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Objectives To determine the prevalence of COVID-19 in the context of a secondary pneumonia surveillance program targeted at low-risk patients; and to identify clinical characteristics associated with COVID-19. Study Design This is a retrospective cohort study. Methods This study is conducted in Tan Tock Seng Hospital, a University affiliated 1600-bed public hospital in Singapore. Patients with pneumonia admitted under our Enhanced Pneumonia Surveillance (EPS) program from 7 February 2020 to 20 March 2020 were included. Relevant clinical variables were collated. Results Out of 1295 patients admitted under our EPS program, 47 (3.6%) patients tested positive for COVID-19. The prevalence of a radiologist-reported normal chest X-ray (CXR) in the COVID-19 positive group was 62.8% compared to 6.2% in the COVID-19 negative group. In patients with a normal CXR, a low normal white blood cell count (WBC) and minimal C-reactive protein (CRP) elevation were associated with COVID-19. Conclusions The pick-up rate of COVID-19 pick-up rate in low-risk patients with pneumonia is 3.6%. However, at least 7.9% of patients who were isolated had a normal CXR. For patients with pneumonia-like illness at presentation but a normal CXR, higher WBC and CRP values may guide early de-isolation. Ultimately, this informs resource allocation for both COVID-19 and non-COVID-19 clinical services.
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10.1016/j.puhe.2020.11.020
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document_parses/pdf_json/d924a07025645bdc7a0043ae65173ab0c6ab1184.json
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Pneumonia surveillance and its attendant clinical risk stratification for COVID-19 in low-risk patients
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