Outcome of noncritical COVID-19 patients with early hospitalization and early antiviral treatment outside the ICU

Background/aim: Despite the fact that the COVID-19 pandemic has been going on for over 5 months, there is yet to be a standard management policy for all patients including those with mild-to-moderate cases. We evaluated the role of early hospitalization in combination with early antiviral therapy with COVID-19 patients in a tertiary care university hospital. Materials and methods: This was a prospective, observational, single-center study on probable/confirmed COVID-19 patients hospitalized in a tertiary care hospital on COVID-19 wards between March 20 and April 30, 2020. The demographic, laboratory, and clinical data were collected. Results: We included 174 consecutive probable/confirmed COVID-19 adult patients hospitalized in the Internal Medicine wards of the University Adult Hospital between March 20 and April 30, 2020. The median age was 45.5 (19–92) years and 91 patients (52.3%) were male. One hundred and twenty (69%) were confirmed microbiologically, 41 (23.5%) were radiologically diagnosed, and 13 (7.5%) were clinically suspected (negative microbiological and radiological findings compatible with COVID-19); 35 (20.1%) had mild, 107 (61.5%) moderate disease, and 32 (18.4%) had severe pneumonia. Out of 171 cases, 130 (74.3%) showed pneumonia; 80 were typical, and 50 showed indeterminate infiltration for COVID-19. Patients were admitted within a median of 3 days (0-14 days) after symptoms appear. The median duration of hospitalization was 4 days (0-28 days). In this case series, 13.2% patients were treated with hydroxychloroquine alone, 64.9% with hydroxychloroquine plus azithromycin, and 18.4% with regimens including favipiravir. A total of 15 patients (8.5%) were transferred to the ICU. Four patients died (2.2%). Conclusion: In our series, 174 patients were admitted to the hospital wards for COVID-19, 69% were confirmed with PCR and/or antibody test. At the time of admission, nearly one fifth of the patients had severe diseases. Of the patients, 95.4% received hydroxychloroquine alone or in combination. The overall case fatality rate was 2.2%.Key words: COVID-19, noncritical illness, hydroxychloroquine, favipiravir

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1 Simpson S, Kay FU, Abbara S, Bhalla S, Chung JH et al. Radiological Society of North America Expert Consensus Statement on Reporting Chest CT Findings Related to COVID-19. Endorsed by the Society of Thoracic Radiology, the American College of Radiology, and RSNA. Radiology: Cardiothoracic Imaging 2020; 2. doi: 10.1148/ryct.2020200152
2. Tanrıover MD, Yıldırım G, Kehya E, Erdogan O, Nacar DK et al. Does the implementation of modified early warning scores spare workforce by decreasing the frequency of nurse assessments? Acta Medica 2014; 3: 80-83.
3. Tanrıöver MD, Halaçlı B, Sait B, Öcal S, Topeli A. Daily surveillance with early warning scores help predict hospital mortality in medical wards. Turkish Journal of Medical Sciences 2016; 46(6): 1786-1791.
4. Satman I, Omer B, Tutuncu Y, Kalaca S, Gedik S et al. Twelveyear trends in the prevalence and risk factors of diabetes and prediabetes in Turkish adults. European Journal of Epidemiology 2013; 28(2): 169-180.
5. Myers LC, Parodi SM, Escobar GJ, Liu Vincent. Characteristics of Hospitalized Adults With COVID-19 in an Integrated Health Care System in California. Journal of the American Medical Association 2020 April 24: E1-E3.
6. Grasselli G, Zangrillo A, Zanella A, Antonelli M, Cabrini L et al. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy Region, Italy. Journal of the American Medical Association 2020; 323(16): 1574-1581. doi: 10.1001/jama.2020.5394
7. Zhang J, Dong X, Cao Y, Yuan Y, Yang Y et al. Clinical characteristics of 140 patients infected with SARSCoV-2 in Wuhan, China. Allergy 2020; 00: 1-12. doi: 10.1111/all.14238
8. Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T et al.Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City Area. Journal of the American Medical Association 2020; 323(20): 2052-2059. doi: 10.1001/jama.2020.6775
9. Farsalinos K, Barbouni A, Niaura R. Systematic review of the prevalence of current smoking among hospitalized COVID-19 patients in China: could nicotine be a therapeutic option? Internal and Emergency Medicine 2020 (15): 845-852. doi: 10.1007/s11739-020-02355-7
10. Wang X, Fang J, Zhu Y, Chen L, Ding F et al. Clinical characteristics of non-critically ill patients withnovel coronavirus infection (COVID-19) in a Fangcang Hospital. Clinical Microbiology and Infection2020. doi: 10.1016/j.cmi.2020.03.032
11. Guan WJ. Clinical characteristics of coronavirus disease 2019 in China. The New England Journal of Medicine 2020. doi: 10.1056/NEJMoa2002032
12. Chen N, Zhou M, Dong X, Qu J, Gong F et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395(10223): 507-513.
13. Huang, C, Wang Y, Li X, Ren L, Zhao J et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet (London, England) 2020; 395(10223): 497-506.
14. Li A, Chen Z, Chen L, Zhan Y, Li S et al. Coinfection with SARS-CoV-2 and other respiratory pathogens in COVID-19 patients in Guangzhou, China. Journal of Medical Virology 2020. doi: 10.1002/jmv.26073
15. Zhu X, Ge Y, Wu T, Zhao K, Chen Y et al. Co-infection with respiratory pathogens among COVID-2019 cases. Virus Res 2020; 285. doi: 10.1016/j.virusres.2020.198005
16. Mavi D, İnkaya AC. COVID-19 Immunopathogenesis. Flora 2020; 25: 1-9. doi: 10.5578/flora.69606
17. Young BE, Wei Xiang Ong S, Kalimuddin S, Low JG, Tan SY et al. For the Singapore 2019 novel coronavirus outbreak research team. Epidemiologic features and clinical course of patients infected with SARS-CoV-2 in Singapore. Journal of the American Medical Association 2020; 323(15):1488-1494. doi: 10.1001/jama.2020.3204
18. Zhang X, Cai H, Hu J, Lian J, Gu J et al. Epidemiological, clinical characteristics of cases of SARS-CoV-2 infection with abnormal imaging findings. International Journal of Infectious Diseases 2020; 94: 81-87.
19. Zheng F, Tang W, Li H, Huang Y-X, Xie L et al. Clinical characteristics of 161 cases of corona virus disease 2019 (Covıd-19) in Changsha. European Review for Medical and Pharmacological Sciences 2020; 24(6): 3404-3410. doi: 10.26355/eurrev_202003_20711
20. Milliona M, Lagiera JL, Gautreta P, Colsona P, Fourniera PE et al. Early treatment of COVID-19 patients with hydroxychloroquine and azithromycin: A retrospective analysis of 1061 cases in Marseille, France. Travel Medicine and Infectious Disease 2020: 101738. doi: 10.1016/j.tmaid.2020.101738
21. Geleris J, Sun Y, Platt J, Zucker J, Baldwin M et al. Observational study of hydroxychloroquine in hospitalized patients with Covid-19. New England Journal of Medicine 2020. doi: 10.1056/NEJMoa2012410
22. Mahevas M, Tran VT, Roumer M et al. Clinical efficacy of hydroxychloroquine in patients with covid-19 pneumonia who require oxygen: observational comparative study using routine care data. BMJ 2020;369:m1844. doi: 10.1136/bmj.m1844
23. Şimşek Yavuz S, Ünal S. Treatment of COVID19. Turkish Journal of Medical Sciences 2020;50(1):611-619
24. Cai Q, Yang M, Liu D, Chen J, Shu D et al. Experimental treatment with favipiravir for COVID-19: an open-label control study. Engineering 2020. doi: 10.1016/j.eng.2020.03.007
25. Tas Z, İnkaya AC, Akova M. Current treatment of COVID-19. Türkiye Klinikleri 2020 (in press)