Clinical features, diagnostics, and outcomes of patients presenting with acute respiratory illness: a comparison of patients with and without COVID-19
Authors: Shah Sachin J. , Barish Peter N. , Prasad Priya A. , Kistler Amy , Neff Norma , Kamm Jack , Li Lucy M. , Chiu Charles Y. , Babik Jennifer M. , Fang Margaret C. , Kangelaris Kirsten Neudoerffer , Langelier Charles ,   the UCSF COVID-19 Hospital Translational and Clinical Epidemiology Working Group, Abe-Jones Yumiko , Alipanah Narges , Alvarez Francisco N. , Botvinnik Olga Borisovna , Castaneda Gloria ,   The CZB CLIAhub Consortium, Dadasovich Rand M. , Davis Jennifer , Deng Xianding , DeRisi Joseph L. , Detweiler Angela M. , Federman Scot , Haliburton John , Hao Samantha , Kerkhoff Andrew D. , Kumar G. Renuka , Malcolm Katherine B. , Mann Sabrina A. , Martinez Sandra , Marya Rupa K. , Mick Eran , Mwakibete Lusajo , Najafi Nader , Peluso Michael J. , Phelps Maira , Pisco Angela Oliveira , Ratnasiri Kalani , Rubio Luis A. , Sellas Anna , Sherwood Kyla D. , Sheu Jonathan , Spottiswoode Natasha , Tan Michelle , Yu Guixia 
Published: May 2020

Background

Emerging data on the clinical presentation, diagnostics, and outcomes of patients with COVID-19 have largely been presented as case series. Few studies have compared these clinical features and outcomes of COVID-19 to other acute respiratory illnesses.

Methods

We examined all patients presenting to an emergency department in San Francisco, California between February 3 and March 31, 2020 with an acute respiratory illness who were tested for SARS-CoV-2. We determined COVID-19 status by PCR and metagenomic next generation sequencing (mNGS). We compared demographics, comorbidities, symptoms, vital signs, and laboratory results including viral diagnostics using PCR and mNGS. Among those hospitalized, we determined differences in treatment (antibiotics, antivirals, respiratory support) and outcomes (ICU admission, ICU interventions, acute respiratory distress syndrome, cardiac injury).

Findings

In a cohort of 316 patients, 33 (10%) tested positive for SARS-CoV-2; 31 patients, all without COVID-19, tested positive for another respiratory virus (16%). Among patients with additional viral testing, no co-infections with SARS-CoV-2 were identified by PCR or mNGS. Patients with COVID-19 reported longer symptoms duration (median 7 vs. 3 days) and were more likely to report fever (82% vs. 44%) fatigue (85% vs. 50%) and myalgias (61% vs 27%); p<0.001 for all comparisons. Lymphopenia (55% vs 34%, p=0.018) and bilateral opacities on initial chest radiograph (55% vs. 24%, p=0.001) were more common in patients with COVID-19. Patients with COVID-19 were more often hospitalized (79% vs. 56%, p=0.014). Of 186 hospitalized patients, patients with COVID-19 had longer hospitalizations (median 10.7d vs. 4.7d, p<0.001) and were more likely to develop ARDS (23% vs. 3%, p<0.001). Most comorbidities, home medications, signs and symptoms, vital signs, laboratory results, treatment, and outcomes did not differ by COVID-19 status.

Interpretation

While we found differences in clinical features of COVID-19 compared to other acute respiratory illnesses, there was significant overlap in presentation and comorbidities. Patients with COVID-19 were more likely to be admitted to the hospital, have longer hospitalizations and develop ARDS, and were unlikely to have co-existent viral infections. These findings enhance understanding of the clinical characteristics of COVID-19 in comparison to other acute respiratory illnesses.