Faculdade de Medicina, Universidade de São Caetano do Sul, São Paulo, Brazil.
Programa de Oncovirologia, Instituto Nacional de Câncer, Rio de Janeiro, Brazil.
BMJ Open. 2021 Jan 12;11(1):e042745. doi: 10.1136/bmjopen-2020-042745.
Despite most cases not requiring hospital care, there are limited community-based clinical data on COVID-19.
The Corona São Caetano programme is a primary care initiative providing care to all residents with COVID-19 in São Caetano do Sul, Brazil. It was designed to capture standardised clinical data on community COVID-19 cases. After triage of potentially severe cases, consecutive patients presenting to a multimedia screening platform between 13 April and 13 May 2020 were tested at home with SARS-CoV-2 reverse transcriptase (RT) PCR; positive patients were followed up for 14 days with phone calls every 2 days. RT-PCR-negative patients were offered additional SARS-CoV-2 serology testing to establish their infection status. We describe the clinical, virological and natural history features of this prospective population-based cohort.
Of 2073 suspected COVID-19 cases, 1583 (76.4%) were tested by RT-PCR, of whom 444 (28.0%, 95% CI 25.9 to 30.3) were positive; 604/1136 (53%) RT-PCR-negative patients underwent serology, of whom 52 (8.6%) tested SARS-CoV-2 seropositive. The most common symptoms of confirmed COVID-19 were cough, fatigue, myalgia and headache; whereas self-reported fever (OR 3.0, 95% CI 2.4 to 3.9), anosmia (OR 3.3, 95% CI 2.6 to 4.4) and ageusia (OR 2.9, 95% CI 2.3 to 3.8) were most strongly associated with a positive COVID-19 diagnosis by RT-PCR or serology. RT-PCR cycle thresholds were lower in men, older patients, those with fever and arthralgia and closer to symptom onset. The rates of hospitalisation and death among 444 RT-PCR-positive cases were 6.7% and 0.7%, respectively, with older age and obesity more frequent in the hospitalised group.
COVID-19 presents in a similar way to other mild community-acquired respiratory diseases, but the presence of fever, anosmia and ageusia can assist the specific diagnosis. Most patients recovered without requiring hospitalisation with a low fatality rate compared with other hospital-based studies.
尽管大多数病例不需要住院治疗，但针对 COVID-19 的社区临床数据有限。
São Caetano do Sul 的 Corona São Caetano 项目是一项初级保健计划，为所有 COVID-19 居民提供服务。它旨在收集社区 COVID-19 病例的标准化临床数据。对可能严重的病例进行分诊后，2020 年 4 月 13 日至 5 月 13 日期间，连续有患者通过多媒体筛查平台就诊，在家中接受 SARS-CoV-2 逆转录酶（RT）PCR 检测；对 RT-PCR 阳性患者进行为期 14 天的随访，每两天通过电话进行一次随访。对 RT-PCR 阴性患者进行额外的 SARS-CoV-2 血清学检测，以确定其感染状态。我们描述了这项前瞻性基于人群的队列的临床、病毒学和自然病史特征。
在 2073 例疑似 COVID-19 病例中，有 1583 例（76.4%）接受了 RT-PCR 检测，其中 444 例（28.0%，95%CI 25.9 至 30.3）为阳性；1136 例 RT-PCR 阴性患者中有 604 例接受了血清学检测，其中 52 例（8.6%）检测到 SARS-CoV-2 血清阳性。确诊 COVID-19 最常见的症状是咳嗽、疲劳、肌痛和头痛；而自我报告的发热（OR 3.0，95%CI 2.4 至 3.9）、嗅觉丧失（OR 3.3，95%CI 2.6 至 4.4）和味觉丧失（OR 2.9，95%CI 2.3 至 3.8）与 RT-PCR 或血清学阳性 COVID-19 诊断的相关性最强。男性、年龄较大的患者、有发热和关节痛的患者以及症状出现较近的患者的 RT-PCR 循环阈值较低。444 例 RT-PCR 阳性病例中，住院率和死亡率分别为 6.7%和 0.7%，住院组中年龄较大和肥胖的患者更为常见。
COVID-19 的表现与其他轻度社区获得性呼吸道疾病相似，但发热、嗅觉丧失和味觉丧失有助于特定诊断。与其他基于医院的研究相比，大多数患者无需住院即可康复，死亡率较低。
