Hospitalization and 30-day fatality in 121,263 COVID-19 outpatient cases

Background: To date, characterisation studies of COVID-19 have focussed on hospitalised or intensive care patients. We report for the first time on the natural history of COVID-19 disease from first diagnosis, including both outpatient and hospital care. Methods: Data was obtained from SIDIAP, a primary care records database covering >6 million people (>80% of the population of Catalonia), linked to COVID-19 RT-PCR tests, hospital emergency and inpatient, and mortality registers. All participants >=15 years, diagnosed with COVID-19 in outpatient between 15th March and 24th April 2020 (10th April for outcome studies) were included. Baseline characteristics, testing, and 30-day outcomes (hospitalisation for COVID-19 and all-cause fatality) were analysed. Results: A total of 121,263 and 95,467 COVID-19 patients were identified for characterisation and outcome studies, respectively. Women (57.8%) and age 45-54 (20.2%) were predominant. 44,709 were tested, with 32,976 (73.8%) PCR+. From 95,467 cases, a 14.6% [14.4-14.9] were hospitalised in the month after diagnosis, with male predominance (19.2% vs 11.3%), peaking at age 75-84. Overall 30-day fatality was 4.0% [95%CI 3.9%-4.2%], higher in men (4.8%) than women (3.4%), increasing with age, and highest in those residing in nursing homes (25.3% [24.2% to 26.4%]). Conclusions: COVID-19 is seen in all age-sex strata, but severe forms of disease cluster in older men and nursing home residents. Although initially managed in primary care, 15% of cases require hospitalization within a month, with overall fatality of 4%.