Descriptive epidemiology of COVID-19 deaths during the first wave of pandemic in India - a single center experience

Abstract

Background With the looming threat of recurrent waves of COVID-19 in the presence of mutated strains, its of paramount importance to understand the demographic and clinical attributes of COVID-19 related mortalities in each pandemic waves. This could help policy makers, public health experts, and clinicians to better plan preventive and management strategies to curb COVID-19 related mortality. Method This was a hospital record based, retrospective cross-sectional descriptive study, at a tertiary care hospital in Rishikesh, India. The study included all deceased patients between March 2020 and January 2021 (first wave) who tested positive for SARS-CoV-2 by RT-PCR and were hospitalized. The study was done to describe demography, clinical presentation, laboratory parameters, treatment given and associated complications of all COVID-19 deaths. Result Out of 424 mortalities, 298 (70.38%) were males and 126 (29.62%) were females. Mean age of patients was 55.85 (SD=16.24 years), out of which 19.5 percent were less than 45 years old, 33.6 percent were 45 to 60 years old and 41.8% were more than 60 years old. Comorbidity in the form of type 2 diabetes mellitus was present in 41.4% [95% CI (41.4-51.1)], hypertension in 39.8% [95% CI (35.1-44.6)], and coronary artery disease in 15.2% [95% CI (11.8-18.8)]. At the time of presentation, shortness of breath was present in 73.6% [95% CI (69.1-77.7)], fever in 64.92% [95% CI (60.1-69.4)], and cough in 46.1%, [95% CI (41.1-50.8)]. Deranged laboratory parameters were lymphopenia in 90.2% [95% CI (86.8-92.7)], transaminitis in 59.7% [95% CI (54.8-64.3)], and hypercreatinemia in 37.7% [95% CI (33.1-42.5)]. Complications manifested were acute respiratory distress syndrome in 78.3% [95% CI (74-82.1)] and shock in 54.7% [95% CI (49.8-59.5)]. Median time duration between onset of symptom and hospital admission was 5 days (IQR = 3-5 days) and median length of hospital stay was 9 days (IQR = 4-14 days). Conclusion During first pandemic wave, COVID-19 related mortality was 2.37 times higher among males, 2.14 times in age group >60 than <45 years. Most common associated comorbidities (>40%) were type 2 diabetes mellitus and hypertension. Most common associated symptoms (>60%) were shortness of breath and fever. Lymphopenia was seen in >90% cases while liver involvement in 60% and kidney in 38% cases. Median hospital stay was doubled the pre-hospital illness.

Comparative study between first and second wave of COVID-19 deaths in India - a single center study

“…Male preponderance of mortality was evident in both the waves. The median number of days between onset of symptom and hospital admission was 6 (3)(4)(5)(6)(7)(8)(9)(10)(11) days in second wave, which is significantly different from corresponding interval in first wave (p<0.000). The median duration of hospital stay was 5 (3-10) days in second wave, which is significantly different from corresponding duration in first wave (p<0.000).…”

“…In contrast to the first wave, fewer patients underwent renal replacement therapy during the second wave. This may be attributed to the rapid progression of the disease and short hospital stays (4). ARDS remains the leading cause of death in the COVID-19 patients, as seen in multiple studies and meta-analyses including this present study (12,24).…”

“…A descriptive study is already done at the same center to assess the comorbidities, risk factors, clinical signs and symptoms, and other baseline characteristics in the first wave (4).…”

“…A descriptive study is already done at the same center to assess the comorbidities, risk factors, clinical signs and symptoms, and other baseline characteristics in the first wave (4). Present study is aimed to look for the difference in the baseline characteristics in first and second waves at a tertiary care hospital in Uttarakhand, India.…”

Isolation and Characterization of Five Severe Acute Respiratory Syndrome Coronavirus 2 Strains of Different Clades and Lineages Circulating in Eastern India

“…In Pune and Madurai districts, India, 85.6 and 2.5% of patients were asymptomatic ( Bhardwaj et al, 2021 ; Laxminarayan et al, 2021 ). In addition, 70.38% mortality was seen in males at a tertiary care hospital in Rishikesh, India ( Tendulkar et al, 2022 ).…”