Clinical Characteristics of Patients With Coronavirus Disease 2019 (COVID-19) Receiving Emergency Medical Services in King County, Washington

• Published in: JAMA network open Vol. 3; no. 7; p. e2014549
• Main Authors: Yang, Betty Y, Barnard, Leslie M, Emert, Jamie M, Drucker, Christopher, Schwarcz, Leilani, Counts, Catherine R, Murphy, David L, Guan, Sally, Kume, Kosuke, Rodriquez, Karen, Jacinto, Tracie, May, Susanne, Sayre, Michael R, Rea, Thomas
• Format: Journal Article
• Language: English
• Published: United States American Medical Association 01-07-2020
• Subjects: Aged; Aged, 80 and over; Betacoronavirus; Clinical Laboratory Techniques; Cohort Studies; Coronavirus Infections - diagnosis; Coronavirus Infections - epidemiology; Coronavirus Infections - therapy; Coronaviruses; Cough - epidemiology; COVID-19; COVID-19 Testing; Dyspnea - epidemiology; Emergency medical care; Emergency Medical Services; Emergency services; Female; Fever - epidemiology; Humans; Hypoxia - epidemiology; Infectious Diseases; Long-Term Care; Male; Middle Aged; Multiple Chronic Conditions - epidemiology; Online Only; Original Investigation; Oxygen Inhalation Therapy; Pandemics; Pneumonia, Viral - diagnosis; Pneumonia, Viral - epidemiology; Pneumonia, Viral - therapy; Respiratory Therapy; Retrospective Studies; Reverse Transcriptase Polymerase Chain Reaction; SARS-CoV-2; Severe acute respiratory syndrome; Severe acute respiratory syndrome coronavirus 2; Tachypnea - epidemiology; Washington - epidemiology; Washington
• ISSN: 2574-3805; 2574-3805
• DOI: 10.1001/jamanetworkopen.2020.14549

The ability to identify patients with coronavirus disease 2019 (COVID-19) in the prehospital emergency setting could inform strategies for infection control and use of personal protective equipment. However, little is known about the presentation of patients with COVID-19 requiring emergency care, particularly those who used 911 emergency medical services (EMS).
To describe patient characteristics and prehospital presentation of patients with COVID-19 cared for by EMS.
This retrospective cohort study included 124 patients who required 911 EMS care for COVID-19 in King County, Washington, a large metropolitan region covering 2300 square miles with 2.2 million residents in urban, suburban, and rural areas, between February 1, 2020, and March 18, 2020.
COVID-19 was diagnosed by reverse transcription-polymerase chain reaction detection of severe acute respiratory syndrome coronavirus 2 from nasopharyngeal swabs. Test results were available a median (interquartile range) of 5 (3-9) days after the EMS encounter.
Prevalence of clinical characteristics, symptoms, examination signs, and EMS impression and care.
Of the 775 confirmed COVID-19 cases in King County, EMS responded to 124 (16.0%), with a total of 147 unique 911 encounters. The mean (SD) age was 75.7 (13.2) years, 66 patients (53.2%) were women, 47 patients (37.9%) had 3 or more chronic health conditions, and 57 patients (46.0%) resided in a long-term care facility. Based on EMS evaluation, 43 of 147 encounters (29.3%) had no symptoms of fever, cough, or shortness of breath. Based on individual examination findings, fever, tachypnea, or hypoxia were only present in a limited portion of cases, as follows: 43 of 84 encounters (51.2%), 42 of 131 (32.1%), and 60 of 112 (53.6%), respectively. Advanced care was typically not required, although in 24 encounters (16.3%), patients received care associated with aerosol-generating procedures. As of June 1, 2020, mortality among the study cohort was 52.4% (65 patients).
The findings of this cohort study suggest that screening based on conventional COVID-19 symptoms or corresponding examination findings of febrile respiratory illness may not possess the necessary sensitivity for early diagnostic suspicion, at least in the prehospital emergency setting. The findings have potential implications for early identification of COVID-19 and effective strategies to mitigate infectious risk during emergency care.