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

Background Early detection is essential to control COVID-19. Symptoms are often unspecific. Data collected merely from patients tested according to testing criteria might lead to missing a bulk of spreaders. Knowledge of symptom development during the disease helps to detect complications early. Few data have been collected in primary care so far.

Aim To extend knowledge of early symptoms as a precondition of timely diagnosis, isolation and contact tracing. To gain understanding of associations between symptoms and complicated disease to help avoid hospitalization.

Design and Settings This study was designed as a retrospective observational study in Austrian GP practices in the year 2020.

Methods Patients above 18 years with a positive SARS-CoV-2 test were included. Data collection comprised basic demographic data, risk factors and the recording of symptoms at several points in time during the course of the infection. Further descriptive data analysis was carried out by using the statistical software program R.

Results Symptoms clearly typical for COVID-19 are rare. Most symptoms are nonspecific, like malaise, fatigue or joint ache. We found symptoms indicating complicated disease, depending on the time of their occurrence. Anosmia we found to develop only after several days in many cases. At the end of the isolation period many patients still experience symptoms.

Conclusion Low threshold contact in GP practices including testing can prevent overlooking early symptoms. Patients may benefit from early monitoring. We recommend a medical check-up at the end of the isolation period.

How this fits in Most testing strategies for COVID-19 are based on symptoms assumed to be typical for the disease. We found strong hints that in the general practice-setting patients frequently do not present any of the “typical” symptoms and, thus, might be overlooked by “traditional” testing strategies. It is those patients though, who are mobile enough to widely spread the disease. Identifying them early in the course of their disease is a requirement for effective containment strategies, e.g. “Test-Trace-Isolate”.