Background Various reports suggested that pre-existing medical illnesses, including hypertension and other demographic, clinical, and laboratory factors, could pose an increased risk of disease severity and mortality among COVID-19 patients. This study aimed to assess the relation of hypertension and other factors to the severity of COVID-19 pneumonia in patients discharged from Eka Kotebe Hospital in June-September, 2020. Methods This is a single-center case-control study of 265 adult patients discharged alive or dead, 75 with a course of severe COVID-19 for the cases arm and 190 with the non-severe disease for the control arm. Three age and sex-matched controls were selected randomly for each patient on the case arm. Chi-square, multivariable binary logistic regression, and odds ratio (OR) with a 95% confidence interval was used to assess the association between the various factors and the severity of the disease. A p-value of <0.05 is considered statistically significant. Results Of the 265 study participants, 80% were male. The median age was 43 IQR(36–60) years. Both arms had similar demographic characteristics. Hypertension was strongly associated with the severity of COVID-19 pneumonia based on effect outcome adjustment (AOR = 2.93, 95% CI 1.489, 5.783, p-value = 0.002), similarly, having diabetes mellitus (AOR = 3.17, 95% CI 1.374, 7.313, p-value<0.007), chronic cardiac disease (AOR = 4.803, 95% CI 1.238–18.636, p<0.023), and an increase in a pulse rate (AOR = 1.041, 95% CI 1.017, 1.066, p-value = 0.001) were found to have a significant association with the severity of COVID-19 pneumonia. Conclusions Hypertension was associated with the severity of COVID-19 pneumonia, and so were diabetes mellitus, chronic cardiac disease, and an increase in pulse rate.
Currently in Ethiopia, patients with a variety of suspected or known pulmonary diseases, including asthma, chronic obstructive pulmonary disease (COPD), and interstitial lung disease, are not being properly identified or monitored. This is due, in part, to a lack of pulmonary function testing because of concerns about possible aerosolized transmission of SARS-CoV-2. We believe that the paucity of pulmonary function testing and its subsequent adverse effect on those with lung disease is an unintended and underreported consequence of the COVID-19 pandemic. This concern is not unique to Ethiopia. A global survey of health-care professionals on the impact of COVID-19 on routine care for chronic diseases found that after diabetes, COPD and asthma were the conditions most significantly impacted by a reduction in health care due to COVID-19. [1][2] Spirometry is an important measurement tool that not only assists with the diagnosis but also the management of those with respiratory diseases. Its use now is also important in identifying those with asthma and COPD who are at increased risk for severe COVID-19 and also in monitoring lung function for those recovering from the infection. [3] In the past 9 months, no spirometric testing has been conducted at Tikur Anbessa Specialized Hospital (TASH), the largest public tertiary hospital in the country located in Addis Ababa, Ethiopia, despite the availability of a well-equipped and well-staffed spirometry service.To help identify the impact of COVID-19 on respiratory patients at TASH, we recently calculated the total number of spirometric tests performed based on the number of patients seen in the chest clinic from mid-March to mid-December 2019. We then estimated the number of spirometric tests that should have been performed during that same time interval in 2020. There were an estimated 396 missed spirometric tests which we believe may have been partially responsible for inadequate assessment and monitoring of respiratory disease status with possible outcome implications for our patients. A formal study is planned to further investigate this likelihood. Shortly, we plan to resume our spirometry service, following strict operational protocols, designed to maintain patient and staff safety, which we have modified for low and middle-income countries (LMICs) from recommendations of the American Thoracic Society [4] and World Health Organization. [5] We think these guidelines can and should be used by other LMIC.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
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