The Open Public Health Journal




ISSN: 1874-9445 ― Volume 13, 2020
LETTER

Scoring System for the Diagnosis of COVID-19



Mohamed Farouk Allam1, *
1 Department of Family Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt

Abstract

Due to the international spread of COVID-19, the difficulty of collecting nasopharyngeal swab specimen from all suspected patients, the costs of RT-PCR and CT, and the false negative results of RT-PCR assay in 41% of COVID-19 patients, a scoring system is needed to classify the suspected patients in order to determine the need for follow-up, home isolation, quarantine or the conduction of further investigations. A scoring system is proposed as a diagnostic tool for suspected patients. It includes Epidemiological Evidence of Exposure, Clinical Symptoms and Signs, and Investigations (if available). This scoring system is simple, could be calculated in a few minutes, and incorporates the main possible data/findings of any patient.

Keywords: Nasopharyngeal swab, COVID-19, diagnosis, RT-PCR, CT, Score system.

Article Information


Identifiers and Pagination:

Year: 2020
Volume: 13
First Page: 413
Last Page: 414
Publisher Id: TOPHJ-13-413
DOI: 10.2174/1874944502013010413

Article History:

Received Date: 18/4/2020
Acceptance Date: 18/4/2020
Electronic publication date: 18/08/2020
Collection year: 2020

© 2020 Mohamed Farouk Allam.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


* Address correspondence to this author at the Department of Family Medicine, Faculty of Medicine, Ain Shams University, 11566 Abbasia, Cairo, Egypt; Tel/Fax: +(202) 24346888; E-mail: farouk.allam@med.asu.edu.eg



To the Editor:

On the 11th of March 2020, The World Health organization (WHO) declared novel coronavirus (COVID-19) as a pandemic in response to the outbreak in more than 110 countries [1Rolling updates on coronavirus disease (COVID-19) Updated 11 March 2020 [(last access March 15, 2020).]; Available at: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen].

The common symptoms and signs of COVID-19 infection include fever, dry cough, shortness of breath, and breathing difficulties. Other less common symptoms include anosmia, sore throat, and runny nose [2Coronavirus disease [(last access March 15, 2020).]; Available at: https://www.who.int/health-topics/coronavirus, 3McIntosh K. Coronavirus disease 2019 [(last access March 15, 2020).]; Available at: https: //www.uptodate.com/contents/coronavirus -disease-2019-covid-19].

The Centers for Disease Control and Prevention (CDC) recommended the collection of a nasopharyngeal swab specimen to test for COVID19. Reverse-transcription polymerase chain reaction (RT-PCR) testing is used for detecting COVID-19 RNA [4Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens from Persons Under Investigation (PUIs) for Coronavirus Disease 2019 [(last access March 15, 2020).]; (COVID-19). February 14, 2020 https://www.cdc.gov/coronavirus/2019-nCoV/lab/guidelines-clinical-specimens.html]. A positive RT-PCR test confirms the diagnosis of COVID-19. If initial testing is negative, but the clinical suspicion remains, the WHO recommends re-sampling and testing from multiple respiratory tract sites [2Coronavirus disease [(last access March 15, 2020).]; Available at: https://www.who.int/health-topics/coronavirus]. A recent study reported that some patients with positive chest CT findings might present with negative results of RT-PCR for COVID-19 [5Ai T, Yang Z, Hou H, et al. Correlation of Chest CT and RT-PCR Testing for Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases. Radiology 2020; 296(2): E32-40.
[http://dx.doi.org/10.1148/radiol.2020200642] [PMID: 32101510] ].

Due to the international spread of the disease, the difficulty of collecting nasopharyngeal swab specimen from all suspected patients, the costs of RT-PCR and CT, and the false negative results of RT-PCR assay in 41% of COVID-19 patients [4Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens from Persons Under Investigation (PUIs) for Coronavirus Disease 2019 [(last access March 15, 2020).]; (COVID-19). February 14, 2020 https://www.cdc.gov/coronavirus/2019-nCoV/lab/guidelines-clinical-specimens.html, 5Ai T, Yang Z, Hou H, et al. Correlation of Chest CT and RT-PCR Testing for Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases. Radiology 2020; 296(2): E32-40.
[http://dx.doi.org/10.1148/radiol.2020200642] [PMID: 32101510] ], a scoring system is needed to classify the suspected patients in order to determine the need for follow up, home isolation, quarantine or carrying out further investigations.

Table 1
Scoring system for diagnosis of COVID-19.

If Available:




The following scoring system is proposed as a diagnostic tool for suspected patients. It includes Epidemiological Evidence of Exposure, Clinical Symptoms and Signs, and Investigations (if available) (Table 1). This scoring system is simple, could be calculated in a few minutes, and incorporates the main possible data/findings of any patient. The scoring system was based on the original scoring system developed by the Saudi Center for Disease Prevention and Control as a byproduct of Saudi Arabia’s long-experience in the management of another coronavirus, Middle East Respiratory Syndrome Coronavirus (MERS-CoV), which presented in the year 2012.

In this novel scoring system, shortness of breath/dyspnea was given 2 points because it is the main characteristic of the severe form of COVID-19 [3McIntosh K. Coronavirus disease 2019 [(last access March 15, 2020).]; Available at: https: //www.uptodate.com/contents/coronavirus -disease-2019-covid-19].

Moreover, cost-effective and accessible investigations such as complete blood picture (CBC) with leucopenia (with or without lymphopenia), ground glass appearance in chest x-ray, and low oxygen saturation below 92% using pulse oximeter were added to the scoring system [2Coronavirus disease [(last access March 15, 2020).]; Available at: https://www.who.int/health-topics/coronavirus, 3McIntosh K. Coronavirus disease 2019 [(last access March 15, 2020).]; Available at: https: //www.uptodate.com/contents/coronavirus -disease-2019-covid-19]. The main advantage of these tests (CBC, chest x-ray, and pulse oximeter) is that they are readily available in most primary healthcare/family medicine centers. The new scoring system was used to detect 24 probable cases, of which 17 were confirmed to have COVID-19 (positive PCR and/or characteristic CT chest), with a sensitivity of 70.8% (data not published).

In light of the current COVID-19 pandemic, this score can be adapted and modified as a simple diagnostic system that can be applied both locally or in the WHO region or even globally.

FUNDING

None.

CONFLICT OF INTEREST

The author declares no conflicts of interest, financial or otherwise.

ACKNOWLEDGEMENTS

Declare None.

REFERENCES
[1] Rolling updates on coronavirus disease (COVID-19) Updated 11 March 2020 [(last access March 15, 2020).]; Available at: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen
[2] Coronavirus disease [(last access March 15, 2020).]; Available at: https://www.who.int/health-topics/coronavirus
[3] McIntosh K. Coronavirus disease 2019 [(last access March 15, 2020).]; Available at: https: //www.uptodate.com/contents/coronavirus -disease-2019-covid-19
[4] Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens from Persons Under Investigation (PUIs) for Coronavirus Disease 2019 [(last access March 15, 2020).]; (COVID-19). February 14, 2020 https://www.cdc.gov/coronavirus/2019-nCoV/lab/guidelines-clinical-specimens.html
[5] Ai T, Yang Z, Hou H, et al. Correlation of Chest CT and RT-PCR Testing for Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases. Radiology 2020; 296(2): E32-40.
[http://dx.doi.org/10.1148/radiol.2020200642] [PMID: 32101510]
Track Your Manuscript:


Endorsements



"Open access will revolutionize 21st century knowledge work and accelerate the diffusion of ideas and evidence that support just in time learning and the evolution of thinking in a number of disciplines."


Daniel Pesut
(Indiana University School of Nursing, USA)

"It is important that students and researchers from all over the world can have easy access to relevant, high-standard and timely scientific information. This is exactly what Open Access Journals provide and this is the reason why I support this endeavor."


Jacques Descotes
(Centre Antipoison-Centre de Pharmacovigilance, France)

"Publishing research articles is the key for future scientific progress. Open Access publishing is therefore of utmost importance for wider dissemination of information, and will help serving the best interest of the scientific community."


Patrice Talaga
(UCB S.A., Belgium)

"Open access journals are a novel concept in the medical literature. They offer accessible information to a wide variety of individuals, including physicians, medical students, clinical investigators, and the general public. They are an outstanding source of medical and scientific information."


Jeffrey M. Weinberg
(St. Luke's-Roosevelt Hospital Center, USA)

"Open access journals are extremely useful for graduate students, investigators and all other interested persons to read important scientific articles and subscribe scientific journals. Indeed, the research articles span a wide range of area and of high quality. This is specially a must for researchers belonging to institutions with limited library facility and funding to subscribe scientific journals."


Debomoy K. Lahiri
(Indiana University School of Medicine, USA)

"Open access journals represent a major break-through in publishing. They provide easy access to the latest research on a wide variety of issues. Relevant and timely articles are made available in a fraction of the time taken by more conventional publishers. Articles are of uniformly high quality and written by the world's leading authorities."


Robert Looney
(Naval Postgraduate School, USA)

"Open access journals have transformed the way scientific data is published and disseminated: particularly, whilst ensuring a high quality standard and transparency in the editorial process, they have increased the access to the scientific literature by those researchers that have limited library support or that are working on small budgets."


Richard Reithinger
(Westat, USA)

"Not only do open access journals greatly improve the access to high quality information for scientists in the developing world, it also provides extra exposure for our papers."


J. Ferwerda
(University of Oxford, UK)

"Open Access 'Chemistry' Journals allow the dissemination of knowledge at your finger tips without paying for the scientific content."


Sean L. Kitson
(Almac Sciences, Northern Ireland)

"In principle, all scientific journals should have open access, as should be science itself. Open access journals are very helpful for students, researchers and the general public including people from institutions which do not have library or cannot afford to subscribe scientific journals. The articles are high standard and cover a wide area."


Hubert Wolterbeek
(Delft University of Technology, The Netherlands)

"The widest possible diffusion of information is critical for the advancement of science. In this perspective, open access journals are instrumental in fostering researches and achievements."


Alessandro Laviano
(Sapienza - University of Rome, Italy)

"Open access journals are very useful for all scientists as they can have quick information in the different fields of science."


Philippe Hernigou
(Paris University, France)

"There are many scientists who can not afford the rather expensive subscriptions to scientific journals. Open access journals offer a good alternative for free access to good quality scientific information."


Fidel Toldrá
(Instituto de Agroquimica y Tecnologia de Alimentos, Spain)

"Open access journals have become a fundamental tool for students, researchers, patients and the general public. Many people from institutions which do not have library or cannot afford to subscribe scientific journals benefit of them on a daily basis. The articles are among the best and cover most scientific areas."


M. Bendandi
(University Clinic of Navarre, Spain)

"These journals provide researchers with a platform for rapid, open access scientific communication. The articles are of high quality and broad scope."


Peter Chiba
(University of Vienna, Austria)

"Open access journals are probably one of the most important contributions to promote and diffuse science worldwide."


Jaime Sampaio
(University of Trás-os-Montes e Alto Douro, Portugal)

"Open access journals make up a new and rather revolutionary way to scientific publication. This option opens several quite interesting possibilities to disseminate openly and freely new knowledge and even to facilitate interpersonal communication among scientists."


Eduardo A. Castro
(INIFTA, Argentina)

"Open access journals are freely available online throughout the world, for you to read, download, copy, distribute, and use. The articles published in the open access journals are high quality and cover a wide range of fields."


Kenji Hashimoto
(Chiba University, Japan)

"Open Access journals offer an innovative and efficient way of publication for academics and professionals in a wide range of disciplines. The papers published are of high quality after rigorous peer review and they are Indexed in: major international databases. I read Open Access journals to keep abreast of the recent development in my field of study."


Daniel Shek
(Chinese University of Hong Kong, Hong Kong)

"It is a modern trend for publishers to establish open access journals. Researchers, faculty members, and students will be greatly benefited by the new journals of Bentham Science Publishers Ltd. in this category."


Jih Ru Hwu
(National Central University, Taiwan)

Browse Contents



Table of Contents


Webmaster Contact: info@benthamopen.net
Copyright © 2020 Bentham Open