Objective To describe the clinical presentation, course of disease and health-care seeking behaviour of the first few hundred cases of coronavirus disease 2019 (COVID-19) in the United Kingdom of Great Britain and Northern Ireland.
Methods We implemented the World Health Organization’s First Few X cases and contacts investigation protocol for COVID-19. Trained public health professionals collected information on 381 virologically confirmed COVID-19 cases from 31 January 2020 to 9 April 2020. We actively followed up cases to identify exposure to infection, symptoms and outcomes. We also collected limited data on 752 symptomatic people testing negative for COVID-19, as a control group for analyses of the sensitivity, specificity and predictive value of symptoms.
Findings Approximately half of the COVID-19 cases were imported (196 cases; 51.4%), of whom the majority had recent travel to Italy (140 cases; 71.4%). Of the 94 (24.7%) secondary cases, almost all reported close contact with a confirmed case (93 cases; 98.9%), many through household contact (37 cases; 39.8%). By age, a lower proportion of children had COVID-19. Most cases presented with cough, fever and fatigue. The sensitivity and specificity of symptoms varied by age, with nonlinear relationships with age. Although the proportion of COVID-19 cases with fever increased with age, for those with other respiratory infections the occurrence of fever decreased with age. The occurrence of shortness of breath also increased with age in a greater proportion of COVID-19 cases.
Conclusion The study has provided useful evidence for generating case definitions and has informed modelling studies of the likely burden of COVID-19.
Boddington, N., Charlett, A., Elgohari, S., Byers, C., Coughlan, L., Vilaplana, T., Whillock, R., Sinnathamby, M., Panagiotopoulos, N., Letley, L., MacDonald, P., Vivancos, R., Edeghere, O., Shingleton, J., Bennett, E., Cottrell, S., McMenamin, J., Zambon, M., Ramsay, M., Dabrera, G., Saliba, V. & Bernal, J. 2020, 'Epidemiological and clinical characteristics of early COVID-19 cases, United Kingdom of Great Britain and Northern Ireland', Bulletin of the World Health Organization, 99(3), pp. 178-189. https://dx.doi.org/10.2471/BLT.20.265603