Epidemiological and Clinical Profile of COVID–19 Suspect Cases in a Teaching Hospital of Bangalore Urban – A Cross Sectional Study

Introduction

COVID–19 is a pandemic that was first reported in Wuhan city of China by WHO on 31^st December 2019. This disease is caused by a novel Coronavirus which was subsequently named SARS-CoV- 2. It is a form of beta coronaviruses associated with human severe acute respiratory syndrome (SARS) and the Middle East respiratory syndrome (MERS).¹

It is a disease with a high magnitude crossing all the international borders, involving a large geographical area, affecting millions of people leading to disabilities and deaths. The catastrophic effect of this disease has ruined the lives in many forms, thereby hampering the quality of Life.²

This disease which was initially assumed as an outbreak of pneumonia with symptoms such as fever, cough, and difficulty in breathing resulted in severe acute respiratory distress leading to respiratory failure. As per the situation report – 110 of World Health organization on COVID–19, there are about 3.8 lakh cases of COVID–19 all over the world with 2.6 lakh deaths.³

After spreading rapidly in China, infecting approximately 85,000 people, it had spread to Europe causing massive loss of life and property which compelled the World Health Organization to declare COVID –19 as a global pandemic on 11^th March 2020.4 Before 3^rd March 2020⁴, India had three cases of coronavirus in Kerala, followed by fourth case in Rajasthan who had infected few of the foreigners who were on Indian tour.⁵ Gradually the number of cases increased in India too.

Therefore, this study was considered to determine the epidemiological and clinical profile of COVID-19 suspects in terms of age, sex, clinical symptoms, travel history, contact with a laboratory-confirmed case of those who were admitted to a tertiary health care facility of Bangalore Urban district. Therefore, this study was conducted to evaluate the epidemiological and clinical profile of COVID-19 suspect cases treated in a teaching hospital of Bangalore Urban district and to assess the association between outcome and clinicalepidemiological profile of COVID-19 suspects.

Material and methods

A cross-sectional study was conducted for a period of three months from March 2020 – July 2020, where almost 1700 COVID suspect cases of all ages who presented to the hospital were included. COVID-19 suspects were defined as those having fever/cold/Influenza-like illness or contacts of Reverse Transcription Polymerase Chain Reaction ( RT-PCR) positive individuals. Patients walking into tertiary care setup as COVID-19 disease suspects were investigated for RT-PCR and were either admitted or sent for home quarantine based on clinical assessment. The admitted patients were discharged/ quarantined/referred based on the test results and clinical severity. All the above patients were included in the study during the study period. 

Ethical approval for the study was obtained from the institutional ethics committee. Data was obtained from the hospital e-records after taking permission from hospital authorities. MS Excel was used to enter the data and was analyzed using statistical software SPSS version 20.0.

Data was expressed in percentages, mean and standard deviation wherever necessary and presented in the form of tables. Chi-square test was used to assess the association between variables and positive report for RTPCR test.

Results

A total of 1720 COVID-19 suspect cases were included in the study. The mean age of the study participants was 37.12 (15.8) years.  

About 1148 (66.8%) of the participants belonged to the age group of 18-44 years. Among them, 190 (11%) were elderly above the age of 60 years and 63 (3.7%) were below the age of 18 years. The majority 1110 (64.5%) of them were males. 55 (3.2%) of them had travel history and 730 (42.4%) of them had contact history. The same is shown in Table 1.

Among 730 individuals who had contact history, 370 (50.7%) of them were primary contacts and 334 (45.8%) of them were healthcare workers. The details of contact history are described in Table 2.

About 671 (39.0%) of them were symptomatic and 371 (21.6%) were having co-morbidities. 344 (20.0%) of them were classified as having Severe Acute Respiratory Illness (SARI) and 222 (12.9%) as having Influenza-like illness (ILI).

When all the suspects were tested for RT-PCR COVID-19 test, 427 (24.8%) of them were positive. Out of those who tested negative, about 996 (57.9%) were admitted. The same is depicted in Table 3.

Among 671 participants who had symptoms, 376 (56%) had fever, cough and cold which were the predominant symptoms reported. 125 (18.6%) of them reported breathlessness and 81 (12.1%) reported cough/cold/sore throat. About 100 (26.9%) of them had both diabetes and hypertension. The same has been depicted in Table 4.

Among 724 admissions, 50 (6.9%) had unfavourable outcome (death). There was a significant association found between age, sex, travel history, contact history and type of case with unfavourable outcome. The same is depicted in Table 5.

Discussion

Treating COVID suspects during the initial phase of the pandemic was an important task to identify contacts and high-risk individuals for the necessary process. The above study evaluated the clinico-epidemiological profile of suspects treated in tertiary care hospital. Among 1720 COVID suspects, 42% had contact history and 39% were asymptomatic. The positivity rate was 25% and 42% of them were admitted for treatment.

Khan M et. al,⁶ conducted a study to describe epidemiological and clinical characteristics of COVID-19 cases at a screening clinic in the year 2020. The positivity rate among the suspects was 14.3% which was less compared to our study. Fever, cough and cold were the commonest symptoms similar to our study findings. 18% of them showed travel history. However, in our study only 7.3% of them had travel history. 

Escosteguy CC et al,⁷ in their study conducted in the year 2020 assessed the factors associated with death among the COVID suspects and showed age as a significant factor to cause death among the suspects. The same was observed in our study and was statistically significant

Owusu M et al,⁸ conducted a study to describe the epidemiological profile of SARS-CoV-2 among selected regions in Ghana. They stated that among suspects, 13.2% were positive which was less when compared to our study. Males showed a higher positivity rate similar to the findings of our study.

Gupta N et al,⁹ conducted a study in 2020 to report the epidemiologic and clinical features of initial 21 patients and reported that 62% of the patients had recent travel history, which was 10 times more than our study. The most common symptoms reported were fever and cough (42.9%) followed by sore throat, headache and breathlessness similar to the findings of our study.

The larger sample size tried to predict the actual scenario during the initial days. However, it cannot be generalized to the entire population as it is limited to hospital settings. The data source was limited to e-record findings and lacks the certainty of findings.

Conclusion and Recommendations

42% of them had contact history and 39% of them were asymptomatic and the positivity rate was 25%. 47% of them were diagnosed to have SARI and 31% of them had ILI. There was a significant association between age, sex, co-morbidities, contact history, and type of case with unfavourable outcome. The study findings could be used to plan further management of COVID-19 as there is a rapid surge in the disease trend.