68 Consecutive patients assessed for COVID-19 infection; experience from a UK regional infectious disease unit

Nicholas Easom; Peter Moss; Gavin Barlow; Anda Samson; Tom Taynton; Kate Adams; Monica Ivan; Phillipa Burns; Kavitha Gajee; Kirstine Eastick; Patrick Lillie

In the UK, public health and clinical services have been working to identify suspected cases according to a national case definition and to arrange testing, predominantly by real-time PCR of nose and throat swabs. Since testing began, local procedures and national guidelines have changed in response to changing understanding of the disease and demand for testing. On the evening of 06/02/2020 the UK definition of a suspected case was extended to include people presenting with respiratory illness (defined as cough, shortness of breath or fever with or without other symptoms) returning from or transiting through China including Hong Kong and Macau, Japan, Malaysia, South Korea, Singapore, Taiwan or Thailand within the last 14 days, with the case definition subsequently changing further on 25/02/2020 to include northern Italy, Iran and further countries in SE Asia. As of 27/02/2020, 7690 tests have been performed nationally, of which 15 were positive (0.2%). Initially, testing has been led by clinicians, predominantly by infectious diseases or emergency department physicians, although there are plans to move to a community testing model led by other groups of healthcare professionals, and some regions have already done so. Patients are instructed to selfisolate while results are pending and until their symptoms have resolved, with possible financial and health implications for the 99.8% so far in the UK who have an illness other than COVID-19. During the 2009 H1N1 influenza pandemic when a syndromic management strategy with presumptive treatment and self-isolation was used, initial clinical diagnoses of influenza were reported to delay diagnoses of a number of diseases including primary HIV infection 7 and Plasmodium falciparum malaria 8 , and although scoring systems were developed it remains difficult to distinguish between viral and bacterial pneumonia on clinical grounds 9 . In addition, many mild respiratory viral infections were managed as influenza 10 , with significant resource implications, both for healthcare services and patients Here we describe our experience of the first 68 patients we have tested for SARS-CoV-2 at a Regional Infectious Diseases unit (RIDU) in the UK. We present the spectrum of illness, alternative diagnoses made and management provided. This is of particular interest at this stage of the epidemic, where many individuals meeting the definition of a suspected case are returning travellers, where the differential diagnosis of respiratory or undifferentiated febrile illness may be broad 11 . These findings have implications for the clinical and logistical support that may be required for roll-out of community testing to be a safe and effective replacement for the current predominantly hospitalbased, physician-led system.