Methods: This cross-sectional observational study was conducted from December 2020 to January 2021 in the internal medicine department of a tertiary care hospital in North India. The study included 237 patients who were positive for COVID-19 and were admitted to our hospital after informed consent. They were classified into three groups: mild, moderate and severe. Results: Fever was the most common symptom presented by 84.4% of the population, while diarrhea was the least common, affecting only 3.4% of the population. Fever, cough, sore throat, headache, and dyspnea were significantly associated with disease severity. Gastrointestinal symptoms such as diarrhea had no significant association with disease severity. Disease severity was statistically associated with comorbidities such as hypertension, diabetes, coronary artery disease, chronic kidney disease, and chronic obstructive pulmonary disease. Conclusion: Men were more likely to develop more severe diseases. However, the correlation was not statistically significant. The number of comorbid conditions and disease severity were found to have a fair and significant relationship. None of the symptoms of diarrhea are related to the severity of the disease.
Introduction
The 2019 novel coronavirus (2019-nCoV) or 2019 coronavirus disease (COVID-19), as it is now called, is spreading rapidly worldwide from its place of origin in the city of Wuhan, Hubei Province, China [1]. 2019-nCoV bears a close resemblance to bat coronaviruses, and bats have been hypothesized to be the primary source. While the origin of 2019-nCoV is still under investigation, current evidence suggests that the spread to humans was through transmission from wild animals illegally sold at the Huanan Seafood Wholesale Market [2]. The pandemic has been renamed SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) because of its similarity to severe acute respiratory syndrome [3,4]. The WHO declared COVID-19 a global pandemic on March 11, 2020 [5]. The severe acute respiratory syndrome outbreak occurred in 2003 and, more recently, there has been an outbreak of a related but different coronavirus, the Middle East respiratory syndrome coronavirus [6]. The primary coronavirus, discovered in bats in 1937, rarely infects humans and is found in animals such as bats, camels and cats, not humans or other mammals. They later mutated, causing the disease to infect rats, cows, pigs, mice, cats, dogs, horses and turkeys. Cough and cold were common symptoms of the first human coronavirus discovered in the 1960s [7]. The sheer volume of symptoms and clinical manifestations observed in patients with COVID-19 showed a huge variety of inter-individual differences. According to a meta-analysis by Sanyaolu et al., conducted in 2020, the most common symptom during COVID-19 was fever followed by dry cough [8]. It has been observed that most of the severely affected patients also had pre-existing co-morbidities such as diabetes, cardiovascular disease and hypertension [8]. It appeared that a higher probability of intensive care unit admission also had a high mortality rate [9,10]. There is therefore a need to assess symptoms, mortality rates, patient profiles and disease severity in the pre-vaccination era to assess early detection and appropriate treatment of critical cases. This is an invaluable asset to the healthcare system in India, which exhibits enormous socio-economic and cultural diversity. Accordingly, this study aims to understand the prevalence of symptoms, comorbidities and mortality rates in the pre-vaccination era and how they can be used to prevent future outbreaks of COVID-19.
Materials & Methods
This cross-sectional observational study lasted 62 days, from December 2020 to January 2021. The study focused on COVID-19 cases admitted to Sharda Hospital in Greater Noida, Uttar Pradesh, India. All patients diagnosed with COVID-19 admitted to Sharda Hospital who were willing to participate in this study were included in the study. Patients under 13 years of age and those who refused to participate were excluded from the study. The prevalence of fever was found to be 88.7% during hospitalization among diagnosed COVID-19 cases, according to a study by Guan et al. [11]. The sample size was calculated using the formula: n = Z2pq/d2; where Z is the ordinate of the standard normal distribution at the α% significance level (1.96 at α = 5% significance level), p is the observed prevalence, q = 100 – p and d is the margin of error (5%) . According to the calculation, 154 people were required for the study. During the study, we were able to recruit 237 patients to the study. All cases of COVID-19 infections underwent the nasopharyngeal swab test, which was evaluated using reverse transcription polymerase chain reaction for the presence of the COVID-19 virus. All patients included in the study underwent a thorough history taking, which included demographic parameters such as age, gender and area of residence, e.g. city or rural area, and a rigorous evaluation to detect various symptoms of COVID-19 infections, such as fever, chills, cough, fatigue, anorexia, myalgia, sore throat, and rhinorrhea. Other co-morbidities such as cardiovascular disease, diabetes mellitus, hypertension, chronic lung disease, chronic kidney disease, cancer and obesity were also assessed in all cases. Patients were classified according to the severity of symptoms [12]as shown in Table 1. Symptom Severity Mild: low-grade fever, nausea, vomiting, and diarrhea, no mental status change and immunocompetent Moderate: respiratory rate greater than 30 breaths per minute, SpO2 greater than 93%, PaO2/FiO2 greater than 300, and pulmonary infiltrates greater than 50% within 24 to 48 hours Severe: septic shock and MODS are all examples of critical respiratory failure (requiring mechanical ventilation) Table 1: Severity of symptoms SpO2: oxygen saturation. PaO2: partial pressure of oxygen. FiO2: fraction of inspired oxygen. MODS: multiple organ dysfunction syndrome. Laboratory investigations included chest X-ray, complete blood count, renal function test, liver function test, electrocardiogram, blood sugar and body mass index calculation.
Statistical analysis
Data were collected and tabulated using Microsoft Excel 2007 (Microsoft Corporation, Redmond, WA) and analyzed using the statistical software package SPSS version 26.0 (IBM Corp., Armonk, NY). Mean and standard deviation (SD) of quantitative parametric data are presented. Percentages and proportions were used to represent qualitative data. As a means of determining significance, the chi-square test was used to compare categorical variables. Other descriptive statistics such as ANOVA and independent t-test were used to compare continuous data. A p value <0.05 was considered statistically significant.
Results
The mean ± SD age among study participants was 37.89 ± 16.10 years. Maximum people were between the age group of 21-30 years (32.1%), followed by 31-40 years (19.8%) and 41-50 years (14.8%). About 14.3% of subjects were asymptomatic. Of the patients, 84.4% had fever, 59.9% had cough, 40.5% had sore throat, 21.5% had headache, 26.6% had shortness of breath, and 3.4% had diarrhea. Comorbidities, namely hypertension, diabetes, coronary artery disease, chronic kidney disease, and chronic obstructive pulmonary disease (COPD) accounted for 8.4%, 6.8%, 2.1%, 2.5%, and 3.4% of the population study, respectively (Table 2). Variable Frequency Percentage Age group (in years) 10-20 25 10.5 21-30 76 32.1 31-40 47 19.8 41-50 35 14.8 51-60 32 13.5 61-70 2938 104. 155 65.4 Woman 82 34.6 Asymptomatic YES 34 14.3 No 203 85.7 Fever YES 200 84.4 No 37 15.6 Coughing YES 142 59.9 NO 95 40.1 Painting YES 96 40.5 No 141 59.5 Churches Yes 51 21.5 No 186 78.5 Acute respiratory distress syndrome Yes 24 10.1 No 213 89.9 Table 2: Distribution of demographic variables among study participants The distribution of comorbidities was found to be the same in asymptomatic and symptomatic individuals. When different comorbidities were compared between the asymptomatic and symptomatic groups using the chi-square test, an insignificant difference was found at p > 0.05 (Table 3). Comorbidities Asymptomatic (n = 34), N (%) Symptomatic (n = 203), N (%) P-value Hypertension Present 1 (2.9%) 19 (9.36%) 0.21 Absent 33 (97, 1%) 184 (90.64%) Diabetes mellitus Present 0 16 (7.9%) 0.09 Absent 34 (100%) 187 (92.1%) Coronary artery disease Present 0 5 (2.5%) 0.355 Absent 34 (100%) 198 (97.5%) Chronic Kidney Disease (97.5%) Preexisting 1 Kidney Disease (2.9%). %) 5 (2.5%) 0.87 Absent 33 (97.1%) 198 (97.5%) Chronic obstructive pulmonary disease Present 0 8 (3.9%) 0.24 Absent 34 (100%) 195 ( 96.1%) Table 3: Symptom distribution of study participants Mild, moderate and severe disease was found in 68, 4 and 10 women and 118, 18 and 19 men,…
