An Observational Study on the Management of COVID-19 Patients in Limited-Resource Hospitals

Abstract

Background: The purpose of this study was to evaluate the effectiveness of limited-resource hospitals in managing mild and moderate hospitalized cases of COVID-19 with comorbidities and in preventing their progression to severe illness. Methods: Data were obtained from 88 moderate COVID-19 patients with comorbidities who were admitted to limited-resource hospitals. The data were classified into several parts: comorbidities, chronic medication before hospital admission, symptoms of COVID-19 before and during hospitalization, clinical features, laboratory findings on hospital admission, complications during hospitalization, as well as worst laboratory values during hospitalization, hospital stay, and outcomes. The clinical features, laboratory results, type of oxygen therapy used, and the final treatment outcome were all evaluated to assess for any potential relationship. Results: All patients were alive upon discharge. Before admission, the majority of patients (60.2%) received COVID-19 treatment, and the average hospital stay was 12 days. The most common symptoms were fever (88.7%), cough (95.5%), shortness of breath (90.9%), myalgia (84.1%), confusion (63.6%), headache (62.5%), sore throat (88.7%), rhinorrhea (17%), chest pain (58%), diarrhea (19.3%), nausea and vomiting (38.6%), anosmia (62.5%), as well as dysgeusia (64.8%). Based on chest radiograph or computed tomography (CT) scan, 9.1% of the patients had unilateral pneumonia, 90.9% had bilateral pneumonia, and 96.6% had multiple mottling and ground-glass opacity. Age was found associated with a significant increase in headache (p = 0.005), rhinorrhea (p = 0.013), chest pain (p = 0.007), and the need for positive airway pressure (p = 0.008). Between pre- and post-hospital admissions, there was a significant increase in lactate dehydrogenase and ferritin but a decrease in platelet, D-dimer, hemoglobin, lymphocytes, neutrophils, and total leucocyte count (p < 0.001). There was a significant association between hospital stay and D-dimer level (p = 0.05). Conclusion: Limited-resource hospitals in Egypt were efficient in managing mild and moderate hospitalized cases of COVID-19 with comorbidities. Many of these cases did not escalate to severe illness and were all alive upon discharge. Early management of COVID-19 tends to delay the disease progression to severe illness and improves patients’ chances of survival. Treating COVID-19 or using oxygen therapy at home can also delay the need for hospitalization in mild or moderate cases.