Peril Elements of Infection Severity, Disease Non-Improvement, Case Fatality and Management of Sars-Cov-2 in Sargodha Region Pakistan

Abstract

Background: Corona virus is +ve stranded RNA virus pervasive in most of the atmospheres and towards the end of year 2019 it originated a pandemic as emerging microorganism which started in Wuhan city of China causing mild respiratory illness to severe acute hypoxemic respiratory distress syndrome in humans causing lot of deaths. Thanks to Almighty ALLAH that its virulence has been decreased in recent past in Pakistan due to better government planning and preventive measures. Objective: To manage moderate to severe COVID- 19 patients with pneumonias in HDU/ attached wards with central oxygen supply and to observe peril elements of infection severity, non-improvement and case fatality. Study Design: Descriptive, cross sectional, multicenter and heterogenous study of fifty COVID positive patients. Settings: High Dependency Unit & Isolation (Pulmonology ward) District Head Quarter Hospital Sargodha & Niazi Teaching Hospital (OPD), Sargodha Pakistan. Duration: From 15 May 2020 to 30 June 2020. Methodology: Fifty COVID- 19 patients over eighteen years of age presented with moderate to severe illness were enrolled for management in this study. Patients having +ve RT- PCR test (nasopharyngeal swab) for COVID-19/ CT chest with pneumonias, pyrexia, cough, tachypnoea with or without confusion, coma, dehydration, fits, low oxygen saturation, feeding difficulties, myocardial or renal injuries, raised liver enzymes, dysfunctional coagulation, expeditious disease advancement with respiratory failure (ARDS) were included in this study for management. Results: Every patient was admitted for moderate to severe COVID 19 pneumonias, tachypnoea etc. Eleven patients needed high flow nasal oxygen (HFNO) humidified oxygen or noninvasive ventilation (NIV) and non-rebreather mask and two patients required invasive ventilation, 24 patients (48%) patients had diabetes mellitus with complications, 8 patients (16%) had chronic obstructive airway disease (COAD) or asthma on steroids and hypertension with complications was diagnosed in 6 (12%) patients as well. As a whole two critically ill (one old aged diabetic) patients died over one and a half month of study period. Conclusion: COVID-19 can be a fatal disease especially in patients with old age, chronic illnesses (diabetes, COAD, hypertension and chronic renal failure etc.), immunocompromised states, early detection with management is of great value. This study interprets that early usage of NIV (CPAP and HFNO) diminishes respiratory failure symptoms, worsening of disease and the need for invasive ventilation.