COVID-19 mortality at a tertiary care center during the Second and Third Waves of the pandemic in Sri Lanka: a cross sectional analysis

Introduction & Objectives The COVID-19 pandemic has claimed over 6.8 million lives globally, with varying impacts across different healthcare systems. Sri Lanka reported 591 and 15,800 deaths during the Second and Third Waves, respectively. This study investigates COVID-19 mortality patterns at a major tertiary care hospital in Sri Lanka during the pandemic, providing crucial insights for resource-limited settings. Methods This descriptive cross-sectional study evaluated COVID-19 deaths at Colombo North Teaching Hospital, Ragama, Sri Lanka from November 2020 to December 2021. Data were sourced from hospital records, supplemented by telephone interviews with family members for missing information, following informed consent. Statistical analyses included Mann-Whitney U tests and Pearson's Chi-squared tests for group comparisons. Results The hospital mortality rate was 14.9% among 8,531 COVID-positive admissions. Among 1,004 recorded deaths, the median age was 72 years (IQR: 62–79, range: 19–99), with males constituting 57.2% of the cohort. Diabetes (61.6%), hypertension (36.9%), and coronary artery disease (14%) were the predominant comorbidities, with 37.2% having multiple comorbidities. COVID-19 pneumonia was the primary cause of death (83%). A majority (78.3%) of the deceased were unvaccinated, while 21.7% had received at least one vaccine dose. Unvaccinated individuals were older, had longer hospital stays, and exhibited more severe symptoms compared to their vaccinated counterparts. Conclusions The high prevalence of diabetes and hypertension among COVID-19 deaths mirrors patterns seen across South Asia, emphasizing the need for integrated management of non-communicable diseases during infectious disease outbreaks. The lower proportion of vaccinated individuals among the deceased suggests vaccine effectiveness, reinforcing the importance of prioritizing high-risk populations in vaccination campaigns. These findings provide guidance for strengthening pandemic preparedness in resource-constrained settings, with potential applications across similar healthcare systems globally.