Variation in COVID-19 management outcome with progression of pandemic- An observational study of a tertiary covid care centre

Abstract

Introduction: Uttarakhand reported its first case of SARS-COV-2 on 15th march 2020. This study is a retrospective descriptive analysis of the changing demographic, clinical and case fatality rate of the disease with the progression of pandemic. Material and methods: The study is on the data of the admitted patients in a tertiary level facility from March 2020- February 2021. Data was analysed in terms of outcome of the admitted patients and the change in the clinical presentation and demographic profile of disease in the admitted patients with progression of disease over the stipulated time frame. Factors affecting the mortality of the admitted cases were also analysed. Results: Symptomatic cases admitted in months of March 2020-July 2020 was 39% while those in month of August 2020-Feburary 2021 formed 90.3% of total admission (p< 0.00001). Case Fatality Rate in age group of >= 60 years was 16% while in <=60 years it was 3.2% (p<0.00001). Comorbidities were associated with 68.8% (n=209) of deaths, of which predominant was diabetes (44%). Out of 139 deaths, 35% were attributed to acute respiratory distress syndrome/Respiratory Failure, 37% were due to Cardiac events while Sepsis with Multiple Organ Dysfunction Syndrome was responsible for 285 mortalities. Conclusion: Home Isolation policy of the COVID-19 positive cases with the advancing pandemic had an adverse impact on the clinical profile, demographic profile and the mortality rate of the admitted patients. Early treatment policy of the admitted SARS-COV-2 positive asymptomatic or symptomatic patients did affect the outcome of the admitted patients in the early phase of the pandemic. Ae more than 60 years and also the co-morbidities are an independent risk factor for mortality in COVID-19 and also the co-morbidities.