• Gerard M O'Reilly, Robert D Mitchell, Biswadev Mitra, Hamed Akhlaghi, Viet Tran, Jeremy S Furyk, Paul Buntine, Anselm Wong, Vinay Gangathimmaiah, Jonathan Knott, Max Raos, Erica Chatterton, Carolyne Sevior, Sophie Parker, Samuel Baker, Ashley Loughman, Nicole Lowry, Dylan Freeman, Muhuntha Sri-Ganeshan, Nicole Chapman, Sherman Siu, Michael P Noonan, Smit De Villiers V Emergency and Trauma Centre, Alfred Health, Melbourne, Victoria, Australia. School of, Peter A Cameron, and COVED Project Team.
• Emergency and Trauma Centre, Alfred Health, Melbourne, Victoria, Australia.
• Emerg Med Australas. 2021 Apr 1; 33 (2): 331-342.

ObjectiveThe aim of the present study was to describe the epidemiology and clinical features of patients presenting to the ED with suspected and confirmed COVID-19 during Australia's 'second wave'.MethodsThe COVID-19 ED (COVED) Project is an ongoing prospective cohort study in Australian EDs. This analysis presents data from 12 sites across four Australian states for the period from 1 July to 31 August 2020. All adult patients who met the criteria for 'suspected COVID-19' and underwent testing for SARS-CoV-2 in the ED were eligible for inclusion. Study outcomes included a positive SARS-CoV-2 test result, mechanical ventilation and in-hospital mortality.ResultsThere were 106 136 presentations to the participating EDs and 12 055 (11.4%; 95% confidence interval [CI] 11.2-11.6) underwent testing for SARS-CoV-2. Of these, 255 (2%) patients returned a positive result. Among positive cases, 13 (5%) received mechanical ventilation during their hospital admission compared to 122 (2%) of the SARS-CoV-2 negative patients (odds ratio 2.7; 95% CI 1.5-4.9, P = 0.001). Nineteen (7%) SARS-CoV-2 positive patients died in hospital compared to 212 (3%) of the SARS-CoV-2 negative patients (odds ratio 2.3; 95% CI 1.4-3.7, P = 0.001). Strong clinical predictors of the SARS-CoV-2 test result included self-reported fever, sore throat, bilateral infiltrates on chest X-ray, and absence of a leucocytosis on first ED blood tests (P < 0.05).ConclusionsIn this prospective multi-site study during Australia's 'second wave', a substantial proportion of ED presentations required SARS-CoV-2 testing and isolation. Presence of SARS-CoV-2 on nasopharyngeal swab was associated with an increase in the odds of death and mechanical ventilation in hospital.© 2020 Australasian College for Emergency Medicine.

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