Epidemiology, Clinical Characteristics, and Outcomes of a Large Cohort of COVID-19 Outpatients in Michigan

Abstract Background: Most individuals with COVID-19 do not initially demonstrate severe features requiring hospitalization. Understanding this population’s epidemiological and clinical characteristics to allow outcome anticipation is crucial in healthcare resource allocation. We aim at describing the epidemiology, clinical characteristics and associated outcomes of high-risk patients diagnosed with COVID-19 at the largest healthcare system in Michigan.Methods: Retrospective, multicenter (8 hospitals) study reporting on 821 patients diagnosed with COVID-19 by real-time reverse transcriptase–polymerase chain reaction (RT-PCR) assay of nasopharyngeal swabs and discharged home to self-isolate after evaluation in Emergency Departments (EDs) within Beaumont Health System in March, 2020. Outcomes were collected through April 14, 2020, with a minimum of 12 day follow up and included subsequent ED visit, admission status, and mortality.Results: Of the 821 patients, mean age was 49.3 (SD 15.7), 46.8% were male and 55.1% were African-American. Cough was the most frequent symptom in 78.2% of patients with a median duration of 3 days (IQR 2-7), and other symptoms included fever 62.1%, rhinorrhea or nasal congestion 35.1% and dyspnea 31.2%. ACEI/ARBs usage was reported in 28.7% patients and 34.0% had diabetes mellitus. Return to the ED for re-evaluation was reported in 19.2% of patients from whom 54.4% were admitted. The patients eventually admitted to the hospital were older (mean age 54.4 vs 48.7, p=.002), had higher BMI (35.4 vs 31.9, p=.004), were more likely male (58.1% vs 46.8%, p=.026), and more likely to have hypertension (52.3% vs 29.4%, p<0.001), diabetes mellitus (74.4% vs 29.3%, p<0.001) or prediabetes (25.6% vs 8.4%, p<0.001), COPD (39.5% vs 5.4%, p<0.001), and OSA (36% vs 19%, p<0.001). The overall mortality rate was 1.3%.Conclusions:We found that 80.8% of patients did not return to the ED for re-evaluation. Sending patients with COVID-19 home if they experience mild symptoms is a safe approach for most patients and would likely mitigate some of the financial and staffing pressures on healthcare systems.