Clinical characteristics and factors associated with COVID-19-related mortality and hospital admission during the first two epidemic waves in 5 rural provinces in Indonesia: A retrospective cohort study

Abstract

Background Data on coronavirus disease 2019 (COVID-19) clinical characteristics and severity from resource-limited settings are limited. This study examined clinical characteristics and factors associated with COVID-19 mortality and hospitalisation in rural settings of Indonesia, from 1 January to 31 July, 2021. Methods This retrospective cohort included individuals diagnosed with COVID-19 based on polymerase chain reaction or rapid antigen diagnostic test, from five rural provinces in Indonesia. We extracted demographic and clinical data, including hospitalisation and mortality from a new piloted COVID-19 information system named Sistem Informasi Surveilans Epidemiologi (SISUGI). We used mixed-effect logistic regression to examine factors associated with COVID-19-related mortality and hospitalisation. Results Of 6,583 confirmed cases, 205 (3.1%) died and 1,727 (26.2%) were hospitalised. The median age was 37 years (Interquartile range 26–51), with 825 (12.6%) under 20 years, and 3,371 (51.2%) females. Most cases were symptomatic (4,533; 68.9%); 319 (4.9%) had a clinical diagnosis of pneumonia and 945 (14.3%) presented with at least one pre-existing comorbidity. Age-specific mortality rates were 0.9% (2/215) for 0–4 years; 0% (0/112) for 5–9 years; 0% (1/498) for 10–19 years; 0.8% (11/1,385) for 20–29 years; 0.9% (12/1,382) for 30–39 years; 2.1% (23/1,095) for 40–49 years; 5.4% (57/1,064) for 50–59 years; 10.8% (62/576) for 60–69 years; 15.9% (37/232) for ≥70 years. Older age, pre-existing diabetes, chronic kidney disease, liver diseases, malignancy, and pneumonia were associated with higher risk of mortality and hospitalisation. Pre-existing hypertension, cardiac diseases, COPD, and immunocompromised condition were associated with risk of hospitalisation but not with mortality. There was no association between province-level density of healthcare workers with mortality and hospitalisation. Conclusion The risk of COVID-19-related mortality and hospitalisation was associated with higher age, pre-existing chronic comorbidities, and clinical pneumonia. The findings highlight the need for prioritising enhanced context-specific public health action to reduce mortality and hospitalisation risk among older and comorbid rural populations.

Characteristics and clinical outcomes of patients with pre-delta, delta and omicron SARS-CoV-2 infection in Indonesia (2020–2023): a multicentre prospective cohort study

“…Our prospective study corroborated previous retrospective analyses in Indonesia that estimated crude hospital mortality at 12–15% for the first (pre-delta) pandemic phase, 1 , 21 and extended these early findings to report on disparate adverse clinical outcomes for the delta and omicron waves. For the severe clinical disease outcome, the age-adjusted percentage of patients varied from 26.8% (22.7–30.9) for pre-delta, up to 50.1% (44.0–56.2) for delta, and down to 15.2% (9.7–20.7) for omicron overall, and 7.2% (0.2–14.1) for the recent BA.4/BA.5/XBB subvariants, and participants admitted with omicron had 64% (18%–84%) lower odds than delta of developing severe disease, after adjusting for known confounders (i.e., age, sex, comorbidities, vaccination, presence of comorbidity).…”

Role of epinephrine in attenuating cytokine storm, decreasing ferritin, and inhibiting ferroptosis in SARS-CoV-2

“…The mortality and morbidity represent an unprecedented challenge to the modern medical era [ 1 ]. Until March 2023, nearly 761.07 million cases and 6.87 million deaths have been reported according to statistics from the World Health Organization [ 2 ]. Clinical manifestations are absent or mild in a substantial proportion of patients who test positive for SARS-CoV-2.…”