On March 11, 2020, a pandemic due to SARS-CoV-2, the cause of coronavirus disease 2019 (COVID-19), was declared. The disease spectrum varies from asymptomatic detection to severe disease. Data on community versus hospitalized cases are limited. We aim to evaluate and compare the epidemiological and clinical characteristics associated with SARS-CoV-2 infection among suspected and confirmed COVID-19 cases primarily diagnosed in the ambulatory setting and compare their illness presentation.
We are prospectively enrolling a longitudinal cohort of laboratory-confirmed or suspected COVID-19 subjects and their close contacts. Suspect cases are defined as anyone who developed fever and/or Covid-19 like-symptoms in the post-Covid-19 era without proven SARS-CoV-2 detection. We consented and interviewed subjects over the phone to capture detailed sociodemographic data, medical and social histories, and clinical characteristics of the illness.
From March 20 to June 16, 2020, 463 subjects were enrolled (Figure 1). Of those, 178 were SARS-CoV-2 positive [164 adults and 13 pediatric (< 18 years) cases] and 192 were COVID-19 suspected (111 adults and 78 pediatric cases). Adult confirmed cases were more likely to be Hispanic and have an underlying medical condition but less likely to be white compared to suspected cases (Table 1). Pediatric confirmed cases were more likely to be Hispanic and have smoke exposure, but less likely to have a travel history compared to suspected cases (Table 1). Both adult and pediatric confirmed subjects had fatigue, headache and cough as the most common symptoms reported. Cough, muscle aches and chest tightness were more likely to be reported in pediatric confirmed than suspected cases; whereas loss of taste, smell and appetite, diarrhea and fever ≥ 100.4 were documented more often in adult confirmed than suspected cases (Figure 2).
We observed differences of clinical presentation between confirmed and suspected cases among both pediatric and adult participants. Further research is needed to determine whether these differences are due to disease severity or absence of proven COVID-19. We are collecting serial nasal swabs, blood and stool specimens, on which future testing will confirm SARS-CoV-2 infection in suspected subjects.