Risk factors and symptoms stratification and mortality of COVID-19 in population of Nowshera (Pakistan)

Background & Objectives: COVID-19 has spread around the globe, and our country is no exception. We have been actively observing and managing these patients and have recorded the salient features including risk factors, the presenting complaints and also the trends of mortality. We aimed to have risk factors stratification, prevalent symptoms at the time of presentation to the hospital and to determine factors contributing to mortality due to COVID-19 in population of Nowshera (Pakistan). Methodology: In this cross sectional study, 75 cases with returned PCR results were included from 15th February 2020 to 18th April 2020. Data were entered in a format in SPSS version 25, prepared in accordance with the objectives of the study. Results: Out of a total of 75 patients, 20 (26.67%) were females and 55 (73.33%) were males. The mean age was 36 +/- 18 y. Out of these, 29 (38.67%) patients were COVID-19 positive by PCR technique, and 46 (61.33%) were negative. The probability of virus detection was higher in male gender (OR = 1.5, Relative Risk (RR) = 1.2). A significant relation of viral infectivity was noted with history of travel to an epidemic area (p = 0.01 OR = 3.85, RR = 1.5) and history of contacts with COVID-19 infected person/s (p = 0.018, OR = 3. 5, RR = 2.3). A high mortality rate of 3/29 (10.34%) for positive COVID-19 cases was recorded. The probability of worse outcome in term of death in COVID-19 positive patients was (p = 0.5, OR = 2.1). Regarding symptoms selection; contact and travel history without any symptoms has a reliability index (RI) of 12/35 (34%) for infectivity. Cough, fever with shortness of breath (RI; 8/12(67%) for positive cases followed by fever and cough with RI of 6/10 (60%) cases etc. Sore throat (RI; 1/13(8%) and flue only (RI;0/3(0%) proved non-reliable symptoms. When plotted the survival graphs of COVID positive vs. COVID negative cases, a similar pattern was recorded that showed the mortality rate in the positive cases was not solely due to COVID-19, though being opportunistic infection, it would have contributed. We recorded refractory COVID-19 in 4/29 (13.79%) cases. Conclusion: We conclude that male gender with history of travel to an epidemic area and contact with COVID-19 patients are strong predisposing factors. Cough, fever with shortness of breath are reliable symptoms for COVID-19 in our suspects. COVID-19 being an opportunistic infection contributes to a higher mortality in respiratory and cardiac patients.