Clinical and epidemiological features discriminating confirmed COVID-19 patients from SARS-CoV-2 negative patients at screening centres in Madagascar

Early and fast detection of COVID-19 patients help limit the transmission and wide spread of the virus in the community and will have impact on mortality by reducing the incidence of infection among vulnerable people. Therefore, community-based screening is critical. We aimed to identify clinical signs and symptoms and epidemiological features that could help discriminate confirmed cases of COVID-19 from SARS-CoV-2 negative patients. We found that age (aOR:1.02, 95%CI:1.02–1.03, p < 0.001), symptoms onset between 3 and 14 days (aOR:1.35, 95%CI:1.09)1.68, p = 0.006), fever or history of fever (aOR:1.75, 95%CI:1.42–2.14, p < 0.001), cough (aOR:1.68, 95%CI:1.31–2.04), sore throat (aOR:0.65, 95%CI:0.49–0.85, p = 0.002), ageusia (aOR:2.24, 95%CI:1.42–3.54, p = 0.001), anosmia (aOR:6.04, 95%CI:4.19–8.69, p < 0.001), chest pain (aOR:0.63, 95%CI:0.47–0.85, p = 0.003), myalgia and/or arthralgia (aOR:1.64, 95%CI:1.31–2.04, p < 0.001), household cluster (aOR:1.49, 95%CI:1.17–1.91, p = 0.001) and evidence of confirmed cases in the neighbourhood (aOR:1.92, 95%CI:1.56–2.37, p < 0.001) could help discriminate COVID-19 patients from SARS-CoV-2 negative. A screening score derived from multivariate logistic regression was developed to assess the probability of COVID-19 in patients. We suggest that a patient with a score ≥14 should undergo SARS-CoV-2 PCR testing. A patient with a score ≥30 should be considered at high risk of COVID-19 and should undergo testing but also needs prompt isolation and contact tracing.