INTRODUCTION:

Coronavirus disease (Covid-19) is an infectious disease caused by severe acute respiratory disease syndrome coronavirus 2 (SARS-COV-2). Covid-19 has affected the countries worldwide. The common symptoms of Covid-19 include fatigue, cough, fever, shortness of reath, loss of taste and smell, body ache, sore throat, chills, runny nose, chest pain and in some cases conjunctivitis. The Covid-19 ranges from mild to severe symptoms and in some cases no symptoms reported^1,2. Aged people and people suffering from chronic illnesses like hypertension, diabetes mellitus and cardiovascular diseases were found to be at greater risk of getting Covid-19 infection because of weak immune system and low potency to fight disease. Post Covid complications are also fatal in these people^3,4. It is important to identify individuals with comorbidities for further communication, action and planning. However no such evidence was obtained from the studied population about the outcomes and prevalence of comorbidities among COVID-19 patients. So the presents study has been undertaken.

MATERIALS AND METHODS:

A descriptive cross-sectional study was done to assess the prevalence of comorbidities and health outcomes among Covid-19 patients residing in Indira colony, Chandigarh. A total of 110 COVID-19 patients were enrolled through total enumeration sampling over a period of two weeks (8^th to 21^st March2021). Inclusion criteria of the study was the confirmed cases of COVID -19 as diagnosed by RTPCR test. All the patients who were ever diagnosed with COVID-19 were included in the study after obtaining informed consent.

Identification of the COVID-19 patients was done with the help of ANM’s working in the selected community. List of all the patients and their contact details was prepared. Data was obtained telephonically from these patients. A semi structured interview schedule was formulated on Google forms to collect the data. Validation of the tool was done with the help of experts in the field of community medicine and nursing and relevant modifications done as per their suggestions. It consisted of four sections as a) sociodemographic profile b) clinical profile c) Assessment of comorbidities and d) Assessment of health outcomes.

All the COVID -19 patients were contacted telephonically and explained about the study through patient information sheet. After receiving their consent on WhatsApp they were asked about their convenient time for recording the responses on Google forms. The anonymity and confidentiality of participants was maintained. Ethical clearance was obtained from ethics committee NINE PGIMER Chandigarh. Appropriate permissions were taken [reference number EC/NINE/2021/13]. Data was analysed by descriptive statistics in which mean, range and standard deviations was calculated. The data was analysed by SPSS 26. The various analytical measures were frequency distribution, range, mean and standard deviation.

RESULTS:

A total of 110 COVID-19 patients were enrolled in the study. Socio- demographic profile of the patients revealed that 57(51.8%) were females and 53(48.2%) were males. Mean age of the participants was 35.47+ 14.5 years. In total 35(31.8%) were illiterate, 86(78.2%) married and 29(26.4%) umenployed. Socioeconomic status as per BG Prasad scale revealed that 47(42.7%) belonged to upper middle class.

Covid-19 profile of the patients. Among 110 participants 7.3% acquired infection through travel, 38.2% acquired from community, 35.5% acquired from family members, 4% acquired it from hospital, 12.7% did not know the source of infection. Nearly half percent (46.3%) were isolated in the home, 27.3% were in the hospital, 26.3% were in other places eg. Dharamshalas, PU hostel. Regarding the isolation period, 55.5% were isolated for 14 days, 40.9% for 15-21 days, 3.6% for >21 days (table 1).

Signs and symptoms experienced by Covid-19 patients is described in table 2. Out of all the patients 90 (81.8%) were symptomatic and 20(18.2%) asymptomatic. The most common presenting symptoms were fever 80 (88.8%) followed by cough 62(68.8%). Loss of taste and loss of smell was reported by 14(15.5%) and 13(14.4%) patients respectively.

Regarding comorbid conditions 25(22.7%) patients reported the presence of one or more than one comorbidity (table 3). The most common comorbidities among participants were diabetes mellitus 11(44%), chronic cardiac disease(24%), COPD(20%) and hypertension(12%).

Health outcomes of Covid-19 patients are described in table 4. Nearly one third of patients 30(27.2%) required hospitalization. Among them 3(10%) needed ventilator support during hospital stay. One third (10%) of the participants needed ventilator support during hospital stay, 13.4% needed oxygen. After Covid-19 infection 14(12.7%) of participants reported weakness/fatigue and 1(0.9%) people reported of chest pain. Among 110 participants included in the study 85.5% people underwent RT-PCR testing after completion of quarantine period. No death was reported among studied subjects.

Table: 1 Covid-19 profile of the patients (N=110)

S No.

Variables

n (%)

Source of Covid-19infection (self-reported)

Travel history

Community acquired

Acquired from family member

Acquired from hospital

Not known

8(7.3)

42(38.2)

39(35.5)

7(6.4)

14(12.7)

Place of isolation

Home isolation

Hospital isolation

Others (Dharamshala, PU hostels)

51(46.3)

30(27.2)

29(26.3)

Duration of isolation

14 days

15-21 days

More than 21days

61(55.5)

45(40.9)

4(3.6)

No. of members infected per family

One person

Two persons

Three persons

Four persons

57(71.2)

19(23.7)

1(1.3)

3(3.8)

Table 2:- Signs and symptoms experienced by Covid-19 patient (N=110)

S. No.	Variables	n (%)
1.	Type of cases Symptomatic Asymptomatic	90(81.8) 20(18.2)
2.	Type of Sign and symptoms experienced	(n=90)
	History of fever	80(88.8)
	Dry Cough	62(68.8)
	Cough with sputum	21(23.3)
	Cough with bloody sputum	6(6.6)
	Sore throat	11(12.2)
	Runny nose	2(2.2)
	Wheezing	2(2.2)
	Chest pain	4(4.4)
	Muscle aches	9(10)
	Fatigue / malaise	9(10)
	Headache	10(11.1)
	Vomiting / nausea	1(1.1)
	Shortness of breath	4(4.4)
	Loss of taste	14(15.5)
	Loss of smell	13(14.4)
	Diarrhea	1(1.1)

Table 3: Comorbidities among COVID-19 patients (N=25)

S. No.	Variables	n (%)
1	Prevalence of comorbidities	(n=110)
	Yes	25(22.7)
	No	85(77.2)
2	Types of Comorbidities	(n=25)
	· Diabetes mellitus	11(44)
	· Hypertension	3(12)
	· Obesity	1(4)
	· COPD	5(20)
	· Chronic cardiac disease	6(24)
	· Asthma	2(8)
	· Hypertension and diabetes mellitus	2(8)
	· COPD and diabetes mellitus	1(4)
	· Obesity and diabetes mellitus	1(4)
3	Duration of comorbidity	(n=25)
	1-3 years	15(60)
	4-6 years	6(24)
	>6 years	4(16)
4	Number of comorbidities in the patients	(n=25)
	1 comorbidities	17(68)
	2 comorbidities	4(16)

Table 4:- Health outcome of the Covid-19 patients (N=110)

S. No.	Variables	n(%)
1.	Place of isolation Home isolation Hospital isolation Others (Dharamshala, PU hostels)	51(46.3) 30(27.2) 29(26.3)
2.	Health outcomes of the Covid-19 patients · Alive · Dead	110(100) 0
3.	Treatment modalities among hospitalzed · Ventilator · Oxygen	(n=30) 3(10) 4(13.4)
4.	Post Covid complications · Weakness / fatigue · Chest pain	14(12.7) 1(0.9)
5.	Rt PCR testing done after isolation period	94(85.5)
6.	Duration of hospital stay · 14 days · 21 days · More than 21 days	(n=30) 10(33.3) 13(43.3) 7(23.3)

DISCUSSION:

Coronavirus disease 2019 (COVID-19) is presented with asymptomatic, mild, or severe pneumonia-like symptoms. This disease can be life-threatening in patients with comorbidities. The present study was conducted to assess the health outcomes and prevalence of co-morbidities among Covid-19 patients of Indira Colony, Chandigarh.

In this study 51.8% participants were females and 48.2% of the participants were males. A similar result has been shown in the study which was conducted in Saudi Arabia by Jumana in the same time period which has 65.9% of participants as females and 35.4% participants as males.⁶ One another study conducted in China in shows that 42.7% of the patients were females and rest were males.⁷Although Covid-19 infection is not specific to a particular gender, the variation could be because of socioeconomic and geographical differences.

The present study reflects the Covid-19 profile of the patients where 46.3% of the participants were home isolated, only few 26.3% were isolated in government-based institutions and 27.2% needed hospitalisation. During the earlier outbreak of Covid-19 infection, all the patients were isolated in hospitals. The increasing number of patients and lack of beds in hospitals led to the need of home isolation. The home isolation was preferred during that time which justifies the high percentage of patients being home isolated. It shows the similar results with the study which was conducted in Austria in 2020 which shows that 69% of the participants were home isolated⁵. In the present study, more than half (55.5%) of the patients were isolated for 14 days while 17.3% of patients were isolated for 21 days depending on the duration of signs and symptoms. Isolation period was as per the recommendation of Ministry of health and family welfare guidelines.⁶

The present study shows that 38.2% of participants were having community acquired infection and about 35.5% acquired it from a family member and only 6.4% acquired it from the hospital while 12.7% of the patients had not known the source of Covid-19 infection. Another study conducted by Muhammad Adnan shows the similar results which concluded that out of 110 participants 56% were having community acquired Covid-19 infection.⁹From this data and significant number of patients with unknown source of infection in the present study, it is seen that the Covid-19 infection was spread to the community level by that time rather than to just those people who had travel history.

Prevalence of symptomatic patient in the present study was 81.8% which is almost similar to the studies done in Korea (91.3%)⁷ but higher than the study done by Saudi Arabia (45.1%)⁸. The difference could be because of the different methodologies adopted to recruit patients.

Fever (88.8%) followed by dry cough (68.8%) were the most common symptom reported in the present study which is similar to the results reported by Paudel SS⁹. The present study reported that about 10% of the hospitalised patients needed ventilation support and 13.4% needed oxygen therapy which was almost similar to the results of another study conducted in New York City area in which about 12.2% patients needed mechanical ventilation¹⁰.

The present study 22.7 % of the patients had comorbid conditions and it is almost similar to the studies done in Thailand¹¹, Singapore¹², Nigeria¹³. Diabetes mellitus (44%), chronic cardiac disease (24%) and hypertension (12%) were the most prevalent comorbidities. Findings are similar with the studies done in China^14,15.Epidemiology transition has resulted in the rise of noncommunicable diseases, moreover there may be lot of cases who are undiagnosed because of lack of awareness.

There are some limitations in this study. Firstly assessment of comorbidities was done based on self-reporting which can lead to underestimation. Secondly as data was collected at one time point so if asymptomatic might have become symptomatic which was not considered.

CONCLUSION:

The study concluded fever as the most common symptom in symptomatic patients followed by cough. The most prevalent co-morbidity in patients was Diabetes Mellitus. Only few participants required mechanical ventilation and there was no fatality seen in the studied population.

REFERENCES:

1. World Health Organization. Coronavirus disease (COVID-19) Situation Report-41 [Internet]. Geneva, switzerland; 2020 [cited 2021 Apr 6]. Available from: https://openwho.org/courses/severe-acute-respiratory-infection.

2. CDC. Coronavirus (COVID-19): symptoms of coronavirus. Centers for Disease Control and Prevention. 2020. [Accessed https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html].

3. Luo L, Fu M, Li Y, Hu S, Luo J, Chen Z, et al. The potential association between common comorbidities and severity and mortality of coronavirus disease 2019: a pooled analysis. Clin Cardiol. 2020;43(12):1478–93

4. Sanyaolu, A., Okorie, C., Marinkovic, A., Patidar, R., Younis, K., Desai, P., ... and Altaf, M. (2020). Comorbidity and its impact on patients with COVID-19. SN comprehensive clinical medicine, 1-8.

5. Kreidl P, Schmid D, Maritschnik S, Richter, L., Borena, W., Genger, J. et al. Emergence of coronavirus disease 2019 (COVID-19) in Austria. Wien Klin Wochenschr. 2020;132(21-22):645-652. doi:10.1007/s00508-020-01723-9

6. https://www.mohfw.gov.in/pdf/ RevisedguidelinesforHomeIsolationofverymildpresymptomatic COVID19cases10May2020.pdf

7. Lee HW, Yoon SY, Lee JK, Park TY, Kim DK, Chung HS, et al. Clinical implication and risk factor of pneumonia development in mild coronavirus disease 2019 patients. Korean J Intern Med. 2021;36(1):1–10. https://doi.org/10.3904/kjim.2020.329

8. AlJishi JM, Alhajjaj AH, Alkhabbaz FL, AlAbduljabar TH, Alsaif A, Alsaif H et al . Clinical characteristics of asymptomatic and symptomatic COVID-19 patients in the Eastern Province of Saudi Arabia. J Infect Public Health. 2021 Jan;14(1):6-11. doi: 10.1016/j.jiph.2020.11.002. Epub 2020 Dec 17. PMID: 33341486; PMCID: PMC7744936.

9. Paudel SS. A meta-analysis of 2019 novel coronavirus patient clinical characteristics and comorbidities. Research Square. 2020. https://doi.org/10.21203/rs.3.rs-21831/v1 [Accessed April 11, 2021, https://www.researchsquare.com/article/rs-21831/v1].

10. Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA. 2020 May 26;323(20):2052-2059. doi: 10.1001/jama.2020.6775. Erratum in: JAMA. 2020 May 26;323(20):2098. PMID: 32320003; PMCID: PMC7177629.

11. Pongpirul WA, Wiboonchutikul S, Charoenpong L, Panitantum N, Vachiraphan A, Uttayamakul S, et al. Clinical course and potential predictive factors for pneumonia of adult patients with Coronavirus Disease 2019 (COVID-19): a retrospective observational analysis of 193 confirmed cases in Thailand. PLoS Negl Trop Dis. 2020;14(10):e0008806. https://doi.org/10. 1371/journal.pntd.0008806

12. Puah SH, Young BE, Chia PY, Ho VK, Loh J, Gokhale RS, et al. Clinical features and predictors of severity in COVID-19 patients with critical illness in Singapore. Sci Rep. 2021;11(1):7477. https://doi.org/10.1038/s41598-021-81377-3

13. Osibogun A, Balogun M, Abayomi A, Idris J, Kuyinu Y, Odukoya O, et al. (2021) Outcomes of COVID-19 patients with comorbidities in southwest Nigeria. PLoS ONE 16(3): e0248281. https://doi.org/10.1371/journal.pone.0248281

14. Li Y, Shi J, Xia J, Duan J, Chen L, Yu X, et al. Asymptomatic and symptomatic patients with non-severe coronavirus disease (COVID-19) have similar clinical features and virological courses: a retrospective single center study. Front Microbiol. 2020. https://doi.org/10.3389/fmicb.2020.01570

15. Liu X-Q, Xue S, Xu J-B, Ge H, Mao Q, Xu X-H, et al. Clinical characteristics and related risk factors of disease severity in 101 COVID-19 patients hospitalized in Wuhan, China. Acta Pharmacol Sin. 2021. https://doi.org/ 10.1038/s41401-021-00627-2

Received on 15.03.2022 Modified on 25.03.2022

Asian J. Nursing Education and Research. 2022; 12(2):235-238.

DOI: 10.52711/2349-2996.2022.00048