.4 kg/m2 vs 31.9 kg/m2, p=0.004), were more likely male (58.1% vs 45.4%, p=0.026), and more likely to have hypertension (52.3% vs 29.4%, p< 0.001), diabetes mellitus (74.4% vs 29.3%, p< 0.001) or prediabetes (25.6% vs 8.4%, p< 0.001), COPD (39.5% vs 5.4%, p< 0.001), and OSA (36% vs 19%, p< 0.001). The overall mortality rate was 1.3%.Conclusion: We found that 80.8% of patients did not return to the ED for re-evaluation. Sending patients with COVID-19 home if they experience mild symptoms is a safe approach for most patients and might mitigate some of the financial and staffing pressures on healthcare systems.Keywords: COVID-19, infectious disease, epidemiology, SARS-CoV-2, demographics, outpatient