Factors affecting death due to COVID-19: an analytical study from a tertiary care hospital of Assam

Background: Globally, the Case Fatality Rate (CFR) due CoVID19 ranges from 0.1-4.7%. CoVID-19 death remained 0.5% till April 2021 in Assam as compared to India (1.3%). Though pre-existing diseases greatly contributes to CFR yet its association study from India is scarce. This study documents association of such death with comorbidities in a tertiary hospital of Assam. Methods: Retrospective analysis of 234 COVID death from May 2020 to December 2020 in Jorhat Medical College (JMCH) were done. Demography, comorbidities at admission and blood parameters were analyzed in Epi-Info version7.2.4.0. Continuous variables were presented as mean±SD or median (interquartile ranges) and correlated with death. Results: Out of 3781 confirmed cases admitted in JMCH, 234 died (72% male) with CFR of 0.06. Highest deaths occurred between 61 to 70 years. Median duration of disease was 4 days (IQR 2-8days). Acute respiratory distress or pneumonia was most common (53.1%) symptom followed by septicemia (24.6%) at admission. Diabetes mellitus (36.6%), hypertension (24.8%), diabetes with hypertension (11.4%) and chronic kidney diseases (22.4%) were common chronic comorbidities. About 64% cases had thrombocytopenia, and 66.9% had leukocytosis at admission. Many cases had coronary artery diseases, left ventricular failure, post-operative complications, post-partum complications, severe hemoptysis, severe anemia, metabolic encephalopathy, acute myocardial infarction, non-ketotic coma and acute gastroenteritis and SARS-COV2 infection. Conclusions: CoVID19 associated mortality in Assam was low and mostly among elderly with chronic comorbidities. CKD was most significantly associated with mortality. Superimposed bacterial infection at admission contributed to many fatal outcomes in COVID19, thus warranting proper empirical antibiotic

Clinical Characterization and Genomic Analysis of Samples from COVID-19 Breakthrough Infections during the Second Wave among the Various States of India

From March to June 2021, India experienced a deadly second wave of COVID-19, with an increased number of post-vaccination breakthrough infections reported across the country. To understand the possible reason for these breakthroughs, we collected 677 clinical samples (throat swab/nasal swabs) of individuals from 17 states/Union Territories of the country who had received two doses (n = 592) and one dose (n = 85) of vaccines and tested positive for COVID-19. These cases were telephonically interviewed and clinical data were analyzed. A total of 511 SARS-CoV-2 genomes were recovered with genome coverage of higher than 98% from both groups. Analysis of both groups determined that 86.69% (n = 443) of them belonged to the Delta variant, along with Alpha, Kappa, Delta AY.1, and Delta AY.2. The Delta variant clustered into four distinct sub-lineages. Sub-lineage I had mutations in ORF1ab A1306S, P2046L, P2287S, V2930L, T3255I, T3446A, G5063S, P5401L, and A6319V, and in N G215C; Sub-lineage II had mutations in ORF1ab P309L, A3209V, V3718A, G5063S, P5401L, and ORF7a L116F; Sub-lineage III had mutations in ORF1ab A3209V, V3718A, T3750I, G5063S, and P5401L and in spike A222V; Sub-lineage IV had mutations in ORF1ab P309L, D2980N, and F3138S and spike K77T. This study indicates that majority of the breakthrough COVID-19 clinical cases were infected with the Delta variant, and only 9.8% cases required hospitalization, while fatality was observed in only 0.4% cases. This clearly suggests that the vaccination does provide reduction in hospital admission and mortality