PONE-D-21-02244Acute Respiratory Infection Rates in Primary Care Anticipate ICU Bed Occupancy During COVID-19 WavesPLOS ONE

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The present investigation is well designed and written. However, the main limitation is represented by the fact that data are somewha old (2020). We suggest the Authors to clearly explain why and how their findings are still clinically useful. 

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Reviewer #1: Yes

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Reviewer #1: Yes

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Reviewer #1: Yes

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Reviewer #1: Yes

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Reviewer #1: This is an important question but it has also been informally understood since the beginning of the pandemic that outpatient cases � hospitalization 2 weeks later � death 4 weeks later (roughly). That said, they provide specificity for this general concept. Also, by tying it to GP visit they establish a somewhat uniform definition of outpatient severity (i.e. asymptomatic or very mild cases wouldn’t visit GP, generally).

I have some concerns about immediate relevance given that the data are in pandemic terms quite old (2020). On the other hand, the concept is an important one and I would therefore strongly support publication.

Introduction

A nice, concise description of what is known and the problem. Very well written.

Methods

Good description of patient population, appropriate to only use index visits for ARI with PCR confirmed COVID-19. Appropriate to include positive rapid antigen as specificity is high for those tests.

US has 27 ICU beds/100,000, so this should be addressed in the Discussion; applying this to other health systems will require consideration of the local context. Criteria for hospital and ICU admission may also vary. And, reporting requirements vary by country. This makes sense in a proper organized national health system, but not in places like my country which lack a true health system. Unfortunately.

Adjustment for holidays and weekends and day of week effects is important. Not being a biostatistician I am not able to judge whether your approach was appropriate, but it seem to be so.

Results

Again, very concise. Was the 17-day lag consistent throughout the study period? Also, this research was done with the ancestral variant. We are now on to omicron. Would be much more compelling if this study including much more recent data and looked at whether the lag was consistent despite changing variants and changing treatments. And, the availability of outpatient treatments like Paxlovid may be game changing.

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Reviewer #1: Yes: Mark H. Ebell MD, MS

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Acute Respiratory Infection Rates in Primary Care Anticipate ICU Bed Occupancy During COVID-19 Waves

PONE-D-21-02244R1

Dear Dr. Guillen,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Kind regards,

Chiara Lazzeri

Academic Editor

PLOS ONE

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