Home isolation, monitoring and follow-up as a management approach for mild to moderate COVID-19: a prospective observational study
DOI:
https://doi.org/10.18203/2320-6012.ijrms20220278Keywords:
COVID-19, SARS-CoV-2, Home-isolation, TreatmentAbstract
Background: The coronavirus disease 2019 (COVID-19) pandemic, caused by SARS-CoV-2 manifests as mild to moderate disease in about 80 per cent of the patients. Present study intends to know the clinical outcomes of treating this cohort, in home-isolation milieu.
Methods: The 171 of 210 suspected COVID-19 patients conforming to inclusion criteria were enrolled and evaluated. Patients were categorized for severity assessment for the purpose of treatment plan, monitoring and follow-up. Data pertaining to clinical profiles, age grouping along with CT chest severity scoring, laboratory data and treatment allocations and outcomes were statistically analyzed.
Results: Among 171 patients, mean age was 48.5 (±11.9) years and males were 108 (63%). The 93 (54%) and 69 (40%) patients had moderate and mild clinical severity, respectively. The 107 (63%) had mild CT severity score and 83 (48.5%) had one or more comorbidities. Neutrophil lymphocyte ratio (NLR), C-reactive protein (CRP) and D-dimer levels were significantly higher in clinically moderate and above 45 years age groups (p<0.05). Overall outcome showed one in mild and 12 in moderate group needed hospitalization and all recovered completely.
Conclusions: Home-isolation, treatment and monitoring of study cohort with mild to moderate COVID-19, helped in timely interventions and uneventful recovery of majority of the patients.
References
World Health Organization, COVID-19 weekly epidemiological update, Geneva. 2022. Available at: https://cdn.who.int/media/docs/default-source/wrindia/situation-report/india-situation-report-101.pdf?sfvrsn=b66ca6fa_4. Accessed on 5th January, 2022.
MOHFW Clinical Management Protocol: COVID-19. New Delhi Ministry of Health and Family welfare, Government of India. 2020. Available at: https://www.mohfw.gov.in/pdf/UpdatedClinicalManagementProtocolforCOVID19dated03072020.pdf. Accessed on 20 September 2020.
The Hindu Bureau. India adds 1.79 lakh COVID-19 cases on January 9, 2022. The Hindu. 2022. Available at: https://www.thehindu.com/news/national/india-adds-179-lakh-covid-19-cases-on-january-9-2022/article38207184.ece. Accessed on 9 January 2022.
Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA network open. 2020;3(3):e203976.
Khasne RW, Dhakulkar BS, Mahajan HC, Kulkarni AP. Burnout among healthcare workers during COVID-19 pandemic in India: Results of a questionnaire-based survey. Indian J Cri Care Med. 2020;24(8):664.
World Health Organization. Clinical management of COVID-19: interim guidance. Geneva. 2020. Availabe at: https://www.who.int/publications/i/item/clinical-management-of-covid-19. Accessed on 30 August 2020.
Atsawarungruangkit A, Yuan J, Kodama T, Cheng MT, Mansouri M, Han B et al. Evolving global and national criteria for identifying a suspected case of COVID-19. J Int Med Res. 2020;48(8):0300060520938943.
Zu ZY, Jiang MD, Xu PP, Chen W, Ni QQ, Lu GM et al. Coronavirus disease 2019 (COVID-19): a perspective from China. Radiology. 2020;200490.
MOHFW Clinical Management Protocol: COVID-19. New Delhi Ministry of Health and Family welfare, Government of India. 2020. Available at: http://clinicalestablishments.gov.in/WriteReadData/2801.pdf. Accessed on 10 August 2020.
Prokop M, Van Everdingen W, Van Rees Vellinga T, Quarles Van Ufford J, Stöger L, Beenen L et al. CO-RADS-A categorical CT assessment scheme for patients with suspected COVID-19: definition and evaluation. Radiology. 2020;201473.
Pan F, Ye T, Sun P, Gui S, Liang B, Li L et al. Time course of lung changes on chest CT during recovery from 2019 novel coronavirus (COVID-19) pneumonia. Radiology. 2020;295(3):715-21.
Archer SL, Sharp WW, Weir EK. Differentiating COVID-19 Pneumonia from Acute Respiratory Distress Syndrome (ARDS) and High-Altitude Pulmonary Edema (HAPE): Therapeutic Implications. Circulation. 2020;142(2):101-4.
World Health Organization. Home care for patients with suspected or confirmed COVID-19 and management of their contacts: interim guidance. 2020. Available at: https://apps.who.int/iris/handle/10665/333782. License: CC BY-NC-SA 3.0 IGO. Accessed on 10 August 2021.
Centers for Disease Control and Prevention. COVID 19. People with certain medical conditions. CDC. 2019. Available at: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html. Accessed on 10 August 2020.
George PM, Barratt SL, Condliffe R, Desai SR, Devaraj A, Forrest I et al. Respiratory follow-up of patients with COVID-19 pneumonia. Thorax. 2020;75(11):1009-16.
Udwadia ZF, Pokhariyal P, Tripathi AK, Kohli A. Fibrotic interstitial lung disease occurring as sequelae of COVID-19 pneumonia despite concomitant steroids. Lung India. 2020;38:S61-3.
Rubin GD, Ryerson CJ, Haramati LB, Sverzellati N, Kanne JP, Raoof S et al. The role of chest imaging in patient management during the COVID-19 pandemic: a multinational consensus statement from the Fleischner Society. Chest. 2020;158(1):106-16.
Mazzei MA, Guerrini S, Zanoni M, Franchi F, Valente S, Cusi MG et al. Novel coronavirus (COVID-19) pneumonia: Portable chest X-ray or computed tomography? An Italian perspective. Lung India. 2021;38(1):S72-3.
Reaz M. Clinical Trial of Ivermectin Plus Doxycycline for the Treatment of Confirmed COVID-19 Infection. NCT04523831. Available at: https://clinicaltrials.gov/ct2/show/NCT04523831. Accessed on 10 August 2020.
Schwartz E. Ivermectin vs. Placebo for the treatment of patients with Mild to Moderate COVID-19. NCT04429711. Available at: https://ClinicalTrials.gov/show/NCT04429711. Accessed on 10 August 2020.
Perez AM. Efficacy, Safety and Tolerability of Ivermectin in Subjects Infected With SARS-CoV-2 With or Without Symptoms (SILVERBULLET). Available at: https://ClinicalTrials.gov/show/NCT04407507. Accessed on 10 August 2020.
Udwadia ZF, Singh P, Barkate H, Patil S, Rangwala S, Pendse A et al. Efficacy and Safety of Favipiravir, an Oral RNA-Dependent RNA Polymerase Inhibitor, in Mild-to-Moderate COVID-19: A Randomized, Comparative, Open-Label, Multicenter, Phase 3 Clinical Trial. Int J Infect Dis. 2020;103:62-71.
Chen C, Huang J, Cheng Z, Wu J, Chen S, Zhang Y et al. Favipiravir versus arbidol for COVID-19: a randomized clinical trial. MedRxiv. 2020.
Lei F, Liu YM, Zhou F, Qin JJ, Zhang P, Zhu L et al. Longitudinal association between markers of liver injury and mortality in COVID‐19 in China. Hepatology. 2020; 72(2):389-98.
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z et al. Clinical course and risk factors for mortality of adult in patients with COVID-19 in Wuhan, China: a retrospective cohort study. The lancet. 2020;395:1054-61
Zhang L, Yan X, Fan Q, Liu H, Liu X, Liu Z et al. D‐dimer levels on admission to predict in‐hospital mortality in patients with COVID‐19. J Thrombosis Haemostasis. 2020;18(6):1324-9.
Velavan TP, Meyer CG. Mild versus severe COVID-19: laboratory markers. Int J Infect Dis. 2020;95:304-7.
Huang I, Pranata R, Lim MA, Oehadian A, Alisjahbana B. C-reactive protein, procalcitonin, D-dimer, and ferritin in severe coronavirus disease-2019: a meta-analysis. Therap adv respiratory dis. 2020;14:1753466620937175.
Yao Y, Cao J, Wang Q, Shi Q, Liu K, Luo Z et al. D-dimer as a biomarker for disease severity and mortality in COVID-19 patients: a case control study. J Intensive Care. 2020;8(1):1-1.
Chan AS, Rout A. Use of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in COVID-19. J Clin Med Res. 2020;12(7):448.
Karolyi M, Pawelka E, Omid S, Kelani H, Mader T, Baumgartner S et al. Late onset pulmonary embolism in young male otherwise healthy COVID-19 patients. Eur J Clin Microbiol Infect Dis. 2020:1-3.
RECOVERY Collaborative Group. Dexamethasone in hospitalized patients with COVID-19-preliminary report. N Eng J Med. 2020;384(8):693-704.
Wang Y, Jiang W, He Q, Wang C, Wang B, Zhou P et al. Early, low-dose and short-term application of corticosteroid treatment in patients with severe COVID-19 pneumonia: single-center experience from Wuhan, China. medRxiv. 2020.
Keller MJ, Kitsis EA, Arora S, Chen JT, Agarwal S, Ross MJ et al. Effect of Systemic Glucocorticoids on Mortality or Mechanical Ventilation in Patients With COVID-19. J Hospital Med. 2020;15(8):489-93.
Majmundar M, Kansara T, Lenik JM, Park H, Ghosh K, Doshi R et al. Efficacy of corticosteroids in non-intensive care unit patients with COVID-19 pneumonia from the New York Metropolitan region. PloS one. 2020;15(9):e0238827.
Xu H, Huang S, Qiu C, Liu S, Deng J, Jiao B et al. Monitoring and Management of Home-Quarantined Patients with COVID-19 using a WeChat-based telemedicine system: retrospective cohort study. J Med Internet Res. 2020;22(7):e19514.
MOHFW, SOP on preventive measures to be followed in Entertainment Parks and similar places to contain spread of COVID-19, New Delhi Ministry of Health and Family welfare, Government of India. 2020.Available at: https://www.mohfw.gov.in/pdf/SOPonpreventivemeasurestobefollowedinEntertainmentParksandsimilarplacestocontainspreadofCOVID19.pdf. Accessed on 10 December 2020.
IHME COVID-19 Forecasting Team, Hay SI. COVID-19 scenarios for the United States. MedRxiv. 2020.
Wang Y, Tian H, Zhang L, Zhang M, Guo D, Wu W et al. Reduction of secondary transmission of SARS-CoV-2 in households by face mask use, disinfection and social distancing: a cohort study in Beijing, China. BMJ Global Health. 2020;5(5):e002794.