Clinical and serological profile of asymptomatic and non- severe symptomatic COVID-19 cases: Lessons from a longitudinal study in primary care in Latin America
Clinical and serological profile of asymptomatic and non- severe symptomatic COVID-19 cases: Lessons from a longitudinal study in primary care in Latin America
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DOI：
10.3399/bjgpopen20x101137
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发表时间：
2021-01-01
期刊：
影响因子：
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通讯作者：
Montero, Joaquin
中科院分区：
文献类型：
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作者：
Puschel, Klaus;Ferreccio, Catterina;Montero, Joaquin
背景：智利是世界上 COVID-19 感染发病率最高的国家之一。初级保健可以在疾病的早期发现和遏制方面发挥关键作用。缺乏关于初级保健中疑似 COVID-19 患者临床概况的信息，并且关于快速血清学检测在疾病诊断和监测中的有效性存在争议。目的：评估快速血清学检测在初级保健中检测和监测 COVID-19 病例的有效性。设计和背景：进行了一项纵向研究，该研究基于 522 名参与者的非随机样本，其中包括 304 名有症状的患者和 218 名高危无症状个体。他们在智利圣地亚哥服务欠缺地区的四个初级卫生诊所接受护理。方法：在基线时通过转录酶聚合酶链式反应 (RT-PCR) 和血清学对参与者进行了系统的 COVID-19 评估和测试，并进行了 3 周的临床和血清学随访。结果：有症状患者中经 RT-PCR 确诊的 COVID-19 病例患病率（27.5%；95% 置信区间 [CI] = 22.1 至 32.8）是无症状参与者（7.9%；95% CI = 4.3 至 11.6）的 3.5 倍。同样，各组之间的免疫反应也存在显着差异。第三周随访期间血清学检测的敏感性为 57.8%（95% CI = 44.8 至 70.1），特异性为 98.4%（95% CI = 95.5 至 99.7）。结论：快速血清学检测对于检测疾病早期的无症状或非重症病例 COVID-19 无效，但对于监测初级保健中的免疫反应有价值。原发性 COVID-19 患者的临床特征和免疫反应与医院人群不同。
Background: Chile has one of the highest incidences of COVID-19 infection in the world. Primary care can play a key role in early detection and containment of the disease. There is a lack of information on the clinical profile of patients with suspected COVID-19 in primary care, and controversy on the effectiveness of rapid serologic tests in the diagnosis and surveillance of the disease. Aim: To assess the effectiveness of rapid serologic testing in detection and surveillance of COVID-19 cases in primary care. Design & setting: A longitudinal study was undertaken, which was based on a non-random sample of 522 participants, including 304 symptomatic patients and 218 high -risk asymptomatic individuals. They were receiving care at four primary health clinics in an underserved area in Santiago, Chile. Method: The participants were systematically assessed and tested for COVID-19 with transcriptase- polymerase chain reaction (RT-PCR) and serology at baseline, and were followed clinically and serologically for 3 weeks. Results: The prevalence rate of RT-PCR confirmed COVID-19 cases were 3.5 times higher in symptomatic patients (27.5%; 95% confidence interval [CI] = 22.1 to 32.8) compared with asymptomatic participants (7.9%; 95% CI = 4.3 to 11.6). Similarly, the immune response was significantly different between groups. Sensitivity of serologic testing was 57.8% (95% CI = 44.8 to 70.1) during the third week follow- up and specificity was 98.4% (95% CI = 95.5 to 99.7). Conclusion: Rapid serologic testing is ineffective for detecting asymptomatic or non- severe cases COVID-19 at early stages of the disease, but can be of value for surveillance of immunity response in primary care. The clinical profile and immune response of patients with COVID-19 in primary differs from those in hospital- based populations.