Management of mild COVID-19: Policy implications of initial experience in India

  1. Rohit Kumar
  2. Bisakh Bhattacharya
  3. Ved Prakash Meena
  4. Anivita Aggarwal
  5. Manasi Tripathi
  6. Manish Soneja
  7. Ankit Mittal
  8. Komal Singh
  9. Nishkarsh Gupta
  10. Rakesh Kumar Garg
  11. Brajesh Kumar Ratre
  12. Balbir Kumar
  13. Shweta Arun Bhopale
  14. Pavan Tiwari
  15. Ankit Verma
  16. Sushma Bhatnagar
  17. Anant Mohan
  18. Naveet Wig
  19. Randeep Guleria

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Abstract

Objectives

Ongoing pandemic due to COVID-19 has spread across countries, surprisingly with variable clinical characteristics and outcomes. This study was aimed at describing clinical characteristics and outcomes of admitted patients with mild COVID-19 illness in the initial phase of pandemic in India.

Design

Retrospective (observational) study.

Setting

COVID facilities under AIIMS, New Delhi, where, isolation facilities were designed to manage patients with mild illness and dedicated COVID ICUs was created to cater patients with moderate to severe illness.

Participants

Patients aged 18 years or more, with confirmed illness were eligible for enrolment. Patients who were either asymptomatic or mildly ill at presentation were included. Patients with moderate to severe illness at admission, or incomplete clinical symptomatology records were excluded.

Methods

Data regarding demographic profile, comorbidities, clinical features, hospital course, treatment, details of results of RT-PCR for SARS-CoV-2 done at baseline and at day 14, chest radiographs (wherever available) as well as laboratory parameters was obtained retrospectively from the hospital records.

Main outcome measures

Final outcome was noted in terms of course of the disease, patients discharged, still admitted (at time of conclusion of study) or death.

Results

Out of 231 cases included, majority were males(78·3%) with a mean age of 39·8 years. Comorbidities were present in 21·2% of patients, diabetes mellitus and hypertension being most common. The most common symptoms were dry cough(81, 35%), fever(64, 27·7%), sore throat(36, 15·6%), and dyspnoea(24, 10·4%); asymptomatic infection was noted in 108(46.8%) patients. Presence of comorbidities was an independent predictor of symptomatic disease (OR- 2·66; 95% CI 1·08 to 6·53, p= 0·03). None of the patients progressed to moderate to severe COVID-19. There were no deaths in this cohort.

Conclusions

Patients with mild disease at presentation had a stable disease course and therefore such cases can be managed outside hospital setting. A large proportion of patients remained asymptomatic throughout the course of infection and those with comorbidities are more likely to be symptomatic.

Trial registration

Not applicable

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  1. ScreenIT

    SciScore for 10.1101/2020.05.20.20107664: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: The permission for the study was obtained from the Institute Ethics Committee.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Statistical analysis: Data was analysed using STATA 13·0.
    STATA
    suggested: (Stata, RRID:SCR_012763)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    This study has several limitations. First, there is sparse literature on mild cases and our patients were younger compared to other reported studies, so direct comparison of clinical manifestations and disease progression is to be done cautiously. However, our patients had a significant burden of comorbidities for their age, which is an important risk factor for severe disease. Secondly, this being a retrospective study there are inherent limitations. Daily symptom screen data was lacking in many cases leading to their exclusion, laboratory data was incomplete particularly with respect to markers like serum ferritin levels and C-reactive protein. Thirdly, there was a selection bias owing to aggressive contact tracing and admission of close contacts for testing. This resulted in a large number of asymptomatic patients being recruited for the study. Nevertheless, to the best of our knowledge, this is the largest report of clinical manifestations and disease course among admitted patients with mild COVID-19 and the data will be useful for policy makers.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.05.20.20107664 on medRxiv
  3. Version published to 10.4103/jfmpc.jfmpc_1198_20