Clinical diagnosis of SARS-CoV-2 infection: An observational study of respiratory tract infection in primary care in the early phase of the pandemic

Alike W van der Velden; Milensu Shanyinde; Emily Bongard; Femke Böhmer; Slawomir Chlabicz; Annelies Colliers; Ana García-Sangenís; Lile Malania; Jozsef Pauer; Angela Tomacinschii; Ly-Mee Yu; Katherine Loens; Margareta Ieven; Theo J Verheij; Herman Goossens; Akke Vellinga; Christopher C Butler

doi:10.1080/13814788.2023.2270707

Clinical diagnosis of SARS-CoV-2 infection: An observational study of respiratory tract infection in primary care in the early phase of the pandemic

Eur J Gen Pract. 2023 Dec;29(1):2270707. doi: 10.1080/13814788.2023.2270707. Epub 2023 Oct 23.

Authors

Alike W van der Velden¹, Milensu Shanyinde², Emily Bongard², Femke Böhmer³, Slawomir Chlabicz⁴, Annelies Colliers⁵, Ana García-Sangenís⁶, Lile Malania⁷, Jozsef Pauer⁸, Angela Tomacinschii⁹, Ly-Mee Yu², Katherine Loens¹⁰, Margareta Ieven¹⁰, Theo J Verheij¹, Herman Goossens¹⁰, Akke Vellinga¹¹, Christopher C Butler²

Affiliations

¹ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
² Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
³ Institute of General Practice, Rostock University Medical Center, Rostock, Germany.
⁴ Department of Family Medicine, Medical University of Bialystok, Bialystok, Poland.
⁵ Department of Family Medicine & Population Health, University of Antwerp, Antwerp, Belgium.
⁶ Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.
⁷ National Center for Disease Control and Public Health, Tbilisi and Arner Science Management LLC, Tbilisi, Georgia.
⁸ DRC Drug Research Centre, Balatonfüred, Hungary.
⁹ University Clinic of Primary Medical Assistance of State University of Medicine and Pharmacy "N. Testemițanu", Chişinǎu, The Republic of Moldova.
¹⁰ Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium.
¹¹ School of Public Health, Physiotherapy and Sports Science, University College Dublin (UCD), Dublin, Ireland.

Abstract

Background: Early in the COVID-19 pandemic, GPs had to distinguish SARS-CoV-2 from other aetiologies in patients presenting with respiratory tract infection (RTI) symptoms on clinical grounds and adapt management accordingly.

Objectives: To test the diagnostic accuracy of GPs' clinical diagnosis of a SARS-CoV-2 infection in a period when COVID-19 was a new disease. To describe GPs' management of patients presenting with RTI for whom no confirmed diagnosis was available. To investigate associations between patient and clinical features with a SARS-CoV-2 infection.

Methods: In April 2020-March 2021, 876 patients (9 countries) were recruited when they contacted their GP with symptoms of an RTI of unknown aetiology. A swab was taken at baseline for later analysis. Aetiology (PCR), diagnostic accuracy of GPs' clinical SARS-CoV-2 diagnosis, and patient management were explored. Factors related to SARS-CoV-2 infection were determined by logistic regression modelling.

Results: GPs suspected SARS-CoV-2 in 53% of patients whereas 27% of patients tested positive for SARS-CoV-2. True-positive patients (23%) were more intensively managed for follow-up, antiviral prescribing and advice than true-negatives (42%). False negatives (5%) were under-advised, particularly for social distancing and isolation. Older age (OR: 1.02 (1.01-1.03)), male sex (OR: 1.68 (1.16-2.41)), loss of taste/smell (OR: 5.8 (3.7-9)), fever (OR: 1.9 (1.3-2.8)), muscle aches (OR: 2.1 (1.5-3)), and a known risk factor for COVID-19 (travel, health care worker, contact with proven case; OR: 2.7 (1.8-4)) were predictive of SARS-CoV-2 infection. Absence of loss of taste/smell, fever, muscle aches and a known risk factor for COVID-19 correctly excluded SARS-CoV-2 in 92.3% of patients, whereas presence of 3, or 4 of these variables correctly classified SARS-CoV-2 in 57.7% and 87.1%.

Conclusion: Correct clinical diagnosis of SARS-CoV-2 infection, without POC-testing available, appeared to be complicated.

Keywords: COVID-19; SARS-CoV-2; diagnostic accuracy; prediction; respiratory tract infection.

Publication types

Observational Study

MeSH terms

Ageusia*
COVID-19 Testing
COVID-19* / diagnosis
Humans
Male
Pain
Pandemics
Primary Health Care
SARS-CoV-2

Grants and funding

AWV, CCB, EB and HG received unrestricted funding for studies from the European Commission (IMI2, H2020 and Horizon Europe). This work is supported by RECOVER (Rapid European COVID-19 Emergency research Response), which has received funding from the EU Horizon 2020 Research and Innovation programme [grant agreement number 101003589].