Discharge of Confirmed COVID-19 Patients Based on WHO or Regional Criteria? A Cohort Study.

BACKGROUND: Increasing the number of COVID-19 patients raises concerns about the capacity of the health care system. This issue emphasizes reducing the admission rate and expediting patient discharge. OBJECTIVE: This study aimed to develop a discharge protocol for COVID-19 patients based on the existing capacity of the healthcare system and to assess its post-discharge outcomes. METHODS: This is a multicenter cohort study. All COVID-19 patients referred to selected medical centers in Qom, Iran, from Feb. 19 to Apr. 19, 2020, were target populations. Eligible patients were classified into a) the criterion group and b) the non-criterion group. Patients were followed up daily for 14 days after discharge by phone, and the required data was gathered and recorded in follow-up form. Univariate (chi-square and t-tests) and multivariate multiple (multivariate probit regression) analysis were used. RESULTS: A total of 2775 patients were included in the study (1440 people in the criterion group and 1335 in the non-criterion group). Based on multivariate probit regression, death was statistically associated with discharge outside our criteria (p<0.001), rising age (p<0.001), and being male (p=0.019), and readmission were associated with discharge outside our criteria (p<0.001), rising age (p=0.009), and having the history of underlying diseases (p=0.003). Furthermore, remission had statistically significant associations with discharge based on our criteria (p<0.001), decreasing age (p=0.001), and lack of a history of underlying diseases (p<0.001). CONCLUSION: Mortality and readmission were significantly lower according to our discharge criteria. Our designed criteria apply to less developed and developing countries due to the limited capacity and resources available in the health care system.

Relationship between coronavirus disease 2019 in pregnancy and maternal and fetal outcomes: Retrospective analytical cohort study.

OBJECTIVE: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has caused many deaths and complications worldwide. However, limited data are available about COVID-19 during pregnancy. This study aimed to assess the epidemiological and clinical features of COVID-19, and the adverse maternal and fetal outcomes. DESIGN: This retrospective analytical cohort study was conducted on all pregnant women with confirmed COVID-19 at Nekouei-Hedayati-Forghani Hospital in Qom, Iran from 15 March 2020 to 15 November 2020. For the same period, 165 pregnant women who did not have COVID-19 were selected at random and included in this study. All epidemiological and clinical features were collected from the medical records of the participants. A logistic regression model was used to determine associations between COVID-19 in pregnancy and maternal and fetal outcomes. FINDINGS: The most common symptoms reported by pregnant women with COVID-19 were shortness of breath (60.9%), dry cough (59%) and fever (42.9%). After adjustment for potential confounding factors, COVID-19 in pregnancy was associated with a significantly higher risk of admission to the intensive care unit (ICU) [odds ratio (OR) 6.16, 95% confidence interval (CI) 1.23-31], caesarean section (OR 0.45, 95 CI 0.25-1.03), preterm birth (OR 3.01, 95% CI 1.4-6.54), fetal distress (OR 5.7, 95% CI 2.13-15.59) and admission to the neonatal intensive care unit (NICU) (OR 3.04, 95% CI 1.21-7.70). KEY CONCLUSIONS: COVID-19 is associated with adverse maternal and fetal outcomes, including ICU admission, caesarean section, fetal distress, preterm birth and NICU admission.