Characteristics and outcomes of hospitalized adults with COVID-19 in Nepal: a multicenter, prospective cohort study

  1. Ashok Chaudhary
  2. Uday Narayan Singh
  3. Pramod Paudel
  4. Niresh Thapa
  5. Kamal Khadka
  6. Prameshwar Kumar Sah
  7. Sher Bahadur Kamar
  8. Jagadish Joshi
  9. Kamar Hasan Ansari
  10. Shree Ram Tiwari
  11. Sarbesh Sharma
  12. Sanjay Kumar Jaiswal
  13. Ramesh Joshi
  14. Samikchya Baskota
  15. Arjun Prasad Tiwari
  16. Hem Raj Pandey

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Abstract

Introduction: There is limited data on clinical course and outcomes of hospitalized adults with COVID-19 in Nepal. Thus, it is imperative to characterize the features of this disease in the domestic context. Methodology: We identified all adult patients with laboratory-confirmed COVID-19 admitted to five different hospitals in Nepal from June 15 to July 15, 2020. We collected epidemiological, socio-cultural and clinicopathologic data, and stratified the patients based on their symptom status. Results: The study included 220 patients with an overall median age of 31.5 (25-37) years, and 181 (82.3%) were males. 159 (72.3%) were asymptomatic, and 163 (74.1%) were imported cases. Of 217 patients with the available data, 110 (50.7%) reported their annual household income less than 2000 US dollars, and 122 (56.2%) practiced Pranayama (yogic rhythmic breathing techniques) regularly. Eight patients (3.6%) required supplemental oxygen and two patients (0.9%) died. None of the patients who practiced Pranayama regularly required supplemental oxygen. Compared to asymptomatic patients, symptomatic patients had greater proportion of females (31.1% vs. 12.6%, p = 0.001), imported cases (85.2% vs. 69.8%, p = 0.02), illiterates (26.8% vs. 12.1%, p = 0.01), alcohol users (43.3% vs. 24.5%, p = 0.01), and had higher platelet count (253×109/L vs. 185×109/L, p = 0.02). Conclusions: Most cases were imported, asymptomatic young males, with very few deaths. Pranayama practice was associated with protection against severe COVID-19, but more data is needed to substantiate this. The association of platelets count with symptom status in the Nepalese population needs further exploration.

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  1. Version published to 10.3855/jidc.13881
  2. ScreenIT

    SciScore for 10.1101/2020.10.03.20206128: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementConsent: We took oral informed consent from the patients.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Statistical analyses were performed using IBM SPSS Statistics, version 25.0 (IBM Corp., Armonk, NY, USA).
    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:
    These observations in our study related to the platelet count need to be interpreted with caution because of caveat that only 65 patients out of 220 had their data on platelet count available, and these data are only from the time of presentation to the hospital. Further studies with more emphasis on laboratory parameters are needed to validate these findings from Nepal. Among the symptomatic patients, regular practice of Pranayama was significantly associated with patients not needing supplemental oxygen. While we did not find any original study exploring Pranayama practice in relation to COVID-19 severity, Pranayama has been found to be beneficial in patients with respiratory illness [36]. Our finding needs to be interpreted with a caution that we did not take into account the potential confounding factors such as age, comorbidities etc. Further appropriately designed studies with more emphasis on this practice are needed. We observed that, compared to asymptomatic patients, symptomatic patients included a greater proportion of patients who had recently come from abroad (31.9% vs. 15.78 %, p=0.024). One study from China, reported mixed findings where some of the symptoms were more common in imported cases compared to local cases whereas some other symptoms were less common [37]. We did not find any study from other South Asian countries looking at this point. We observed that being illiterate (no formal schooling at all), use of alcohol, subjective feelings of being stigmat...

    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

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  3. Version published to 10.1101/2020.10.03.20206128v1 on medRxiv