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

Background: Most outpatients with coronavirus disease 2019 (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 Methods: Retrospective, multicenter (8 hospitals) study reporting on 821 patients diagnosed with COVID-19 by real-time reverse transcriptase-polymerase chain reaction 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 years (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 years, p=0 002), had higher BMI (35 4 kg/m2 vs 31 9 kg/m2, p=0 004), were more likely male (58 1% vs 45 4%, p=0 026), 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% Conclusion: 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 might mitigate some of the financial and staffing pressures on healthcare systems