ABSTRACT
Background: The coronavirus disease 2019 (COVID-19) pandemic imposed the most devastating challenge on healthcare systems worldwide. Iran was among the first countries that had to confront serious shortages in reverse-transcriptase-polymerase chain reaction (RT-PCR) testing for severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) and ventilators availabilities throughout the COVID-19 outbreak. Objectives: This study aimed to investigate the clinical course of hospitalized COVID-19 patients with different real-time RT-PCR test results during the first three weeks of the outbreak in Qazvin province, Iran. Methods: In this retrospective cohort study, patients with a positive chest computed tomography (CT) scan for COVID-19 who were admitted to all 12 hospitals across Qazvin province, Iran, between February 20 and March 11, 2020, were included and followed up until March 27, 2020. A multivariate logistic regression model was applied to compare the independent associates of death among COVID-19 patients. Then, patients were categorized into six groups based on admission to the intensive care unit (ICU) and rRT-PCR test status (positive, negative, or no test). Also, multilevel logistic regression was used to compare the odds of surviving in each group against the reference group (PCR negative patients not-received ICU) to show if the rational allocation of ICU occurred while its capacity is limited. Results: In this study, we included 998 patients (57% male;median age: 54 years) with positive chest CT scan changes. Among them, 558 patients were examined with rRT-PCR test and 73.8% tested positive. Case fatality rate (CFR) was 20.68 and 7.53% among hospitalized patients with positive and negative tests, respectively. While only 5.2% of patients were admitted to the ICU, CFR outside ICU was 17.70 and 4.65% in patients with positive and negative results not admitted to the ICU, respectively. Conclusions: Total CFR in all hospitalized COVID-19 patients in Qazvin province during the first three weeks of the pandemic was 11.7%. Also, according to the results, the main risk factors included a positive rRT-PCR test, age more than 70 years, and having two or more comorbidities or just immunodeficiency disorders. Hence, the ICU admission criteria or prioritized ICU beds allocation should be considered with more emphasis on rRT-PCR results when the capacity of ICU beds is low.
ABSTRACT
The epidemic of COVID-19 and its associated acute respiratory syndrome has posed an unprecedented challenge in identifying effective drugs to prevent and treat it. Due to the high prevalence of this disease and the high number of people at risk, medical staff needs accurate evidence regarding effective drug treatments for this infection. There is currently no effective treatment for COVID-19. But the rapid development of knowledge about the virology of SARS-CoV-2 provides a significant number of potential pharmacological targets. Evidence suggests that the data provided on the efficacy of hydroxychloroquine is contradictory, but it seems that Remdesivir, although not yet approved by the US Food and Drug Administration, has strong laboratory activity against the virus is the most promising drug treatment. In addition to these results, some clinical trials have ruled out the effectiveness of Oseltamivir and limit the use of corticosteroids. Also, current clinical evidence does not support the use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers in patients with COVID-19. The COVID-19 epidemic is the largest global public health crisis of the present era since the outbreak of the flu pandemic in 1918. The speed and volume of clinical trials that have begun to examine potential treatments for COVID-19 indicate the urgent need to find the optimal treatment for this problem as soon as possible, which has not yet been conclusively effective.