European Journal of Cardiovascular Medicine

The COVID-19 pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has posed an unprecedented global health crisis since its emergence in Wuhan, China, in December 2019.¹ The rapid and widespread transmission of the virus has led to significant morbidity and mortality, overwhelming healthcare systems worldwide. In India, the first case of COVID-19 was reported on January 30, 2020. Since then, the country has witnessed multiple waves of infection with varying degrees of severity across different regions.²

Tezpur, a town in the northeastern state of Assam, is served by the Tezpur Medical College & Hospital (TMCH), a tertiary care center providing critical healthcare services to a large population. Understanding the clinical-epidemiological characteristics of COVID-19 patients in this region is crucial for tailoring public health interventions and optimizing patient management strategies. This study analyzes the demographic profile, clinical features, co-morbidities, treatment modalities, and outcomes of COVID-19 patients admitted to TMCH, thereby contributing to the broader epidemiological knowledge base necessary for effective pandemic response.

The epidemiology of COVID-19 has shown considerable variability influenced by factors such as geography, population density, and healthcare infrastructure. In India, states have experienced disparate COVID-19 burdens, with varying case fatality rates and recovery rates reflecting the heterogeneity in healthcare delivery and socio-economic conditions. ³ Assam, being part of the less densely populated northeastern region, faced unique challenges regarding healthcare accessibility and infrastructure, which potentially impacted the management and outcomes of COVID-19 cases.⁴

Clinico-epidemiological studies are essential in understanding the natural history of COVID-19, identifying high-risk groups, and evaluating the effectiveness of clinical interventions. These studies help delineate the spectrum of clinical manifestations ranging from asymptomatic infections to severe respiratory illness requiring intensive care.⁵ Co-morbidities such as hypertension, diabetes, and cardiovascular diseases have been identified as significant risk factors for adverse outcomes in COVID-19 patients. Furthermore, understanding the demographic distribution, including age, sex, and socio-economic status, provides insights into the vulnerability and resilience of different population subgroups.⁶

The clinical management of COVID-19 has evolved rapidly, with numerous therapeutic interventions being investigated and implemented. Early in the pandemic, treatment strategies were primarily supportive, focusing on oxygen therapy, mechanical ventilation, and management of complications such as acute respiratory distress syndrome (ARDS) and secondary infections.⁷ With the advent of evidence-based therapies such as remdesivir, dexamethasone, and monoclonal antibodies, there has been a paradigm shift in the treatment protocols, aiming to reduce viral replication and modulate the host inflammatory response. However, the accessibility and applicability of these therapies in resource-limited settings like Tezpur present significant challenges that warrant detailed investigation.⁸

In addition to clinical management, public health measures such as testing, contact tracing, isolation, and vaccination have been pivotal in controlling the spread of SARS-CoV-2. The role of healthcare institutions in implementing these measures, alongside clinical care, underscores the importance of an integrated approach to pandemic management.⁹ TMCH has been at the forefront of the COVID-19 response in Tezpur, providing clinical care and contributing to community-based interventions aimed at mitigating the transmission of the virus.

This study aims to comprehensively analyze the clinical-epidemiological characteristics of COVID-19 patients admitted to TMCH, highlighting the interplay between clinical features, co-morbidities, treatment outcomes, and public health interventions. By elucidating these aspects, the study seeks to inform evidence-based practices and policy-making for better preparedness and response to ongoing and future pandemics. The findings from this study will contribute to the growing body of literature on COVID-19 and provide valuable insights into the regional dynamics of the disease, which can be leveraged for enhancing healthcare delivery in similar settings.¹⁰

OBJECTIVES

General Objective

• To analyze the clinical-epidemiological characteristics of COVID-19 patients at Tezpur Medical College & Hospital (TMCH) during 2020.

Specific Objectives

• To describe the demographic profile of COVID-19 patients.
• To identify common clinical symptoms.
• To assess the impact of co-morbidities on outcomes.
• To evaluate the treatment modalities used.
• To analyze mortality rates and their correlations

This retrospective cohort study analyzed COVID-19 patient data from Tezpur Medical College & Hospital (TMCH) between January 2020 and December 2020. Medical records of 1710 admitted patients were reviewed to extract demographic details, clinical symptoms, co-morbidities, treatment modalities, and outcomes. Data were collected from electronic health records and hospital databases. Descriptive statistics were used to summarize the findings, including frequencies, percentages, and mean values. Mortality rates and correlations between co-morbidities and outcomes were assessed to determine the impact of various factors on patient health and survival.

Inclusion Criteria:

• Confirmed COVID-19 diagnosis.
• Admitted to TMCH between January 2020 and December 2020.
• Complete medical records available.
• All age groups included.

Exclusion Criteria

• Non-COVID-19 admissions.
• Incomplete clinical records.
• Patients admitted to other hospitals.
• Duplicate or overlapping records.

Data Collection

Data were collected from medical records of 1710 COVID-19 patients admitted to Tezpur Medical College & Hospital from January 2020 to December 2020. Information extracted included demographic details (age, sex, socio-economic status), clinical symptoms, co-morbidities, treatment modalities, and outcomes (recovery, mortality). Data were retrieved from electronic health records and hospital databases to ensure accuracy and completeness.

Data Analysis

Data were analyzed using SPSS Version 26. Descriptive statistics were used to summarize the demographic characteristics, clinical symptoms, co-morbidities, treatment modalities, and outcomes of patients. Frequencies and percentages were calculated for categorical variables, while means and standard deviations were determined for continuous variables. Correlation analyses examined relationships between co-morbidities and mortality rates. Comparative analyses assessed differences in outcomes based on age and sex. Statistical significance was set at a p-value of <0.05. The findings were interpreted to identify key trends and patterns relevant to patient management and outcomes.

Ethical Considerations

The study adhered to ethical guidelines for research involving human subjects. Approval was obtained from the institutional review board of Tezpur Medical College & Hospital. Patient confidentiality was maintained by anonymizing all data, and ensuring that personal identifiers were removed. Informed consent was not required due to the retrospective nature of the study. All data handling and analysis followed ethical standards to protect patient privacy and ensure the integrity of the research.

Table 1: Demographic Characteristics of COVID-19 Patients (n=1710)

The demographic data reveal a higher prevalence of COVID-19 in males (55.6%) and the 18-44 age group (49.7%), indicating a significant impact on younger adults. The mortality rate in older people (>65 years) is notable, underscoring the need for targeted interventions for vulnerable populations.

The data highlights fever (85.4%) and cough (77.8%) as the most prevalent symptoms among COVID-19 patients, with significant association (p < 0.01). Shortness of breath (71.5%) and fatigue (57.3%) are also common, emphasizing the respiratory and systemic impact of the virus. Sore throat, while less frequent (46.8%), still presents notably, suggesting a broad spectrum of clinical manifestations.

Table 2: Co-morbidities

The prevalence of co-morbidities among COVID-19 patients reveals hypertension (35.2%) and diabetes (30.4%) as significant risk factors, significantly impacting outcomes (p < 0.01). Cardiovascular diseases (15.8%) and chronic respiratory conditions (8.8%) also contribute to increased vulnerability. The relatively low percentage of patients without co-morbidities (9.8%) highlights the importance of managing these underlying conditions to improve patient outcomes.

Supportive care was the predominant treatment modality (90.1%), reflecting its broad use in managing COVID-19. Oxygen therapy (58.7%) was also extensively utilized, critical for patients with respiratory distress. Antiviral medications (22.3%) and mechanical ventilation (8.8%) were less common but crucial for severe cases. The low percentage of patients receiving no treatment (2.9%) underscores the comprehensive care approach adopted.

Table 3: Mortality Rate

The overall mortality rate of 6.8% highlights a significant burden of severe outcomes among COVID-19 patients. Deaths were notably higher in patients with co-morbidities (18.4%) compared to those without (2.7%, p < 0.01), indicating a critical link between underlying health conditions and increased mortality. The mean age of deceased patients (68 years) further emphasizes the heightened risk for older adults, reinforcing the need for targeted care strategies for elderly patients and those with pre-existing conditions.

The mortality data across age groups reveal a marked increase with age, with no deaths in the 0-17 years group and a rising trend in older age groups: 1.4% in 18-44 years, 9.0% in 45-64 years, and 28.6% in 65+ years (p < 0.01). This highlights the age-related vulnerability to severe outcomes. Gender differences in mortality were also noted, with males experiencing a slightly higher mortality rate (7.4%) compared to females (6.2%, p < 0.01). These findings underscore the importance of age and gender-specific strategies in managing and mitigating the impact of COVID-19.

The treatment outcomes show that supportive care had the highest recovery rate (82.0%) and a relatively low mortality rate (8.1%, p < 0.01), indicating its effectiveness in managing moderate cases. Oxygen therapy also showed favorable recovery (75.0%) but a higher mortality rate (15.0%, p < 0.01), reflecting its critical role in severe respiratory distress. Antiviral medications, while beneficial, had a lower recovery rate (68.0%) and higher mortality (18.0%, p < 0.01), suggesting their effectiveness might be limited to specific patient subgroups or stages of illness. Mechanical ventilation, though essential for the most critical cases, had the lowest recovery rate (50.0%) and the highest mortality (30.0%, p < 0.01), highlighting its use for patients with severe complications and poor prognosis. These results emphasize optimizing treatment protocols based on disease severity and patient condition.

The analysis of symptom prevalence and mortality indicates that shortness of breath was associated with the highest mortality rate (8.0%, p < 0.01), underscoring its severity as a critical symptom of COVID-19. Fever and cough also showed significant mortality rates (6.5% and 7.2%, respectively, p < 0.01), reflecting their common association with severe outcomes. Fatigue and sore throat, while present, had lower mortality rates (5.9% and 4.5%, respectively, p < 0.01), suggesting they are less predictive of severe disease progression. This data highlights the need for close monitoring and prompt intervention for patients exhibiting severe respiratory symptoms

The data on post-COVID complications reveals a range of persistent health issues affecting patients after recovery. Pulmonary complications, such as persistent cough (14.6%) and interstitial lung disease (10.5%), are prevalent, highlighting ongoing respiratory challenges. Cardiovascular issues, including myocarditis (5.8%) and postural orthostatic tachycardia syndrome (POTS, 3.5%), also remain significant, emphasizing the need for cardiovascular follow-up. Neurological complications like cognitive dysfunction (7.6%) and persistent headaches (6.4%) are common, indicating the potential for long-term neurological effects. Musculoskeletal issues, including muscle weakness (9.4%) and joint pain (8.2%), further reflect the multi-system impact of COVID-19. Additionally, psychiatric disorders such as anxiety (11.7%) and depression (10.5%) underscore the mental health burden of the disease. These findings underscore the need for comprehensive post-COVID care strategies addressing physical and mental health.

Table 4: Outcomes of COVID-19 Patients

The outcomes for COVID-19 patients show a high recovery rate of 93.1%, with 117 deaths (6.8%). Mortality was significantly higher among patients with co-morbidities (18.4%, p < 0.01) compared to those without (2.7%, p < 0.01), highlighting the critical role of underlying health conditions in adverse outcomes. The average age of recovered patients was 52 years, whereas the deceased had a higher average age of 68 years, indicating that older age is a major risk factor for mortality. Treatment modalities were varied, with supportive care being the most prevalent (90.1%), followed by oxygen therapy (58.7%) and antiviral medications (22.3%). Mechanical ventilation was used in 8.8% of cases, typically for the most severe patients. The average hospital stay was 12 days, reflecting the extended care required for severe cases. These results underscore the importance of tailored treatment approaches and continued focus on managing co-morbidities to improve patient outcomes.

This study aimed to elucidate the clinical-epidemiological characteristics of COVID-19 patients admitted to Tezpur Medical College & Hospital (TMCH) from January 2020 to December 2020, focusing on demographic profiles, clinical symptoms, co-morbidities, treatment modalities, and outcomes. Our findings offer valuable insights into the regional impact of COVID-19, shedding light on patient characteristics, treatment effectiveness, and post-COVID complications.

Our study revealed that most admitted patients were aged 18-44 years (49.7%) with a slightly higher proportion of males (55.6%). This demographic is consistent with global trends, where younger individuals often show higher case rates, although severity may vary.⁵ The high prevalence of symptoms such as fever (85.4%) and cough (77.8%) aligns with the common clinical presentation reported in other studies.⁶ The overall mortality rate of 6.8% reflects a moderate outcome compared to global data, which reports varying fatality rates depending on the region and healthcare infrastructure.¹¹

Our study also highlights significant post-COVID complications, including persistent cough (14.6%), interstitial lung disease (10.5%), and cardiovascular issues like myocarditis (5.8%). These findings align with recent studies showing that a substantial proportion of COVID-19 survivors experience long-term health effects.¹² The prevalence of these complications underscores the importance of ongoing monitoring and rehabilitation for COVID-19 survivors, particularly in resource-limited settings like Tezpur.

Comparison with Existing Literature

Several key points emerge when comparing our results to studies from other regions. For instance, a study conducted in India. A similar reported age distribution but noted a higher mortality rate among older adults. This discrepancy could be attributed to variations in healthcare quality, access to treatment, and regional healthcare infrastructure. In contrast, studies from high-income countries like the United States and Europe often report higher mortality rates overall due to more extensive reporting and differing healthcare systems.¹³

Our findings regarding co-morbidities are consistent with the literature, which identifies hypertension (35.2%) and diabetes (30.4%) as significant risk factors for severe outcomes.¹⁴ The high prevalence of these conditions in our cohort underscores the need for targeted management strategies for patients with underlying health issues. The mortality rate among patients with co-morbidities was notably higher (18.4%) compared to those without (2.7%), corroborating findings from other studies that emphasize the role of pre-existing health conditions in exacerbating COVID-19 severity.⁸

Implications of Research Findings

The data indicate that while TMCH provided effective supportive care, there is a need for improved management strategies, particularly for patients with severe symptoms and co-morbidities. Although less common, the use of antiviral medications and mechanical ventilation highlights the evolution of treatment practices and their impact on patient outcomes. For example, the lower percentage of patients receiving antiviral treatments in our study compared to other regions may reflect differences in treatment availability and guidelines.^15-18

The results have practical implications for healthcare policy and practice. The high prevalence of co-morbidities among deceased patients indicates the necessity of preemptive healthcare measures and the integration of chronic disease management into COVID-19 care protocols. Identifying common post-COVID complications also provides a basis for developing targeted follow-up care strategies. Comprehensive post-discharge care plans could help mitigate long-term health impacts and improve patient outcomes.

The study’s findings reflect regional and global patterns in COVID-19 epidemiology, treatment, and outcomes. While similarities exist with international studies, differences in mortality rates and treatment approaches highlight the impact of local healthcare infrastructure and resources. Our results contribute to the broader understanding of COVID-19’s effects, emphasizing the need for ongoing research and adaptation of healthcare practices to address the disease's acute and long-term consequences.

This study highlights key aspects of COVID-19 outcomes at Tezpur Medical College & Hospital, revealing a moderate mortality rate and significant post-COVID complications. The findings underscore the need for targeted interventions, especially for co-morbid patients, and highlight the importance of comprehensive post-discharge care. These results align with global patterns but also underscore regional healthcare challenges, emphasizing the need for continued adaptation and improvement in pandemic response strategies.

Recommendations

• Focus on better-managing hypertension and diabetes in COVID-19 patients.
• Implement robust follow-up and rehabilitation services for survivors.
• Improve the availability of antiviral and advanced treatments.

Acknowledgment

We acknowledge the dedicated staff of Tezpur Medical College & Hospital for their tireless efforts during the pandemic. Special thanks to our research team and patients for their invaluable contributions. Your commitment has been crucial to this work.

Article at a Glance

Study Purpose: To analyze the clinical and epidemiological aspects of COVID-19 patients at Tezpur Medical College & Hospital in 2020.

Key Findings: Out of 1710 patients, 117 died (6.84% mortality rate). Common symptoms included fever and cough, with comorbidities like diabetes linked to higher mortality.

Newer Findings Added: The study details regional patient profiles and highlights the influence of comorbid conditions on COVID-19 outcomes.

Abbreviations

COVID-19: Coronavirus Disease 2019

TMCH: Tezpur Medical College & Hospital

SARS-CoV-2: Severe Acute Respiratory Syndrome Coronavirus 2

ARDS: Acute Respiratory Distress Syndrome

Funding: No funding sources

Conflict of interest: None declared

1. Jebril N. World Health Organization declared a pandemic public health menace: a systematic review of the coronavirus disease 2019 “COVID-19”. Available at SSRN 3566298. 2020 Apr 1.
2. Sharma CK, Banerjee R, editors. Coronasphere: Narratives on COVID 19 from India and its Neighbours. Taylor & Francis; 2022 Dec 23.
3. Ghosh A, Nundy S, Mallick TK. How India is dealing with COVID-19 pandemic. Sensors International. 2020 Jan 1;1:100021.
4. Gupta N, Praharaj I, Bhatnagar T, Thangaraj JW, Giri S, Chauhan H, Kulkarni S, Murhekar M, Singh S, Gangakhedkar RR, Bhargava B. Severe acute respiratory illness surveillance for coronavirus disease 2019, India, 2020. Indian Journal of Medical Research. 2020 Feb 1;151(2-3):236-40.
5. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, Liu L, Shan H, Lei CL, Hui DS, Du B. Clinical characteristics of coronavirus disease 2019 in China. New England journal of medicine. 2020 Apr 30;382(18):1708-20.
6. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, Qiu Y, Wang J, Liu Y, Wei Y, Yu T. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. The lancet. 2020 Feb 15;395(10223):507-13.
7. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. jama. 2020 Apr 7;323(13):1239-42.
8. Agarwal A, Hunt BJ, Stegemann M, Rochwerg B, Lamontagne F, Siemieniuk RA, Agoritsas T, Askie L, Lytvyn L, Leo YS, Macdonald H. A living WHO guideline on drugs for covid-19. bmj. 2020 Sep 4;370.
9. Kucharski AJ, Russell TW, Diamond C, Liu Y, Edmunds J, Funk S, Eggo RM, Sun F, Jit M, Munday JD, Davies N. Early dynamics of transmission and control of COVID-19: a mathematical modelling study. The lancet infectious diseases. 2020 May 1;20(5):553-8.
10. Kumar SU, Kumar DT, Christopher BP, Doss CG. The rise and impact of COVID-19 in India. Frontiers in medicine. 2020 May 22;7:250.
11. Wu Z, Wang Q, Zhao J, Yang P, McGoogan JM, Feng Z, Huang C. Time course of a second outbreak of COVID-19 in Beijing, China, June-July 2020. Jama. 2020 Oct 13;324(14):1458-9.
12. Kumar S, Maheshwari V, Prabhu J, Prasanna M, Jayalakshmi P, Suganya P, Malar BA, Jothikumar R. Social economic impact of COVID-19 outbreak in India. International journal of pervasive computing and communications. 2020 Jul 17;16(4):309-19.
13. Debata B, Patnaik P, Mishra A. COVID‐19 pandemic! It's impact on people, economy, and environment. Journal of public affairs. 2020 Nov;20(4):e2372.
14. Yin T, Li Y, Ying Y, Luo Z. Prevalence of comorbidity in Chinese patients with COVID-19: systematic review and meta-analysis of risk factors. BMC infectious diseases. 2021 Dec;21:1-3.
15. Beigel JH, Tomashek KM, Dodd LE, Mehta AK, Zingman BS, Kalil AC, Hohmann E, Chu HY, Luetkemeyer A, Kline S, Lopez de Castilla D. Remdesivir for the treatment of Covid-19. New England Journal of Medicine. 2020 Nov 5;383(19):1813-26.
16. Rawat A, Hivre M, Sharma A, Zaidi SA, Abedin MZ, Hasan MH. Smoking And Coronary Heart Disease Impact. Journal of Pharmaceutical Negative Results. 2023 Jan 1:1737-42.
17. Saravanakumar R, Maniraj SP, Barshan AD, Das S, Hasan H, Alazzam MB. Clustering big data for novel health care system. InAIP Conference Proceedings 2023 Nov 21 (Vol. 2587, No. 1). AIP Publishing.
18. Kumar VM, Pandi-Perumal SR, Trakht I, Thyagarajan SP. Strategy for COVID-19 vaccination in India: the country with the second highest population and number of cases. npj Vaccines. 2021 Apr 21;6(1):60.