A total of 205 patients with COVID-19 have been treated at our centre. We included 199 patients in our study, having excluded six patients as key data were lacking in their medical records. The mean age of patients was 34 ± 16 (SD) years ranging from 2 to 91 years old. A male preponderance was observed making up 73.9% of patients. 109 patients body mass index (BMI) were recorded with a mean of 25.3 ± 6.3 (SD) ranging from 15 to 52. Besides that, 53 patients (26.6%) in our cohort have comorbidities; mainly hypertension, diabetes mellitus and dyslipidemia. Interestingly, there were no patients with background chronic obstructive pulmonary disease.
Out of 124 entries regarding cigarette smoking, 15 patients were active cigarette smokers while 8 are reformed smokers. Only 7 out of 62 participants consume alcoholic beverages. Eventually, 196 patients were discharged well, one patient with multiple comorbidities succumbed to the disease and two patients were transferred out to a nearby hospital catering for infectious diseases prior to our centre’s active management of COVID-19 patients. Our sample’s demographic details are summarised in Table 1.
Table 1
Demographic information of our cohort of COVID-19 patients (n = 199)
demographics
|
n (%)
|
Age (years old)
|
|
< 10
|
1 (0.5)
|
10–19
|
27 (13.6)
|
20–29
|
78 (39.2)
|
30–39
|
34 (17.1)
|
40–49
|
24 (12.1)
|
50–59
|
15 (7.5)
|
60–69
|
12 (6)
|
70–79
|
6 (3)
|
80–89
|
1 (0.5)
|
> 90
|
1 (0.5)
|
GENDER
|
|
MALE
|
147 (73.9)
|
FEMALE
|
52 (26.1)
|
BMI
|
|
< 18.5
|
7 (6.4)
|
18.5–22.9
|
40 (36.7)
|
23-26.9
|
32 (29.4)
|
> 27
|
30 (27.5)
|
SmOKING
|
|
ACTIVE
|
15 (12.1)
|
NON-SMOKER
|
101 (81.5)
|
REFORMed
|
8 (6.4)
|
ALCOHOL
|
7 (11.3)
|
Comorbidites
|
53 (26.6)
|
DM
|
13
|
Hypertension
|
26
|
Dyslipidaemia
|
10
|
IHD
|
4
|
CKD
|
3
|
COPD
|
0
|
Others
|
29
|
NO COMORBIDS
|
146 (73.4)
|
Outcome
|
|
DISCHARGED
|
196 (98.5)
|
DECEASED
|
1 (0.5)
|
TRANSFER OUT
|
2 (1)
|
From our data, most patients (95%) were diagnosed through screening (via contact tracing, high risk groups) and only 10 patients (5%) were detected due to presenting symptoms. Besides that, 31 (15.6%) had history of recent overseas travel. Cough and fever were the most prevalent symptom affecting 45 (22.6%) and 40 (20.1%) patients respectively. In addition, non-specific and pleuritic chest pain were the most common atypical symptoms affecting 21 patients (10.5%) followed by headache and anosmia. Atypical symptoms like headache, giddiness, behavioural changes were more commonly seen in the elderly population. Table 2 summarises the clinical manifestations present on admission as well as during admission.
Table 2
Clinical manifestation upon presentation and during hospital admission (n = 199)
Parameters / symptoms
|
symptoms on presentation
|
symptoms during admission
|
total
|
|
|
n = 53 (%)
|
n = 43 (%)
|
n = 96 (%)
|
p-value
|
Cough
|
32 (16.1)
|
13 (6.5)
|
45
|
0.019*
|
Productive
|
10 (5)
|
1 (0.5)
|
11
|
-
|
Breathlessness
|
11 (5.5)
|
5 (2.5)
|
16
|
0.059
|
T < 37.8
|
25 (12.6)
|
2 (1.0)
|
27
|
0.704
|
T > 37.8
|
12 (6)
|
1 (0.5)
|
13
|
0.551
|
Headache
|
6 (3)
|
1 (0.5)
|
7
|
0.791
|
Giddiness
|
2 (1)
|
0 (0)
|
2
|
0.881
|
Lethargy
|
5 (2.5)
|
0 (0)
|
5
|
0.825
|
Body Weakness
|
0 (0)
|
1 (0.5)
|
1
|
0.482
|
Anosmia
|
11 (5.5)
|
0 (0)
|
11
|
0.550
|
Low Glasgow Coma Scale
|
1 (0.5)
|
0 (0)
|
1
|
0.360
|
Nausea
|
1 (0.5)
|
2 (1.0)
|
3
|
0.345
|
Vomiting
|
0 (0)
|
1 (0.5)
|
1
|
0.482
|
Abdominal Pain
|
3 (1.5)
|
3 (1.5)
|
6
|
0.113
|
Rash
|
0 (0)
|
0 (0)
|
0
|
-
|
Diarrhoea
|
4 (2)
|
6 (3.0)
|
10
|
0.831
|
Chest Pain
|
9 (4.5)
|
12 (6)
|
21
|
0.005*
|
Sore Throat
|
17 (8.5)
|
6 (3.0)
|
23
|
0.385
|
Rhinorrhoea
|
20 (10.1)
|
3 (1.5)
|
23
|
0.012*
|
Myalgia / Arthralgia
|
5 (2.5)
|
1 (0.5)
|
6
|
0.336
|
*Chi square test was used, accepting a p-value of < 0.05 as significant |
Majority of our samples were clinical category one; 93 patients (46.7%), followed by 79 patients (39.7%) with category two, 22 patients (11.1%) with category 3, 3 and 2 patients respectively with category 4 and 5. The distribution of our patient’s clinical category is illustrated in Fig. 1. In addition, the highest MEWS documented were score 1 and 2 with 157 (79.3%) and 32 (16.2%) respectively.
In terms of blood abnormalities, 50 (25.1%) patients had blood abnormalities on admission while 55 (27.6%) patients in total had abnormalities during admission. The most common abnormality noted was raised liver transaminases. Notably, one quarter of all patients had bilirubin levels at the upper limit of normal at some point during admission regardless of symptoms. All patients had chest X-rays with 30 patients demonstrating radiological abnormalities including peripheral air space opacity and/or consolidation. 44 patients had computed tomography of the thorax demonstrating peripheral opacity or consolidation in only 20 patients. 45 patients were given medications during their stay; 43 given hydroxychloroquine, 14 administered azithromycin, 4 given kaletra, 2 on interferon and one given tocilizumab.
Based on our sample, 43 (21.6%) patients were presymptomatic, 53 (26.6%) were symptomatic while 103 (51.8%) were true asymptomatics. There were 9 paucisymptomatic patients each in the symptomatic and presymptomatic groups while there were 10 (23.3%) and 5 (9.4%) patients presenting with atypical symptoms in the presymptomatic and symptomatic group respectively. Presymptomatic patients in our cohort presented with symptoms from day 1 to 14 of admission with a mean of 4 ± 2.69 (SD) day of admission and 7.37 ± 4.32 (SD) days after first positive COVID-19 RT-PCR test with a range of 1 to 24 days. Three outliers manifested symptoms beyond 14 days; 2 at day 17 and one at day 24. Figure 2 demonstrates the different clinical classification in our cohort.
Upon comparing both groups, there was a higher proportion of symptomatic patients with cough (p = 0.019) and rhinorrhoea (p = 0.012) that was found to be significant. On the other hand, chest pain was more prevalent in the presymptomatic group (p = 0.005). The proportion of males and females among the different clinical groups were significantly different (p = 0.019) with a larger percentage of females in the presymptomatic group compared to males. Also, more females were started on treatment; majority on hydroxychloroquine; compared to the opposite sex (p = 0.016). Further analysis between genders did not show any significant association with regards to blood and chest x-ray abnormalities.
Besides that, there were four patients with clinical category four and above in the symptomatic group with only one in the presymptomatic group with category four. A larger proportion of patients in the symptomatic group had higher overall MEWS and this was statistically significant (p = 0.023). With regards to the time from positive to negative COVID-19 RT-PCR, the mean day till negative swab was 16.42 ± 4.32 (SD) day of illness. The mean day of illness of negative swabs from presymptomatic, symptomatic and true asymptomatic groups were 17, 18, and 15 days respectively. However, the findings were not statistically significant to suggest the symptomatic groups had a longer duration of positivity (p-value = 0.293).
Otherwise, no significant difference was observed related to categories, smoking history, blood abnormalities, and radiological findings among patients with different clinical groups. Table 3 summarises the comparison of the different clinical groups with multiple variables while table 4 compare the variables between genders.
Table 3
Comparing presymptomatic, symptomatic and true asymptomatic group (n = 199) of patients with COVID-19
|
PRESYMPTOM-ATIC
n = 43 (%)
|
SYMPTOMATIC
n = 53 (%)
|
TRUE ASYMPTOMATIC
n = 103 (%)
|
TOTAL
n = 199
|
p-VALUE
|
GENDER
|
FEMALE
|
18 (34.6)
|
14 (26.9)
|
20 (38.5)
|
52
|
0.019*
|
MALE
|
25 (17.0)
|
39 (26.5)
|
83 (56.5)
|
147
|
|
HIGHESTMEWS
|
0
|
1 (50)
|
0 (0)
|
1 (50)
|
2
|
|
1
|
34 (21.7)
|
34 (21.7)
|
89 (56.6)
|
157
|
|
2
|
5 (15.6)
|
15 (46.9)
|
12 (37.5)
|
32
|
0.023*
|
3
|
3 (50)
|
3 (50)
|
0 (0)
|
6
|
|
4
|
0 (0)
|
0 (0)
|
1 (100)
|
1
|
|
CATEGORY AFTER RE-EVALUATION
|
1
|
0 (0)
|
1 (1.1)
|
92 (98.9)
|
93
|
|
2A
|
27 (45.8)
|
32 (54.2)
|
0 (0)
|
59
|
|
2B
|
8 (40)
|
12 (60)
|
0 (0)
|
20
|
|
3A
|
5 (25)
|
4 (20)
|
11 (55)
|
20
|
-
|
3B
|
2 (100)
|
0 (0)
|
0 (0)
|
2
|
|
4A
|
1 (50)
|
1 (50)
|
0 (0)
|
2
|
|
4B
|
0 (0)
|
1 (100)
|
0 (0)
|
1
|
|
5
|
0 (0)
|
2 (100)
|
0 (0)
|
2
|
|
SMOKER
|
NO
|
24 (23.8)
|
20 (19.8)
|
57 (56.4)
|
101
|
|
REFORMED
|
1 (12.5)
|
4 (50)
|
3 (37.5)
|
8
|
0.359
|
YES
|
2 (13.3)
|
5 (33.3)
|
8 (53.3)
|
15
|
|
BLOOD ABNORMALITIES ON ADMISSION
|
NO
|
33 (22.1)
|
38 (25.5)
|
78 (52.3)
|
149
|
0.817
|
YES
|
10 (20)
|
15 (30)
|
25 (50)
|
50
|
|
BLOOD ABNORMALITIES DURING STAY
|
NO
|
32 (22.2)
|
35 (24.3)
|
77 (53.5)
|
144
|
0.485
|
YES
|
11 (20)
|
18 (32.7)
|
26 (47.2)
|
55
|
|
BLOOD INDICES
|
CBC
RP
LFT
|
2 (1)
4 (2)
11 (5.5)
|
1 (0.5)
6 (3)
20 (10)
|
3 (1.5)
10 (5)
24 (12)
|
6
20
55
|
0.442
0.487
0.119
|
RADIOLOGICAL INVESTIGATIONS
|
X-RAY CHANGES
CT THORAX PERFORMED
|
10 (5)
8 (4)
|
9 (4.5)
11 (5.5)
|
11 (5.5)
25 (12.6)
|
30
44
|
0.126
0.748
|
NEGATIVE PCR BASED ON DAY OF ILLNESS
|
MEAN
|
17 DAYS
|
18 DAYS
|
15 DAYS
|
16.42 DAYS
|
0.293
|
*. The Chi-square statistic is significant at the .05 level.
|
Table 4
Statistical comparison between genders and clinical variables in our cohort of COVID-19 patients
VARIABLES
|
MALE (%)
n = 147
|
FEMALE (%)
n = 52
|
p-VALUE
|
BLOOD ABNORMALITIES ON ADMISSION
|
40 (27.2)
|
10 (19.2)
|
0.254
|
BLOOD ABNORMALITIES DURING STAY
|
41 (27.9)
|
14 (26.9)
|
0.893
|
CHEST X-RAY ABNORMALITY
|
20 (13.6)
|
10 (19.2)
|
0.330
|
TREATMENT GIVEN
|
27 (18.4)
|
18 (34.6)
|
0.016*
|
*. The Chi-square statistic is significant at the .05 level.
|
Lastly, we had a large number of foreign nationals admitted; 59 (29.6%) patients in total; comprising of Indonesians, Bangladeshis, Pakistanis, Indian and Myanmar nationals. From this diverse demograph, 11 patients each were presymptomatic and symptomatic while 31 were true asymptomatic. Besides that, 4 patients were clinically category 3 but none were ill.