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Early descriptions of COVID-19 in the U.S. focused on hospitalized patients, and exposures were mostly documented in congregate settings such as meat and poultry plants and long-term care facilities. To see the wider picture, 11 academic medical centers in nine states in the IVY Network (Influenza Vaccine Effectiveness in the Critically Ill) interviewed a random sample of adults who had tested positive — both outpatients and inpatients — after the national social distancing guidelines of March 16, 2020.
CDC
The survey
CDC staff phoned patients 14–21 days after testing (a few at 28–35 days), with interviews in eight languages, asking about demographics, chronic conditions, symptoms on the test date, and exposures in the two weeks before illness. Tests were done March 31–May 10; interviews April 15–May 24, 2020.
Of 798 patients called, 398 completed interviews; after excluding proxy interviews, 350 were analyzed:
| Outpatients | 271 (77%) — 70 tested in emergency departments, 201 elsewhere; 22 were later admitted |
| Inpatients | 79 (23%) — 17 in intensive care |
| Median age | 43 |
| Female | 53% |
| White / Hispanic / Black | 33% / 33% / 21% |
Inpatients vs outpatients
| Inpatients | Outpatients | |
|---|---|---|
| Median age | 54 | 42 |
| White | 19% | 37% |
| Household income under $25,000 | 28% | 13% |
| Median chronic conditions | 2 | 1 |
| Shortness of breath at testing | 72% | 32% |
| Loss of smell or taste | 43% | 59% |
| Back to usual health at 14–21 days (symptomatic) | 39% (20 of 51) | 64% (150 of 233) |
Inpatients more often had heart conditions, chronic lung disease and diabetes; 43% were Hispanic and 28% Black — though the analysis didn't adjust for other factors. 92% of respondents asked about symptoms had at least one on the day they were tested.
About a third of symptomatic outpatients hadn't returned to normal health two to three weeks after testing — whereas in the 2012–13 flu season, almost all working adults with confirmed flu seen as outpatients were back to normal activities within 14 days.
Where they were exposed
- Only 46% (153 of 332) knew of close contact — within 6 feet — with someone with COVID-19 in the two weeks before illness.
- Those contacts were most often family members (45%) or co-workers (34%).
- 64% of participants were employed, but only 17% (35 of 209) could telework. Outpatients were more likely to be working (70% vs 42%) and to be around people outside the home. 25% of those employed worked in health care.
What it means
With most patients unaware of any contact, controlling spread requires screening, case investigation, contact tracing and isolation, plus social distancing and wider use of cloth face coverings. Since so many were working and few could work from home, workplace safety measures need strengthening. And because patients reported a wide range of symptoms, many different symptoms should prompt testing.
Limits
- As a phone survey, it may under-represent the sickest patients, who might still have been in hospital or have died.
- Patients came from academic centers and aren't representative nationally; some groups, such as essential workers, may have been tested preferentially.
- Answers were self-reported, and symptoms were captured only on the test date.
- No adjustment was made for other factors when comparing groups.
Sources
Based on Tenforde MW, Billig Rose E, Lindsell CJ, et al., "Characteristics of Adult Outpatients and Inpatients with COVID-19 — 11 Academic Medical Centers, United States, March–May 2020," MMWR volume 69, number 26, Centers for Disease Control and Prevention; a work of the United States government in the public domain.
Licens: CC0 1.0 (offentligt eje) · Bearbejdet efter www.cdc.gov
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