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PONE-D-20-25198

Characterisation of 22446 patients attending UK emergency departments with suspected COVID-19 infection: Observational cohort study

PLOS ONE

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Academic Editor

PLOS ONE

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Additional Editor Comments (if provided):

Dear Dr. Goodacre,

I have received comments from one reviewer.

This reviewer has raised some interesting points and I look forward to seeing your responses.

yours sincerely,

Walter Taylor.

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

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Reviewer #1: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

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Reviewer #1: Yes

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Reviewer #1: Yes

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5. Review Comments to the Author

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Reviewer #1: The manuscript presented by Goodacre and colleagues adds important epidemiological information to the understanding of the SARS-CoV-2 epidemic in the UK. The authors analysed the clinical data of 22446 patients admitted with suspected COVID-19 to 70 emergency rooms in the UK from March 26th until May 28th 2020. In summery

- Male sex as a risk factor for a more severe cause of COVID-19

- COVID-19 results in a more severe course than other respiratory diseases even when the groups have similar rates of comorbidities in the beginning.

- And to some interest, ethnical differences which (to my knowledge) can’t be explained by biological facts. Black and Asian adults were roughly 15 years younger, had a better performance status, were less likely to be admitted to hospital and were less likely to die. Nevertheless, they had a higher rate of COVID-19 positive tests and needed more organ support.

For me the last point is of importance. The authors state that Black and Asian patients might have a higher risk for a more severe COVID-19 course. But the review article they cite (Ref. 21) may not be optimal to prove this claim. Most studies included in this review reporting differences in outcome depending on ethnicity were from the US. Due to fundamental differences in the US and UK health care systems, the result of these studies are rather a surrogate for social imbalances and inequalities in the access to health care than a prove for biological differences.

The study is well executed and the presentation of the results are fine. However, in the discussion the authors claim that their study allows to “…guide planning for future emergency care.” I would like to question this in at least in part. Because the manuscript describes the first wave. Presumable some of the parameters will be the same during the ongoing pandemic but others will change; the introduction of the virus will happen through other routes, precaution measures for populations at risk are still in place and pandemic response will be based on the experience of the past. How an epidemic may change you see for example in Germany, the average age of patients diagnosed with CODIV-19 dropped from 52 years in May 2020 to 32 years in August (national surveillance data from the Robert Koch Institute). Hospital and ICU admission rates dropped from ≈ 10% and 4% to 3% and >1% respectively.

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Reviewer #1: No

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Characterisation of 22445 patients attending UK emergency departments with suspected COVID-19 infection: Observational cohort study

PONE-D-20-25198R1

Dear Dr. Goodacre,,

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,

Walter R. Taylor

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

None

Reviewers' comments: