Outpatient Management and Workup of Confirmed and Suspected COVID-19 Cases: A Brief Perspective from a Developing Country at the Height of the Pandemic

Rationale: To date, the COVID-19 pandemic has affected over 189 countries representing a global health problem of enormous proportions not only as a health crisis, but one with devastating social and economic implications for years to come. Adding to the already complex scenario are the different responses to the pandemic between countries according to their own strengths and weaknesses. The aim of our study was to provide a brief overview on how confirmed and suspected cases of COVID-19 were managed and worked up in an outpatient setting. Methods: We conducted an observational telephone-based study among 153 outpatients with a confirmed or suspected diagnosis of COVID-19 from the city of Guayaquil-Ecuador from April to May 2020. To be included in the study, participants were required to have a confirmed diagnosis of COVID-19 through a positive polymerase chain reaction (PCR) test. Alternatively, in cases where testing for was not accessible we considered a suspected case in those who presented with typical symptoms of COVID-19, and had either a compatible computed tomography (CT) scan, or a positive IgM in a rapid serological test. Results: The final sample comprised 153 patients, with a mean age of 44.3 years, and a gender distribution of 54.9% male and 45.1% female. The most reported comorbidity was hypertension (30.1%), followed by allergies (15.7%), and type 2 diabetes (7.2%). From all the patients, only 47.1% had a confirmed diagnosis through a positive PCR test for COVID-19. Fatigue was identified as the most common symptom in 82.3% of patients, followed by subjective fever (79.1%), and cough (76.6%). Regarding the workup of these cases, we found that CT scans were performed in 69.9% of cases, followed by PCR testing (47.1%), and chest x-ray (21.6%). Regarding treatment, acetaminophen was the most frequently prescribed medication (83%), followed by azithromycin (66.1%), n-acetylcysteine (56.2%), nitazoxanide (34.7%), hydroxychloroquine (25.5%), and corticosteroids (11.2%).Conclusions: During peak months of the pandemic in our country we found that roughly half of suspected outpatient cases with COVID-19 surveyed in our study had undergone confirmatory PCR testing. This finding may be the result of oversaturation of the healthcare system and a decreased capacity to perform confirmatory tests in our country. Furthermore, there was a considerable outpatient use of experimental treatments that may have led to potential drug interactions and side effects that were not accounted or supervised directly by a healthcare professional. class='MsoNormal' style='text-align:justify;lineheight: 150%'> .