Iranian Journal of Medical Sciences

Document Type : Original Article(s)

Authors

1 Non-Communicable Disease Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

2 Communicable Disease Control Center, Shiraz University of Medical Sciences, Shiraz, Iran

10.30476/ijms.2021.90768.2174

Abstract

Background: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has entered our lives with the fear of outbreak, death, and recurrence. Our objective in this study is to evaluate the epidemiological features of Coronavirus Disease 2019 (COVID-19) infection and death in Fars province, Iran.
Methods: A cross-sectional study was conducted from February 18th to September 30th, 2020, where age, history of underlying diseases, sex, community-wide quarantine, nationality, close contact, pregnancy, medical staff job, traveling , and residency were compared between alive and deceased groups. Data were analyzed using IBM SPSS software, version 22.0, and the significance level was set at 0.05.
Results: Regarding 57958 new cases of COVID-19, the basic reproduction number (R0) was estimated as 2.8, requiring a minimum of 65% immunization to reach herd immunity. Moreover, an R0=0.36 was required to reach the endemic state in the region. The incidence, mortality, fatality, and recurrence rates of COVID-19 were estimated as 1347.9 per 100,000 dwellers, 209.5 per 1000,000 dwellers, 1.6 %, and 3.1 per 100,000 dwellers, respectively. Age, history of underlying diseases, urban residency, and the male sex were significantly higher in the deceased group (OR=1.09, 5.48, 1.24, and 1.32; All Ps<0.001, <0.001, 0.005, and <0.001, respectively). In addition, the recurrence rate among positive cases was estimated as 0.23% with a median±inter-quartile range equal to 84±46.25 days. Community-wide quarantine was shown to be a protective factor for death due to COVID-19 (OR=0.58, P=0.005).
Conclusion: Community-wide quarantine blocks the transmission of COVID-19 effectively. COVID-19 enjoys no solid immunity. History of underlying diseases, the male sex, urban residency, and age were among the most significant causes of death due to COVID-19. Further investigations are recommended on the genetic structure of SARS-CoV-2, treatments, and vaccination.

Keywords

  1. Yang P, Wang X, Liu P, Wei C, He B, Zheng J, et al. Clinical characteristics and risk assessment of newborns born to mothers with COVID-19. J Clin Virol. 2020;127:104356. doi: 10.1016/j.jcv.2020.104356. PubMed PMID: 32302955; PubMed Central PMCID: PMCPMC7194834.
  2. Xie M, Chen Q. Insight into 2019 novel coronavirus - An updated interim review and lessons from SARS-CoV and MERS-CoV. Int J Infect Dis. 2020;94:119-24. doi: 10.1016/j.ijid.2020.03.071. PubMed PMID: 32247050; PubMed Central PMCID: PMCPMC7118633.
  3. Giannis D, Ziogas IA, Gianni P. Coagulation disorders in coronavirus infected patients: COVID-19, SARS-CoV-1, MERS-CoV and lessons from the past. J Clin Virol. 2020;127:104362. doi: 10.1016/j.jcv.2020.104362. PubMed PMID: 32305883; PubMed Central PMCID: PMCPMC7195278.
  4. Lai CC, Shih TP, Ko WC, Tang HJ, Hsueh PR. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): The epidemic and the challenges. Int J Antimicrob Agents. 2020;55:105924. doi: 10.1016/j.ijantimicag.2020.105924. PubMed PMID: 32081636; PubMed Central PMCID: PMCPMC7127800.
  5. Acter T, Uddin N, Das J, Akhter A, Choudhury TR, Kim S. Evolution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as coronavirus disease 2019 (COVID-19) pandemic: A global health emergency. Sci Total Environ. 2020;730:138996. doi: 10.1016/j.scitotenv.2020.138996. PubMed PMID: 32371230; PubMed Central PMCID: PMCPMC7190497.
  6. Al-Qahtani AA. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2): Emergence, history, basic and clinical aspects. Saudi J Biol Sci. 2020;27:2531-8. doi: 10.1016/j.sjbs.2020.04.033. PubMed PMID: 32336927; PubMed Central PMCID: PMCPMC7179492.
  7. Kang S, Peng W, Zhu Y, Lu S, Zhou M, Lin W, et al. Recent progress in understanding 2019 novel coronavirus (SARS-CoV-2) associated with human respiratory disease: detection, mechanisms and treatment. Int J Antimicrob Agents. 2020;55:105950. doi: 10.1016/j.ijantimicag.2020.105950. PubMed PMID: 32234465; PubMed Central PMCID: PMCPMC7118423.
  8. Singh A, Shaikh A, Singh R, Singh AK. COVID-19: From bench to bed side. Diabetes Metab Syndr. 2020;14:277-81. doi: 10.1016/j.dsx.2020.04.011. PubMed PMID: 32283498; PubMed Central PMCID: PMCPMC7194797.
  9. Li H, Liu SM, Yu XH, Tang SL, Tang CK. Coronavirus disease 2019 (COVID-19): current status and future perspectives. Int J Antimicrob Agents. 2020;55:105951. doi: 10.1016/j.ijantimicag.2020.105951. PubMed PMID: 32234466; PubMed Central PMCID: PMCPMC7139247.
  10. Tu H, Tu S, Gao S, Shao A, Sheng J. Current epidemiological and clinical features of COVID-19; a global perspective from China. J Infect. 2020;81:1-9. doi: 10.1016/j.jinf.2020.04.011. PubMed PMID: 32315723; PubMed Central PMCID: PMCPMC7166041.
  11. Law S, Leung AW, Xu C. Severe acute respiratory syndrome (SARS) and coronavirus disease-2019 (COVID-19): From causes to preventions in Hong Kong. Int J Infect Dis. 2020;94:156-63. doi: 10.1016/j.ijid.2020.03.059. PubMed PMID: 32251790; PubMed Central PMCID: PMCPMC7195109.
  12. Mirmohammadkhani M, Paknazar F, Rashidy-Pour A. Evaluation of the epidemiological pattern of COVID-19 applying basic reproduction number: an educational review article. Koomesh. 2020;22:373-9. doi: 10.29252/koomesh.22.3.373.
  13. Aghaali M, Kolifarhood G, Nikbakht R, Saadati HM, Hashemi Nazari SS. Estimation of the serial interval and basic reproduction number of COVID-19 in Qom, Iran, and three other countries: A data-driven analysis in the early phase of the outbreak. Transbound Emerg Dis. 2020;67:2860-8. doi: 10.1111/tbed.13656. PubMed PMID: 32473049; PubMed Central PMCID: PMCPMC7300937.
  14. Shahriarirad R, Khodamoradi Z, Erfani A, Hosseinpour H, Ranjbar K, Emami Y, et al. Epidemiological and clinical features of 2019 novel coronavirus diseases (COVID-19) in the South of Iran. BMC Infect Dis. 2020;20:427. doi: 10.1186/s12879-020-05128-x. PubMed PMID: 32552751; PubMed Central PMCID: PMCPMC7301075.
  15. Nikpouraghdam M, Jalali Farahani A, Alishiri G, Heydari S, Ebrahimnia M, Samadinia H, et al. Epidemiological characteristics of coronavirus disease 2019 (COVID-19) patients in IRAN: A single center study. J Clin Virol. 2020;127:104378. doi: 10.1016/j.jcv.2020.104378. PubMed PMID: 32353762; PubMed Central PMCID: PMCPMC7172806.
  16. McHugh ML. The odds ratio: calculation, usage, and interpretation. Biochemia medica. 2009;19:120-6. doi: 10.11613/BM.2009.011.
  17. Shereen MA, Khan S, Kazmi A, Bashir N, Siddique R. COVID-19 infection: Origin, transmission, and characteristics of human coronaviruses. J Adv Res. 2020;24:91-8. doi: 10.1016/j.jare.2020.03.005. PubMed PMID: 32257431; PubMed Central PMCID: PMCPMC7113610.
  18. Abd El-Aziz TM, Stockand JD. Recent progress and challenges in drug development against COVID-19 coronavirus (SARS-CoV-2) - an update on the status. Infect Genet Evol. 2020;83:104327. doi: 10.1016/j.meegid.2020.104327. PubMed PMID: 32320825; PubMed Central PMCID: PMCPMC7166307.
  19. Pan A, Liu L, Wang C, Guo H, Hao X, Wang Q, et al. Association of Public Health Interventions With the Epidemiology of the COVID-19 Outbreak in Wuhan, China. JAMA. 2020;323:1915-23. doi: 10.1001/jama.2020.6130. PubMed PMID: 32275295; PubMed Central PMCID: PMCPMC7149375.
  20. Harapan H, Itoh N, Yufika A, Winardi W, Keam S, Te H, et al. Coronavirus disease 2019 (COVID-19): A literature review. J Infect Public Health. 2020;13:667-73. doi: 10.1016/j.jiph.2020.03.019. PubMed PMID: 32340833; PubMed Central PMCID: PMCPMC7142680.
  21. Perez-Lopez FR, Tajada M, Saviron-Cornudella R, Sanchez-Prieto M, Chedraui P, Teran E. Coronavirus disease 2019 and gender-related mortality in European countries: A meta-analysis. Maturitas. 2020;141:59-62. doi: 10.1016/j.maturitas.2020.06.017. PubMed PMID: 33036704; PubMed Central PMCID: PMCPMC7309755.
  22. Zheng Z, Peng F, Xu B, Zhao J, Liu H, Peng J, et al. Risk factors of critical & mortal COVID-19 cases: A systematic literature review and meta-analysis. J Infect. 2020;81:e16-e25. doi: 10.1016/j.jinf.2020.04.021. PubMed PMID: 32335169; PubMed Central PMCID: PMCPMC7177098.
  23. Alzamora MC, Paredes T, Caceres D, Webb CM, Valdez LM, La Rosa M. Severe COVID-19 during Pregnancy and Possible Vertical Transmission. Am J Perinatol. 2020;37:861-5. doi: 10.1055/s-0040-1710050. PubMed PMID: 32305046; PubMed Central PMCID: PMCPMC7356080.
  24. Dashraath P, Wong JLJ, Lim MXK, Lim LM, Li S, Biswas A, et al. Coronavirus disease 2019 (COVID-19) pandemic and pregnancy. Am J Obstet Gynecol. 2020;222:521-31. doi: 10.1016/j.ajog.2020.03.021. PubMed PMID: 32217113; PubMed Central PMCID: PMCPMC7270569.
  25. Kasraeian M, Zare M, Vafaei H, Asadi N, Faraji A, Bazrafshan K, et al. COVID-19 pneumonia and pregnancy; a systematic review and meta-analysis. J Matern Fetal Neonatal Med. 2020:1-8. doi: 10.1080/14767058.2020.1763952. PubMed PMID: 32429786.
  26. Schwartz DA. An Analysis of 38 Pregnant Women With COVID-19, Their Newborn Infants, and Maternal-Fetal Transmission of SARS-CoV-2: Maternal Coronavirus Infections and Pregnancy Outcomes. Arch Pathol Lab Med. 2020;144:799-805. doi: 10.5858/arpa.2020-0901-SA. PubMed PMID: 32180426.
  27. Takemoto MLS, Menezes MO, Andreucci CB, Knobel R, Sousa LAR, Katz L, et al. Maternal mortality and COVID-19. J Matern Fetal Neonatal Med. 2020:1-7. doi: 10.1080/14767058.2020.1786056. PubMed PMID: 32674646.
  28. Bonifacio LP, Pereira APS, Araujo D, Balbao V, Fonseca B, Passos ADC, et al. Are SARS-CoV-2 reinfection and Covid-19 recurrence possible? a case report from Brazil. Rev Soc Bras Med Trop. 2020;53:e20200619. doi: 10.1590/0037-8682-0619-2020. PubMed PMID: 32965458; PubMed Central PMCID: PMCPMC7508196.
  29. Chen D, Xu W, Lei Z, Huang Z, Liu J, Gao Z, et al. Recurrence of positive SARS-CoV-2 RNA in COVID-19: A case report. Int J Infect Dis. 2020;93:297-9. doi: 10.1016/j.ijid.2020.03.003. PubMed PMID: 32147538; PubMed Central PMCID: PMCPMC7129213.
  30. Fernandes Valente Takeda C, Moura de Almeida M, Goncalves de Aguiar Gomes R, Cisne Souza T, Alves de Lima Mota M, Pamplona de Goes Cavalcanti L, et al. Case Report: Recurrent Clinical Symptoms of COVID-19 in Healthcare Professionals: A Series of Cases from Brazil. Am J Trop Med Hyg. 2020;103:1993-6. doi: 10.4269/ajtmh.20-0893. PubMed PMID: 32888288; PubMed Central PMCID: PMCPMC7646791.
  31. Xiao AT, Tong YX, Zhang S. False negative of RT-PCR and prolonged nucleic acid conversion in COVID-19: Rather than recurrence. J Med Virol. 2020;92:1755-6. doi: 10.1002/jmv.25855. PubMed PMID: 32270882; PubMed Central PMCID: PMCPMC7262304.
  32. Zhou L, Liu K, Liu HG. [Cause analysis and treatment strategies of “recurrence” with novel coronavirus pneumonia (COVID-19) patients after discharge from hospital]. Zhonghua Jie He He Hu Xi Za Zhi. 2020;43:281-4. doi: 10.3760/cma.j.cn112147-20200229-00219. PubMed PMID: 32118391.
  33. Sjodin H, Wilder-Smith A, Osman S, Farooq Z, Rocklov J. Only strict quarantine measures can curb the coronavirus disease (COVID-19) outbreak in Italy, 2020. Euro Surveill. 2020;25. doi: 10.2807/1560-7917.ES.2020.25.13.2000280. PubMed PMID: 32265005; PubMed Central PMCID: PMCPMC7140595.
  34. Aleta A, Martin-Corral D, Pastore YPA, Ajelli M, Litvinova M, Chinazzi M, et al. Modelling the impact of testing, contact tracing and household quarantine on second waves of COVID-19. Nat Hum Behav. 2020;4:964-71. doi: 10.1038/s41562-020-0931-9. PubMed PMID: 32759985; PubMed Central PMCID: PMCPMC7641501.
  35. Parmet WE, Sinha MS. Covid-19 - The Law and Limits of Quarantine. N Engl J Med. 2020;382:e28. doi: 10.1056/NEJMp2004211. PubMed PMID: 32187460.
  36. Muscogiuri G, Barrea L, Savastano S, Colao A. Nutritional recommendations for CoVID-19 quarantine. Eur J Clin Nutr. 2020;74:850-1. doi: 10.1038/s41430-020-0635-2. PubMed PMID: 32286533; PubMed Central PMCID: PMCPMC7155155.
  37. Mazza M, Marano G, Lai C, Janiri L, Sani G. Danger in danger: Interpersonal violence during COVID-19 quarantine. Psychiatry Res. 2020;289:113046. doi: 10.1016/j.psychres.2020.113046. PubMed PMID: 32387794; PubMed Central PMCID: PMCPMC7190494.