The coronavirus disease has made a huge impact globally since late 2019. Pneumonia of unknown aetiology emerged from city of Wuhan, Hubei Province, China, in November 2019. Chinese scientists isolated the virus and it was named novel coronavirus 2019 (nCov-2019) (1). Later, the World Health Organization (WHO) reclassified this pathogen as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the disease as Coronavirus Disease 2019 (COVID-19) (2).
As of June 30, 2020, there are over 10 million confirmed cases and nearly 500,000 deaths reported worldwide (3). COVID-19 spreads by human-to-human transmission through droplets, faeco-oral routes, and direct physical contact (4). The incubation period of COVID-19 varies between 2 to 14 days(5). Most patients show clinical symptoms in 5 to 6 days(5). Noted epidemiological prognostic risk factors include being male, being older-aged (above 65 years), being a smoker, and having obesity, diabetes, chronic pulmonary diseases, hypertension, cardiovascular diseases, and chronic kidney disease. The disease is more severe when more risk factors are observed at presentation(6). A wide array of clinical features is shown in patients with COVID-19. Clinical manifestations can be classified as asymptomatic or symptomatic, carrier or infective state, and ranging from mild prodrome to profusely symptomatic(5). The usual triad of symptoms at the time of presentation are fever, dry cough, and dyspnoea(5). Several factors affect the clinical picture including the virulence of the strain of the virus and host factors such as age, immunity status and patient comorbidities(7). The Chinese Center for Disease Control and Prevention has described the epidemiological characteristics of patients in their case series consisting of 72,314 COVID-19 patients. The majority exhibited a mild level of disease (81%) while 14% had moderate to severe disease conditions and 5% were critically ill(8).
On January 27, 2020, the first case was reported in Sri Lanka. It was an imported case: a Chinese tourist. The first confirmed local case was reported on March 11, 2020. Since then, the number of cases has increased gradually. As of June 30, 2020, the number of confirmed cases is 2,033, out of which 1,661 have completely recovered. Only 11 deaths have been reported(9). In Sri Lanka, diagnosed patients are managed according to the local guidelines in designated treatment hospitals for COVID-19 island-wide(10).
Only limited publications on COVID-19 in local contexts are available. The interim analysis on clinical and epidemiological characteristics of the confirmed first 100 COVID-19 patients from Sri Lanka following their discharge/death is one of the important literatures among them(11). The lack of availability of data highlighted the importance and necessity of researching this valuable information. As a result, the Sri Lanka College of Internal Medicine designed this multi-centre study in designated treating centres of COVID-19 patients to cover the whole island.
Clinical and epidemiological characteristics, morbidity, and mortality of COVID-19 patients can vary from country to country. Various studies from many parts of the globe have reported different prominent clinical characteristics(5, 12–15). People belonging to certain ethnic groups might be at an increased risk of acquisition, disease severity, and poor outcomes in COVID-19 for a variety of reasons(16). The factors that may influence clinical features and outcomes are ethnicity, mean age of population, geographical region, humidity, climate, and other country-specific factors such as overcrowding, and most importantly the circulating strain of the virus (17, 18). For example, South Asians usually have higher rates of non-communicable diseases (NCDs) such as diabetes mellitus, hypertension, and cardiovascular diseases, which are associated with severe disease and mortality in COVID-19(16). Furthermore, ethnicity could interact with the spread of the virus through factors such as lower socioeconomic statuses, culture, religion, and behavioural factors(16). Therefore, there is an urgent need to study the epidemiological and clinical characteristics of patients with COVID-19 in Sri Lanka. It is also important to study outcomes such as mortality, the number of patients requiring oxygen therapy and intensive care unit (ICU) care, and the total durations of hospital stays which may be unique to Sri Lankan patients with COVID-19.
The objectives of this study is to evaluate the clinical and epidemiological characteristics and outcomes of patients with COVID-19 admitted to six treatment centres in Sri Lanka.