Background: The interaction between COVID-19, non-communicable diseases, and chronic infectious diseases such as HIV and tuberculosis (TB) are unclear, particularly in low- and middle-income countries (LMIC) in Africa. We investigated this interaction using a nationally representative hospital surveillance system in South Africa. Methods: A national surveillance system for laboratory-confirmed COVID-19 hospital admissions (DATCOV) was established. Using DATCOV data, we describe the demographic characteristics, clinical features, and in-hospital mortality among individuals admitted to public and private hospitals with COVID-19 during 5 March to 11 August 2020. Multivariable logistic regression models were used to compare individuals who were HIV-infected and HIV-uninfected and determine the factors associated with in-hospital mortality. Findings: Hospital admissions peaked at 1,560 admissions per day, in late July. Among the 41,877 individuals admitted with laboratory-confirmed COVID-19, 7,662 (18.3%) died. Comorbidities were documented in 27,555 (65.8%) individuals, most commonly observed were hypertension (36.8%), diabetes (29.6%), obesity (19.7%), and HIV (8.7%); TB was reported in 0.7% of individuals. Increased risk of in-hospital mortality was associated with HIV and TB, as well as other described risk factors for COVID-19, such as increasing age, male sex, non-White race (Black, mixed and Indian race), chronic underlying conditions particularly hypertension, diabetes and obesity. In addition, HIV-infected individuals with immunosuppression had increased risk of mortality (adjusted odds ratio 2.2; 95% confidence interval 1.6-3.1). Among HIV-infected individuals, the prevalence of other comorbidities associated with severe COVID-19 outcomes was 39.9%. The effect of multiple comorbidities on mortality was similar in HIV-infected and -uninfected individuals. Interpretation: These data provide a better understanding of the interaction of non-communicable diseases, chronic infectious diseases like HIV and TB and COVID-19. Increasing age and presence of chronic underlying comorbidities (particularly hypertension and diabetes) are important additional factors associated with COVID-19 mortality in a middle-income African setting and are common among HIV-infected individuals. HIV- and TB-infected individuals, particularly those with additional comorbidities, would benefit from COVID-19 prevention and treatment programmes.
Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the disease it causes, coronavirus disease 2019 (COVID-19), has spread rapidly across the globe resulting in more than 7,000,000 cases and 400,000 deaths worldwide, of which 52,991 cases and 1162 deaths have occurred in South Africa. Objective: To describe the clinical characteristics of the first 100 patients with COVID-19 admitted to a tertiary hospital in Johannesburg, South Africa. Methods: We conducted a single-centre retrospective review of the first 100 patients with reverse transcriptase polymerase chain reaction-confirmed COVID-19 infection admitted to a tertiary academic hospital in Johannesburg, South Africa. Results: The 100 patients were predominantly male (53%), of black ethnicity (79%) and had a median age of 42 years. The most common comorbidities were hypertension (31%), diabetes mellitus (18%) and 47% of the patients had an endomorphic phenotype. Eleven per cent (11%) of our patients were HIV positive. During hospitalisation, 14 patients (14%) required admission to the intensive care unit (ICU). For those patients with an outcome available, the overall mortality rate was 10% (n = 6), and 57% (n = 4/7) for those admitted to the ICU. Mean length of stay for those who had died or had been discharged was 6.8 days. Conclusion: This case series describes clinical characteristics in the first 100 patients with confirmed COVID-19 admitted to a large centre in Johannesburg, South Africa. Our findings are concordant with universally reported data; however, more data is needed on COVID-19 in the South African setting, specifically related to tuberculosis and HIV.
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