CLINICAL CLASSIFICATION OF COVID-19 PATIENTS, A SURVEY

 

CLINICAL CLASSIFICATION OF COVID-19 PATIENTS, A SURVEY

Abstract:      

Purpose: the purpose of this study is to classify the patients into different categories, to identify the distribution of symptoms in Covid-19 patients and to find out the mortality rate in our village.

Methods and materials: A survey of Covid-19 patients was done in Mandapeta, E.G District, A.P.. In this survey we have collected the list of 160 Covid-19 patients with the help of volunteers and visited individual patient after 25 days from the day of positive test result. The data from the patient’s records, patients and care givers was collected. Ordinal Scale for Clinical Improvement was used to classify the patients into different categories.

Results: The data from 160 patients was analyzed. Based on the results we find that 30% of the patients were ambulatory with no active symptoms. 60.625% of the patients were hospitalized with mild to moderate disease, 7.5% of the patients were hospitalized with severe disease and 1.875% of the patients died with the disease. Cough, loss of smell and fever were the mostly reported symptoms. Shortness of breath was reported in 36 patients.

Conclusion: Based on our survey, we found that these is no effect of the disease in 30% of the cases and they did not require any treatment, mild to moderate disease in 60.625% of the cases, severe disease in 7.5% of the cases and the mortality rate was 1.875%.

Key words: Covid-19, Mortality rate, Ordinal Scale for Clinical Improvement, Shortness of Breath (SOB), Ambulatory.

Introduction:

^[1]COVID-19 is a highly contagious infection that is caused by the virus SARS CoV-2, a kind of coronavirus.COVID-19 can occur with none symptoms. It also can cause symptoms that are severe and complications which will be fatal. Doctors don't yet know the complete impact that corona virus has on the body, but COVID-19 commonly affects a person’s ability to breath ^[1]. ^[2]Even if an individual has no symptoms, they will pass the infection to others. It is vital to require steps to stop this. There is no cure for COVID-19. To prevent the illness, take precautions, like washing the hands frequently, wearing a face-covering publicly , and staying faraway from others. Isolating is particularly crucial for people that feel ill^[2].

Asymptomatic or unknown: ^[3]Some people that have COVID-19 are asymptomatic. This means that they are doing not have any known symptoms of COVID-19 or associated symptoms, like sneezing. A person who is asymptomatic might transmit the virus to others without even realizing it. Positive asymptomatic patients should maintain interpersonal distance and wear a mask. People who had contact with the covid patient should follow all the precautions even if he/she has no symptoms^[3].

Mild to moderate:                                                                  

^[4]There will be very less difference between mild and moderate symptoms and therefore the treatment is more or less the same .The most common symptoms of mild-to-moderate cases are:

A fever: the bulk of individuals with COVID-19 experience a fever. A study which was conducted in January, 2020 noted that 98% of patients with COVID-19 had a fever.

Fatigue: Some people may need less energy or need more sleep.

Cough: The cough tends to be dry, but it's going to not always be.

Other symptoms include: sore throat, headache, nasal congestion, malaise, muscle aches, gastrointestinal issues, such as diarrhea, nausea, or vomiting, lack of appetite.

While viruses like the flu often hit babies and young children very hard, most research around COVID-19 suggests that children are likely to experience mild symptoms or no symptoms at all. Most for the covid 19 research works done in the earlier times focused only on respiratory symptoms but later in the recent research it was  found that covid 19 can affect other organ systems too. In some people changes in their sense of smell or taste occurs often before other symptoms appear^[4].

Severe cases:

^[5]Data on the prevalence of severe symptoms are hard to interpret because testing remains limited. Most people only seek medical aid if they need severe symptoms, and a few might not notice any symptoms in the least.

Symptoms of severe cases typically include: high fever above 103℉ (39.4℃), difficulty breathing, blue lips or face, persistent pain or pressure in the chest, new-onset confusion (“altered mental status”).

On average, people who develop severe symptoms, such as shortness of breath, do so within 8 days of other symptoms first appearing. People with preexisting medical conditions may notice that their symptoms get worse and these patients need intensive care such as oxygen therapy, non invasive ventilation and sometime addition organ support. It was found that 12% of all people with a COVID-19 diagnosis in Italy needed treatment in intensive care units^[5].

Methods and materials:

A survey of Covid-19 patients was done in Mandapeta, E.G District, A.P. In this survey we have collected the list of 160 Covid-19 patients with the help of volunteers and visited individual patient after 25 days from the day of positive test result. The data from the patient’s records, patients and care givers was collected. The collected data was then cleaned based on the inclusion and exclusion criteria and then used to draw results. Ordinal Scale for Clinical Improvement was used to classify the patients into different categories.

Ordinal scale for clinical improvement: ^[6]World Health Organization Ordinal Scale for Clinical Improvement (WHO-OSCI) The WHO-OSCI is an ordinal scale of 9 severity levels (from 0 to 8) for COVID-19. This scale was established by the WHO, which recommends its use for any therapeutic study on COVID-19^[6].

Results:

Table 1: classification of patients based on severity:

30% (48) of the total cases were ambulatory with no active symptoms. 60.625% (97) of the cases with Mild-Moderate Disease. 7.5% (12) of the cases with severe disease. And 1.875% (3) deaths.

Disease severity	No. of cases (%)
Ambulatory	48 (30)
Hospitalized With Mild-Moderate Disease	97 (60.625)
Hospitalized With Severe Disease	12 (7.5)
Deaths	3 (1.875)
Total	160 (100)

Graph 1:

 

Table 2: Classification Of Patients Based On Ordinal Scale For Clinical Improvement:

12 (7.5%) of the cases were ambulatory without any limitations in their daily activities, 36 (22.5%) of cases were ambulatory with limitations. 76 (47.5) of the hospitalized cases required no oxygen therapy with 21 (13.125%) of the hospitalized cases received oxygen therapy by masks and nasal prongs. 7 (4.375%) of the hospitalized were kept on NIV/ high flow oxygen and 5 (3.125%) were supported by intubation/ mechanical ventilation. 3(1.875%) deaths were reported.

State of patient	Description	No of patients (%)
Ambulatory	Without limitations	12 (7.5)
	With limitations	36 (22.5)
Hospitalized with mild-moderate disease	No oxygen therapy	76 (47.5)
	Oxygen by masks and nasal prongs	21 (13.125)
Hospitalized with severe disease	Non invasive ventilation/ high flow oxygen	7 (4.375)
	Intubation/ mechanical ventilation	5 (3.125)
	Ventilation + additional organ support	0 (0)
Death	Death	3 (1.875)
	Total	160 (100)

 

Graph 2:

Table 3: Distribution of symptoms in 160 patients:

Shortness of breath (sob) was the least common symptom with cough, fever, cold being the common symptoms in majority of patients.

 

Symptoms	No. of patients
Cold	103
Cough	106
Fever	112
Loss of smell	87
Shortness of breath (SOB)	36
Body pains	98

 

Graph 3:

 

Conclusion: Based on our survey, we found that there is no-very less effect of the disease in 30% of the cases and no treatment was given to them, mild to moderate disease in 60.625% of the cases. Severe disease in 7.5% of the cases and the mortality rate was 1.875%.

Limitations of the study: In some cases due to the lack of patient records, the data taken may not be correct as the information was obtained by simply asking the patients and their care takers.

Acknowledgement: I am very thankful to the volunteers who helped me gathering the details of Covid 19 patients.

Source of funding: Nothing

References:

1)      Coronavirus types symptoms facts and preventions june 24, 2021 https://cute766.info/coronavirus-types-symptoms-facts-and-preventions/

2)      All you need to know about COVID-19 Medically reviewed by Meredith Goodwin, MD, FAAFP — Written by Kathleen Davis, FNP — Updated on January 24,2021 https://www.medicalnewstoday.com/articles/covid-19

3)      What are the symptoms of COVID-19 by severity level? Medically reviewed by Meredith Goodwin, MD, FAAFP — Written by Zawn Villines on March 31, 2020 https://www.medicalnewstoday.com/articles/coronavirus-symptoms-severity-levels

4)      Rajesh T. Gandhi, M.D., John B. Lynch, M.D., M.P.H., and Carlos del Rio, M.D. Mild or Moderate Covid-19 The new england journal of medicine N Engl J Med 2020;383:1757-66. DOI: 10.1056/NEJMcp2009249.

5)      *Abdulzahra Hussain,^1,2 Deepak Rao,³ Thomas Buttle,³ Lynette Linkson,³ William Owen,4Elizabeth Hadley,³ Shamsi EL-Hasani risk factors for severe coronavirus disease (covid-19) EMJ Respir. 2020;8[1]:120-126.

6)      WHO Ordinal Scale For Clinical Improvement https://www.who.int/blueprint/priority-diseases/key-action/COVID-19_Treatment_Trial_Design_Master_Protocol_synopsis_Final_18022020.pdf