Epidemiological and Clinical Characteristics of COVID-19: A Retrospective Multi-Center Study in Pakistan

Oxygen Requirement and Associated Risk Factors in Post-COVID-19 Patients Admitted to a Tertiary Care Center: A Cross-Sectional Study

Background

COVID-19 commonly affects the lungs and may lead to mild to severe hypoxemia. The supplemental oxygen requirement gradually reduces with the improvement in lung pathology. However, a few patients may have exertional desaturation, and ongoing oxygen needs at the time of hospital discharge. The objective of this research was to study the requirement of oxygen therapy in the immediate post-COVID-19 period and its associated risk factors.

Materials and Methods

An analytical cross-sectional study was conducted on the admitted post-COVID-19 patients who had recently tested real-time polymerase chain reaction (RT-PCR) negative in a tertiary care center from August 2021 to mid of October 2021. Nonprobability consecutive sampling was used, and the sample size was 108. The data were analyzed using the Statistical Package for the Social Sciences (IBM-SPSS), version 23. The mode of oxygen therapy (nasal cannula, face mask, reservoir mask, or mechanical ventilation) in the first two weeks of the study was presented appropriately in a table. The nonparametric statistical tests were applied to determine the association between the duration of post-COVID-19 oxygen therapy and several other risk factors such as age, gender, comorbidities, smoking status, exposure to firewood, COVID-19 vaccination, and severity of COVID-19.

Results

95 (87.96%) cases required oxygen therapy in their immediate post-COVID-19 period. The overall median duration of oxygen therapy was 6.00 (4.00-10.00) days. The nasal cannula was the most commonly used mode of oxygen supplement. The duration of oxygen therapy was significantly higher in patients aged more than 60 years (6.00 [5.00-11.00], p = 0.013), chronic obstructive pulmonary disease (10.00 [6.00-12.75], p = 0.006), history of chronic smoking (9.00 [5.50-13.00], p = 0.044), and severe COVID-19 infection (7.00 [5.00-10.50], p = 0.042).

Conclusions

The proportion of patients requiring oxygen therapy in the immediate post-COVID-19 period was higher than that reported in other studies. In addition, old age (>60 years), chronic obstructive pulmonary disease, chronic smoking, and severe COVID-19 infection significantly increased the duration of oxygen therapy. So, these factors should be assessed while discharging patients from COVID-19 facilities, and oxygen supplementation should be planned for needy patients.

Attitude and Acceptance towards COVID-19 Booster Doses among Literacy Advantaged Population in Pakistan: A Cross-Sectional Study

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has affected billions of lives and is expected to impose a significant burden on the economy worldwide. Vaccination is the only way to prevent the infection. However, convincing people to get themselves vaccinated is challenging in developing countries such as Pakistan. Therefore, a cross-sectional questionnaire-based study was conducted (n = 982 participants) all over Pakistan to evaluate the perception, knowledge, attitude, and acceptance of the general public towards the SARS-CoV-2 vaccine, in general, and a booster dose of SARS-CoV-2, in particular. The highest number of participants were from the province of Punjab (84.5%), followed by Islamabad (3.8%), Sindh (3.7%), Khyber Pakhtunkhwa (2.7%), Baluchistan (2.6%), Gilgit Baltistan (1.4%), and Azad Jammu and Kashmir (1.4%). A total of 915 participants were vaccinated against COVID-19, out of which 62.2% received one booster dose, followed by double booster doses (25.5%) and single vaccine shots (12.3%). The highest number of vaccinated participants were from Punjab (85.8%), followed by Islamabad (3.9%), Sindh (2.8%); Khyber Pakhtunkhwa (2.6%); Baluchistan (2.3%); Gilgit-Baltistan (1.3%); and Azad, Jammu, and Kashmir (1.2%). Among the vaccinated individuals, 71.4% were unemployed, 27.4% were employed (653), and 1.2% were retired from service. However, no significant association was observed among genders and educational levels in regard to acceptance of the booster vaccine. The outcomes of the study revealed that the increased acceptance of booster doses of the SARS-CoV-2 vaccines among the public was associated with the intent of personal and family protection. Moreover, individuals with low socioeconomic status and pregnant females showed the least acceptance towards the vaccine inoculation. The study also revealed a decline trend of accepting SARS-CoV-2 vaccine among children.

Epidemiological and clinical profile of Laboratory confirmed cases of COVID 19 admitted in Tertiary care Hospital Jammu, J&K

Background: Three or more waves of COVID 19 pandemic have hit the different parts of world including India very hard, taking toll on the lives of people both in terms of morbidity and mortality. Keeping this in mind, the present study was conducted with an aim to determine the socio-demographic and clinical profile of laboratory confirmed COVID 19 cases and to determine their association with oxygen requirement and outcome of disease at the time of discharge. Methods: The present cross-sectional study was conducted on lab confirmed COVID 19 cases admitted in tertiary care hospital in Jammu from June-July 2021.Data was collected using convenient sampling method. The self-designed questionnaire used for data collection obtained information regarding socio-demographic characteristics of patients as well as clinical features of the disease. Results: Out of total 161 patients studied, 60.8% were males and 39.2% were females. Mean age was 51.2 ± 17.5 years.  Comorbid conditions were present in 37.8% patients, with hypertension being the most common ( 36%). Cough, Fever, breathlessness and myalgia were the main presenting symptoms (90%, 81%, 57.7% and 56% respectively).  The variables which were found to have statistically significant association with oxygen requirement and the outcome of disease at the time of discharge were age, gender and presence of co-morbidity (p <0.05). Conclusions: Advancing age, male gender and presence of underlying co-morbidity were found to be significant risk factors for the requirement of oxygen and poor outcome of the disease.

The global response: How cities and provinces around the globe tackled Covid-19 outbreaks in 2021

Background

Tackling the spread of COVID-19 remains a crucial part of ending the pandemic. Its highly contagious nature and constant evolution coupled with a relative lack of immunity make the virus difficult to control. For this, various strategies have been proposed and adopted including limiting contact, social isolation, vaccination, contact tracing, etc. However, given the heterogeneity in the enforcement of these strategies and constant fluctuations in the strictness levels of these strategies, it becomes challenging to assess the true impact of these strategies in controlling the spread of COVID-19.

Methods

In the present study, we evaluated various transmission control measures that were imposed in 10 global urban cities and provinces in 2021- Bangkok, Gauteng, Ho Chi Minh City, Jakarta, London, Manila City, New Delhi, New York City, Singapore, and Tokyo.

Findings

Based on our analysis, we herein propose the population-level Swiss cheese model for the failures and pitfalls in various strategies that each of these cities and provinces had. Furthermore, whilst all the evaluated cities and provinces took a different personalized approach to managing the pandemic, what remained common was dynamic enforcement and monitoring of breaches of each barrier of protection. The measures taken to reinforce the barriers were adjusted continuously based on the evolving epidemiological situation.

Interpretation

How an individual city or province handled the pandemic profoundly affected and determined how the entire country handled the pandemic since the chain of transmission needs to be broken at the very grassroot level to achieve nationwide control.

Funding

The present study did not receive any external funding.

Co-Infections, Secondary Infections, and Antimicrobial Use in Patients Hospitalized with COVID-19 during the First Five Waves of the Pandemic in Pakistan; Findings and Implications

Background: COVID-19 patients are typically prescribed antibiotics empirically despite concerns. There is a need to evaluate antibiotic use among hospitalized COVID-19 patients during successive pandemic waves in Pakistan alongside co-infection rates. Methods: A retrospective review of patient records among five tertiary care hospitals during successive waves was conducted. Data were collected from confirmed COVID-19 patients during the first five waves. Results: 3221 patients were included. The majority were male (51.53%), residents from urban areas (56.35%) and aged >50 years (52.06%). Cough, fever and a sore throat were the clinical symptoms in 20.39%, 12.97% and 9.50% of patients, respectively. A total of 23.62% of COVID-19 patients presented with typically mild disease and 45.48% presented with moderate disease. A high prevalence of antibiotic prescribing (89.69%), averaging 1.66 antibiotics per patient despite there only being 1.14% bacterial co-infections and 3.14% secondary infections, was found. Antibiotic use significantly increased with increasing severity, elevated WBCs and CRP levels, a need for oxygen and admittance to the ICU; however, this decreased significantly after the second wave (p < 0.001). Commonly prescribed antibiotics were piperacillin plus an enzyme inhibitor (20.66%), azithromycin (17.37%) and meropenem (15.45%). Common pathogens were Staphylococcus aureus (24.19%) and Streptococcus pneumoniae (20.96%). The majority of the prescribed antibiotics (93.35%) were from the WHO’s “Watch” category. Conclusions: Excessive prescribing of antibiotics is still occurring among COVID-19 patients in Pakistan; however, rates are reducing. Urgent measures are needed for further reductions.

Heterogeneity and Risk of Bias in Studies Examining Risk Factors for Severe Illness and Death in COVID-19: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis synthesized the evidence on the impacts of demographics and comorbidities on the clinical outcomes of COVID-19, as well as the sources of the heterogeneity and publication bias of the relevant studies. Two authors independently searched the literature from PubMed, Embase, Cochrane library, and CINAHL on 18 May 2021; removed duplicates; screened the titles, abstracts, and full texts by using criteria; and extracted data from the eligible articles. The variations among the studies were examined by using Cochrane, Q.; I2, and meta-regression. Out of 11,975 articles that were obtained from the databases and screened, 559 studies were abstracted, and then, where appropriate, were analyzed by meta-analysis (n = 542). COVID-19-related severe illness, admission to the ICU, and death were significantly correlated with comorbidities, male sex, and an age older than 60 or 65 years, although high heterogeneity was present in the pooled estimates. The study design, the study country, the sample size, and the year of publication contributed to this. There was publication bias among the studies that compared the odds of COVID-19-related deaths, severe illness, and admission to the ICU on the basis of the comorbidity status. While an older age and chronic diseases were shown to increase the risk of developing severe illness, admission to the ICU, and death among the COVID-19 patients in our analysis, a marked heterogeneity was present when linking the specific risks with the outcomes.

Perceived risk and perceptions of COVID-19 vaccine: A survey among general public in Pakistan

Background

The coronavirus disease has become a global pandemic, and it continues to wreak havoc on global health and the economy. The development of vaccines may offer a potential eradication of COVID-19. This study evaluated the general knowledge, attitude, and perception of COVID-19 vaccines in the Pakistani population.

Methods

A self-reporting e-survey and questionnaire-based survey from vaccination centers of different cities of Pakistan among 502 participants were conducted. The questionnaire comprised four sections inquiring demographics, vaccination status, and perception or attitude towards the vaccine. Univariate logistic regression was applied to predict the knowledge, attitude and behavior of participants.

Results

The mean age of participants was 50.8±20.3 years. 53% of the participants have both doses of vaccine administered. Pain on the site of injection (49.8%) was the most common symptom, followed by asthenia (43.0%), muscle pain (29.5%), and swelling (24.5%) on the site of vaccine administration. Females complain of more symptoms than males. More severe symptoms were reported after the first dose of vaccine administration; these symptoms subsided within a week for most participants. Overall, the respondents have a positive attitude towards the vaccine. 47.4% are sure about the vaccine’s efficacy, 48.6% said getting vaccinated was their own decision, and 79.9% also recommended others to get vaccinated.

Conclusion

The study concluded that the Pakistani population has a positive attitude but inadequate knowledge towards COVID-19 vaccines. Immediate awareness and vaccination education programs should be conducted by the authorities to complete the mass vaccination schedule.

Gastrointestinal manifestations and possible mechanisms of COVID-19 in different periods

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, has become a pandemic worldwide. Although COVID-19 mainly affects the respiratory system, gastrointestinal (GI) manifestations have been frequently reported in such cases, even as initial symptoms. There have been several studies on different GI manifestations in patients with mild and severe disease or in remission. In this review article we summarized different GI manifestations of COVID-19 at various disease stages and the possible mechanisms based on published literatures, as well as the significance of GI manifestations in systemic inflammatory injury.

Utilization of complementary and alternative medicine for the prevention of COVID-19 infection in Ghana: A national cross-sectional online survey

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82.5% of all participants reported CAM use during the COVID-19 pandemic period.

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69.1% of CAM users intended it for COVID-19 infection prevention.

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Commonly used CAM include vitamins, spiritual healing/prayer, minerals and herbals.

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Age, sex and COVID-19 illness perception significantly predicted CAM use.

Complementary and alternative medicine (CAM) use is widespread and has played critical roles in preventing infections, including previous coronaviruses. This study sought to document current practices in the use of CAM for the prevention of COVID-19 disease in Ghana. An anonymous electronic survey was conducted from February 1, 2021 to April 30, 2021. Data on demographic characteristics, basic clinical information, illness perceptions about COVID-19, and CAM use during the pandemic period were generated. While about 82.5% (986/1195) of the participants used CAM during the COVID-19 period, 69.1% (681/986) of CAM users intented it for COVID-19 infection prevention. Vitamin supplements (88.1%, 869/986), spiritual healing/prayer (23.3%, 230/986), mineral supplements (22.3%, 220/986), botanical/herbal medicines (22.2%, 219/986), and diet therapy (19.4%, 191/986) were the main types of CAM used. From the adjusted binary logistic regression model, current age (aOR: 1.03, 95%CI: 1.01–1.05), sex (aOR: 1.41, 95%CI: 1.02–1.95), participants’ perceptions of consequences (aOR: 1.10, 95%CI: 1.04–1.17), identity (aOR: 1.15, 95%CI: 1.06–1.25) and concerns about COVID-19 (aOR: 0.91, 95%CI: 0.85–0.97) were statistically significant predictors of CAM use. These results suggest the need for appropriate public health policy on COVID-19 and CAM use in addition to directing further research initiatives toward an optimized COVID-19 prevention scheme using clinically validated CAM treatments. Research to validate the clinical efficacy of these products, especially the herbs, for COVID-19 prevention while isolating lead compounds that could be optimized and used for the treatment and prevention of COVID-19 is also recommended.