Management of COVID-19 Pneumonia: Experience in a Peripheral Tertiary Level Hospital in Bangladesh

Abstract

Background: Since the detection of the first case of the novel SARS-CoV-2 virus in Wuhan, China, on December 31, 2019, the world stepped into an era of the pandemic as declared by WHO on March 11, 2020. With no prior knowledge regarding this new pandemic, the evidence-based practice of medical management was at stake. Experience sharing from different corners of the world played an essential role in building knowledge to save the world. Methods: The researchers collected data for this retrospective study, from hospital records of the COVID-19 dedicated unit of Sylhet Women’s Medical College, Sylhet, Bangladesh, that was formed temporarily in July 2020, in response to the pandemic situation in the country. This article includes data on 3408 admitted COVID-19 patients with moderate to severe symptoms, managed in the isolation unit including its intensive care unit (ICU) up to November 2021. Results: The mean age of the patients was 57.21±12.58 years and male to female ratio was 1:1.8. Fever (44.4%), cough (38.9), and fatigability (33.3%) were the common symptoms. Diabetes mellitus (67.7%), systemic hypertension (63.7%), asthma (8.65%), chronic obstructive pulmonary disease (21.94%), and, ischemic heart disease (31.2%) were the top co-morbid conditions. Of the study subjects, 68.2% were RT-PCR positive for COVID-19, 67.3% had an abnormal baseline chest X-ray, and 91.1% had a ground glass shadow on a high-resolution CT scan of chest. Average C-reactive protein, D-dimer, and serum ferritin values were 71.68±60.38, 1.16±2.11, and 839±748.57 respectively. Hypoxemia, which was a common problem among them, was managed with oxygen therapy with an appropriate delivery device, with or without supplementation by dexamethasone (78.3%), or methylprednisolone (18.8%). Eighteen (18) patients refused to receive any antiviral therapy, 61 received oral Favipiravir and the rest of them received injectable Remdesevir. Standard care was augmented with Baricitinib in 60 patients. Thirty-six (36) patients in the ICU, with poor response to standard care, were treated with Tocilizumab. Death rates were 9.46% in the non-ICU block, but they were 6-10 times higher in the ICU. Conclusion: Every medical professional learned from the initial two years of the COVID-19 pandemic. Lessons learnt from experience helped building up the knowledge pool necessary for generating effective protocols for COVID-19 pneumonia management.