Severe Acute Respiratory Infection Surveillance during the Initial Phase of the COVID-19 Outbreak in North India: A Comparison of COVID-19 to Other SARI Causes

Abstract

A bstract Introduction World Health Organization proposes severe acute respiratory infection (SARI) case definition for coronavirus disease 2019 (COVID-19) surveillance; however, early differentiation between SARI etiologies remains challenging. We aimed to investigate the spectrum and outcome of SARI and compare COVID-19 to non-COVID-19 causes. Patients and methods A prospective cohort study was conducted between March 15, 2020, to August 15, 2020, at an adult medical emergency in North India. SARI was diagnosed using a “modified” case definition—febrile respiratory symptoms or radiographic evidence of pneumonia or acute respiratory distress syndrome of ≤14 days duration, along with a need for hospitalization and in the absence of an alternative etiology that fully explains the illness. COVID-19 was diagnosed with reverse transcription-polymerase chain reaction testing. Results In total, 95/212 (44.8%) cases had COVID-19. Community-acquired pneumonia ( n = 57), exacerbation of chronic lung disease ( n = 11), heart failure ( n = 11), tropical febrile illnesses ( n = 10), and influenza A ( n = 5) were common non-COVID-19 causes. No between-group differences were apparent in age ≥60 years, comorbidities, oxygenation, leukocytosis, lymphopenia, acute physiology and chronic health evaluation (APACHE)-II score, CURB-65 score, and ventilator requirement at 24-hour. Bilateral lung distribution and middle-lower zones involvement in radiography predicted COVID-19. The median hospital stay was longer with COVID-19 (12 versus 5 days, p = 0.000); however, mortality was similar (31.6% versus 28.2%, p = 0.593). Independent mortality predictors were higher mean APACHE II in COVID-19 and early ventilator requirement in non-COVID-19 cases. Conclusions COVID-19 has similar severity and mortality as non-COVID-19 SARI but requires an extended hospital stay. Including radiography in the SARI definition might improve COVID-19 surveillance. How to cite this article Pannu AK, Kumar M, Singh P, Shaji A, Ghosh A, Behera A, et al . Severe Acute Respiratory Infection Surveillance during the Initial Phase of the COVID-19 Outbreak in North India: A Comparison of COVID-19 to Other SARI Causes. Indian J Crit Care Med 2021;25(7):761–767.

Comparing critically ill ARDS patients with COVID-19 vs. without COVID-19: A prospective, bivariate and multi-variable analysis of 690 patients

“…53 Interestingly, the only moderately-large prospective study in which data for COVID and non-COVID cases were collected at the same location over the exact same time period, and in which multivariable analysis was performed to identify predictors of mortality found the APACHE-II score to be only significant predictor, with mechanical ventilation predictive in non-COVID cases. 40 Note that we found both to be predictive of both COVID and non-COVID related ARDS. One potential explanation for this difference is that our study had 160 and 530 COVID and non-COVID cases, respectively, vs. just 95 and 117 in the Indian study.…”

“…One exception that appears to have overcome all the above-mentioned shortcomings was a study conducted in India which compared 95 COVID and 117 non-COVID ARDS patients all treated at a single, tertiarycare, academic hospital from March 15 through August 15, 2020the first wave of COVID-19 in that area. 40 In this study, logistic regression identified higher APACHE-II scores as predictive of mortality in COVID but not non-COVID patients. However, that there were only 212 patients total might have resulted in inadequate statistical power to detect other predictors either distinct to COVID or shared by both COVID and non-COVID ARDS patients.…”

Changing spectrum of primary pyomyositis in North India

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“…scrub typhus, malaria); thus the diagnosis of pyomyositis may be overlooked. 18–20 Moreover, muscle pain may be absent in up to 25% of cases of pyomyositis. 9…”

Disability-adjusted life years (DALYs) due to the direct health impact of COVID-19 in India, 2020

“…A study from India reported 12 days duration of COVID-19 for hospitalized patients 34 . Another study from Germany also reported an overall hospitalization of 12 (7–20) days for COVID-19 patients needing oxygen supplementation outside the ICU 35 .…”