Artículos

Demographic and clinical characteristics of patients infected with COVID-19 at the General Hospital of Macas

Características demográficas y clínicas de pacientes contagiados de COVID-19 en el Hospital General de Macas

Sandra Paola Nagua Uyaguari
University of Cuenca, Ecuador., Ecuador
Isabel Cristina Mesa-Cano
University of Cuenca,, Ecuador
Andrés Alexis Ramírez-Coronel
University of Cuenca,, Ecuador

Demographic and clinical characteristics of patients infected with COVID-19 at the General Hospital of Macas

Archivos Venezolanos de Farmacología y Terapéutica, vol. 40, núm. 6, pp. 563-568, 2021

Sociedad Venezolana de Farmacología Clínica y Terapéutica

Queda prohibida la reproducción total o parcial de todo el material contenido en la revista sin el consentimiento por escrito del editor en jefe.

Recepción: 28 Junio 2021

Aprobación: 15 Agosto 2021

Publicación: 10 Octubre 2021

Resumen: El COVID-19 es una enfermedad provocada por el virus SARS-CoV-2. La Organización Mundial de la Salud la declaró pandemia mundial el 11 de marzo de 2020. En el Hospital General de Macas ingresaron al servicio de UCIM 24 pacientes de etnia shuar de los cuales 14 fallecieron. El oriente ecuatoriano alberga comunidades indígenas shuar en donde sus creencias, cultura, situación sociodemográfica y económica podría dificultar el diagnóstico temprano y la propagación del virus. Objetivo: Determinar las características demográficas y clínicas de pacientes contagiados de COVID-19 en el servicio de UCIM del Hospital General de Macas. Metodología Investigación cuantitativa cuya población fue de 110 personas (N=110) que ingresaron al servicio de UCIM del Hospital General de Macas. Se realizó un muestreo no probabilístico por conveniencia de acuerdo con los ingresos hospitalarios, misma que estuvo integrada por jóvenes, adultos y adultos mayores diagnosticados y con clínica de SAARS COVID-19 al ingreso al servicio. Se revisó la historia clínica de los pacientes y bases de datos. La información fue revisada, analizada, transcrita en Word, se usó el software INFOSTAT y para la generación de tablas y gráficos se usó el software Microsoft Excel.

Palabras clave: Enfermedad, pueblos indígenas, pandemia.

Abstract: COVID-19 is a disease caused by the SARS-CoV-2 virus. The World Health Organization declared it a global pandemic on March 11, 2020. In the General Hospital of Macas, 24 patients of Shuar ethnicity were admitted to the ICU service, 14 of whom died. Eastern Ecuador is home to indigenous Shuar communities where their beliefs, culture, socio-demographic and economic situation could hinder early diagnosis and spread of the virus. Objective: To determine the demographic and clinical characteristics of patients infected with COVID-19 in the ICU of the General Hospital of Macas. Methodology: Quantitative research with a population of 110 people (N=110) admitted to the ICU of the General Hospital of Macas. A non-probabilistic convenience sampling was carried out according to hospital admissions, which consisted of young people, adults and older adults diagnosed with SAARS COVID-19 at admission to the service. The patients' medical records and databases were reviewed. The information was reviewed, analyzed, transcribed into Word, INFOSTAT software was used, and Microsoft Excel software was used to generate tables and graphs.

Keywords: Disease, indigenous peoples, pandemic.

Introduction

COVID-19 (Coronavirus Disease) is a disease caused by the SARS-CoV-2 virus1,2. The World Health Organization (WHO) declared it a pandemic on March 11, 20201. There are several signs and symptoms that an infected person may present, according to related studies carried out in Argentina, which indicated that the most frequent symptoms in patients were: fever, cough, dyspnea3. The most prevalent comorbidities were: hypertension, obesity, cardiovascular disease and chronic respiratory disease1. In the imaging tests, bilateral pulmonary involvement predominates4. Authors report different cutaneous manifestations such as erythematous rash, vesicles, urticaria and necrosis2.

It has been shown that the majority of patients infected by Covid-19 are adults, and a very low percentage are young or under 20 years of age5. However, due to the increase in the infected population, this population group (which group? The young or the shuar?) is likely to contract the virus and be a source of spread6. According to Covid-19 situation reports issued in Ecuador, the elderly have been the most affected by the pandemic5. It should be emphasized that the Ecuadorian state lacks specific public policies to prevent and neutralize the risk of disappearance of these population groups, (which group? The young or the shuar?) as well as tools to ensure the fulfillment of collective rights7.

WHO reports that indigenous people, Afro-descendants and people belonging to other ethnic groups may be at higher risk of contracting COVID-19 due to a number of limitations in the use of basic hygiene measures, such as hand washing or social distancing due to their lifestyles and the socioeconomic conditions in which they live7,8. During the pandemic, community health in indigenous communities is seriously affected not only by the high prevalence of chronic non-communicable and infectious diseases and previous precarious socioeconomic conditions8,9; but also by the lack of information, which makes this population group prefer not to seek health assistance and to adopt non-pharmacological alternatives to overcome the virus, without having the due certification of the benefits of these practices, due to the recent appearance of the virus and the unknown lethality10.

In the province of Morona Santiago, according to the provincial bulletin of extraction issued on May 28, 2020, of the 103 people with confirmed diagnosis in the province; 73 were between the ages of 15 to 49 years and until July, the number of Covid-19 cases increased significantly reaching 2,238 people infected since the first confirmed case11. Likewise, the Confederation of Indigenous Nationalities of the Ecuadorian Amazon, CONFENIAE, reported an exponential increase in infection, with 1,435 confirmed cases and 37 deaths, of which 25 were confirmed with Covid-19 and 12 with other symptomatologies. Of those infected, 48.7% were Kichwa, 23.41% were Shuar and 20.7% were Waorani12,13.

In the city of Macas, belonging to the province of Morona Santiago, patients with clinical and symptomatology of Covid-19 are admitted daily. Many of them are of Shuar ethnicity, so the following question prevails: ¿What are the demographic and clinical characteristics of patients infected with COVID-19?

According to epidemiological models of transmission in Chile and Colombia, the behavior of the pandemic is analyzed with the evolution of the data provided by the countries and the increase in the number of tests performed, the number of people diagnosed positive, the population and the total number of deaths14. SIR or SEIR models have also been developed15. Control strategies have also been identified for Covid-19, which are mainly based on the concepts of social distancing and quarantine15.

It is necessary to analyze the relationship between the clinical and demographic characteristics of patients infected with the new virus and leave research bases where traditional knowledge and wisdom are included in the health area to form a real intercultural health.

For the above mentioned, the following general objective has been established: To determine the demographic and clinical characteristics of patients infected with COVID-19 in the UCIM service of the General Hospital of Macas. To achieve this objective, the following specific objectives were necessary: To estimate the prevalence of patients with COVID-19 according to demographic and clinical characteristics. To analyze if there are differences in clinical characteristics according to age, sex and ethnicity and finally to identify demographic characteristics and mortality due to COVID-19 in the Shuar population.

Methodology

Type of research

Descriptive quantitative research

Population

The sample population was 110 people (n=110) admitted to the ICU service of the General Hospital of Macas- Morona Santiago during the period April 2020 to May 2021.

Sample

A non-probabilistic convenience sampling was performed according to hospital admissions and discharges. The medical records and databases managed in the service were reviewed and analyzed for information, which was reviewed, analyzed, transcribed into Word, Excel and Infostat software was used for the extraction of statistical data.

Variables

The prevalence of Covid-19 will be analyzed according to demographic characteristics and clinical characteristics at admission to the Intermediate Care Unit. At the end, the results of the condition at discharge of the Shuar ethnic group will be related to the demographic characteristics and the variables Age and Sex.

Inclusion Criteria

Within the inclusion criteria, the clinical history of all young people, adults and older adults diagnosed and with clinical SARS COVID-19 was reviewed.

Exclusion Criteria

Patients admitted to the service for other diseases, pregnant women, and medical records that could not be accessed due to errors in entering the ID number were excluded.

Procedure

For the following study, the corresponding permissions were requested from the General Manager of the institution to review the medical records, which was accepted. They were then downloaded from the HOSVITAL system, stored and finally downloaded for the creation of an Excel database. Variables describing demographic and clinical characteristics were created. In addition, a code was assigned to preserve the confidentiality and anonymity of each patient treated based on the HELSINKI ethical principles. Subsequently, the database was transferred to the INFOSTAT software where the statistical analysis was performed.

Statistical analysis

A descriptive univariate analysis was performed using absolute and relative frequencies for qualitative variables (nominal and ordinal) and for quantitative variables (discrete and continuous) summary measures such as central tendency, position and dispersion were presented, depending on the normality of the variables using the Shapiro Wilks or France test.

Subsequently, a bivariate analysis was performed, firstly, the normality and homoscedasticity (Levene) of the dependent variable was established by partitioning the independent variables; and in the second step, an analysis of differences of means was performed using Student's t-test for independent samples of two groups and the ANOVA test for groups of three or more. The aforementioned statistical analyses were carried out using the Infostat program.

RESULTS

Table 1: Demographic Characteristics

Table 1
Demographic Characteristics
f%
AGEYOUNG ADULT OLDER ADULT6 53 5110 48 46
SEXMALE6256
WOMAN4844
GUALAQUIZA55
LIMON33
RESIDENCIAMACAS7467
MENDEZ76
SUCUA1312
TAISHA87
ETHNICITYMESTIZO8678
SHUAR2422
SECONDARY6761
ACADEMIC LEVELHIGHER2119
SUPERIOR2220

Table 1 shows that 48% and 46% of the patients admitted to the ICU service at the General Hospital of Macas were adults and older adults, respectively. Of this group, 56% were men and 44% were women.

The most frequent residence of 67% of the patients was the city of Macas, and Sucua with 12%, while the rest of the patients said they belonged to other cantons of the province. The highest number of infections according to ethnicity was: mestizo with 78% of those admitted, while in the Shuar ethnicity it was 22%. The percentages according to academic level were primary school with 61%, high school with 20%, followed by secondary school with 19%.

Table 2: Clinical Characteristics

Table 2
Clinical Characteristics
AVERAGEMEDIANSTANDARD DEVIATIONMINIMUMMAXIMUMp
SPO289.67939.4643980.00
HEART RATE86.378518.74451350.01
RESPIRATORY RATE27.69268.1715520.00
TEMPERATURE36.87370.7336400.00
SYSTOLIC BLOOD PRESSURE123.95125.5024.57602020.01
DIASTOLIC BLOOD PRESSURE74.6773.5014.45301180.13
WEIGHT72.017017.3342.201380.00
BLOOD GLUCOSE165.3813684.16515450.00

Prepared by: The authors

The review of the medical records showed that 100% of the patients who entered this study manifested asthenia, cough, respiratory distress and the X-ray examination showed alveolar-interstitial infiltrates characteristic of Covid-19.

Regarding the vital signs on admission to the service, most patients were afebrile with mean temperatures of 36.8°C, tachypneic, saturating over 90% with oxygen support. Blood pressure between 125/ 75 mmHg and with metabolic disorders given the values of capillary glycemia with maximum values of 545 mg/dl and minimum of 51 mg/dl at admission. The maximum weight recorded was 138 kg and the minimum weight was 42.20 kg.

Table 3: Clinical Difference according to Demographic Data

Table 3
Clinical Difference according to Demographic Data
EDADAdolescenteAd. JovenAdultoAdulto MayorF (Anova, Bf)Kw
SPO288.508591950.19
HEART RATE9290.5087.6884.470.76
RESPIRATORY RATE2523.2529260.12
TEMPERATURE3736,536.8536.920.71
SYSTOLIC BLOOD PRESSURE112.50112.50123.53125.750.66
DIASTOLIC BLOOD PRESSURE75.5080.7574.7074.140.85
WEIGHT77.5075.5067.975.790.12
BLOOD GLUCOSE3491091381480.01

SEXO Hombre (Md) Mujer (Md) U P
Heart Rate85.4883.6525.28.500.41
Respiratory Rate27.0025.502673.000.95
Temperature36.8936.852627.500.81
Systolic Blood Pressure130.00123,002374.000.08
Diastolic Blood Pressure76.7172.042424.500.14
Weight70.5066.502422.000.14
Blood Glucose131.50149.502912.000.13
ETNIA Mestiza (md)Shuar (md) U p
Heart Rate85.9186.001377.000.74
Respiratory Rate25.0026.501405.000.59
Temperature36.8836.831319.000.91
Systolic Blood Pressure130.00116.00938.000.00
Diastolic Blood Pressure77.0070.421103.500.09
Weight72.0055.00584.000.00
Blood Glucose140.50123.501116.000.20

Prepared by: The authors

According to the clinical differences according to age, all variables except for oxygen saturation and blood glucose are not normal and according to these data Bonferroni and kruskal Wallis were used. In the variables of sex and ethnicity, the medians were analyzed.

It can be seen that there are differences in the clinical characteristics according to the demographic data. According to age there are differences at respiratory level. The group of adolescents and young adults presented moderate to severe hypoxia, while, the group of adults and older adults presented mild hypoxia. It should be noted that all saturation values were taken with supplemental oxygen support. Regarding respiratory frequency, all age groups, sex and ethnicity presented some degree of tachypnea. However, the group of adults and older adults presented higher tachypnea. The highest mean weight recorded was in the group of adolescents, young adults and older adults. It was found that the mestizo ethnic group registered higher weights than the Shuar ethnic group. Capillary glycemia is elevated in women of mestizo ethnicity and in all age groups, but the group of adolescents and older adults is noteworthy because it shows a higher peak of capillary hyperglycemia.

Table 4
Demographic Characteristics and Mortality of the Shuar Ethnic Group
N=24
Agef%
Male Female1354.16
1145.8
Age Adolescent 1 4.10
Young28.33
Adult1770.83
Adult Older416.66
Residence
Macas1458.33
Mendez28.33
Sucua28.33
Taisha625
Academic Level
Primary1979.16
Secondary14.16
Higher416.66
Condition Of Exit
Ucim Discharge937,50
Deceased1250
Reference14.16
Discharge Requested28.33

Prepared by: The authors

According to age, most of the infected persons were adults and older adults, according to sex, COVID-19 prevailed more men than women residing in the city of Macas and Taisha. The majority of this group had primary education followed by professionals with third level education.

According to the condition of discharge, 12 people died and 2 requested discharge. According to the reports in the medical records, these two people, due to the health conditions in which they were, most probably died, which adds up to the number of deaths in this group.

DISCUSSION

In this analysis, the prevalence of Covid-19 according to demographic characteristics in relation to age is adults and older adults. According to sex, more men than women enter the service, which coincides with several articles describing increased morbimortality in adults and the male gender (16.7). Regarding illiteracy in the Shuar ethnic group, primary education prevails; an article published in Colombia on the impact of Covid-19 in the Amazon, indicates similar data in indigenous ethnic groups17.

Within the clinical characteristics there is the expression of asthenia, cough, respiratory difficulty and in the X-Ray examination there was evidence of alveolar-interstitial infiltrates characteristic of Covid-19, these data are similar to other studies reported at national and international level where metabolic diseases such as diabetes mellitus type II and nutritional disorders such as overweight are also included7,15,18,19. The sample collected in the study according to the Shuar ethnic group corresponds to 22% which corresponds to a small sample, however, López in his publication agrees that this is a worrying reality due to the low demographics of these populations13.

The study shows that the Shuar population is admitted with moderate hypoxia and more than half of those admitted died. Some authors indicate that many of the hospital admissions due to severe respiratory insufficiency related to Covid-19 are of people who did not go to health centers in a timely manner8,10and that the cultures have their own cosmovision and traditional medicines. Moncada and Salazar indicate that it is not possible to impose other types of practices without negative consequences and perhaps worse than the evils to be avoided20. Another factor in this problem may be residence in rural areas where accessibility to health care is limited.

In this study, although the majority of the Shuar ethnic group indicated that they live in the city of Macas, a good percentage indicated that they live in Taisha, a remote town in Morona Santiago that is difficult to access. This is indicated by the WHO through its humanitarian response plan in Ecuador, which recognizes the vulnerability of these peoples due to their relative geographic isolation.

CONCLUSIONS

We were able to identify the prevalence of Covid-19 according to the demographic and clinical characteristics of the patients admitted to the ICU area of the General Hospital of Macas. In addition, it was found that there were no clinical differences according to age, sex or ethnicity, which gives food for thought and raises new hypotheses about the evolution and virulence of the disease. Mortality in the Shuar ethnic group is high given the low demography of these peoples. It is essential that health personnel in remote communities carry out promotional activities on respiratory hygiene and warn about the warning signs in which the population should isolate themselves and seek health care, given the high mortality rate in these ethnic groups.

Knowledge of the behavior of Covid-19 can help to create new prevention alternatives. Especially in groups that are socially isolated by different factors, vulnerable and at higher risk of death.

It leaves a basis for future research and urges the creation of new intercultural policies adapted to the reality of each people and which include the knowledge and ancestral knowledge of the indigenous communities of Ecuador.

References

1. Pascarella G, Strumia A, Piliego C, Bruno F, Del Buono R, Costa F, et al. COVID-19 diagnosis and management: a comprehensive review. Vol. 288, Journal of Internal Medicine. 2020.

2. The main skin manifestations of COVID-19 identified. Br J Dermatol. 2020;183(1):e17.

3. Wainer P, Saavedra F, Tagliapietra V, Abeledo D, Migliore D, Lapadula P, et al. covid-19 experience in a private sanatorium in Buenos Aires during the first month of the pandemic: 26 CASES. Argentina. 2020;1(COVID 19).

4. Seabra C, Fagundes V. The importance of chest radiography in the diagnosis of pneumonia in COVID-19. Galicia Clinica. 2021;82(1).

5. Ministry of Public Health. Alert for multisystemic inflammatory syndrome. 2020; Available from: https://www.salud.gob.ec/wp-content/uploads/Alerta_por_síndrome_inflamatorio_multisistémico_2020-MSP.pdf

6. Health Services Development Directorate. Differentiated management of adolescents facing the Covid-19 pandemic in the Integrated Health Services Network. 2021;1-12. Available from: https://www.ccss.sa.cr/web/coronavirus/assets/materiales/personal/lineamientos/443.pdf

7. PAHO/WHO. Covid-19 Ecuador humanitarian response plan. Organ Mund la Salud [Internet]. 2020;1-44. Available from: https://reliefweb.int/sites/reliefweb.int/files/resources/20200430-EHP-ECUADOR-COVID-19.pdf

8. Protocol with intercultural relevance for the prevention and care of COVID-19 in indigenous peoples and nationalities of Ecuador. Prevention And Care of Covid-19 In Indigenous Peoples and Nationalities. 2020;1-39. Available from: https://www.salud.gob.ec/wp-content/uploads/2020/10/Actualizacion-2.0-Protocolo-Con-Pertinencia-Intercultural-Para-La-Prevencion-Y-Atencion-Del-Covid-19-En-Pueblos-Y-Nacionalidades-Indigenas-Afroecuatorianos-Y-Montubios-Del-Ecuador-1.pdf

9. Abufhele M, Jeanneret V, Abufhele M, Jeanneret V. Puertas Adentro: La otra cara de la pandemia. Rev Chil Pediatrics [Internet];91(3):319. Available from: http://www.revistachilenadepediatria.cl/index.php/rchped/article/view/2487

10. Gonçalves JE, Mendes RCMG, Silva WM da, Peixinho BC, Oliveira MB de Albuquerque JL da S, et al. Indigenous traditional medicine in times of the COVID-19 pandemic. Rev Eletrônica Acervo Saúde. 2020;12(10):e4713..

11. Ministry of Public Health. Boletin Provincial [Internet]. 2020. Available from: https://www.salud.gob.ec/wp-content/uploads/Morona-Santiago-2-6.pdf

12. CONFENIAEIE. COVID 19 records update [Internet]. 2020. Available from: https://confeniae.net/2020/actualizacion-de-registros-de-covid-19-y-lanzamiento-del-portal-interactvio-para-monitoreo-del-impacto-de-la-pandemia-en-territorios-amazónicos

13. Enrique L. The subalternity of native languages in times of pandemic [Internet]. lAngewandte Chemie International Edition, 6(11), 951-952. 1967. Available from: https://tarea.org.pe/wp-content/uploads/LuisEnriqueLopez-Otra_peste_mas.pdf

14. Alicia Aleman, Mercedes Pérez, Gabriela Cuello, Griselda Bittar, Magdalena Irisarri, Cavalleri F. Epidemiological models in the SARS-CoV-2 pandemic: concept, applications and scope. Rev Uruguaya Med Interna. 2020;05(03).

15. Catano-Lopez A, Rojas-Diaz D. Discrete models of COVID-19 transmission and preliminary publications in science: a systematized search. 2020.

16. Arcos IV De. Analysis of association of sociodemographic factors with covid-19 severity and mortality. 2017;(1):19. Available from: http://site.curn.edu.co:8080/jspui/bitstream/123456789/385/1/tercer semestre enferm bquilla 2020-2.pdf.

17. Issn S. Impact of the covid-19 pandemic in the Amazon, Colombia. Rev la Univ Ind Santander Saludevista la Univ Ind Santander Salud [Internet]:187-9. Available from: https://www.redalyc.org/journal/3438/343864478022/343864478022.pdf

18. Medina P, Gualoto B, Chamorro P, Vera P. Nursing care to adult patients with COVID-19 without respiratory complications. Protoc Nursing care to adult patients with COVID-19 without Respir Complications [Internet]. Available from: file:///D:/maestria/PROTOCOLO-COVID-19-nursing-.pdf.

19. Casas-Rojo JM, Antón-Santos JM, Millán-Núñez-Cortés J, Lumbreras-Bermejo C, Ramos-Rincón JM, Roy-Vallejo E, et al. Clinical characteristics of patients hospitalized with COVID-19 in Spain: Results from the SEMI-COVID-19 Registry. Rev Clin Esp.

20. Moncada-Mapelli E, Salazar-Granara A. Traditional medicine and COVID-19, opportunity for the revaluation of Peruvian Medicinal Plants. Rev of the Medical Corps of HNAAA.

HTML generado a partir de XML-JATS4R por