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CDC Survey Reveals Telling Information on COVID-19 Outpatients

Results highlight burden of disease and potential issues associated with contact tracing.

We know a lot about patients hospitalized with coronavirus 2019 (COVID-19)—relatively speaking.

However, at least generally, we have less of a sense of the burden of disease for those with confirmed SARS-CoV-2 infection who aren’t sick enough to rush off to the emergency department.

A new survey conducted by the US Centers for Disease Control and Prevention (CDC)—and released earlier this month—goes some toward addressing that knowledge gap. The survey, with 350 respondents, 77% of whom were recuperating and isolating in outpatient settings (a fancy way of saying “at home”), reveals just how serious the virus is, even for those who don’t end up in the hospital.

For example, 36% of the outpatient respondents reported that they had not returned to a “baseline level of health” 14 to 21 days after receiving a positive test result for the new coronavirus, according to CDC researchers. In addition, just 17% of the respondents said they were able to “telework,” suggesting that in addition to still feeling sick they likely also experienced financial hardships as a result of their COVID-19 diagnosis, the researchers found. Also, most respondents said they had worked during the 2 weeks preceding their illness,

“underscoring the need for enhanced measures to ensure workplace safety,” the researchers said.

In addition, 96% of patients tested in an outpatient setting had at least one symptom of the disease on the day they were tested. Overall, 32% reported (compared to 72% of hospitalized patients) and 59% said they experienced “loss of smell or taste” (compared to 43% of hospitalized patients).

Perhaps not surprisingly—given what we think we know about COVID-19—outpatient respondents tended to be younger (median age 42 years) than their hospitalized counterparts (median age: 54 years). The well-documented racial disparities among COVID-19 patients showed up in the survey findings as well: 28% and 43% of inpatient respondents were Black or Hispanic, respectively, while those percentages were 19% and 30%, respectively, for outpatient respondents.

In all, 18% of outpatient respondents lacked health insurance or had unknown insurance status, compared to 15% of inpatient respondents—suggesting, potentially, that lack of health insurance may compel some to attempt to recover from COVID-19 at home.

And, outpatient respondents were less likely to report having an underlying health condition (eg, diabetes, heart disease, kidney disease) than inpatient respondents, meaning they are generally less likely to experience serious illness after being infected.

Finally, in findings that don’t bode well for efficient contact tracing, only 46% of all respondents reported recent contact with a COVID-19 patient, with 45% of contacts being a family member and 34% involving a work colleague. Notably, 7 of the respondents were “missing data in the case contact histories,” the CDC researchers said.

“Case investigation, contact tracing, and isolation of infected persons are needed to prevent ongoing community transmission, given the frequent lack of a known contact,” they wrote.

Based on their findings, they added, “enhanced measures to ensure workplace safety, including social distancing and more widespread use of cloth face coverings, are warranted.”