With the ongoing COVID-19 pandemic, transplant patients and those with end-stage organ failure are in a particularly vulnerable position and are impacted by the disease from various aspects. Among the problems transplant patients endure one could name that elective surgeries such as live donor transplant procedures have been put on hold in many countries [13, 14]. Also, a decrease in the number of donor transplants, where the procedure is established, continues in some countries, albeit with modified donor and recipient criteria, in an attempt to reduce the risk of COVID-19 transmission or infection after transplantation [14, 15]. Additionally, administered immunosuppression drugs in these patients increase the risk of disease contraction and progression [6]. With the current situation, adopted policies will result in a loss of transplant opportunities and therefore a substantial increase in the number of waiting list patients with also a significant impact on patient and hospitals, such as an increase in dialysis capacity and provision for kidney transplant patients, with additional inevitable morbidity and mortality; Hence, caring for patients who are at higher risk of disease progression is vital during this distinct period.
Our study demonstrated that 59.47%patients had a mild presentation of COVID-19. In a similar study, Pereia et al [16] reported 90 patients in an epicenter in the United States, Among these, twenty-two (24%) had mild, 41 (46%) moderate, and 27 (30%) severe disease. The higher rate of mild patients in our study can be contributed to the implanted policies for screening and early detection of the disease, which subsequently resulted in a higher detection rate along with identifying patients at early stages of the disease, also some studies declared transplanted patients due to their immunosuppression status presented with less severe symptoms [17, 18]. However, relying on molecular detection of the disease rather than the clinical presentations for commencing treatment is still a controversial issue [19].
The mortality rate in our study was 11% which was higher than the reported rate of the province (8%) [20]. Also, Pacual et al reported a fatality rate of about 45.8% during the first 60 days after kidney transplantation [21]. The mortality rate varies among studies which may be due to the patients included and comorbidities, which in our case the major cause of mortality was ARDS. So, special attention should be given to decelerate the progression of the disease and avoid reaching severe phases. Diabetes mellitus and hypertension were the most detected comorbidities in our study, which was also reported in other studies [16, 20], which has been reported to be linked with ACE2-increasing drug treatment in these patients. [22]
Regarding personnel and healthcare worker infection rates, 81 out of 450 cases (18%) had either PCR or clinical features in favor of COVID-19. Based on PCR results, only 14 (3.1%) had positive PCR tests, which was lower than a previous study in our province which demonstrated an infection rate of 5.6% among healthcare workers [23]. Chu et al [24] reported a rate of 57 cases during 5 weeks by the means of clinical presentations and based on WHO interim guidance [25], our study also demonstrated a higher detection rate by exploiting clinical presentations, in which 67 cases were detected by this method. Whether molecular or clinical features should be used in the context of detecting COVID-19 cases is still a matter of debate which reports highlight employing clinical features due to the high rate of PCR false negatives. [26] Furthermore, the highest group at risk of infection was nurses which accounted for 8 out of 14 (57.1%) positive PCRs for COVID-19 in our study versus a 51.3% rate in a previous study in Fars [23]. This fact may be due to that nurses have more patient contact in comparison with other healthcare workers which increases the risk of infection [27]. Although safety measures and self-protection equipment were provided for all health care workers, these populations are still at risk and should be routinely screen to provide early detection and treatment.
This is while a person working in Iran typically earns around 44,800,000 IRR per month (11,300,000 IRR lowest average) [28], while based on our data, the average cost for COVID-19 treatment among the patients in our study was around 10,800,000 IRR, which is 23–95% of an average individual’s salary. Other studies have reported that a maximum cost of 20,000 USD for COVID-19 inpatient admissions [22]. This is aside from the substantial cost of purchasing PPE and disinfectants during this period imposed on the hospital along with the decreased number of elective surgeries which subsequently results in a significant reduction in the income for hospitals, which is mentioned in other studies [29, 30]. Therefore these facts, along with other studies, demonstrate that the global health issue caused by the COVID-19 pandemic not only impacts the individual’s health, but also the economy, mental status, and other various aspects [22, 31, 32], therefore considering all these factors is vital in going on with this global pandemic.
Although this study provides optimistic evidence of controlling the disease, some limitations remain. Our report was during the initial four months of the pandemic in Iran, and long-term follow-up of the discharged patients are not available. This is while the disease is still persistent in the country and many centers and individuals are still struggling with its impact, therefore precise evaluating management and therapeutic options is vital for optimizing the ultimate results.