Clinical Evolution and Risk Factors of Hospitalized Patients with COVID-19, Haiti, March-June 2020

In December 2019, a coronavirus epidemic emerged in China. Within months, the epidemic was considered a public health emergency of international concern. In Haiti, the first laboratory-confirmed cases of COVID-19 were reported on March 19, 2020, in a context where there was some limitations of knowledge on the modes of transmission, the severity, the clinical characteristics and the risk factors of the disease. This study has made it possible to characterize the epidemic and investigate the associations between the risk factors, co morbidities, and clinical evolution of the disease. To develop the epidemiological and clinical profile of patients with COVID-19 in Haiti, data were collected from the clinical records of patients hospitalized for COVID-19 from March 16 to June 16, 2020, in 22 healthcare facilities. Univariate, bivariate, and logistic regression model analyses were performed to describe and explore the risk factors, comorbidities, and treatments associated with patients’ clinical evolution. Statistical significance was determined using a 95% confidence interval or p-value of ?0.05.  Diabetes and high blood pressure were the main comorbidities that had a statistically significant association with the severe form of the disease and the occurrence of death. The likelihood of dying increased with age, and patients in the severe form were almost four times more likely to die. The administration of ceftriaxone to patients was significantly related to recovery from the disease. Diabetes, high blood pressure, and age were the major risk factors for the severity and mortality of people infected with COVID19. Ceftriaxone administration was protective against recovery

Geographical coverage of SARS-CoV-2 screening and care centers in Haiti: what do national surveillance data tell us?

Summary Background In Haiti, reported incidence and mortality rates for COVID-19 were lower than expected. We aimed to analyze factors at communal and individual level that might lead to an underestimation of the true burden of the COVID-19 epidemic in Haiti during its first two years. Methods We analyzed national COVID-19 surveillance data from March 2020 to December 2021, to describe the epidemic using cluster detection, time series, and cartographic approach. We performed multivariate Quasi-Poisson regression models to determine socioeconomic factors associated with incidence and mortality. We performed a mixed-effect logistic regression model to determine individual factors associated with the infection. Results Among the 140 communes of Haiti, 57 (40.7%) had a COVID-19 screening center, and the incidence was six times higher in these than in those without. Only 22 (15.7%) communes had a COVID-19 care center, and the mortality was five times higher in these than in those without. All the richest communes had a COVID-19 screening center while only 30.8% of the poorest had one. And 75% of the richest communes had a COVID-19 care center while only 15.4% of the poorest had one. Having more than three healthcare workers per 1000 population in the commune was positively associated with the incidence (SIR: 3.31; IC95%: 2.50, 3.93) and the mortality (SMR: 2.73; IC95%: 2.03, 3.66). At the individual level, male gender (adjusted OR: 1.11; IC95%: 1.01, 1.22), age with a progressive increase of the risk compared to youngers, and having Haitian nationality only (adjusted OR:2.07; IC95%: 1.53, 2.82) were associated with the infection. Conclusions This study highlights the weakness of SARS-CoV-2 screening and care system in Haiti, particularly in the poorest communes, suggesting that the number of COVID-19 cases and deaths were probably greatly underestimated

Surveillance flow chart for reporting outpatient SARS-CoV-2 cases—Haiti: Data streams for the detection, investigation, and testing of persons suspected of having SARS-CoV-2 infection from March 18 to August 4, 2020.

NP: Nasopharyngeal; LNSP: National Public Health Laboratory (Laboratorie nationale de santé publique; NAAT: Nucleic acid amplification testing; DELR: Directorate of Epidemiology, Laboratories and Research (Direction d’epidemiologie, de laboratoire et de recherches).</p

Characteristics of all COVID-19 cases, by symptom status, Haiti, March to August 2020.

Characteristics of all COVID-19 cases, by symptom status, Haiti, March to August 2020.</p

Characteristics of symptomatic COVID-19 cases by disease severity.

Characteristics of symptomatic COVID-19 cases by disease severity.</p

SARS-CoV-2 outbreak by week of onset–Haiti: Number of suspected and confirmed outpatient SARS-CoV-2 cases and percent positivity of tests by epidemiological week from March 18 to August 4, 2020.

SARS-CoV-2 outbreak by week of onset–Haiti: Number of suspected and confirmed outpatient SARS-CoV-2 cases and percent positivity of tests by epidemiological week from March 18 to August 4, 2020.</p

Logistic regression modelling evaluating risk factors related to the severity of clinical manifestations of COVID-19 outpatients, i.e. comparing moderate-to-severe and mild case as the outcome.

Logistic regression modelling evaluating risk factors related to the severity of clinical manifestations of COVID-19 outpatients, i.e. comparing moderate-to-severe and mild case as the outcome.</p