The Journal of Association of Chest Physicians

ORIGINAL ARTICLE
Year
: 2022  |  Volume : 10  |  Issue : 1  |  Page : 7--10

Profile of initial 500 COVID-19 cases at a tertiary care center of western India


Parikshit Thakare1, Vishal Rakh2, Ketaki Utpat1, Sandeep Sharma1, Unnati Desai1, Kalyani Dongre2, Sarika Patil3, Surbhi Rathi3, Shailesh Mohite3, Mohan Joshi3,  
1 Department of Pulmonary Medicine, TNMC & BYL Nair Hospital, Mumbai, Maharashtra, India
2 Department of Community Medicine, TNMC & BYL Nair Hospital, Mumbai, Maharashtra, India
3 TNMC & BYL Nair Hospital, Mumbai, Maharashtra, India

Correspondence Address:
Dr. Parikshit Thakare
Department of Pulmonary Medicine, Second Floor, OPD Bldg, TNMC & BYL Nair Hospital, AL Nair Road, Mumbai Central, Mumbai 400008, Maharashtra
India

Abstract

Background: Coronavirus disease 2019 (COVID-19) pandemic occurring due to the novel corona virus has impacted the world and caused global healthcare crisis with loss of precious lives. The scarcity of data pertaining to the profile of its manifestations continues to be a hurdle to clarity in understanding, protocol formation, and hence patient management. Methods: The objective of this study is to report the initial experience with demographic profile and clinical presentation of the patients presenting at a tertiary care center in western India which is converted into a dedicated COVID hospital. This is a retrospective observational study of initial 500 cases presented to our institute between March 26 and April 30, 2020. The demography data, clinical parameters, associated comorbidities, and outcome parameters were noted and analyzed. Results: The mean age of the study population was 45.13 years with almost equal male and female preponderance. Out of total cases, 113 cases were critical. The most common comorbidities noted were hypertension and diabetes. Total 84 patients died due to COVID-19 infection. Conclusion: COVID-19 is common in adult age group with almost equal male to female preponderance. Most of the cases were stable patients. Out of the critical subgroup, more than half cases required oxygenation and one-fifth cases required ventilatory management. Majority of the cases recovered with a favorable outcome and they were either discharged or transferred to a step down facility.



How to cite this article:
Thakare P, Rakh V, Utpat K, Sharma S, Desai U, Dongre K, Patil S, Rathi S, Mohite S, Joshi M. Profile of initial 500 COVID-19 cases at a tertiary care center of western India.J Assoc Chest Physicians 2022;10:7-10


How to cite this URL:
Thakare P, Rakh V, Utpat K, Sharma S, Desai U, Dongre K, Patil S, Rathi S, Mohite S, Joshi M. Profile of initial 500 COVID-19 cases at a tertiary care center of western India. J Assoc Chest Physicians [serial online] 2022 [cited 2022 Sep 25 ];10:7-10
Available from: https://www.jacpjournal.org/text.asp?2022/10/1/7/339691


Full Text



 INTRODUCTION



A novel coronavirus, designated as 2019-nCoV, emerged in Wuhan, China, at the end of 2019. Soon after that it rapidly spread across whole world and affected more than 150 countries in a short duration of time period. The virus that causes coronavirus disease 2019 (COVID-19) was initially called as 2019-nCoV and was then termed as syndrome coronavirus 2 (SARS-CoV-2) by the International Committee on Taxonomy of Viruses.[1] The coronavirus disease was declared as a pandemic on March 11, 2020 by the World Health Organization.[2] This is the third coronavirus that emerged among the human population in the last two decades. The other two were the severe acute respiratory syndrome coronavirus (SARS-CoV) outbreak in 2002 and the Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak in 2012.[3] The 2019-nCoV has close similarity to bat coronaviruses, and it has been postulated that bats are the primary source. As the origin of the 2019-nCoV is still being investigated, current evidence suggests spread to humans occurred via transmission from infected meat of wild animals sold in the Wuhan Seafood Wholesale Market.[4] It has been affecting India too at a rapid rate with more than 5 lakh population infected with the virus in a span of just 3 to 4 months. The spectrum of the viral infection ranges from asymptomatic cases to mild cases on one end to those with moderate and severe illness requiring hospitalization, oxygenation, or mechanical ventilation at the other end. Fortunately, the virus causes mild illness in maximum population but the course of its infection is variable and difficult to predict. The disease passes through phases of initial incubation period, stage of viremia followed by a cytokine storm in some patients, and occasionally stage of fibrosis. However, there is heterogeneity in the timelines and the intensity of the clinical manifestations of these stages. The understanding of these phenomena is vital for the choice of the appropriate therapy. As it is a novel virus, there is insufficient literature on the first hand experience of outcomes and the patterns of this disease. The main objective of the study was to report the initial experience of the demographic profile, clinical presentations, and the outcomes of the patients presented at a tertiary care center converted into a dedicated COVID hospital.

 MATERIALS AND METHODS



It was a retrospective observational study of clinical and demographic profile of COVID-positive patients admitted during the time period of March 25 to April 30, 2020. The data analysis was performed 1 week after this study time period. The isolation facility at our hospital was assessed for preparedness according to a checklist standardized by Ministry of Health and Family Welfare (MoHFW).[5] All the healthcare workers caring for infected patients received comprehensive training and demonstrated competence in implementing infection control practices and procedures. The oropharyngeal swab reports were available from the local Viral Research and Diagnostic Laboratory or the private laboratories which used the quantitative polymerase chain reaction for confirmation. All laboratory-confirmed cases irrespective of the mild, moderate, and severe illness were hospitalized at a tertiary care center were eligible for inclusion in this study and the demographic, clinical, and laboratory data were recorded. The cases of less than 20 years of age were excluded from the study. All the initial 500 laboratory-confirmed cases were hospitalized at various medical wards of the tertiary care center which was designated as a dedicated COVID hospital facility in Mumbai city. All the cases were assessed with respect to clinical history, vital parameters including pulse oximetry and laboratory investigations such as complete blood hemogram, renal function test, liver function test, and random blood glucose along with basic radiology in the form of chest roentography and electrocardiogram. The associated comorbidities were noted if present. Those patients who were either asymptomatic or having symptoms such as cough, sore throat, fever, loss of taste, loss of smell, loose stools, and headache with oxygen saturation above 94% were classified as a stable cases and mild illness. The patients presenting with the symptom of breathlessness and baseline oxygen saturation of less than 94% were admitted in high dependency unit (HDU) of the hospital and labeled as critical group of the patients. Depending on the clinicoradiologic situation, these groups of cases were offered oxygen support with various devices such as nasal prongs, face mask, and nonreservoir breathing mask (NRBM). These groups of the cases were classified as moderate illness. The critical patients requiring ventilatory support were managed either with noninvasive ventilation (NIV) through bilevel-positive airway pressure (bilevel PAP) machines or the bilevel PAP mode of ventilators or invasive mechanical ventilation. These were the severe illness cases requiring intensive care and intensive monitoring. All the patients received standard treatment as per the Indian Council of Medical Research guidelines and were monitored during their stay at the hospital. The outcomes were noted as discharged, still admitted, transferred to step down facilities known as COVID care centers (CCCs), or death. Revised discharge policy of MoHFW was followed.

 RESULTS



Total 500 patients were included in the study from March 25 to April 30, 2020. The mean age of the study population was 45.13 years (range 20–100 years) [Table 1]. There was almost equal male and female preponderance of the patients; 251 cases were males and 249 cases were females. Out of the 500 study population, 15 females were pregnant and 8 females were in postpartum recovery phase. Out of the 500 patients, 387 cases were stable (77.4%) and 113 were critical cases (22.6%). Out of the 113 critical cases, 56 cases were managed with nasal prongs oxygenation, 18 cases were given face mask oxygenation, 17 cases managed with NRBM oxygenation, 12 cases have been given bilevel PAP NIV, and 10 cases have been managed with invasive mechanical ventilation [Figure 1].{Table 1}{Figure 1}

Out of the total 500 cases, majority (83.2%) had a favorable outcome; 211 cases (42.2%) discharged in stable state, 54 patients were still admitted on day of analysis, and 151 (30.2%) stable patients were transferred to CCC facilities for monitoring of their symptoms and isolation facility. Only 84 patients (16.8%) died in the hospital. The associated comorbidities were noted among 88 out of 500 cases (17.6%). The most common comorbidities noted being hypertension reported in 45 cases out of 88 cases (51.1%) and diabetes mellitus observed in 35 cases out of 88 patients (39.7%). The other common comorbidities noted were chronic kidney disease (16 cases), ischemic heart disease (13 cases) along with bronchial asthma, hypothyroidism, seizure disorder, and chronic obstructive lung disease and interstitial lung disease. The other associated comorbid conditions noted were malignancy (seven cases), tuberculosis (two cases), and chronic liver disease along with portal hypertension (two cases) [Table 2].{Table 2}

 DISCUSSION



In our study of 500 cases, it was observed that COVID-19 infection predominantly affected the younger age group more than older population. The maximum number of cases was noted in third decade amounting to 135 cases out of total study population. Secondly, most frequent COVID-19 infections were noted in sixth decade; total of 103 cases were observed in age group 51 to 60 years. It was found that frequency of COVID-19 infection reduced after fifth decade; between age group of 61 and 100 years, only 92 cases were noted. The mean age of study population was found to be 45.13 years which is close to study reported by Huang et al.[6] (49.0 years). Our study found that there was no statistical difference between genders; the male and female sex ratio was almost equal to 1 which is close to the study quoted by Wang et al.[7] which showed a slight male predominance (54.3%).

Total 15 cases out of 500 study population were pregnant women corresponds to 3% of the total cases and 6% of the total 249 COVID-19-infected female patients. A study by Campbell et al.[8] showed prevalence of COVID-19 being 13.5% in pregnant women. The lesser prevalence of pregnant patients can be attributed to inclination of pregnant patients to visit dedicated maternity hospitals in the vicinity. The COVID-19 cases were classified into stable and critical groups. The stable group of the patients had mild symptoms such as sore throat, cough, headache, myalgia, fever, and some atypical symptoms such as diarrhea, loss of taste, and loss of smell. In our study, almost 77% patients were stable and managed with standard symptomatic treatment. The critical group of the patients was patients who required either HDU or intensive care unit management. Out of 500 cases, 113 cases (22.4%) were critical cases. The study by Docherty et al.[7] also revealed 17% cases required intensive care or HDU management. This relatively higher percentage of critical patients presenting to our institute can be attributed to the fact that our hospital is a tertiary care referral center and hence the patients who are referred to our special screening outpatient department were moderate to severe cases to begin with. These groups of the patients required various oxygen delivery devices along with higher antibiotics as per hospital pneumonia management protocol and if needed noninvasive or invasive ventilation.

There were various kinds of oxygen delivery devices available in the hospital such as nasal cannula, simple face mask, and NRBM. The choice of the interface depended on the need of fraction of inspired oxygen to provide oxygenation and maintain oxygen saturation in the critical cases. Out of 113 critical cases, 56 cases managed with nasal prongs, 18 cases treated with simple face mask, and 17 cases managed with nonreservoir breathing mask. Approximately, one-fifth population of critical cases required ventilatory support in intensive care unit which amounts to 22 cases (19.46%). Out of 22 cases, NIV was required in 12 cases and invasive ventilation needed in 10 cases. This reiterates the fact that a majority of the critical patients could be successfully managed with only oxygen therapy and NIV. Only a very small proportion required invasive mechanical ventilation. This highlights the fact that majority of these patients can be managed successfully in step down units such as CCCs with access to oxygenation and NIV facility. The worldwide studies found that COVID-19 was commonly associated with various comorbidities.

The comorbidities impact the course of the disease and they affect the clinical outcome of the disease. Total 88 cases out of 500 cases (17.6%) were found to have associated comorbidities. The most common comorbidities are hypertension and diabetes mellitus. The other comorbidities noted are chronic kidney disease, bronchialasthma, ischemic heart disease, and malignancy. The study by Guan et al.[3] in 1099 COVID-19 cases showed comorbidities of hypertension (23.7%) and diabetes mellitus (16.2%) were most common. The study by Zhou et al.[8] also revealed hypertension (30%) and diabetes (19%) being most common comorbidities. Overall, it has been found that cardiovascular and endocrine system has been commonly affected than other systems. In addition, COVID-19 infection has good recovery rate and most of the cases improved after symptomatic and supportive management. The clinical outcome of the infection depends on various factors such as age, associated comorbidities, and clinical state of the patient. In our study, out of the total 500 cases, 84 patients (16.8%) died in the hospital, 211 cases (42.2%) discharged in stable state, and 151 (30.2%) stable patients were transferred to CCC and 54 (10.8%) cases were still receiving treatment when data analysis was performed. The study carried out by Docherty et al.[7] in the United Kingdom had similar outcome, 41% cases discharged alive, 26% died, and 34% continued to receive treatment at their center. This provides a ray of hope in the mid of the scarce data available on these relevant issues in COVID management and outcomes. We also emphasize on the need for studies involving larger sample sizes and also follow-up studies. There was an unavoidable referral bias in view of the place of study being a COVID hospital catering and draining more of severe COVID cases.

 CONCLUSION



The initial 500 cases presenting to the dedicated COVID hospital showed that COVID-19 is common in adult age group with almost equal male to female preponderance. Most of the cases were stable. Out of the critical lot, more than half cases required oxygenation and one-fifth cases required ventilator management. Most of the cases recovered with a favorable outcome. The most common comorbidities noted being hypertension and diabetes in these COVID-19 cases.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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