key: cord-303442-5fjb6iz8
authors: Morshed, M. S.; Mosabbir, A. A.; Chowdhury, P.; Ashadullah, S. M.; Hossain, M. S.
title: Clinical manifestations of patients with Coronavirus Disease 2019 (COVID- 19) attending at hospitals in Bangladesh
date: 2020-08-01
journal: nan
DOI: 10.1101/2020.07.30.20165100
sha: 
doc_id: 303442
cord_uid: 5fjb6iz8

Bangladesh is in the rising phase of the ongoing coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). However, the scientific literature on clinical manifestations of COVID-19 patients from Bangladesh is virtually absent. This is the first study aimed to report the sociodemographic and clinical characteristics of patients with COVID-19 in Bangladesh. We conducted a cross-sectional study at three dedicated COVID-19 hospitals. A total of 103 RT-PCR confirmed non-critical COVID-19 patients were enrolled. Sociodemographic factors, underlying disease conditions, clinical symptoms and vital signs including oxygen saturation were documented and analyzed. The median age of the patients was 37 years (IQR: 31-53); most of the patients (71.8%) were male. Mild, moderate and severe illness were present in 74.76%, 9.71% and 15.53% of patients respectively. More than half (52.4%) patients had a co-morbidity, with hypertension being the most common (34%), followed by diabetes (21.4%) and Ischemic heart disease (9.7%). Fever (78.6%), weakness (68%) and cough (44.7%) were the most common clinical manifestations. Other common symptoms included loss of appetite (37.9%), difficulty breathing (37.9%), altered sensation of taste or smell (35.0%), headache (32%) and bodyache (32%). The median time from onset of symptom to attending hospitals was 7 days (IQR 4-10). This study will help both the clinicians and epidemiologists to understand the magnitude and clinical spectrum of COVID-19 patients in Bangladesh.

The world has been experiencing one of the most serious public health crises in the history of humankind. The ongoing pandemic of coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). As of 28 July 2020, over 16 million individuals have been infected with over 650,000 deaths worldwide [1] . SARS-COV-2 infection predominantly results in an acute respiratory illness. In addition, it can cause a myriad of extrapulmonary symptoms. The clinical spectrum ranges from asymptomatic or mildly symptomatic flu-like illness to potentially life-threatening critical conditions [2] . Recent studies suggest that the clinical spectrum of COVID-19 can vary among different ethnicities and geographical locations across the world [3] .

Owing to a population of over 160 million, inadequate healthcare system, and poor personal hygiene among the general population, Bangladesh is considered one of the high-risk countries for coronavirus spread. The first official case of COVID-19 was reported on 8 March 2020, and the epidemic still appears to be in a growing phase. As of 30 July 2020, a total of 234,889 cases and 3083 deaths have been reported in Bangladesh [1] . However, the information on clinical manifestations from Bangladesh is scarce in the literature. Therefore, this study aimed to document the clinical spectrum of COVID-19 patients attending fever clinics in Bangladesh.

This was a cross-sectional study conducted among RT-PCR confirmed COVID-19 patients attending the fever clinic of a dedicated COVID-19 Hospital (Kurmitola general hospital) in Dhaka city of Bangladesh and two Upazila health complexes from different districts (Jessore and Jhenaidah) from 5 July to 18 July 2020. Diagnosis of SARS-COV-2 infection and assessment of severity were done based on the WHO interim guidance [4] . Data were collected only from non-critical COVID-19 patients as critical patients required immediate intensive care admission making them unable to respond to the questions. Socio-demographic and clinical data were evaluated and collected by experienced clinicians using a pretested case record form. We used Pearson's chi square test, Fisher's exact test and Kruskal Wallis test to compare . CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)

The copyright holder for this preprint this version posted August 1, 2020. . https://doi.org/10.1101/2020.07.30.20165100 doi: medRxiv preprint differences between mild, moderate and severe patients where appropriate. Logistic regression was used to study associations. P <0.5 was set as statistically significant.

A total of 103 laboratory-confirmed COVID-19 patients were enrolled. About 75% (77) of cases presented with mild symptoms, followed by nearly 15% severe and 10% moderate cases.

Overall, the median age of the participants was 37 years (IQR: 31-53); more than 80% of these patients were under 60 years. ( Table 1 ). Most of the patients were male (71.8%). More than half of the patients (52.4%) had at least one co-morbidity, including hypertension in 35 (34%), diabetes in 22 (21.4%) and ischaemic heart disease in 10 (9.7%) patients. Notably, around 80% of moderate and severe cases had comorbidity. The median time from onset of symptom to attending fever clinic was 7 days (IQR 4-10).

Overall, the most common symptoms reported were fever (78.6%), weakness (68%) and cough (44.7%) followed by loss of appetite (37.9%), difficulty breathing (37.9%), altered sensation of taste or smell (35.0%), headache (32%) and body ache (32%). Less common symptoms included sore throat (28.2%), diarrhoea (22.3%) and chest pain (14.6%). Fever was the most prevalent symptom in all groups of patients. Interestingly, 80% of moderate patients experienced difficulty breathing compared to 62.5% severe patients. (Table 2 ). More than half of the severe cases had tachycardia (56.3%) and tachypnoea (56.3%) at presentation; their median oxygen saturation was 87.5% (IQR 77.25-89.0).

This study aimed to determine the clinical characteristics of RT-PCR confirmed patients with COVID-19 attending fever clinics of government hospitals in Bangladesh. To the best of our knowledge, this is the first hospital-based report presenting clinical features of COVID-19 patients from Bangladesh.

. CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted August 1, 2020. . Other symptoms: Vomiting 8 (7.8%), abdominal pain 6 (5.8%), dizziness 5 (4.9%), red eye 4 (3.9%)

. CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted August 1, 2020. . https://doi.org/10.1101/2020.07.30.20165100 doi: medRxiv preprint

The most prevalent symptoms of non-critical COVID-19 patients in Bangladesh consist of fever (78.6%), fatigue (68%), and cough (44.7%). Similarly, in a meta-analysis from China, most prevalent symptoms were fever (80.4%), cough (63.1%) and fatigue (46%) (ref) .5 However, studies from China included both critical and non-critical patients. In contrast, one study from Europe on mild to moderate patients reported that headache (70.3%), loss of smell (70.2%), nasal obstruction (67.8%) were the most common symptoms; fever was reported by only 45.4% of patients. Interestingly, 39% of mild cases, 40% of moderate cases and 12.5% of severe cases reported altered sensation of taste or smell in this study. While olfactory and gustatory dysfunctions were prevalent symptoms in European patients, they were only rarely reported in Chinese patients [6, 7] .

In this study, about 15% cases were presented with severe symptoms. This is consistent with a summary report of 72,314 cases from China [8]. As expected, most of the severe patients (81.3%) had co-morbidity. Age >60 years, patients with Diabetes mellitus, Ischemic heart disease and chronic kidney disease had significantly higher odds of developing the severe disease at presentation (Supplementary Table 1 ).

Our study has some limitations. First, the sample size of this study was small. Second, we could not include critical patients due to the requirement of emergency management. Therefore, our findings could not be generalized in the context of Bangladesh.

Our study reports the presenting symptoms of SARS-COV-2 infections among the Bangladeshi population. Although there are certain similarities in the range of symptoms with the Chinese population, where the pandemic originated, there are some unique findings like the high prevalence of olfactory and gustatory dysfunctions. This study will help both the clinicians and epidemiologists understand the magnitude and clinical spectrum of COVID-19 patients in Bangladesh.

None of the authors have any conflict of interest to declare

We are grateful to Brigadier General Jamil Ahmad, director, Kurmitola General Hospital (KGH); Dr. Tania Easmin, medical officer, KGH; Dr. Md. Rashed Al Mamun, upazilla health . CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted August 1, 2020. . CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)

The copyright holder for this preprint this version posted August 1, 2020. . https://doi.org/10.1101/2020.07.30.20165100 doi: medRxiv preprint

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The epidemiology, diagnosis and treatment of COVID-19

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Clinical characteristics of 3062 COVID-19 patients: A meta-analysis

Clinical and epidemiological characteristics of 1420 European patients with mild-to-moderate coronavirus disease 2019

and family planning officer (UHFPO), Shailkupa, Jhenaidah and Dr. Md. Alamgir, UHFPO, Keshabpur, Jessore for their generous support in data collection.