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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 28  |  Issue : 2  |  Page : 81-87

Clinical characteristics, treatment modalities and outcome of coronavirus disease 2019 patients treated at thisday dome isolation and treatment centre, federal capital territory Abuja, Nigeria


1 Department of Obstetrics and Gynaecology, Irrua Specialist Teaching Hospital, Irrua, Edo State; ThisDay Dome Isolation and Treatment Centre for COVID-19, Abuja, Nigeria
2 ThisDay Dome Isolation and Treatment Centre for COVID-19, Abuja; Department of Community Medicine; Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
3 Department of Community Medicine, Irrua Specialist Teaching Hospital, Irrua, Edo State; ThisDay Dome Isolation and Treatment Centre for COVID-19, Abuja, Nigeria
4 Department of Internal Medicine, Irrua Specialist Teaching Hospital, Irrua, Edo State; ThisDay Dome Isolation and Treatment Centre for COVID-19, Abuja, Nigeria
5 Department of Community Medicine, University of Abuja Teaching Hospital, Gwagwalada, Nigeria
6 Accident and Emergency Unit, Irrua Specialist Teaching Hospital, Irrua, Edo State; ThisDay Dome Isolation and Treatment Centre for COVID-19, Abuja, Nigeria
7 HIV Counselling Unit, Irrua Specialist Teaching Hospital, Irrua, Edo State; ThisDay Dome Isolation and Treatment Centre for COVID-19, Abuja, Nigeria
8 Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State; ThisDay Dome Isolation and Treatment Centre for COVID-19, Abuja, Nigeria
9 Dialysis Unit, Irrua Specialist Teaching Hospital, Irrua, Edo State; ThisDay Dome Isolation and Treatment Centre for COVID-19, Abuja, Nigeria
10 Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital; Department of Psychiatry, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria

Date of Submission23-Apr-2021
Date of Decision23-Jul-2021
Date of Acceptance26-Jul-2021
Date of Web Publication03-Sep-2021

Correspondence Address:
Dr. Cyril Oshomah Erameh
Department of Internal Medicine, Irrua Specialist Teaching Hospital, Irrua, Edo State; ThisDay Dome Isolation and Treatment Centre for COVID-19, Abuja; Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/npmj.npmj_532_21

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  Abstract 


Introduction: Coronavirus disease 2019 (COVID-19), a highly transmissible viral infection has spread worldwide causing exponential increase in morbidity and mortality. But so far, there is limited information available to describe the presenting characteristics, outcomes and treatment modalities of COVID-19 patients in Nigeria. This study aimed to describe the demographic and clinical characteristics, underlying comorbidities, treatment modalities and outcomes of patients isolated and treated in a repurposed COVID-19 isolation and treatment centre in Abuja, Nigeria. Materials and Methods: A retrospective study which reviewed the medical records of 300 confirmed COVID-19 patients isolated and treated according to the World Health Organisation and Nigeria Centre for Disease Control guidelines between 22nd July and 26th October, 2020 in ThisDay Dome Isolation and Treatment Centre. Data collected from the medical records include demographics, clinical features, treatment measures and outcomes. Results: Out of 300 patients studied, 61.0% were male. The mean age of the participants was 38.2 ± 14.7. Less than half of the patients (40.3%) had one or more underlying comorbidities with hypertension the most common co-morbidity. Majority (62%) of patients were mildly symptomatic, 33% were asymptomatic while only 2% were severely symptomatic. The most common presenting symptoms include cough 34.0%, fever 30.3%, anosmia 28.7% and dysgeusia 22.7%. Older age (P < 0.001), tertiary education and the presence of underlying comorbidity (P < 0.001) were significantly associated with symptomatic presentation of COVID-19. The median duration of time between positive laboratory testing and presentation for treatment was 5 days (0–29). All patients were treated with a combination of Ivermectin, Azithromycin, Zinc and Vitamin C with no recorded death. The median length of stay at facility was 9 days. Conclusion: Close attention should be given to patients with co-morbidities as an inefficient management of such co-morbidities could lead to mortalities which may not be directly attributable to COVID-19.

Keywords: Clinical characteristics, coronavirus disease 2019, Nigeria, outcome, treatment modalities


How to cite this article:
Okogbenin SA, Erameh CO, Egbuta OC, Iraoyah KO, Onyebujoh JT, Erohubie CE, Jaggu AY, Onovo R, Avbuluimen M, Odewale MA, Enigbe EE, Ifada EC, Okogbenin EO. Clinical characteristics, treatment modalities and outcome of coronavirus disease 2019 patients treated at thisday dome isolation and treatment centre, federal capital territory Abuja, Nigeria. Niger Postgrad Med J 2021;28:81-7

How to cite this URL:
Okogbenin SA, Erameh CO, Egbuta OC, Iraoyah KO, Onyebujoh JT, Erohubie CE, Jaggu AY, Onovo R, Avbuluimen M, Odewale MA, Enigbe EE, Ifada EC, Okogbenin EO. Clinical characteristics, treatment modalities and outcome of coronavirus disease 2019 patients treated at thisday dome isolation and treatment centre, federal capital territory Abuja, Nigeria. Niger Postgrad Med J [serial online] 2021 [cited 2021 Dec 7];28:81-7. Available from: https://www.npmj.org/text.asp?2021/28/2/81/325558




  Introduction Top


The coronavirus disease 2019 (COVID-19) is a highly transmissible viral infection caused by a novel coronavirus named the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It was first reported on 31st December 2019 in Wuhan, Hubei province China where 27 cases of pneumonia of unknown aetiology were identified.[1] In so short a time, the disease has spread worldwide with an exponential increase in morbidity and mortality and continues to be a public health emergency globally.[2] The World Health Organisation (WHO) on 11th March 2020 declared COVID-19 a pandemic.[3]

COVID-19 is transmitted rapidly by inhalation of infected respiratory droplets generated during coughing, sneezing and even talking. The incubation period ranges from 2 to 14 days with an average of 5 days.[4] The common symptoms as documented in various studies include fever, cough, sore throat, breathlessness, fatigue and malaise among others.[5],[6],[7] The disease is mild in most people, but in the elderly and those with co-morbidities, it may progress to pneumonia, acute respiratory distress syndrome and multi-organ dysfunction.[4] The diagnosis is by reverse transcriptase polymerase chain reaction (RT-PCR) from a throat or nasopharyngeal swab and treatment is essentially supportive to alleviate symptoms.

On 27th February 2020, Nigeria recorded her index case, a foreigner who arrived Lagos from Italy.[8] Since then, the number of persons infected and related deaths have continued to increase steadily in Nigeria. The Federal Capital Territory (FCT) is one of the high burden states with an increased demand for isolation and treatment centres. Consequently, This Day Dome Event Centre, a social event centre was repurposed into an Isolation and Treatment Centre to manage mild-to-moderate cases of COVID-19.

Even with increase in the number of persons infected, there is limited information available to describe the presenting characteristics and outcomes of COVID-19 patients in Nigeria. In one of such available studies, Bowale et al.[9] described the clinical presentations, case management and outcomes of the first 32 COVID-19 patients in Nigeria. The study revealed that the mean age of the patients was 38.1 years with two-third of the patients being male. It was also noted that 75% of the patients presented in moderately severe condition while 16% were asymptomatic. Similarly, another study conducted on the characteristics of COVID-19 patients admitted at Abubakar Tafawa Balewa Teaching Hospital Bauchi showed that about two-thirds of the patients were males with a mean age of 41 years, but in contrast, it was noted that 58.3% were asymptomatic.[10] This study aims to describe the demographic and clinical characteristics, underlying co-morbidities, the main treatment modalities and outcomes of all the patients isolated and treated in a repurposed COVID-19 isolation centre from July to October 2020.


  Patients and Methods Top


Study site

This study was conducted at ThisDay Dome isolation and treatment centre, a 300-bed facility for the management of COVID-19 located at the central area of Abuja, the FCT, Nigeria. It was previously a social event centre repurposed into an isolation centre to meet the increased demand for isolation and treatment facilities in the wake of the COVID-19 pandemic. This isolation centre is funded by the ThisDay media and Technology group, the Sahara Energy group and the Central Bank of Nigeria. It is comprised of male and female open wards with a male: female bed space ratio of 70:30 and four intensive care units equipped with pulse oximeters, oxygen cylinders and CCTV for monitoring patients. Regular nutritious meals, as well as recreation with games such as Ludo, Chess, Whot and Scrabble, were provided for the patients. A team of medical doctors and nurses from the Irrua Specialist Teaching Hospital was invited to isolate and treat the patients. Health-care workers comprising doctors, nurses, health assistants and hygienists from the FCT were also posted to assist.

Study design and population

This was a retrospective study which reviewed the medical records of all 300 patients isolated and treated between 22nd July and 26th October 2020 at ThisDay Dome Isolation and Treatment Centre. All patients seen at the centre were confirmed to have COVID-19 through laboratory testing using real-time RT-PCR assay for SARS-COV2.

Data collection and analysis

The patients' data such as their demographics, signs and symptoms on presentation, vital signs on presentation, co-morbidities, treatment measures and outcomes such as complications and death, as well as the duration of hospitalisation, were collected from their medical records.

Patients' conditions were categorised into the following according to the WHO:[11]

  • Asymptomatic; if he tests positive for SARS-CoV-2 by RT-PCR, but has no symptoms
  • Mild; if he has any of the various signs and symptoms of COVID-19 such as fever, cough, sore throat, malaise, headache and muscle pain without shortness of breath or dyspnea
  • Moderate; if he has clinical symptoms of pneumonia (fever, cough and difficulty with breathing) but no signs of severe pneumonia, including SpO2 ≥90% on room air
  • Severe if he has clinical signs of pneumonia (evidence of lung consolidation, bronchial breath sounds and crepitations) plus one of the following: respiratory rate >30 breaths/min; severe respiratory distress or SpO2 <90% on room air.


Asymptomatic patients were discharged 14 days after the initial positive result while those with symptoms were discharged 10 days after symptom onset with at least 3 days without symptoms according to the Nigeria Centre for Disease Control Discharge criteria for COVID-19 Infection.[12]

Informed consent was also obtained from the study participants before their health records were reviewed. All patients' data were handled with utmost confidentiality.

Data collected were analyzed using the SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp. Normally distributed continuous data are presented as the mean ± standard deviation while nonnormally distributed data are presented as the median (range). The categorical data are presented as frequencies, percentages and charts. Pearson's Chi-square test and Fisher's exact test were used to determine the association between the categorical variables. The results were assessed to be statistically significant at P < 0.05.


  Results Top


Patients' demographic and clinical characteristics

Out of 300 patients studied, 183 (61.0%) are male, whereas 117 (39.0%) are females. The mean age was 38.2 ± 14.7 years with majority 130 (43.3%) within the age range of 20–39 years. Most of the patients 218 (72.7%) had tertiary level of education and 53 (17.7%) had secondary level of education. One hundred and twenty-one (40.3%) patients had one or more underlying comorbidity. Hypertension was the most common comorbidity 80 (26.7%), followed by peptic ulcer 51 (17.0%) and diabetes mellitus 12 (4.0%) [Table 1].
Table 1: Baseline characteristics of the patients with coronavirus disease 2019

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Majority 182 (62.0%) of patients presented with mild symptoms, 100 (33.0%) were asymptomatic while only 6 (2.0%) had severe symptoms on presentation [Figure 1]. The most common presenting symptoms were cough 102 (34.0%), fever 91 (30.3%), anosmia 86 (28.7%) and dysgeusia 68 (22.7%) followed by rhinorrhoea 58 (19.3%), fatigue 54 (18.0%), chest pain 47 (15.7%), headache 39 (13.0%) and diarrhoea 34 (11.3%). Vital signs of patients on presentation showed mean body temperature of 36.3°C (±0.4), median pulse rate of 87 bpm (56–129), systolic blood pressure (BP) of 134 mmHg (96–197), diastolic BP of 85 mmHg (59–119) and pulse oximetry of 98% (80–99) [Table 2].
Figure 1: Pie chart showing the category of presenting symptoms

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Table 2: Signs and symptoms of the coronavirus disease-2019 patients

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[Table 3] shows the association between select demographic characteristics of patients and symptomatic COVID-19 presentation using a Chi-square analysis. Older age (P < 0.001), tertiary level of education (P < 0.001) and the presence of underlying comorbidity (P < 0.001) were significantly associated with symptomatic presentation of COVID-19 among the patients. Majority of patients 19 (90.5%) aged 60 years and above and more than half of the patients with tertiary education 141 (64.7%) presented with symptoms. A larger proportion of patients with comorbidity 84 (69.4%) presented with symptomatic COVID-19. In addition, when compared with patients with no comorbidity, a significantly higher proportion of patients with comorbidity presented with moderate-to-severe illness (P = 0.002) [Table 4].
Table 3: Association between demographic characteristics of patients and symptomatic presentation of coronavirus disease-2019 using Chi-square analysis

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Table 4: Association between severity of presenting symptoms and co-morbidity in patients with coronavirus disease-2019

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Over half 158 (52.7%) of the patients presented for treatment within 3–5 days of positive laboratory testing while only 24 (8.0%) presented in 2 days or less. The median duration of time between positive laboratory testing and presentation for treatment was 5 days (0–29). Upon admission, almost all 280 (93.3%) the patients were treated with a combination of Ivermectin, Azithromycin, Zinc and Vitamin C. Ivermectin was given at a dose of 200 μg/kg, day 1, then 100 μg/kg/day, from day 2 to day 5. Azithromycin was given at a dose of 500 mg daily for 10 days, Zinc sulfate at a dose of 40 mg daily and Vitamin C at a dose of 500 mg daily for 10 days. In addition, some received oral Augmentin (Co-Amoxiclav) 87 (29.0%), sedatives 69 (23.0%), steroids 57 (19.0%), oxygen therapy 16 (5.3%), intravenous antibiotics 10 (3.3%) and anticoagulant (Enoxaparin) 11 (3.7%). Oral Augmentin was given at a dose of 1 g b.d, subcutaneous Enoxaparin at a dose of 40–80 mg daily and oral dexamethasone, 8 mg Stat, then 4 mg b.d for 5–7 days. Among all patients treated only 5 (1.7%) and 3 (1.0%) developed pneumonia and sepsis, respectively. As at October 26, 2020, majority 287 (95.7%) of the patients had been discharged with only one (0.3%) referral; 12 (4.0%) patients had home-based care with monitoring through telephone. There was no death recorded. The median length of stay at the facility was 9 days (1–13) [Table 5].
Table 5: Main treatment and outcomes of the coronavirus disease 2019 patients

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  Discussion Top


In this retrospective study, we describe the clinical characteristics, treatment modalities and outcome of the first COVID-19 patients managed in a repurposed isolation and treatment centre in Abuja, Nigeria. Majority of the patients were males (61.0%) and those within the age range of 20–39 years (43.3%), with a mean age of 38.2 ± 14.7 years. This is similar to findings in previous studies conducted in Ghana,[13] Ibadan[14] and Lagos,[9] Nigeria, and shows that the SARS-CoV-2 mainly infects the young and working age in our environment. This may be because those in this age group are active and tend to cluster together socially and at work, thus increasing their chances of getting infected. Moreover, they are likely not to adhere to infection prevention measures such as frequent hand hygiene and wearing of facemask when outside the home. However, studies have reported higher mean or median age of COVID-19 patients in countries such as Saudi Arabia (44 years),[15] China (52 years)[5] and the United States of America (63 years)[16] compared to that found in this study. The findings from this study also indicate that the majority of the patients 218 (72.7%) completed tertiary education while 53 (17.7%) completed secondary education.

Over half 158 (52.7%) of the patients presented for isolation and treatment within 3–5 days of positive laboratory testing while only 24 (8.0%) presented in 2 days or less. This is because most of these patients received their results about 3–5 days after the test was done. This delay may be due to possible backlogs at the accredited laboratories that test for the SARS-Cov-2 and some inefficiency of logistics involved in the dissemination of results to patients.

More than half of the patients 168 (56.0%) presented with symptoms and as reported in previous studies[6],[13],[17] the most common symptom found in our study was cough 102 (34.0%). This was followed by fever 91 (30.3%), anosmia 86 (28.7%) and dysgeusia 68 (22.7%). The prevalence of smell and taste dysfunction in COVID-19 widely varies in literature. For instance, a retrospective study conducted to investigate the clinical features of confirmed cases of COVID-19 in a hospital at Trevenans, France, reported that 37 (53%) and 34 (48%) of the patients presented with anosmia and dysgeusia, respectively.[18] Another study conducted in Iraq noted that smell dysfunction and taste dysfunction occurred in 89.2% and 83.1% of the confirmed COVID-19 patients investigated, respectively.[19]

Older age was observed to be significantly associated with symptomatic presentation of COVID-19. Of the 21 patients that were 60 years and above, 19 (90.5%) were symptomatic while 2 (9.5%) were asymptomatic. Older age has been associated with severe COVID-19 globally[16],[20],[21] and this may be due to reduced immunity; thus, older adults are likely to be symptomatic, compared to the younger age group who may have mild or no symptoms. Similarly, tertiary education was found to be significantly associated with symptomatic presentation. Of the 218 patients who completed tertiary education, 141 (64.7%) were symptomatic while 77 (35.3%) were asymptomatic. People with tertiary education are likely to be more enlightened and would be more aware of the symptoms of COVID-19, especially with the nationwide awareness campaign. They would also be more likely to attribute their symptoms to COVID-19; therefore, seeking testing and treatment compared to those with little or no education who may attribute their symptoms to other common diseases such as malaria and may not see the need to go for testing or treatment.

Out of 300 patients studied, 121 (40.3%) presented with at least one underlying comorbidity. The most common comorbidity observed was hypertension 80 (26.7%), followed by peptic ulcer 51 (17.0%) and diabetes mellitus 12 (4.0%). It was evident from this study that the presence of comorbidities was significantly associated with symptomatic COVID-19 presentation. Of the 121 patients with co-morbidities, 84 (69.4%) had symptoms whereas 37 (30.6%) had no symptoms. Furthermore, a significantly higher proportion of patients with comorbidities presented with moderate-to-severe illness. This is similar to previous studies conducted in Nigeria which suggested an association between comorbidities and increased severity of COVID-19.[22],[23] The presence of comorbidities has untoward effects on the body's immunity. Conditions such as diabetes mellitus, chronic kidney disease and cancers have been known to reduce immunity. In addition, other chronic conditions such as systemic hypertension also take their toll on the various organ systems of the body. As such, superimposed COVID-19 infection would further decimate the body's defences leading to an increased likelihood to present with a severe disease with symptoms. These combined effects impact greatly the overall outcome in the patients. During their stay in the isolation and treatment centre, the co-morbidities were effectively managed with oral medications and in some cases, insulin injection in diabetics.

Majority 280 (93.3%) of the patients were treated with a combination of Ivermectin, Azithromycin, Zinc and Vitamin C. In addition, some received oral Augmentin 87 (29.0%), sedatives 69 (23.0%), steroids 57 (19.0%), oxygen therapy 16 (5.3%), intravenous antibiotics 10 (3.3%) and anticoagulant 11 (3.7%). The sedative used in these patients was Lorazepam. It was observed that some patients had poor sleep and this was coupled with anxiety. Therefore, a combination of psychosocial counselling by a psychiatrist and the use of Lorazepam was very effective in alleviating their symptoms. Using the above treatment regimen, the patients made good clinical recovery and were all discharged home after a mean duration of stay in the treatment facility of 9 days. Severe cases also received antibiotics (oral Augmentin 1 g b.d), anticoagulant (subcutaneous Enoxaparin 40–80 mg daily) and oral dexamethasone, 8 mg Stat, then 4 mg b.d for 5–7 days and on few occasions, inhaled Budesonide in addition to the treatment regimen stated above. At the time of discharge, the oxygen saturation was at least 98% in room air for all patients. It is worthy of note to mention that the case fatality rate in this study was 0%!


  Conclusion Top


From this study, it was found that older age, tertiary education and presence of comorbidity was significantly associated with symptomatic presentation of COVID-19. A combination of Azithromycin, Ivermectin, Zinc and Vitamin C was also seen to be effective in the management of mild, moderate and severe cases of COVID-19. It was also clear that early commencement of treatment prevents the development of life-threatening complications. Furthermore, adjunct treatment modalities of steroids, anticoagulants and oxygen therapy in addition to the above treatment combination were found to be effective in the management of severe cases of COVID-19. Patients with co-morbidities should be given close attention, as inefficient management of such co-morbidities could lead to mortality, which may not be directly attributable to COVID-19.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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