Determinants of Time to Convalescence among COVID-19 Patients at Millennium COVID-19 Care Center in Ethiopia: A prospective cohort study

  1. Tigist W. Leulseged
  2. Ishmael S. Hassen
  3. Endalkachew H. Maru
  4. Wuletaw C. Zewde
  5. Nigat W. Chamesew
  6. Kalkidan T. Yegile
  7. Abdi B. Bayisa
  8. Tariku B. Jagema
  9. Teketel T. Admasu
  10. Mesay G. Edo
  11. Eyosias K. Gurara
  12. Meseret D. Hassen
  13. Etsegenet Y. Menyelshewa
  14. Firaol M. Abdi
  15. Mahlet B. Tefera
  16. Siham S. Ali

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Abstract

Aim

To estimate time to recovery/convalescence and identify determinants among COVID-19 infected patients admitted to Millennium COVID-19 Care Center in Addis Ababa, Ethiopia.

Methods

A prospective cohort study was conducted among a randomly selected sample of 360 COVID-19 patients who were on follow up from 2 nd June to 5 th July 2020. Kaplan Meier plots, median survival times, and Log-rank test were used to describe the data and compare survival distribution between groups. Association between time to recovery/ convalescence and determinants was assessed using the Cox proportional hazard survival model, where hazard ratio, P-value, and 95% CI for hazard ratio were used for testing significance.

Results

The mean age of the participants was 32.4 years (± 12.5 years). On admission, 86.9 % had mild COVID-19, 78.6% were asymptomatic and 11.4% of the patients had a history of pre-existing co-morbid illness. The Median time to recovery/ convalescence among the study population was 16 days. The log-rank test shows that having non-mild (moderate and severe) disease, having one or more symptoms at presentation, and presenting with respiratory and constitutional symptoms seems to extend the time needed to achieve recovery. The Final Cox regression result shows that the presence of symptom at presentation was found to be a significant factor that affects time to recovery/ convalescence, the rate of achieving recovery/ convalescence among symptomatic patients was 44% lower than patients who were asymptomatic at presentation (HR= 0.560, 95% CI= 0.322-0.975, p-value=0.040).

Conclusions

Presence of symptom was found to be associated with delayed viral clearance. This implies symptomatic patients are more likely to be infectious because of the prolonged viral shedding in addition to the presence of a more concentrated virus in the upper respiratory tract that enhances the transmission. Therefore, attention should be given in the isolation and treatment practice of COVID-19 patients with regard to presence of symptom.

Key Messages

  • The study assessed the time to RT-PCR proven recovery (two consecutive negative viral shedding) and identified determinants that affected the time.

  • Symptomatic infection is associated with delayed viral clearance.

  • The finding of the study could be used to guide the isolation and treatment practice.

Article activity feed

  1. ScreenIT

    SciScore for 10.1101/2020.10.07.20208413: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    RandomizationThe data collection tool was pretested on 5% of randomly selected patients and their medical charts and necessary amendment on the data collection tool was made.
    Blindingnot detected.
    Power AnalysisSample Size Determination and Sampling Technique: The sample size was determined by using sample size calculation formula of the survival method by considering the following statistical assumptions: 95% Confidence Interval (CI), power of 90%, survival probability of 0.5, 5% marginal error,
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Data Management and Data Analysis: The collected data was coded and entered into Epi-Info version 7.2.1.0, cleaned and stored and exported into SPSS version 23 for analysis.
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    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:
    Therefore, the result has to be interpreted with this limitation in mind.

    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 10.1101/2020.10.07.20208413v1 on medRxiv