COURSE OF HOSPITALIZATION & OUTCOME OF COVID-19 ADMISSIONS DURING SECOND WAVE OF PANDEMIC IN A TERTIARY CARE INSTITUTE, BIHAR, INDIA

Introduction: With emergence of new strains of SARS-COV-2 and increased transmission of the virus, it is necessary to study the socio-demography, epidemiology, clinical course, outcome of Covid-19 patients to add to the existing pool of literature and understand the lacunae behind its epidemiology. Methods: A record based observational study done among 100 COVID-19 admissions of second wave using a pre designed Performa containing details regarding covid-19 admissions and results tabulated and necessary statistical tests applied and significance attributed to P<0.05. Results: Among 100 admissions, Median age was 56.5 (IQR:40-65) years,12% having history of contact with COVID-19 cases, coughbeing the common symptom(84%) and 61% having one or more comorbidity with median 10 days of hospital stay, 59% requiring oxygen treatment,14% required ICU care and 7(7%) reaching primary outcome(expired). Conclusion: Cough is the most common presenting symptom with more admissions in middle aged-elderly.One requiring ICU, Artificial ventilation, Intubation and Oxygen supplement had more mortality than others.


Bio-Statistical Analysis
The information collected was entered in MS Excel and analysis was done using IBM SPSS version22. Descriptive analyses was conducted todescribe the demographic characteristics. The quantitative variables was expressed as mean (SD)/median (IQR) depending on normality and The categorical variables was expressed as proportion and percentages. Pearson's Chi-Square test/Fischer's exact was used to testthe association between categorical variables like requirement of oxygen supplement, ICU, artificial ventilation, Intubation and Independent T test/Mann Whitney U test was used for assessing difference in SPO2 levels, duration of stay, oxygen supplement among dead and alive groups.Values of P< 0.05 was considered statistically significant(two-sided tests)

Discussion:-
Second wave of COVID-19 pandemic hit the country severely with more death rates, depletion of resources, havoc and panic in the air. [15] Our study tried to explore the sociodemographic, clinic-epidemiological, outcomes of COVID-19 admissions during second wave of COVID-19 pandemic among the first 100 admissions of second wave in a tertiary care hospital in Patna, Bihar.
The median age in our study was 56.5 with an Inter quartile range of 40-65 years. Asimilar finding was found in a study in Delhi [13] with median age of 54.5 years. Another study in Delhi [16] showed mean age of 40.3 years much lesser than what we got. Our study had increasing trend of admissions in >60 age group(40%) followed by 45-60 years .This finding of higher rate of admission in middle and elderly age groups is in line with other studies. [17] while Gupta et al [16] had increasing admissions in 41-60 years age group. This may be due to presence of one or more comorbidities in these age group, increasing the risk of complications.
Three fourth of the admissions were males in our study while a study in Wuhan [9] showed almost two fifth were males and Prakash et al [17] showed almost 88% were males in their study. Males by virtue of working outdoors are at higher risk of exposure.
Our study showed that more than one fifth had history of contact with covid-19 positive case without any protection and also had history of travel to hotspots which is in line with a study done in Lucknow. [17] In our study, all 100 were symptomatic with one or more symptoms while a study in Jaipur, Rajasthan revealed that almost one third were asymptomatic. [18] Cough was the most common presenting symptom which was in line with other studies [9,16,18] while Gupta et al [19] showed fever has main presenting symptom.
In our study almost two thirdof patients had one or more comorbidity which was more compared to a study done in Delhi among 200 patientswhere nearly half had comorbidities. [19] The mean SPO2 on admission was 91.1% on room air. A study in Delhi [19] showed mean SPO2 of 95%, which falls under no respiratorydistress.Our institute being a tertiary referral center, received mostly severe distress and complicated cases.
The median duration of stay in our study was 10 days(IQR:8-14 days) which is less compared to a study by Guan et al who had median 12 days of stay. [9] Coming to treatment and outcome, more than half (59%) required oxygen support and 14% required ICU support in our study while a study in Wuhan [9] showed that 41.3% required oxygen therapy and 16.2% required ICU management. Nearly one tenth(7%) reached the primary outcome and expired in our study which was in line with another hospital study in Delhi [20] and more compared to a study in Wuhan. [9] In our study,compared to those alive, dead had a longer duration of stay which is in line with a study by Guan et al. [9] Though COVID-19 affected most human race, the clinic-epidemiological features are different in different waves.

Conclusion:-
Our study had more admissions in middle-age and elderly, with male predominance and significant proportion of history of exposure to COVID-19 cases and history of travel.More mortality was seen in those who required ICU, Oxygen supplement, Artificial ventilation and Intubation. This observational study puts more insight towards the socio-demography of COVID-19 patients in east India and their clinical presentation and outcomes. The varying