Clinical features, diagnostics, and outcomes of patients presenting with acute respiratory illness: A retrospective cohort study of patients with and without COVID-19()

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; Abe-Jones, Yumiko; Alipanah, Narges; Alvarez, Francisco N.; Botvinnik, Olga Borisovna; Castaneda, Gloria; 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; Mary, 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

BACKGROUND: Most data on the clinical presentation, diagnostics, and outcomes of patients with COVID-19 have been presented as case series without comparison to patients with other acute respiratory illnesses. METHODS: We examined emergency department patients 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 clinical presentation, diagnostics, treatment, and outcomes. FINDINGS: Among 316 patients, 33 tested positive for SARS-CoV-2; 31 without COVID-19 tested positive for another respiratory virus. Among patients with additional viral testing (27/33), no SARS-CoV-2 co-infections were identified. Compared to those who tested negative, patients with COVID-19 reported longer symptoms duration (median 7d vs. 3d, p < 0.001). Patients with COVID-19 were more often hospitalized (79% vs. 56%, p = 0.014). When hospitalized, patients with COVID-19 had longer hospitalizations (median 10.7d vs. 4.7d, p < 0.001) and more often developed ARDS (23% vs. 3%, p < 0.001). Most comorbidities, medications, symptoms, vital signs, laboratories, treatments, 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. FUNDING: National Center for Advancing Translational Sciences, National Heart Lung Blood Institute, National Institute of Allergy and Infectious Diseases, Chan Zuckerberg Biohub, Chan Zuckerberg Initiative.