Early Discern COVID-19 from the Suspected Patients via Fever Clinics: A Multicenter Cohort Study from Shanghai

Background: The outbreak of novel coronavirus disease 2019 (COVID-19) has led to increasing international concern. Effective screening strategy and early recognition of the disease are crucial to limiting spread of this worldwide challenge. Methods: Fever clinics of 25 hospitals evenly distributed in 16 Districts of Shanghai were selected. All patients visiting the fever clinics from the begin of the outbreak of Shanghai (17 January 2020) to 16 February were enrolled. A standardized procedure for COVID-19 screening was presented and all the suspected cases were monitored and analyzed till they were confirmed or excluded. Findings: Among 53617 patients who visiting fever clinics, 1004 (1·87%) were considered as suspected cases, with 188 (0·35% of all patients, 18·73% of suspected cases) diagnosed as confirmed cases finally. Compared with the excluded cases, confirmed cases were older and the highest temperatures were relatively lower (p<0·01), and more symptoms like fatigue, headache, bad appetite and myalgia (p<0·05) were observed. Confirmed cases showed increased infected lung lobes (≥3) and ground glass opacity (GGO) in CT scans (p<0·001). Lower peripheral blood leucocytes and lymphocytes, procalcitonin, and higher lactate dehydrogenase and erythrocyte sedimentation rates were observed in confirmed cases (p<0·05). Exposure history (OR= 4·17), GGO (OR= 2·57), fatigue (OR= 1·61), and lymphocytes < 0·8×10^9/L (OR= 2·15,) were independent risk factors for confirmed COVID-19 cases. Interpretation: The screening strategy is needed for excluding the diseases besides COVID-19 during the spread of this contagious disease. Relevant independent risk factors identified from this study may helpful for early recognition of the disease. Funding Statement: This work was supported by the National Natural Science Fund for Distinguished Young Scholars to JFX (81925001), Shanghai Leading Talent Program (No. 2016036 to JFX) and the Project of the Shanghai Hospital Development Center (16CR3036A to JFX). Declaration of Interests: All authors declare that they have no competing interests. Ethics Approval Statement: The study was approved by the Research Ethics Committee of Shanghai Pulmonary Hospital and participating hospitals. Written informed consent was waived by the Ethics Commission of the designated hospitals for this emerging public health issue.