Difference in presentation, outcomes, and hospital epidemiologic trend of COVID-19 among first, second, and third waves in Dhaka Medical College (preprint)

Background This study aimed to examine the differences in epidemiologic and disease aspects among patients with COVID 19 Methods: We reviewed the hospital records between April 2020 and September 2021 and followed up on the patients for post COVID complications. Findings: Older adult patients were predominantly affected during the first and second waves, followed by middle-aged patients. Men were predominantly admitted, considering the three waves; although more women were admitted in the second wave. Cough was more common in the second and third waves than in the first wave 522 (59.7%). Respiratory distress was the most common in the third wave, 251(67.1%), and least common in the first wave 403 (46.1%). Anosmia was more common in the third wave 116 (31.2%). In the third wave, patients presenting in a critical state 23 (6.2%) and severe disease 152 (40.8%) were more common. The hospital admission median (IQR) was longer in the first wave, 12 (8-20), than in other waves. More patients were admitted in the first wave (52%) than in the other waves, and patients received more oxygen in the third wave (75%) than in the other waves. Death occurred more commonly in the first wave (51%) than in the other waves. Patients were investigated more commonly in the first and third waves than in the second wave. The positivity rate was high in the third wave (22.8%) than in other waves. In the third wave, the positivity rate was higher in women (24.3%) than in men. Post COVID cough increased in the second wave and fatigue was higher in the third wave than in other waves. Tiredness and memory loss was greater during the second wave than in other waves. Conclusion: This study revealed that the presenting symptoms, outcomes, and epidemiologic trends differed during the COVID 19 waves.

Experiences of the physicians in the largest COVID-19 dedicated hospital of Bangladesh about COVID-19 and its aftermath (preprint)

Background: The doctors and the other health care workers are the first-line fighters against COVID-19. This study aims to identify the prevalence, risk factors, clinical severity of COVID-19 infection among the doctors working in the COVID unit. We also analyzed the hospital data for admission and RT-PCR positivity among the physicians. Methods: It was a cross-sectional survey and review of the hospital database. We surveyed from September 2021 to October 2021 and explored the hospital data from march 2020 to September 2021.We included 342 physicians for analysis in the survey. We reviewed hospital data of 1578 total admitted patients and 336 RT-PCR test positive physicians for analyzing the hospital admission rate, the positivity rate for COVID-19 among the physicians and the other patients in the different COVID- 19 surges. Findings: In this study, we demonstrated the physicians sufferings during the pandemic era. We have observed four surges in the hospital admission and RT-PCR for COVID-19 positivity rate among the physicians and the general population. The physicians experienced a similar surge in the hospital admission and positivity rate to the general population. The hospital admission was lower in the fourth surge among the physicians than the general population. The positivity rate was higher in the first, second and third surge among the physicians. In the survey, a total of 146(42%) respondents had COVID-19 infection, and among them, 50(34.2%) had re-detectable positive SARS-CoV-2 infection. Most of them experienced mild (77[52.7%]) to moderate (41[28.1%]) symptoms. Increasing age (OR, 95%CI, p-value; 1.15, 1.05-1.25, 0.002), male sex (OR, 95%CI, p-value; 5.8, 3.2-9.8, <0.001), and diabetes (OR, 95%CI, p-value; 25.6, 2-327.2, 0.01) were the risk factor of having COVID-19. Female sex and diabetes were the risk factors for re-detectable positive SARS-CoV-2 infection. (OR, 95%CI, p-value; 0.24, 0.09-0.67, 0.006; 44, 8.9-218.7, <0.001 respectively). Most respondents suffered for 7-14 days. Total 98(67%) suffered from post-COVID fatigue. Conclusions: The physicians observed four surges in hospital admission and COVID-19 positivity rate. A significant number of the COVID-warrior became positive for SARS-CoV-2, had r e-detectable positive SARS-CoV-2 infection, and suffered in the post-COVID-19 state.

Meta-analysis of randomized trials of ivermectin to treat SARS-CoV-2 infection (preprint)

Ivermectin is an antiparasitic drug being investigated for repurposing to SARS-CoV-2. In-vitro, ivermectin showed limited antiviral activity and a COVID-19 animal model demonstrated pathological benefits but no effect on viral RNA. This meta-analysis investigated ivermectin in 18 randomized clinical trials (2282 patients) identified through systematic searches of PUBMED, EMBASE, MedRxiv and trial registries. Ivermectin was associated with reduced inflammatory markers (C-Reactive Protein, d-dimer and ferritin) and faster viral clearance by PCR. Viral clearance was treatment dose- and duration-dependent. In six randomized trials of moderate or severe infection, there was a 75% reduction in mortality (Relative Risk=0.25 [95%CI 0.12-0.52]; p=0.0002); 14/650 (2.1%) deaths on ivermectin; 57/597 (9.5%) deaths in controls) with favorable clinical recovery and reduced hospitalization. Many studies included were not peer reviewed and meta-analyses are prone to confounding issues. Ivermectin should be validated in larger, appropriately controlled randomized trials before the results are sufficient for review by regulatory authorities.

Post COVID Syndrome Among Symptomatic COVID-19 Patients: A Prospective Study in a Tertiary Care Center in Bangladesh (preprint)

Background: Post COVID syndrome is defined in this articles as: 1. Persistence of the symptoms beyond the virologic clearance. 2. New development of symptoms or exaggeration of chronic diseases within 1 month after initial clinical and virologic cure, the etiology of which postulated to be viral. The study aims to find the incidence, association, and the risk factors for the development of the syndrome.Methods: This Prospective Cohort study was conducted in Dhaka Medical college Hospital, from 01, June 2020 to 10, August 2020. Consecutive patients were enrolled and followed up for at least 1 month after recovery.Findings: Among 400 recruited patients 355 patients were analyzed. Mean (SD) age was 39•9(13•4) years, with male dominance (1•4:1). Total 162 (46%) patients developed post COVID symptoms. Among them post viral fatigue117 (70%) was most prevalent. Post COVID features are significantly higher among the female [RR, 95% CI, p 1•2, (1•02-1•48), 0•03], those who suffered for longer period (p= 0•00) and those who had prolonged positivity [RR, 95% CI, p; 1•09, (1•00-1•19), 0•00] for Covid 19. Severity of the COVID had also positive association (p value=0•02). Those who have Fever [RR, 95% CI, p; 1•5, (1•05-2•27), 0•03], Cough [RR, 95% CI, p; 1•36, (1•02-1•81),, 0•04] respiratory distress [RR, 95% CI, p; 1•3, (1•4-1•56),0•001], and lethargy [RR, 95% CI, p ;1•2, (1•06-1•35),0•003] as the presenting features were more susceptible. Logistic regression established female gender, respiratory distress, lethargy and long duration of the disease as risk factors.Interpretations: Female gender, patient presenting with respiratory distress, lethargy and who suffered for long duration are the risk factors.Funding: Received no funds from any source.Declaration of Interests: The authors declare that there is no conflict of interests regarding the publication of this paper.Ethics Approval Statement: Ethical approval was obtained from institutional ethical committee.