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I have some issues with their patient selection criteria. I am not sure that all of them were Covid-19 positive.

Just read the following from the paper:

STUDY POPULATION

Patients enrolled in the study were residents of the city of Sao Paulo, Brazil, after the pandemic was officially declared in this city.

Positive epidemiology for COVID-19 was defined as living in a city with more than 100 confirmed cases of COVID-19. Consecutive outpatients with persistent flu-like symptoms (suspected COVID19 infection), persisting for a period equal to or greater than 2 days, were first evaluated by the telemedicine team or by the emergency department medical doctor.

All physicians had access to medical records of all subjects, such as clinical history, laboratory parameters, images exams and electrocardiograms.

Those who had no immediate need for hospitalization and no contraindications for treatment were invited to participate in the study. Treatment with hydroxychloroquine associated with azithromycin was suggested and prescribed if consented from patient.

The swab laboratory was not mandatory and chest computed tomography was performed according to medical judgment.

Lung injury criteria for COVID-19 were defined as the computed tomography scans with the presence of ground glass opacities in multiple lung lobes with bilateral predominance and peripheral localization (which may evolve to the central region).

Definitions of the severity of lung injury according to tomographic aspects were: Mild (<25% of lung involvement), moderate (25% to 50% of lung involvement) and high (>50% of lung involvement).

All patients were part of the same health care provider, with access to the same network of hospitals, outpatient clinics and diagnostic clinics in the city of São Paulo-Brazil.

In case patients needed to be referred to hospital, they were evaluated, admitted and treated by medical staff advised to follow the standard protocol from the institution.

The main hospitalization admission criteria were:
● Worsening general condition
● Oxygen Saturation < 90%

INCLUSION CRITERIA:

● Patient over 18 years old and flu-like persistent symptoms > 3 days, with a probable diagnosis of COVID-19 and no immediate indication for hospitalization.

EXCLUSION CRITERIA:

● Severe related retinopathy
● Severe liver disease
●Myasthenia Gravis
● Known QT enlargement
● Pregnant
●Severe Renal Failure

MY COMMENT: To me, it looks like not all of the patients were actually tested for Covid-19. They were simply ASSUMED to have it based on symptoms. What if they had the Flu or Pneumonia unrelated to Covid-19?

Am I wrong in what I understand?