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Published on: December 19, 2020
Characteristics and factors associated with severity of COVID-19 infections in primary care
Yeow Siong Lee1, Jazlan Jamaluddin2, Bee Kiau Ho3
1MBBS (IMU), MMed (Family Medicine) (UM), Klinik Kesihatan Selayang Baru, Jalan Sungai Tua, Batu Caves, Selangor Darul Ehsan, Malaysia.
Insights
COVID-19 severity in Malaysia
Area of Science:
- Epidemiology
- Public Health
- Infectious Diseases
Background:
- Primary care facilities are crucial for early COVID-19 assessment in Malaysia.
- The post-vaccination period necessitated an evaluation of COVID-19 severity risk factors.
Purpose of the Study:
- To identify risk factors for severe COVID-19 at primary care presentation after vaccination.
- To analyze demographic, comorbidity, clinical, and vaccination data.
Main Methods:
- Retrospective analysis of 4406 adult COVID-19 patients from October-December 2021.
- Utilized Selangkah system data from 10 government health clinics in Gombak district.
- Employed univariate and multivariable logistic regression to determine severity factors.
Main Results:
- 97.1% of cases were mild, 2.9% severe.
- Key severity determinants included fever, dyspnea, lethargy, upper respiratory symptoms, low oxygen saturation (<95%), tachypnea (>20 breaths/min), CoronaVac vaccination, and hypertension.
- Significant differences in severity were observed between COVID-19 vaccine types.
Conclusions:
- The high proportion of mild cases suggests a positive impact of vaccination, with 84.9% fully vaccinated.
- Clinical features and comorbidities identified can aid primary care physicians in patient stratification for appropriate management (hospital referral vs. home quarantine).
- Vaccine type may influence COVID-19 severity.
Introduction:
Primary care service plays a vital role in early clinical assessment of patients with COVID-19 in Malaysia. This study aimed to evaluate the potential risk factors of COVID-19 severity at presentation to primary care facilities in the post-vaccination period.
Method:
Clinical records from the Selangkah system of all patients with COVID-19 aged above 18 years seen at COVID-19 assessment centres located in 10 government health clinics in Gombak district, Selangor, from 1 October to 31 December 2021 with complete documentation and outcomes were retrieved. Demographics, comorbidities, clinical features and vaccination statuses and types were retrospectively evaluated. The variables were compared between mild and severe diseases. Univariate and multivariable logistic regressions were used to identify the factors affecting disease severity.
Results:
A total of 4406 patients (median age=37 years, men=51.2%) were analysed. Approximately 97.1% of the cases were mild, while 2.9% were severe. Fever, difficulty breathing, lethargy, throat irritation/runny nose, oxygen saturation of <95%, respiratory rate of >20 breaths per minute, CoronaVac vaccination and hypertension were the determinants of severity (P<0.05).
Conclusion:
The high proportion (97.1%) of mild cases in this study compared with an earlier report (81.8%) during the pre-vaccination period may suggest the impact of vaccine, as 84.9% of this cohort was fully vaccinated. Our study also demonstrated a significant difference in COVID-19 severity between the vaccine types. The identified clinical features and comorbidities could assist primary care doctors in stratifying patients with COVID-19 judiciously in terms of hospital referral or home quarantine.
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