A cross-sectional study of patients presenting for hospital-based screening for COVID-19: risk of disease, and healthcare access preferences.

Amanda Rojek; Martin Dutch; Daniel Peyton; Rachel Pelly; Mark Putland; Harriet Hiscock; Jonathan Knott

The Coronavirus Disease 2019 (COVID-19) pandemic, caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) risks placing "overwhelming demands on our health system". (1) (2) (3) (4) This is particularly so for hospital Emergency Departments (EDs) and General Practitioners (GPs) who are seen as key providers of screening for the virus. (5) However, during the early phase of importation of SARS-CoV-2 in Australia there was limited community transmission. (6) Under this scenario, the pre-test probability of infection in individuals without epidemiological risk (such as relevant travel, or close contact with a confirmed case) is low. Unnecessary presentations for testing during this phase places additional strain on the public health service, including EDs. As we enter the pandemic phase of SARS-CoV-2, it will become critically important that the right patient is assessed, and then if necessary, treated at the right facility. This can be achieved by considering alternative strategies for screening well patients, and managing mild cases. (5) There is a paucity of literature describing the healthcare-seeking behaviours of those who present for screening for a high consequence infectious disease in Australia. As Australia moves from containment to mitigation of COVID-19, we must rapidly generate evidence to calibrate and direct policy for safe, effective and efficient models of care for COVID-19. We do not know how many mildly unwell patients elect to present to an ED for screening and the barriers and facilitators to other models of care.