COVID-19 clinical course, testing and treatments used in hospitalized and ambulatory patients
1. Timing of COVID-19 could be improved:
5-7 days delay between first symptoms & healthcare intervention could be improved.
This delay could significantly affect the evolution, prognosis and outcome in some patients.
Probably this time-frame will be shorten in future as the patients and doctors are more vigilant and aware about the disease.
Delay between symptoms presentation and healthcare seek: 6-7 days in patients hospitalized versus 5 days in mild-patients attended with at-home follow-up system.
2-4 days between general hospitalization and ICU hospitalization.
Average of 11-14 days of hospital stay in hospitalized patients.
2. Increase testing in patients followed at-home is needed:
Massive testing must be implemented to at least all the patients showing symptoms.
Only 22% of patients with mild disease were tested to confirm the diagnosis of COVID-19.
3. At-home follow-up system for mild-patients is good but need some improvement:
At-home follow-up has resulted efficient but improvement in communication systems has to be implemented, specially to allow the doctor to verify the symptoms referred by the patients on the phone.
The at-home system must facilitate doctors the use of new technologies to contact and follow the patients: real-time audio-video technology must be available to primary care doctors.
3 demands from doctors following patients by phone:
Facilitate protective equipment.
Improve communication systems.
4. Risk factors (HT and Diabetes) are correlated to severity:
Several studies have confirmed the association of certain risk factors to severity.
In clinical practice, our study confirm that the presence of hypertension and diabetes increases dramatically with severity and ICU hospitalization.
75% of patients in ICU had hypertension vs only 39% of total patients COVID-19 treated by doctors.
56% of patients in ICU had Diabetes vs only 26% of total patients with COVID-19.
ERC, ECV and EPOC seems to be less correlated with severity.
5. Some prognostic markers are used in clinical practice and correlated to severe course:
Several studies have established the early markers of severe clinical course.
Our study confirm that more severe patients (ICU) had higher lymphopenia, higher D-Dimer levels and higher IL-6 levels vs global.
Low lymphocytes count is highly correlated with severity as well as D-Dimer and IL-6.
6. Few treatments are used in clinical practice:
Specialists are using treatments in higher % of patients.
Hydroxichloroquine & Azitromicin are used in 80-84% of patients treated by specialists.
Lopinavir-Ritonavir combination is used in 61% of patients treated by specialists.
7. Doctors have suffered moderate to extreme stress:
100% of participants have some level of stress.
69% of doctors treating COVID-19 in hospitals had moderate-extreme stress.
50% of specialists doctors suffered extreme stress.
38% of primary care doctors suffered extreme stress.
8. Scientific information is demanded by doctors:
81% of doctors request more information and updates about treatment efficacy.
75% of hospital specialists demand more information about other hospital’s protocols of treatment.
63% of hospital specialists demand more information about prognostic factors used in other hospitals.
69% of all doctors demand more information about epidemiology and risk factors.
Online survey performed by Axis Pharma between 15 and 27 April 2020. Sample size is 24 doctors (16 hospital and 8 primary care doctors doing at-home and phone follow-up).