DISCUSSION

The research was carried out by Nishtar Hospital Multan, to evaluate the prevalence of covid-19 among different genders and age groups. It also differentiates patients on basis of Signs and Symptoms, family history, the way patient was diagnosed, history of any chronic disease, hospitalization, admission, morbidity and mortality in covid patient . As regards gender, In week of April 2020, the UK intensive care and National Audit research center (ICNAR) published a report on 2249 patients admitted to intensive care . Data showed men with covid 19 were more than women ( 53.2% vs 37.5 % ) , mechanical ventilation (73%vs 27% ) , Respiratory support (71% vs 29 % ) which is in accordance with our results which showed covid-19 came out to be more prevalent among males (51.4%) as compared to females (48.6%). The reason for this is not yet completely understood, however it is generally seen that, women are less vulnerable to various viral infection e.g. Coxsackie viruses virus B, SARS etc. This may be due to various factors including the presence of several immune related genes of X chromosomes and there is evidence of greater reactivation of these genes in immune cells from women than men, influence of steroid hormones on immunity etc. As regards the age, a study examining 133 COVID-19 patients in Wuhan China, reported a similar male predominance of covid 19 in persons aged above 65 years (58% male vs. 42% female). In our study Covid-19 prevalence above 65 years was 2.7% in both males and females. The various symptoms associated with covid-19 are fever, cough, shortness of breath, flue like symptoms, body aches and anosmia etc. ISARIC multinational study shows Male Female Fever 71% 66% Cough 70% 66% Shortness of breath 67% vs 64% while nausea and vomiting more common in female than male ( 23 %vs 16 % ). Our study shows : -Fever. (Male 19.5% Female 21.9%) -Tiredness ( Male 15.6% Female 9.5%) -Dry cough (Male 6.4% Female 10.9%) Fever a common symptom of COVID is defined by The American College of Critical Care Medicine and Infectious Disease Society as “Core body temperature greater or equal to 38.3 °C . NICE considers an infant or child has fever if their temperature is 38 °C or higher .Reports suggest that fever is most common after five days of exposure on average. The next consideration was to see that how a COVID-19 affected person was diagnosed. A study showed that 72% of COVID-19 admissions were males versus 28% of those were females based on clinical evaluation. According to the data collected by our colleagues, the maximum number of patients were diagnosed on the basis of clinical evaluation(males 55.8% _ females 57.5%) , followed by routine surveillance (22.1% males_26% females) , contact tracing(18.2% males_9.5% females) , and others(males 3.8%_females 6.8%). The history of these patients was also evaluated to see that how did they contract this virus Clinical and demographic features of COVID-19 patients in Shiraz, South of Iran showed history of contact with infected cases(16.8%) and history of travelling (26.5%)in males and females. According to our research among males, mass gathering was the major factor (29.8%)while in case of females it was contact with covid patients (35.6%).14.2%males and 12.3%females also had a traveling history. There were 40%males and 27.4%females that did not have any such history which would give a clue as to how did they contract the virus. Chronicity and comorbidity influences the risk of COVID-19 infection and the course of the disease. It is a well-known fact that the patients suffering from any chronic disease become immuno-compromised and this adversely affects the ability of their immune system to cope up with any type of infections. According to a study conducted on COVID-19; the most frequent association was with hypertension (19.5%), diabetes ( 14.2%), cardiovascular diseases (14.2%) and asthma(6.2%). Our collected data suggests that COVID-19 patients suffering from chronic diseases like diabetes(16.9% males and 5.5% females) , hypertension(6.5%males and 10.9%females) , cardiac diseases(6.5% males and 2.7% females) and asthma(6.5% males and 2.5% females) are having very severe and fatal symptoms of COVID-19 infection. We also assessed the hospitalization time and ICU admissions in COVID-19 positive patients. A research conducted by Shiraz University showed hospitalization (25.7%) and ICU admissions (9.7%) in male and female covid 19 patients. Male to female ratios of our Results showed that more females were admitted to the ICU i.e. 19.2% as compared to males 15.5% and hospitalization rate of patients was 31.16% in males and 27.3% in females The last but not the least is the outcome of the research. In the first week of April 2020, the UK Intensive Care and National Audit Research Centre (ICNARC) published a report on the first 2,249 patients admitted to intensive care in the UK with COVID19. It showed that men with COVID-19 were more likely to die than women (53.2% v. 37.5%) whereas in our study it showed that although COVID-19 had higher prevalence rate among men but mortality rate was pretty more in females i.e. 16.4% as compared to males 10.4% On the whole, it is novel virus and there is a need to carry out more studies on it in order to develop a good treatment plan or a vaccine and to prevent the people from getting infected with this fatal virus.