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1.
Journal of family medicine and primary care ; 11(6):3000-3005, 2022.
Article in English | EuropePMC | ID: covidwho-2033721

ABSTRACT

Introduction: The clinical and epidemiological presentations of patients with coronavirus disease 2019 (COVID-19) in India is still not well explored. We studied the epidemiological and clinical profile and outcomes of COVID-19 patients admitted to a tertiary care private hospital in Kerala, India. Methods: In this retrospective study, we analyzed data of 476 adult (≥18 years) COVID-19 patients admitted to a tertiary care hospital in Kerala from September 1, 2020 to March 31, 2021. The patients were categorized into mild, moderate, and severe cases and followed till discharge or death. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 23.0 with a significance set at P < 0.05. Results: The median age was 57 years (56% men). Mild, moderate, and severe cases accounted for 17%, 65%, and 18%, respectively. Around 75% had at least one comorbidity, and 51% had multiple comorbidities. The most common comorbidities were diabetes (45%), hypertension (44%), dyslipidemia (15%), and cardiac problems (12%). The elevated D-dimer values among patients in different categories were significantly different, with 74% in severe, 46% in moderate, and 19% in mild category patients. Serum ferritin, C-reactive protein, lactic acid dehydrogenase, and neutrophil to lymphocyte ratio values were significantly higher for severely ill patients. Thirty deaths (67% men) occurred during the study period, with a case fatality rate of 6.3%. Mortality mainly happened in the older age group (80%) and those with multimorbidity (90%). Conclusion: Age and multimorbidity are the major contributing factors for death in hospitalized COVID-19 patients. Generalization of the findings necessitates well-designed large-scale studies.

2.
J Family Med Prim Care ; 11(6): 3000-3005, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1934407

ABSTRACT

Introduction: The clinical and epidemiological presentations of patients with coronavirus disease 2019 (COVID-19) in India is still not well explored. We studied the epidemiological and clinical profile and outcomes of COVID-19 patients admitted to a tertiary care private hospital in Kerala, India. Methods: In this retrospective study, we analyzed data of 476 adult (≥18 years) COVID-19 patients admitted to a tertiary care hospital in Kerala from September 1, 2020 to March 31, 2021. The patients were categorized into mild, moderate, and severe cases and followed till discharge or death. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 23.0 with a significance set at P < 0.05. Results: The median age was 57 years (56% men). Mild, moderate, and severe cases accounted for 17%, 65%, and 18%, respectively. Around 75% had at least one comorbidity, and 51% had multiple comorbidities. The most common comorbidities were diabetes (45%), hypertension (44%), dyslipidemia (15%), and cardiac problems (12%). The elevated D-dimer values among patients in different categories were significantly different, with 74% in severe, 46% in moderate, and 19% in mild category patients. Serum ferritin, C-reactive protein, lactic acid dehydrogenase, and neutrophil to lymphocyte ratio values were significantly higher for severely ill patients. Thirty deaths (67% men) occurred during the study period, with a case fatality rate of 6.3%. Mortality mainly happened in the older age group (80%) and those with multimorbidity (90%). Conclusion: Age and multimorbidity are the major contributing factors for death in hospitalized COVID-19 patients. Generalization of the findings necessitates well-designed large-scale studies.

6.
Infect Dis Model ; 5: 608-621, 2020.
Article in English | MEDLINE | ID: covidwho-733820

ABSTRACT

BACKGROUND: Due to uncertainties encompassing the transmission dynamics of COVID-19, mathematical models informing the trajectory of disease are being proposed throughout the world. Current pandemic is also characterized by surge in hospitalizations which has overwhelmed even the most resilient health systems. Therefore, it is imperative to assess health system preparedness in tandem with need projections for comprehensive outlook. OBJECTIVE: We attempted this study to forecast the need for hospital resources for one year period and correspondingly assessed capacity and tipping points of Indian health system to absorb surges in need due to COVID-19. METHODS: We employed age-structured deterministic SEIR model and modified it to allow for testing and isolation capacity to forecast the need under varying scenarios. Projections for documented cases were made for varying degree of containment and mitigation strategies. Correspondingly, data on health resources was collated from various government records. Further, we computed daily turnover of each of these resources which was then adjusted for proportion of cases requiring mild, severe and critical care to arrive at maximum number of COVID-19 cases manageable by health care system of India. FINDINGS: Our results revealed pervasive deficits in the capacity of public health system to absorb surge in need during peak of epidemic. Also, model suggests that continuing strict lockdown measures in India after mid-May 2020 would have been ineffective in suppressing total infections significantly. Augmenting testing to 1,500,000 tests per day during projected peak (mid-September) under social-distancing measures and current test to positive rate of 9.7% would lead to more documented cases (60, 000, 000 to 90, 000, 000) culminating to surge in demand for hospital resources. A minimum allocation of 13x, 70x and 37x times more beds for mild cases, ICU beds and mechanical ventilators respectively would be required to commensurate with need under that scenario. However, if testing capacity is limited to 9,000,000 tests per day (current situation as of 19th August 2020) under continued social-distancing measures, documented cases would plummet significantly, still requiring 5x, 31x and 16x times the current allocated resources (beds for mild cases, ICU beds and mechanical ventilators respectively) to meet unmet need for COVID-19 treatment in India.

7.
Public Health Pract (Oxf) ; 1: 100009, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-175723

ABSTRACT

This commentary highlights the potential consequences of the COVID-19 pandemic for India's rural population. The rural health care system in India is not adequate or prepared to contain COVID-19 transmission, especially in many densely populated northern Indian States because of the shortage of doctors, hospital beds, and equipment. The COVID-19 pandemic creates a special challenge due to the paucity of testing services, weak surveillance system and above all poor medical care. The impacts of this pandemic, and especially the lockdown strategy, are multi-dimensional. The authors argue for the need to take immediate steps to control the spread and its aftereffects and to use this opportunity to strengthen and improve its primary health care system in rural India.

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