Protean presentation of COVID-19: An evidence-based study – Lessons learned

Abstract

Introduction: Variants of the severe acute respiratory syndrome (SARS) coronavirus 2, responsible for SARS, continue to cause devastating impact on public health and the economy. To critically assess the clinical, laboratory, extent of radiological involvement in the lung parenchyma, and their outcomes among admitted cases during the pandemic surge and to determine whether there is a protean presentation of the biological behavior of the COVID-19 virus variants, a study was conducted in the Odisha province of Eastern India. Materials and Methods: A retrospective observational study was conducted by data collected from the electronic medical records relating to detail demographic, clinical, laboratory, imaging, and outcome among the reverse transcriptase–polymerase chain reaction (RT-PCR)-positive admitted cases relating to three cycles of admission from April 2020 to April 2022 consisting of the 272 admitted cases during the period from April 2020 to December 2020 as a first wave and 200 admitted cases during the period from April 2021 to August 2021 as a second wave and pattern of illness from February 2022 to April 2022, as per local health authority information. In the 200 cases, there were 70 COVID-19-vaccinated and 130 nonvaccinated persons. Following COVID-recovered cases, a study was undertaken for the pulmonary imaging evaluation Results: Wide variations in incidence and illness type were seen, with pneumonia accounting for 28% of cases in the second wave and mild upper respiratory illnesses for 79% of cases in the first. Acute respiratory distress syndrome was observed in 72% of cases, and nonvaccinated people had a higher prevalence of severe cases than vaccinated people. Males suffered more than females. Normal platelet count in coagulopathy associated with COVID was witnessed. More extensive lung involvement and associated comorbidities were poor prognostic indicators, but paradoxically, cases recovered despite elevated neutrophil–lymphocyte ratios, C-reactive protein, and D -dimer levels. Conclusion: While the majority of illnesses during the second wave were moderate to severe, mild upper respiratory illnesses were observed during the first wave period. The subsequent COVID illness was a mild upper respiratory infection. This was due to the community-wide rollout of the COVID vaccine, which began in phases and continued in full force. After the RT-PCR for COVID turned out to be negative during the second wave, long COVID started to appear among the recovered cases. It included pulmonary manifestations such as, fatigue, coughing, and dyspnea, and imaging features such as fibrosis, ground-glass opacity, cavities, and extrapulmonary presentations. Vaccination of the population is the only tool to contain this pandemic.