Relationship of socio-demographics, comorbidities, symptoms and healthcare access with early COVID-19 presentation and disease severity

BackgroundCOVID-19 studies are primarily from the inpatient setting, skewing towards severe disease. Race and comorbidities predict hospitalization, however, ambulatory presentation of milder COVID-19 disease and characteristics associated with progression to severe disease is not well-understood.MethodsWe conducted a retrospective chart review including all COVID-19 positive cases from Stanford Health Care (SHC) in March 2020 to assess demographics, comorbidities and symptoms in relationship to: 1) their access point of testing (outpatient, inpatient, and emergency room (ER)) and 2) development of severe disease.ResultsTwo hundred fifty-seven patients tested positive: 127 (49%), 96 (37%), and 34 (13%) at outpatient, ER and inpatient, respectively. Overall, 61% were age<55; age>75 was rarer in outpatient setting (11%) than ER (14%) or inpatient (24%). Most patients presented with cough (86%), fever/chills (76%), or fatigue (63%). 65% of inpatients reported shortness of breath compared to 30-32% of outpatients and ER patients. Ethnic/minority patients had a significantly higher risk of developing severe disease (Asian OR=4.8 [1.6-14.2], Hispanic OR=3.6 [1.1-11.9]). Medicare-insured patients were marginally more likely (OR=4.0 [0.9-17.8]). Other factors associated with developing severe disease included kidney disease (OR=6.1 [1.0-38.1]), cardiovascular disease (OR=4.7 [1.0-22.1], shortness of breath (OR=5.4 [2.3-12.6]) and GI symptoms (OR=3.3 [1.4-7.7]; hypertension without concomitant CVD or kidney disease was marginally significant (OR=2.3 [0.8-6.5]).ConclusionsEarly widespread symptomatic testing for COVID-19 in Silicon Valley included many less severely ill patients. Thorough manual review of symptomatology reconfirms the heterogeneity of COVID-19 symptoms, and challenges in using clinical characteristics to predict decline. We re-demonstrate that socio-demographics are consistently associated with severity.