Mitigating the Severity of COVID-19 Illness in the Primary Care Patient Population through Early Identification and Close Monitoring of Underlying Comorbidities (preprint)

Purpose: Prior studies have identified risk factors which prognosticate severity of SARSCoV2 illness among hospitalized patients. Since the majority of patients first present to ambulatory care sites, there is a need to identify early predictors of disease progression in this population. Methods: This retrospective cohort study investigated the impact of underlying comorbid conditions on SARSCoV2 infection severity in the ambulatory setting. All patients who presented to a single federally qualified health center (FQHC) between March to May 2020 with a positive SARSCoV2 test were reviewed for inclusion. Patient demographics, symptomology, prior medical history, and outcomes were collected. Results: 301 patients were included, with nearly equal numbers of patients with (n=151) and without (n=150) underlying comorbidities. Overall, 269 patients (89%) had a mild outcome and 32 patients (11%) had a severe outcome. Advanced age (OR: 9.4 [95% CI: 3.4 to 27.4], p < 0.001) and male gender (OR: 3.2 [95% CI: 1.2 to 9.8], p = 0.02) were significant predictors of severe outcomes. Additionally, every obesity category (1: BMI = 30.0 to 34.9; 2: BMI = 35 to 39.9; 3: BMI = 40.0 plus) was associated with more severe outcomes compared to non-obese (OR: 3.5, p = 0.05; OR: 5.2, p = 0.03; OR: 13.9, p = 0.01). Compared to an HbA1C < 6, an HbA1C of 7.1 to 8.0 showed a clinically significant association. Conclusion: SARSCoV2 severity can be prognosticated in the ambulatory population by the presence and severity of preexisting comorbidities. Early identification and risk stratification of these comorbidities will allow clinicians to develop plans for closer monitoring to prevent severe illness.

Prevalence of SARS-CoV-2 infection in previously undiagnosed health care workers at the onset of the U.S. COVID-19 epidemic (preprint)

ImportanceHealthcare workers are presumed to be at increased risk of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection due to occupational exposure to infected patients. However, no epidemiological study has examined the prevalence of SARS-CoV-2 infection in a cohort of healthcare workers during the early phase of community transmission. ObjectiveTo determine the baseline prevalence of SARS-CoV-2 infection in a cohort of previously undiagnosed healthcare workers and a comparison group of non-healthcare workers. DesignProspective cohort study SettingA large U.S. university and two affiliated university hospitals Participants546 health care workers and 283 non-health care workers with no known prior SARS-CoV-2 infection ExposureHealthcare worker status and role Main outcome(s) and measure(s)SARS-CoV-2 infection status as determined by presence of SARS-CoV-2 RNA in oropharyngeal swabs. ResultsAt baseline, 41 (5.0%) of participants tested positive for SARS-CoV-2 infection, of whom 14 (34.2%) reported symptoms. The prevalence of SARS-CoV-2 infection was higher among healthcare workers (7.3%) than in non-healthcare workers (0.4%), representing a 7.0% greater absolute risk (95% confidence interval for risk difference 4.7%, 9.3%). The majority of infected healthcare workers (62.5%) worked as nurses. Positive tests increased across the two weeks of cohort recruitment in line with rising confirmed cases in the hospitals and surrounding counties. Conclusions and relevanceIn a prospective cohort conducted in the early phases of community transmission, healthcare workers had a higher prevalence of SARS-CoV-2 infection than non-healthcare workers, attesting to the occupational hazards of caring for patients in this crisis. Baseline data reported here will enable us to monitor the spread of infection and examine risk factors for transmission among healthcare workers. These results will inform optimal strategies for protecting the healthcare workforce, their families, and their patients. Clinicaltrials.gov registration number:NCT04336215 Key pointsO_ST_ABSQuestionC_ST_ABSAmong previously undiagnosed individuals, is the prevalence of SARS-CoV-2 infection higher in U.S. healthcare workers compared to non-healthcare workers in the early phase of the U.S. COVID-19 epidemic? FindingsThe prevalence of SARS-CoV-2 infection was 7.3% in healthcare workers and 0.4% in non-healthcare workers, representing 7.0% greater absolute risk in the former (95% confidence interval for risk difference 4.7%, 9.3%). Infections were most common among nursing staff. MeaningHealth care workers, particularly those with high levels of close patient contact, may be particularly vulnerable to SARS-CoV-2 infection. Additional strategies are needed to protect these critical frontline workers.