|Year : 2023 | Volume
| Issue : 1 | Page : 79-82
An observational comparative study of clinicoepidemiological profile of COVID-19 patients admitted in the tertiary care hospital during first and second wave on pandemic
Surendra Babu Darivemula1, Chennakesavulu Dara2, Triveni Sagar2, Sudha Bala1, Venkatesham Animalla1
1 Department of Community Medicine, ESIC Medical College, Hyderabad, Telangana, India
2 Department of General Medicine, ESIC Medical College, Hyderabad, Telangana, India
|Date of Submission||12-Nov-2022|
|Date of Decision||17-Jan-2023|
|Date of Acceptance||28-Jan-2023|
|Date of Web Publication||14-Mar-2023|
Surendra Babu Darivemula
Department of Community Medicine, ESIC Medical College, Sanath Nagar, Hyderabad, Telangana
Source of Support: None, Conflict of Interest: None
Background: The World Health Organization declared COVID-19 a global pandemic on March 11, 2020. India confirmed its first case of COVID-19 on 30 January and within 8 weeks the total number of cases had crossed the 1000 mark. Methods: An Observational comparative study was done to see the clinic epidemiological profile, and identify the determinants of COVID 19 patients admitted in the hospital in the last 1 year in both the first and second waves with respect to. All individuals testing positive for severe acute respiratory syndrome coronavirus 2 RNA using reverse transcription polymerase chain reaction were included. Results: A total of 1710 was hospitalized, 701 (40.9%) and 1009 (59.1%) were involved in first and second wave. The mean age was 42.58 ± 13.99 and 45.32 ± 14.18 and majority of them were belong to the 20–60 years and the comparison was showing statistically significant (P = 0.004). The participants affected with the risk factors like smoking 276 (27.3) and alcohol 237 (23.5) with P < 0.0001. The duration of stay was (median 6 [inter quartile range (IQR) 3–7] days in the first wave vs. median 7 [IQR 3–9] days in the second wave; P < 0.001). Conclusion: The second wave had shown more aggressive nature in spreading the COVID-19 infection than the first wave. Besides the steep rise of the cases, there has been more among the patients with commodities and risk factors in the second wave.
Keywords: Clinicoepidemiological, COVID-19, observational study
|How to cite this article:|
Darivemula SB, Dara C, Sagar T, Bala S, Animalla V. An observational comparative study of clinicoepidemiological profile of COVID-19 patients admitted in the tertiary care hospital during first and second wave on pandemic. Biomed Biotechnol Res J 2023;7:79-82
|How to cite this URL:|
Darivemula SB, Dara C, Sagar T, Bala S, Animalla V. An observational comparative study of clinicoepidemiological profile of COVID-19 patients admitted in the tertiary care hospital during first and second wave on pandemic. Biomed Biotechnol Res J [serial online] 2023 [cited 2023 Jun 5];7:79-82. Available from: https://www.bmbtrj.org/text.asp?2023/7/1/79/371686
| Introduction|| |
The World Health Organization declared COVID-19 a global pandemic on 11 March 2020. India confirmed its first case of COVID-19 on 30 January and within 8 weeks the total number of cases had crossed the 1000 mark. As on July 17, 2021, 177 million individuals have got infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) (the virus causing the disease) and more than 38 lakhs have lost their lives across 213 countries and 2 international conveyances. About 80% of the individuals with SARS-CoV-2 infection either remain asymptomatic or show mild symptoms of flu (e.g., fever, cough, sore throat); these may be managed at home or in isolation centers to check the spread of transmission. The remaining 10%–15% have moderate to severe symptoms, and need institutional care ranging from oxygen therapy, intensive care to ventilator support. The elderly and those with comorbidities (e.g., diabetes mellitus, hypertension, renal diseases, etc.) are at higher risk of developing florid symptoms and meet adverse outcomes. Comparative analysis of the average admissions to intensive care units (ICUs) shows an 68% in the first wave and about 14% in the second one. Hospitalized people are 839% in the first wave and about 156% in the second one. Since corona virus is affecting all age groups, we would like to see the demographic differences and clinical presentation variation in both the first and second waves with respect to clinic epidemiological profile, and identify the determinants of COVID 19 patients admitted in the hospital in the last 1 year.
| Methods|| |
A observational (descriptive design) comparative study.
- First wave - May–December 2020 and
- Second wave - January–June 2021.
General Medicine Department of ESIC Medical College, Hyderabad.
Purposive sampling was done and included all the participants admitted during that study period.
- Inclusion: COVID-19 patients admitted in the first and second wave. All individuals testing positive for SARS-CoV2 RNA using reverse transcription polymerase chain reaction from first wave and second wave were included. Those who had admitted were taken as the sample. The patients with laboratory confirmed/Clinically presented with radiological evidence COVID-19 patients aged more than 18 years diagnosed after May 1, 2020–June 30, 2021 hospitalized and treated in the hospital were included
- Exclusion criteria: Those below 18 years and pregnant women, asymptomatic and require home isolation were excluded from the study.
Data collection procedure
Since it was the record based study the consent form and the patient information sheet was not needed and the waiver of consent was obtained from the competent authority to retrieve the data. The data were retrieved from the hospital electronic medical records. This includes data on socio-demographic parameters (age, gender, and place of residence), presenting symptoms and signs, history of comorbidities, triage details (isolation center, ward, ICU), and outcome. We included data from all patients in our records without extracting information that could potentially reveal the patient's identity. The clinical details pertaining to COVID (including positivity status, severity, hospitalization, duration of hospital stay and treatment given) and relevant laboratory parameters like Serum Ferritin and other parameters was included.
The institute ethical clearance was obtained from the Institute Ethics committee with Approval No: ESICMC/SNR/IEC-F372/10-2021.
The data were analyzed using SPSS version 20.0. (IBM Corp., Armonk, New York, 2010). The results were shown in proportion, mean, standard deviation and relevant statistical test was done for comparing both the waves.
| Results|| |
A total of 1710 were hospitalized during the study period, amongst them 701 (40.9%) were involved in the first wave and 1009 (59.1%) were involved in the second wave affected with COVID-19. The mean age of the participants was 42.58 ± 13.99 and 45.32 ± 14.18 in the first wave and second wave respectively and majority of them were belong to the 20–60 years and the comparison was showing statistically significant (P = 0.004). The comparative profile of participants according to their demographic and clinical characteristics of enrolled patients at admission during the two waves is presented in [Table 1]. The mean age of the study participants was approximately 2 years lower in the second wave as compared to the same in the first wave which was significant (P < 0.001).Compared with the first wave, the median duration of COVID-19 symptoms until hospital admission was 2 days shorter in the second wave (median 6 [inter quartile range (IQR) 3–7] days in the first wave versus median 7 [IQR 3–9] days in the second wave; P < 0.001). The participants affected with the risk factors like smoking 276 (27.3) and alcohol 237 (23.5) and the comparison was shown to be significant with P < 0.0001. In the first wave, most patients received either chloroquine, hydroxychloroquine or no medical treatment. In the second wave most patients received dexamethasone and/or remdesivir, according to the Dutch treatment guidelines. The use of chloroquine, hydroxychloroquine and ipinavir/ritonavir had stopped completely after the first wave. Majority of the patients received corticosteroids, remdesivir and oxygen in the second wave and the comparison was shown to be statistically significant with P = 0.0001.
|Table 1: Distribution of the participant according to demographic and clinical characteristics of the patients|
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In [Table 2], distribution of participants according to their biochemical parameters and the sample size varies for each variable. The D-dimers with >500 were (137 vs. 744) C-reactive protein with raised with >5 were (602 vs. 871), interleukin 6 with >30 were (83 vs. 136), lactate dehydrogenase with >280 were (139 vs. 642), serum ferritin in males (36 vs. 169) and in females (39 vs. 49) and CORAD score with >3 were (86 vs. 731), respectively. The comparison of all the biochemical parameters were found to be statistically significant with P < 0.0001and for CORADS P = 0.031. In [Figure 1], the most common presenting symptom was uneasiness (679, 577), cough (667. 315), fever (213, 623), shortness of breath (174, 385), anosmia (176, 343), myalgia (86, 346) and thyroid (71, 50) and other comorbidity were diabetes (26, 392) and hypertension (9, 485). The comparison of all the common presenting symptoms was shown to be statistically significant with P < 0.0001.
|Figure 1: Distribution of the participants according to the presenting symptoms and morbidity. SOB: Shortness of breath|
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|Table 2: Distribution of participants according to their biochemical parameters|
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| Discussion|| |
The study addresses the comparison of the clinicoepidemiological profile of the hospitalized patients during the first and second wave of COVID-19 pandemic. The mean age of the admitted patients in the current investigation was lower in the second wave as compared to first. This small difference, though significant, might not be clinically important. The second and subsequent waves in India, and other countries such as Germany, Japan, South Korea, and Iran have also reported a shift towards younger demography.,,, The present study showed younger age group involved in the second wave. Published literature reports that the second wave in India has affected the younger age group with the reason for the same to be explored further. The duration of stay in the hospital with the IQR was more in the first wave 3–9 (IQR-9) than the second wave 3–7 (IQR-6). Similar study in India from the national registry had also reported that the first wave, the discharged patients had a shorter length of stay in the second wave. The patients who recovered and were discharged had a longer stay in the hospital as compared to the deceased in both the waves. This could be one of the important reasons for the change in age pattern seen for hospitalized patients. Also, the restrictive measures becoming less stringent since the decline in cases from September 2020, with the younger ones stepping out for work, could have resulted in higher rate of infection. Hospitalization among younger ones might be a reflection of the early care-seeking behavior prompted by the experiences of the first wave. The clinical severity of SARS-CoV-2 infections declined significantly in the second wave compared with the first wave, most likely reflecting lower viral inoculation as a result of social distancing, increased use of face masks, promotion of outdoor activities, and restrictions on gatherings. The current study showed that respiratory symptoms were more common in both the waves.
| Conclusion|| |
The second wave had shown more aggressive nature in spreading the COVID-19 infection than the first wave. Besides the steep rise of the cases, there has been more among the patients with comorbidities and risk factors in the second wave. The symptomatology has remained focused primarily on respiratory system with uneasiness, cough, and fever reported in higher proportions during the second wave of COVID-19 in India.
Since the pandemic was started at the end of January 2020 in India, but the data were retrieved from the month of May 2020. Our hospital had been notified as COVID care center from May 2020. We tried to include all the patients from that duration.
Financial support and sponsorship
Conflicts of interest
The authors declare that none of the authors have any competing interests.
| References|| |
Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19); 2020.
Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al.
Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020;382:1708-20.
Coccia M. The impact of first and second wave of the COVID-19 pandemic in society: Comparative analysis to support control measures to cope with negative effects of future infectious diseases. Environ Res 2021;197:111099.
Béraud G, Timsit JF, Leleu H. Remdesivir and dexamethasone as tools to relieve hospital care systems stressed by COVID-19: A modelling study on bed resources and budget impact. PLoS One 2022;17:e0262462.
Kumar G, Mukherjee A, Sharma RK, Menon GR, Sahu D, Wig N, et al.
Clinical profile of hospitalized COVID-19 patients in first & second wave of the pandemic: Insights from an Indian registry based observational study. Indian J Med Res 2021;153:619-28.
] [Full text]
Reddy MM, Zaman K, Mishra SK, Yadav P, Kant R. Differences in age distribution in first and second waves of COVID-19 in eastern Uttar Pradesh, India. Diabetes Metab Syndr 2021;15:102327.
Jalali SF, Ghassemzadeh M, Mouodi S, Javanian M, Akbari Kani M, Ghadimi R, et al.
Epidemiologic comparison of the first and second waves of coronavirus disease in Babol, North of Iran. Caspian J Intern Med 2020;11:544-50.
Graichen H. What is the difference between the first and the second/third wave of Covid-19? German perspective. J Orthop 2021;24:A1-3.
Seong H, Hyun HJ, Yun JG, Noh JY, Cheong HJ, Kim WJ, et al.
Comparison of the second and third waves of the COVID-19 pandemic in South Korea: Importance of early public health intervention. Int J Infect Dis 2021;104:742-5.
Saito S, Asai Y, Matsunaga N, Hayakawa K, Terada M, Ohtsu H, et al.
First and second COVID-19 waves in Japan: A comparison of disease severity and characteristics. J Infect 2021;82:84-123.
Jain VK, Iyengar KP, Vaishya R. Differences between first wave and second wave of COVID-19 in India. Diabetes Metab Syndr 2021;15:1047-8.
[Table 1], [Table 2]