The effect of national restrictions on computed tomography severity score and the prognosis of COVID-19

Year 2022, , 94 - 97, 01.02.2022

İsmet Miraç Çakır , Tümay Bekci , Serdar Aslan , Uluhan Eryürük , Emrah Sülün , İskender Aksoy , İlknur Yavuz

https://doi.org/10.28982/josam.954935

Abstract

Background/Aim: The SARS-CoV-2 pandemic is spreading rapidly all over the world and has high mortality rates. Governments implement quarantine or restrictions to prevent the virus from getting out of control. Computed Tomography (CT) has an important place in the diagnosis of COVID-19 and patient management. This study aimed to evaluate the changes in chest CT findings and the disease prognosis of COVID-19 pneumonia during the restriction and post-restriction periods.
Methods: A total of 1150 patients whose COVID-19 disease was confirmed by a reverse transcriptase-polymerase chain reaction and who underwent chest CT examination between April 1-September 30, 2020 were included in this retrospective cohort study. The participants were categorized into two groups according to CT examination dates, as during (April 1-May 31), and after the restriction periods (June 1-September 30). Each patient's CT severity score (CTSS) was calculated, and the need for admission to the intensive care unit (ICU) and mortality related to COVID-19 were noted for statistical analysis.
Results: Of the 1150 cases, 213 were in the restriction period group (RPG), while 937 were in the post-restriction period group (PRPG). The median value of CTSS was 5 in the RPG, and 6 in the PRPG (P=0.095). In the RPG and PRPG, the number of patients who needed ICU admission were 20 (9.4%), and 50 (5.3%), respectively, while 12 (7%) and 39 (4.2%) patients, respectively, died from COVID-19. Both parameters were comparable between the two groups (P=0.073, P=0.060 respectively).
Conclusion: The restrictions did not change the severity of the COVID-19 disease, ICU hospitalization rate, and death rate.

Keywords

COVID-19, Computed tomography, Restriction period, Post-restriction period

References

• 1. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382:727-33.
• 2. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395:497-506.
• 3. Aslan S, Bekçi T, Çakır İM, Ekiz M, Yavuz İ, Şahin AM. Diagnostic performance of low-dose chest CT to detect COVID-19: A Turkish population study. Diagn Interv Radiol. 2021 Mar;27(2):181-7.
• 4. Zhao W, Zhong Z, Xie X, Yu Q, Liu J. Relation between chest CT findings and clinical conditions of coronavirus disease (COVID-19) pneumonia: a multicenter study. AJR Am J Roentgenol. 2020;214: 1072-7.
• 5. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395:1054-62.
• 6. Giangreco G. Case fatality rate analysis of Italian COVID-19 outbreak. J Med Virol. 2020;92:919-23.
• 7. Pan F, Ye T, Sun P, Gui S, Liang B, Li L, et al. Time course of lung changes on chest CT during recovery from 2019 novel coronavirus (COVID-19) pneumonia. Radiology. 2020;295:715-21.
• 8. Parmet WE, Sinha MS. Covid-19 - The Law and Limits of Quarantine. N Engl J Med. 2020 Apr 9;382(15):e28.
• 9. Tang S, Mao Y, Jones RM, Tan Q, Ji JS, Li N, et al. Aerosol transmission of SARS-CoV-2? Evidence, prevention, and control. Environ Int. 2020 Nov;144:106039.
• 10. Van Doremalen N, Bushmaker T, Morris DH, Holbrook MG, Gamble A, Williamson BN, et al. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. N. Engl. J. Med. 2020;382:1564–7.
• 11. Liu Y, Ning Z, Chen Y, Guo M, Liu Y, Gali NK, et al. Aerodynamic analysis of SARS-CoV-2 in two Wuhan hospitals. Nature. 2020;5827813:557-60.
• 12. Tellier R, Li Y, Cowling BJ, Tang JW. Recognition of aerosol transmission of infectious agents: a commentary. BMC Infect Dis. 2019;19:101.
• 13. Lu J, Gu J, Li K, Xu C, Su W, Lai Z, et al. COVID-19 outbreak associated with air conditioning in restaurant, Guangzhou, China, 2020. Emerg Infect Dis. 2020;26:1628-31.
• 14. Shen Y, Li C, Dong H, Wang Z, Martinez L, Sun Z, et al. Community Outbreak Investigation of SARS-CoV-2 Transmission Among Bus Riders in Eastern China. JAMA Intern Med. 2020 Dec 1;180(12):1665-71.
• 15. Von Seidlein L, Alabaster G, Deen J, Knudsen J. Crowding has consequences: Prevention and management of COVID-19 in informal urban settlements. Build Environ. 2020;188:107472.
• 16. Kampf G, Todt D, Pfaender S, Steinmann E. Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents. J Hosp Infect. 2020;104:246–51.
• 17. Van Damme W, Dahake R, van de Pas R, Vanham G, Assefa Y. COVID-19: Does the infectious inoculum dose-response relationship contribute to understanding heterogeneity in disease severity and transmission dynamics? Med Hypotheses. 2020 Nov 25;146:110431.
• 18. Liu Y, Yan LM, Wan L, Xiang TX, Le A, Liu JM, et al. Viral dynamics in mild and severe cases of COVID-19. Lancet Infect Dis. 2020;20:656-7.
• 19. 19 Pan Y, Zhang D, Yang P, Poon LLM, Wang Q. Viral load of SARS-CoV-2 in clinical samples. Lancet Infect Dis. 2020;204:411-2.
• 20. Yu F, Yan L, Wang N, Yang S, Wang L, Tang Y, et al. Quantitative detection and viral load analysis of SARS-CoV-2 in infected patients. Clin Infect Dis. 2020;71:793-8.
• 21. Yu X, Sun S, Shi Y, Wang H, Zhao R, Sheng J. SARS-CoV-2 viral load in sputum correlates with risk of COVID-19 progression. Crit Care. 2020;24:170.
• 22. Leung NHL, Chu DKW, Shiu EYC, Chan KH, McDevitt JJ, Hau BJP, et al. Respiratory virus shedding in exhaled breath and efficacy of face masks. Nat Med. 2020;26:676-80.
• 23. Gandhi M, Beyrer C, Goosby E. Masks do more than protect others during COVID-19: reducing the inoculum of SARS-CoV-2 to protect the wearer. J Gen Intern Med. 2020;35:3063-6.
• 24. Meier BM, Habibi R, Yang YT. Travel restrictions violate international law. Science. 2020;367:1436.
• 25. Geoghegan JL, Holmes EC. The phylogenomics of evolving virus virulence. Nat Rev Genet. 2018;19:756-69.
• 26. Berngruber TW, Froissart R, Choisy M, Gandon S. Evolution of virulence in emerging epidemics. PLoS Pathog. 2013 Mar;9(3):e1003209.
• 27. Chu DK, Akl EA, Duda S, Solo K, Yaacoub S, Schünemann HJ. COVID-19 Systematic Urgent Review Group Effort (SURGE) study authors. Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis. Lancet. 2020 Jun 27;395:1973-87.
• 28. Sterne JAC, Murthy S, Diaz JV, Slutsky AS, Villar J, Angus DC, et al. WHO Rapid Evidence Appraisal for COVID-19 Therapies (REACT) Working Group. Association between administration of systemic corticosteroids and mortality among critically ill patients with COVID-19: a meta-analysis. JAMA. 2020;324:1330-41.
• 29. Centre for Evidence-Based Medicine. The declining case fatality ratio in England. https://www.cebm.net/covid-19/the-declining-case-fatality-ratioin- england/.
• 30. Burgess S, Smith D, Kenyon JC, Gill D. Lightening the viral load to lessen covid-19 severity. BMJ. 2020 Dec 10;371:m4763.