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If you have any questions on BMJ Open’s open peer review process please email [email protected] BMJ Open An evaluation of patient characteristics, management and outcomes for COVID-19 at district hospitals in the Western Cape, South Africa: Descriptive observational study ForJournal: peerBMJ Open review only Manuscript ID bmjopen-2020-047016 Article Type: Original research Date Submitted by the 16-Nov-2020 Author: Complete List of Authors: Mash, Robert; Stellenbosch University, Family Medicine and Primary Care Presence-Vollenhoven, Mellisa; Stellenbosch University, Family Medicine and Primary Care; Western Cape Provincial Government, Metro Health Services Adeniji, Adeloye; Stellenbosch University, Family Medicine and Primary Care; Western Cape Provincial Government, Rural Health Services Christoffels, Renaldo; University of Cape Town, Family Medicine; Western Cape Provincial Government, Metro Health Services Doubell, Karlien; Stellenbosch University, Family Medicine and Primary Care; Western Cape Provincial Government, Rural Health Services Eksteen, Lawson; Stellenbosch University, Family Medicine and Primary Care; Western Cape Provincial Government, Rural Health Services Hendrikse, Amee; Western Cape Provincial Government, Metro Health Services Hutton, Lauren; Stellenbosch University, Family Medicine and Primary Care; Western Cape Provincial Government, Rural Health Services Jenkins, Louis; Stellenbosch University, Family Medicine and Primary Care; Western Cape Provincial Government, Rural Health Services Kapp, Paul; Stellenbosch University, Family Medicine and Primary Care; Western Cape Provincial Government, Rural Health Services Lombard, Annie; Stellenbosch University, Family Medicine and Primary Care; Western Cape Provincial Government, Metro Health Services Marais, Heleen; Western Cape Provincial Government, Metro Health Services Rossouw, Liezel; University of Cape Town, Family Medicine; Western Cape Provincial Government, Metro Health Services Stuve, Katrin; Stellenbosch University, Internal Medicine; Western Cape Provincial Government, Metro Health Services Ugoagwu, Abi; University of Cape Town, Family Medicine; Western Cape Provincial Government, Metro Health Services Williams, Beverley; Stellenbosch University, Family Medicine and Primary Care; Western Cape Provincial Government, Rural Health Services COVID-19, ACCIDENT & EMERGENCY MEDICINE, Respiratory infections Keywords: < THORACIC MEDICINE For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 1 of 28 BMJ Open 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 For peer review only 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 2 of 28 1 2 3 4 5 6 7 8 9 I, the Submitting Author has the right to grant and does grant on behalf of all authors of the Work (as defined 10 in the below author licence), an exclusive licence and/or a non-exclusive licence for contributions from authors 11 who are: i) UK Crown employees; ii) where BMJ has agreed a CC-BY licence shall apply, and/or iii) in accordance 12 with the terms applicable for US Federal Government officers or employees acting as part of their official 13 duties; on a worldwide, perpetual, irrevocable, royalty-free basis to BMJ Publishing Group Ltd (“BMJ”) its 14 licensees and where the relevant Journal is co-owned by BMJ to the co-owners of the Journal, to publish the 15 Work in this journal and any other BMJ products and to exploit all rights, as set out in our licence. 16 17 The Submitting Author accepts and understands that any supply made under these terms is made by BMJ to 18 the Submitting Author Forunless you peer are acting as review an employee on behalf only of your employer or a postgraduate 19 student of an affiliated institution which is paying any applicable article publishing charge (“APC”) for Open 20 Access articles. Where the Submitting Author wishes to make the Work available on an Open Access basis (and 21 intends to pay the relevant APC), the terms of reuse of such Open Access shall be governed by a Creative 22 Commons licence – details of these licences and which Creative Commons licence will apply to this Work are set 23 out in our licence referred to above. 24 25 Other than as permitted in any relevant BMJ Author’s Self Archiving Policies, I confirm this Work has not been 26 accepted for publication elsewhere, is not being considered for publication elsewhere and does not duplicate 27 material already published. I confirm all authors consent to publication of this Work and authorise the granting 28 of this licence. 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 3 of 28 BMJ Open 1 2 An evaluation of patient characteristics, management and 3 4 outcomes for COVID-19 at district hospitals in the Western Cape, 5 6 South Africa: Descriptive observational study 7 8 Robert Mash, Division of Family Medicine and Primary Care, Stellenbosch University. 9 10 [email protected] [corresponding author] 11 12 Mellisa Presence- Vollenhoven, Division of Family Medicine and Primary Care, Stellenbosch 13 University and Metro Health Services, Western Cape Government. 14 15 [email protected] 16 17 Adeloye Adeniji, Division of Family Medicine and Primary Care, Stellenbosch University and 18 Rural Health Services,For Western peer Cape Government. review [email protected] only 19 20 Renaldo Christoffels, Division of Family Medicine, University of Cape Town and Metro Health 21 22 Services, Western Cape Government. [email protected] 23 24 Karlien Doubell, Division of Family Medicine and Primary Care, Stellenbosch University and 25 Rural Health Services, Western Cape Government. [email protected] 26 27 Lawson Eksteen, Division of Family Medicine and Primary Care, Stellenbosch University and 28 29 Rural Health Services, Western Cape Government. [email protected] 30 31 Amee Hendrikse, Department of Family Medicine, Metro Health Services, Western Cape 32 Government. [email protected] 33 34 Lauren Hutton, Division of Family Medicine and Primary Care, Stellenbosch University and 35 36 Rural Health Services, Western Cape Government. [email protected] 37 38 Louis Jenkins, Division of Family Medicine and Primary Care, Stellenbosch University and 39 Rural Health Services, Western Cape Government. [email protected] 40 41 Paul Kapp, Division of Family Medicine and Primary Care, Stellenbosch University and Rural 42 Health Services, Western Cape Government. [email protected] 43 44 45 Annie Lombard, Division of Family Medicine and Primary Care, Stellenbosch University and 46 Metro Health Services, Western Cape Government. [email protected] 47 48 Heleen Marais, Department of Family Medicine, Metro Health Services, Western Cape 49 Government. [email protected] 50 51 Liezel Rossouw, Division of Family Medicine, University of Cape Town and Metro Health 52 53 Services, Western Cape Government. [email protected] 54 55 Katrin Stuve, Department of Medicine, Stellenbosch University and Metro Health Services, 56 Western Cape Government. [email protected] 57 58 Abi Ugoagwu, Division of Family Medicine, University of Cape Town and Metro Health 59 60 Services, Western Cape Government. [email protected] 1 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 4 of 28 1 2 Beverley Williams, Division of Family Medicine and Primary Care, Stellenbosch University 3 and Rural Health Services, Western Cape Government. [email protected] 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 For peer review only 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 2 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 5 of 28 BMJ Open 1 2 Keywords 3 4 COVID-19; coronavirus; signs and symptoms; disease management; risk factors; mortality; 5 6 South Africa; district hospitals 7 8 Abstract 9 10 Objectives: To describe the characteristics, clinical management and outcomes of patients 11 12 with COVID-19 at district hospitals. 13 14 Design: A descriptive observational cross-sectional study. 15 16 Setting: District hospitals (4 in Metro and 4 in Rural Health Services) in the Western Cape, 17 South Africa. District hospitals were small (<150 beds) and led by family physicians. 18 For peer review only 19 Participants: All patients who presented to the hospitals’ emergency centre and who tested 20 21 positive for COVID-19 between March-June 2020. 22 23 Primary and secondary outcome measures: Source of referral, presenting symptoms, 24 demographics, co-morbidities, clinical assessment and management, turn-around-time, 25 clinical outcomes, factors related to mortality, length of stay and location.