Time taken by individuals with respiratory symptoms to present to primary care: a descriptive study of assessments at Australian General Practitioner-led respiratory clinics
DOI:
https://doi.org/10.33321/cdi.2022.46.20Keywords:
COVID-19, Coronavirus disease 2019, SARS-CoV-2, respiratory symptoms, primary health care, public health response, testing, AustraliaAbstract
Effective control of coronavirus disease 2019 (COVID-19) has been challenging, in part due to significant asymptomatic and pre-symptomatic transmission of disease. Reducing the time between symptom onset and COVID-19 testing and isolation allows enhanced outbreak control. The purpose of this study is to describe the time taken by participants to present to general practitioner-led (GP) respiratory clinics for assessment following the development of symptoms, and to explore associations between demographic and geographic characteristics and the time to presentation.
A total of 314,148 participants, who were assessed in GP respiratory clinics between 1 February and 31 August 2021, were included in the analysis. The median age of participants at presentation was 33 years (interquartile range, IQR: 15–49).
The median time from development of symptoms to presentation for assessment at GP respiratory clinics was 2 days (IQR: 1–3). Participants were more likely to present within one day of symptom onset if they were aged between 15 and 64 years (43.4%), lived in urban areas (40.9%) or were non-Indigenous (40.2%). Participants in New South Wales and Victoria had twice the odds (OR 2.01; 95% confidence interval (CI): 1.95, 2.08) of presenting at a GP respiratory clinic within one day of symptom onset in August 2021, when there was a COVID-19 outbreak in those states, than they did in March 2021, when there was no COVID-19 outbreak in Australia.
The number of days from symptom onset to presentation at a GP respiratory clinic was strongly associated with the presence of a COVID-19 outbreak. Participant age, location of the clinic, and Indigenous status of participants were also associated with the time to presentation. This study highlights the importance of recognising COVID-19 as a potential cause of symptoms, as well as the importance of providing easily accessible, and culturally appropriate, testing facilities for the population.
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References
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497–506. doi: https://doi.org/10.1016/S0140-6736(20)30183-5.
Wei WE, Li Z, Chiew CJ, Yong SE, Toh MP, Lee VJ. Presymptomatic transmission of SARS-CoV-2 — Singapore, January 23–March 16, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(14):411–5. doi: https://doi.org/10.15585/mmwr.mm6914e1.
Xin H, Li Y, Wu P, Li Z, Lau EHY, Qin Y et al. Estimating the latent period of coronavirus disease 2019 (COVID-19). Clin Infect Dis. 2021. doi: https://doi.org/10.1093/cid/ciab746.
Bae S, Lim JS, Kim JY, Jung J, Kim S-H. Transmission characteristics of SARS-CoV-2 that hinder effective control. Immune Netw. 2021;21(1). doi: https://doi.org/10.4110/in.2021.21.e9.
He X, Lau EHY, Wu P, Deng X, Wang J, Hao X et al. Temporal dynamics in viral shedding and transmissibility of COVID-19. Nat Med. 2020;26(5):672–5. doi: https://doi.org/10.1038/s41591-020-0869-5.
Casey-Bryars M, Griffin J, McAloon C, Byrne A, Madden J, Mc Evoy D et al. Presymptomatic transmission of SARS-CoV-2 infection: a secondary analysis using published data. BMJ Open. 2021;11(6):e041240. doi: https://doi.org/10.1136/bmjopen-2020-041240.
Johansson MA, Quandelacy TM, Kada S, Prasad PV, Steele M, Brooks JT et al. SARS-CoV-2 transmission from people without COVID-19 symptoms. JAMA Netw Open. 2021;4(1):e2035057-e. doi: https://doi.org/10.1001/jamanetworkopen.2020.35057.
Moghadas SM, Fitzpatrick MC, Sah P, Pandey A, Shoukat A, Singer BH et al. The implications of silent transmission for the control of COVID-19 outbreaks. Proc Natl Acad Sci U S A. 2020;117(30):17513–5. doi: https://doi.org/10.1073/pnas.2008373117.
Australian Government Department of Health, Communicable Diseases Network Australia (CDNA). Coronavirus disease 2019 (COVID-19): CDNA national guidelines for public health units. [Internet.] Canberra: Australian Government Department of Health; 2021. Available from: https://www1.health.gov.au/internet/main/publishing.nsf/Content/cdna-song-novel- coronavirus.htm.
Australian Government Department of Health. What you need to know about coronavirus (COVID-19): how to get tested. [Internet.] Canberra: Australian Government Department of Health; 11 August 2021. Available from: https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/ongoing-support-during-coronavirus-covid-19/what-you-need-to-know-about-coronavirus-covid-19#how-to-get-tested.
Reddy KP, Shebl FM, Foote JHA, Harling G, Scott JA, Panella C et al. Cost-effectiveness of public health strategies for COVID-19 epidemic control in South Africa: a microsimulation modelling study. Lancet Glob Health. 2021;9(2):e120–9. doi: https://doi.org/10.1016/S2214-109X(20)30452-6.
Kretzschmar ME, Rozhnova G, Bootsma MCJ, van Boven M, van de Wijgert JHHM, Bonten MJM. Impact of delays on effectiveness of contact tracing strategies for COVID-19: a modelling study. Lancet Public Health. 2020;5(8):e452–9. doi: https://doi.org/10.1016/S2468-2667(20)30157-2.
Department of the Prime Minister and Cabinet. Media release: 11 Mar 2020. Canberra: Australian Government Department of the Prime Minister and Cabinet; 11 March 2020. Available from: https://www.pm.gov.au/media/24-billion-health-plan-fight-covid-19#:~:text=The%20Australian%20Government%20has%20unveiled,coronavirus%20(COVID%2D19).
Australian Government Department of Health. Coronavirus (COVID-19) GP respiratory clinics. [Internet.] Canberra: Australian Government Department of Health; 9 October 2020. Available from: https://www.health.gov.au/initiatives-and-programs/coronavirus-covid-19-gp-respiratory-clinics.
StataCorp. Stata: Release 17. Statistical Software. College Station, TX: StataCorp LLC; 2021.
Keast DH, Marshall JN, Stewart MA, Orr V. Why do patients seek family physicians’ services for cold symptoms? Can Fam Physician. 1999;45:335–40.
New South Wales Government, Agency for Clinical Innovation. COVID-19 Risk Monitoring Dashboard. [Webpage.] Sydney: New South Wales Department of Health; 2021. Available from: https://aci.health.nsw.gov.au/covid-19/critical-intelligence-unit/dashboard.
Mowbray F, Woodland L, Smith LE, Amlôt R, Rubin GJ. Is my cough a cold or covid? A qualitative study of COVID-19 symptom recognition and attitudes toward testing in the UK. Front Public Health. 2021;9:716421. doi: https://doi.org/10.3389/fpubh.2021.716421.
Rubin GJ, Smith LE, Melendez-Torres GJ, Yardley L. Improving adherence to ‘test, trace and isolate’. J R Soc Med. 2020;113(9):335–8. doi: https://doi.org/10.1177/0141076820956824.
Smith LE, Potts HWW, Amlôt R, Fear NT, Michie S, Rubin GJ. Adherence to the test, trace, and isolate system in the UK: results from 37 nationally representative surveys. BMJ. 2021;372:n608. doi: https://doi.org/10.1136/bmj.n608.
Clipman SJ, Wesolowski A, Mehta SH, Cobey S, Cummings DAT, Solomon SS. Improvements in SARS-CoV-2 testing cascade in the US: data from serial cross-sectional assessments. Clin Infect Dis. 2021. doi: https://doi.org/10.1093/cid/ciab683.
Bevan I, Stage Baxter M, Stagg HR, Street A. Knowledge, attitudes, and behavior related to COVID-19 testing: a rapid scoping review. Diagnostics (Basel). 2021;11(9). doi: https://doi.org/10.3390/diagnostics11091685.
Carter P, Megnin-Viggars O, Rubin GJ. What factors influence symptom reporting and access to healthcare during an emerging infectious disease outbreak? A rapid review of the evidence. Health Secur. 2021;19(4):353–63. doi: https://doi.org/10.1089/hs.2020.0126.
Government of New South Wales. COVID-19 restrictions tightened across Greater Sydney. [Internet.] Sydney: Government of New South Wales; 9 July 2021. Available from: https://www.nsw.gov.au/media-releases/covid-19-restrictions-tightened-across-greater-sydney.
Premier of Victoria. Seven day lockdown to keep Victorians safe. [Internet.] Melbourne: Victoria State Government, Premier of Victoria; 5 August 2021. Available from: https://www.premier.vic.gov.au/seven-day-lockdown-keep-victorians-safe.
Australian Institute of Health and Welfare (AIHW). Rural & remote health. Canberra: Australian Government, AIHW; 22 October 2019. Available from: https://www.aihw.gov.au/reports/rural-remote-australians/rural-remote-health/contents/summary.
Stanley F, Langton M, Ward J, McAullay D, Eades S. Australian First Nations response to the pandemic: a dramatic reversal of the ‘gap’. J Paediatr Child Health. 2021. doi: https://doi.org/10.1111/jpc.15701.
He B, Zaidi S, Elesedy B, Hutchinson M, Paleyes A, Harling G et al. Effectiveness and resource requirements of test, trace and isolate strategies for COVID in the UK. R Soc Open Sci. 2021;8(3):201491. doi: https://doi.org/10.1098/rsos.201491.
Department of the Prime Minister and Cabinet. National plan to transition Australia’s national COVID-19 response. Canberra: Australian Government Department of the Prime Minister and Cabinet; 6 August 2021. Available from: https://www.pm.gov.au/sites/default/files/media/national-plan-to-transition-australias-national-covid-19-response-30-july-2021.pdf.
Gupta A, Gonzalez-Rojas Y, Juarez E, Casal MC, Moya J, Falci DR et al. Early Covid-19 treatment with SARS-CoV-2 neutralizing antibody sotrovimab. N Engl J Med. 2021;385(21):1941–50. doi: https://doi.org/10.1056/NEJMoa2107934.
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