3.1 Demographic and clinical characteristics of the patients
Of the 442 patients admitted to the hospital, 422 had SARS-CoV-2 infection confirmed by the RT-PCR test. Among the confirmed COVID-19 patients, 64% (n = 271) were male, and 36% (n = 150) were female, and among them four female patients were pregnant. The demographic and health characteristics of the patients are presented in Tables 1 and 2, disaggregated according to their gender and age.
Among the admitted COVID-19 patients, the majority of patients ( 28%, n = 120) were 35-49 years old. While most of the patients (38%, n = 159) were service holders, the study sample consisted of 17% (n = 71) healthcare workers. Around 41% (n = 168) of the patients could not recall any contact history with previously confirmed COVID-19 patients, and an additional 40% (n = 164) patients provided positive contact history. Before admitting to the hospital, almost two-third (66%, n = 277) of the patients had the symptoms of COVID-19 for one week. Half of the patients (52%, n = 154) reported having at least one underlying comorbidity.
Male patients reported a higher proportion of comorbidity than females (69% vs. 41%), though it was not statistically significant. However, looking into individual type of comorbidity, significantly higher proportion of male patients had Diabetes (P < 0.001), Hypertension (P < 0.001), Ischemic heart disease (P = 0.048) compared to the female patients (Figure 2), while 30% (n = 22) females presented with Asthma, compared to 14% (n = 16) men and this difference is statistically significant (P = 0.027). At triage in the hospital, out of 422 patients, 379 presented any clinical feature of COVID-19, and the most common symptom (80%) was fever (Figure 3). Consequently, the next three most frequent symptoms were associated with respiratory systems, which were cough (60%, n = 227), dyspnea (41%, n = 155), and sore throat (21%, n = 81).
The clinical record showed the blood SpO2 level of 304 patients (72% of the study sample). A lower SpO2 level is a critical factor indicating the severity of COVID-19, and Table 3 presents the SpO2 level (≤ 93% vs.> 93%) according to the patients' characteristics.
The SpO2 level of the patients presented significant association with their age (P < 0.001), occupation (P = 0.002), and presence of underlying comorbidity (P < 0.001). We have observed that lower SpO2 levels were reported for older patients. Similarly, almost twice as many patients with lower SpO2 levels reported comorbidity (69% vs. 31%), indicating a strong association between the underlying health condition and the severity of the disease among confirmed COVID-19 patients.
3.2 Radiological and laboratory findings
Of the confirmed patients, 274 had their chest X-ray available, while computed tomography (C.T.) of the chest was not conducted due to resource constraints. Table 4 shows the radiological findings and the result of laboratory investigations during hospitalization. X-ray finding suggestive of Pneumonia was observed among 39 % (n = 107) of the patients, indicated by mixed inhomogeneous opacity in the posterior-anterior (P.A.) view of lung X-ray.
Laboratory findings suggests, only 3% (n = 2) and 10% (n = 7) patients presented leukopenia and thrombocytopenia accordingly. However, 29% (25 out of 85) patients had their Neutrophil Lymphocyte Ratio elevated more than 3.5 times. Among other findings, elevated level of SGPT (58.54%, n = 144), C-reactive Protein (37%, n = 90), serum creatinine (21%, n = 53), and D-dimer (22%, n – 32) were observed. SpO2 level was significantly associated with radiological findings of Pneumonia (P < 0.001), serum Creatinine (P < 0.011), serum C-reactive Protein (P = 0.004), and Neutrophil Lymphocyte Ratio (P = 0.001). The patients with lower SpO2 level had the poor prognostic values of the radiological and laboratory findings.
3.3 Treatment and medications
All patients (n = 422) received symptomatic medication for their illness during hospitalization. Table 5 presents the treatment and medication given to patients.
Majority of the patients received antibiotics (77%, n = 318), and anticoagulants therapy (56%, n = 232). These proportions were even higher among the patients with lower SpO2 levels – 93% and 87% for antibiotic and anticoagulants therapy accordingly. Overall, 63% (n = 262) patients received oxygen supplementation. Except for one patient, everyone presented with a SpO2 level ≤ 93% received oxygen supplement, and more than half of the patients (59%, n = 114) received oxygen supplement despite having their SpO2 level > 93%. Most of the older adults and senior patients received anticoagulant and glucocorticoid medications. Among all patients, 29% (n = 121) received Hydroxychloroquine and 6% (n = 27) received Ivermectin. More than 95% of these patients receiving these therapies were between 19 and 49 years. Moreover, a negligible number of patients with low SpO2 level received Hydroxychloroquine (14%, n = 15) and Ivermectin (5%, n = 6) therapies.
The clinical record showed that 7.43% of the patients (n = 31) received antiviral medications. Only ten patients received injectable Remdesivir, and 21 patients received oral antiviral Favipiravir therapy. Among other drugs, four patients received Convalescent Plasma therapy, and three patients received injectable Tocilizumab (Interleukin-6 inhibitor).
3.4 Clinical outcomes and persistent complications
The median duration of hospital stay for the patients was 12 days; mean 12.36 days, standard deviation [SD] 6.51 days, and range 1 to 32 days. Across the age groups, significant variability of hospitalization duration (P = 0.012) (Figure 4). While the elderly patients (59+ years) had the most variability of hospital stay (S.D. = 7.30-day, range 1 to 31), their average hospitalization duration was 11 days. In contrast, younger patients (19-24 years) had, on average, the most prolonged hospital stay (mean 14.11 days, SD 5.92, and range 3 to 27 days).
More than 90% (n = 381) patients successfully weaned from SARS-CoV-2 infection (Table 1). During their hospital stay, 13 patients (3%) died due to COVID-19, 18 patients (4%) were referred out to other facilities, and eight patients (2%) were discharged voluntarily after signing risk bonds. After discharge, the hospital was able to conduct a teleconsultation to follow up on 399 patients. An additional eight deaths (2%) were reported during the follow-up teleconsultation (Figure 5). The follow-up was conducted on average, 66 days after the discharge of the patients (range 1 to 129 days). Out of 399 patients, 164 patients (41%) reported experiencing complications after hospital discharge. Among them, 84 patients (51%) reported one, 50 reported two (37%), 30 reported three compilations (22%).
During the follow-up period, additional eight deaths were reported. The majority of the patients' complications were associated with respiratory systems, consisting of around 62% (n = 52) of the first and 44% (n = 22) of the second complications. The type of respiratory complications consisted of cough and cold, chest heaviness, shortness of breath, and pain during breathing. Among other frequently reported complications were post-COVID fatigue syndrome, fever, and musculoskeletal pain.