Connecting Dots in COVID-19 Dr Swapnil Pawar
The literature published from various countries has helped us to understand the disease pattern in COVID-19 pandemic.
The New York experience
Richardson et al. evaluated a large case series of 5,700 patients admitted to 12 hospitals under Northwell Health, the biggest health care provider in New York (1). They analyzed the clinical characteristics and outcomes of patients hospitalized over a 35-day period between March 1, 2020, and April 4, 2020. All patients tested positive for SARS-CoV-2 by RT-PCR on the nasopharyngeal sample. Patients were followed up until they were discharged alive or dead, or until the study endpoint. On April 4, 2020, the final follow-up date, 2634 (46.2%) patients were either discharged alive or dead, while 3066 were still undergoing continued treatment in hospital.
The median age of patients was 63 (IQR: 52–75) years, with a distinct male preponderance (60.3%). Common comorbidities included hypertension (56%), obesity (BMI ≥30, 41.7%), morbid obesity (BMI ≥35, 19%), and diabetes mellitus (33.8%). Lymphopenia (less than 1,000/microliter) was observed in 3387 (60%) patients. Important clinical outcomes are depicted in Table 1.
Table 1. Important clinical outcomes of the New York case series
|Dead or discharged alive at follow-up||2634/5700 (46.2%)|
|Discharged alive||2081/2634 (79%)|
Outcomes of ventilated patients
|Total number of ventilated patients during the study period||1151/5700 (20.2%)|
|Ventilated patients who were dead/discharged alive at follow-up||320/1151 (27.8)|
|Patients who continued to be on ventilation at follow-up||831 (72.2%)|
|Mortality among ventilated patients at follow up||282/1151 (24.5%)|
Renal replacement therapy was required in 81 (3.2%) patients. The overall median length of hospital stay (from admission to death or discharge) was 4.1 (IQR, 2.3–6.8) days.
From Lombardy, Italy
Graselli et al. reported on 1591 patients who were treated in 72 hospitals of the Lombardy ICU network between 20th February and 18th March, 2020. Among 1591 patients included, the median age was 63 (IQR: 56–70) years. The majority of patients were males (82%); 68% had comorbidities, hypertension being most common. Data on respiratory support was available in 1300 patients; among these patients, 1150 (88%) required invasive mechanical ventilation, and 137 (11%) received non-invasive ventilation. The median PEEP level was 14 (IQR: 12–16), and the median PaO2/FiO2 ratio was 160 mm Hg (IQR: 114–220). The FiO2 requirement was more than 0.5 in 89% of patients. At the time of follow-up on 25th March, 2020, data was available on 1581 patients; 405 (26%) of patients had died, 920 (58%) were still in ICU, and 256 (16%) were discharged from the ICU (1). This study clearly shows that critically ill patients with COVID-19 have a protracted and complicated clinical course with high mortality.