Symptoms and risk factors for hospitalization of COVID-19 presented in primary care

Objective To extend knowledge of early symptoms as a precondition of early identification, and to gain understanding of associations between early symptoms and the development of a severe course of the disease. Design Retrospective observational study Setting Austrian GP practices in the year 2020, patients above 18 years were included. Participants We recruited 22 practices who included altogether 295 participants with a positive SARS-CoV-2 test. Main outcome measures Data collection comprised basic demographic data, risk factors and the recording of symptoms at several points in time in the course of the illness. Descriptive analyses for possible associations between demographics and symptoms were conducted by means of cross table. Group differences (hospitalized yes/no) were assessed using Fisher’s exact test. The significance level was set to 0.05; due to the observational character of the study, no adjustment for multiplicity was performed. Results Little more than one third of patients report symptoms generally understood to be typical for Covid-19. Most patients present with a variety of unspecific complaints. We found symptoms indicating complicated disease, depending on when they appear. The number of symptoms is likely to be a predictor for the need of hospital care. More than 50% of patients still experience symptoms 14 days after onset. Conclusions Underrating unspecific symptoms as possible indicators for SARS-CoV-2 infection harbours the danger of overlooking early disease. Monitoring patients during their illness using the indicators for severe disease we identified may help to identify patients who are likely to profit from early intervention. Data availability statement All data referred to in the manuscript are available from: Department of General Medicine and Family Practice, Karl Landsteiner Privatuniversitaet, Krems, Austria Article Summary Strengths and limitations This study investigates data on the course of COVID-19 collected exclusively from patients in primary care and explores a wide range of symptoms. GPs were free to make their own testing decision according to their clinical judgement, and they followed each patient individually from day 1 to day 10 or 14. Limitations of our study concern the limited number of patients, due to the increased workload under difficult working conditions during the pandemic as well as the effort not being remunerated. However, the number of cases needed to identify group differences was calculated in advance, and this number has been reached. Our overall results are in accordance with our preliminary result analyses.