Demographic, Clinical characteristics and course of the disease
A total of 11393 adult patients were admitted at the Aga Khan University Hospital between Feb 26th, 2020, and June 10th, 2020. Out of this, 445 patients were diagnosed with COVID-19 based on RT-PCR positivity for SARS-CoV-2. Most of those admitted were males (298, 66.97%) and had a mean age of 51.6 (18-91) years. Asymptomatic disease occurred in 55 (12.36%) of the patients, while severe/critical disease occurred in 137 (30.79%). Most (268, 60.22%) patients had at least one or more than one co-morbidity, of which hypertension was the most common (37.5%) followed by diabetes (36.4%) (Table 1). Admissions peaked in May and then steadily reduced over time. The proportion of patients with severe disease increased with time with 25% of patients admitted with severe disease in March and 34% of patients admitted with severe disease in May (Figure 1).
In those who were symptomatic, the most common symptom was fever (80%) followed by cough (61.3%) and shortness of breath (61.0%). The median duration of illness prior to presentation was 7 days (IQR 3-10) and was longer with worsening severity of illness (median of 3 days in mild, 7 days in moderate, and 7 days in severe respectively). Chest X-rays were performed in almost all patients (97%). Chest X-rays were normal in 21.57% of patients. Unilateral involvement was seen less frequently as compared to bilateral disease (7.69 versus 66% respectively). Median C - reactive protein level was 83.3 mg/L (IQR: 27.8 -178.9) and the median Ferritin level was 551 ng/ml (IQR: 254.1-1258.3). Overall, 124 (27.9%) required non-invasive ventilation (NIV) and 64 (14.5%) required invasive positive pressure (IPPV) ventilation. Treatment received varied as the protocols changed with chloroquine use dropping from 2.25% of patients to zero between February and April. Similarly, hydroxychloroquine was given to 31% of patients overall with use declining from 47% to 2.1% between April and June. Septic shock was seen in 62 (14%) of the cases while 44 (9.9%) presented in multi-organ dysfunction. Acute kidney injury was seen in 96 (21.62%) and 46 (10.34%) patients presented with a myocardial infarction alone. Secondary infections were common and occurred in 59 (13.3%) of patients. A total of 58 died with an overall mortality rate of 13%. (Table 1).