The long-term effects of COVID-19 among survivors is a matter of concern. This research aimed to study persistent symptoms in post-COVID-19 patients attending a follow-up clinic at a tertiary care hospital in Nepal. All patients, presenting to the outpatient clinic during the study duration of six weeks, with history of positive reverse transcriptase- polymerase chain reaction for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) at least two weeks prior to presentation, were included. The duration of follow-up ranged from 15 till 150 days with the mean duration of 28 days after diagnosis of COVID-19. Of 118 patients, 43 (36.4%) had a history of mild COVID-19, 15 (12.8%) had moderate, and 60 (50.8%) had severe. At the time of presentation, 97 (82.2%) patients reported that they had at least one persistent/new symptom beyond two weeks from the diagnosis of COVID-19. Dyspnea, fatigue, chest heaviness, and cough were the commonest persistent complaints in 48 (40.7%), 39 (33.1%), 33 (28%), and 32 (27.1%) patients, respectively. The findings in our study highlight the need for extended monitoring of post-COVID-19 patients following discharge, in order to understand and mitigate long-term implications of the disease.

Like the world over, Nepal was also hard hit by the second wave of COVID-19. We audited the clinical care provided to COVID-19 patients admitted from April to June 2021 in a tertiary care hospital of Nepal. This was a cohort study using routinely collected hospital data. There were 620 patients, and most (458, 74%) had severe illness. The majority (600, 97%) of the patients were eligible for admission as per national guidelines. Laboratory tests helping to predict the outcome of COVID-19, such as D-dimer and C-reactive protein, were missing in about 25% of patients. Nearly all (>95%) patients with severe disease received corticosteroids, anticoagulants and oxygen. The use of remdesivir was low (22%). About 70% of the patients received antibiotics. Hospital exit outcomes of most (>95%) patients with mild and moderate illness were favorable (alive and discharged). Among patients with severe illness, about 25% died and 4% were critically ill, needing further referral. This is the first study from Nepal to audit and document COVID-19 clinical care provision in a tertiary care hospital, thus filling the evidence gap in this area from resource-limited settings. Adherence to admission guidelines was excellent. Laboratory testing, access to essential drugs and data management needs to be improved.

BACKGROUND Coronavirus disease (COVID-19) is an infectious disease caused by a newly discovered coronavirus referred to as SARS-CoV-2. Biomarkers has been linked with severity and appears to influence clinical outcomes among COVID-19 patients. Aims: This study aimed to describe the association of inflammatory biomarkers with clinical characteristics, severity and outcomes among COVID 19 patients in a tertiary tropical and infectious disease hospital in Nepal. METHODS This was a retrospective observational study where medical and lab records of COVID-19 inpatients (patients tested positive for SARS-CoV-2 via reverse transcriptase-polymerase chain reaction (RT-PCR)) admitted between April 2021 and September 2021 at Sukraraj Tropical and Infectious Disease Hospital, representing the second wave of COVID-19 were reviewed. Medical records of the patients were collected till discharge and inflammatory biomarkers were evaluated in relation to clinical presentations, severity and outcome among patients. Statistical analysis was done using SPSS 23. RESULTS A total of 628 COVID-19 confirmed patients admitted in the study period were included in the study, 487 patients (77.5%) improved, 118 (18.8%) expired, and 23 (3.7%) were referred. Severity at presentation was significantly associated with Ferritin (p 0.013), CRP (<0.001), D-dimer levels (0.003) and Neutrophil-to-Lymphocyte ratio (NLR) (<0.001). Fever was found to have significant association with CRP (p<0.001) and ferritin (p 0.004), but not with D-dimer (p 0.587). Non-survivors were found to have significant association with higher ferritin (p <0.001), CRP (p<0.001), D-dimer (p <0.001) and NLR (<0.001). The duration of hospital stay was significantly affected by D-dimer (p 0.001) and CRP levels (p<0.001). Similarly need for mechanical ventilation had significant association with higher levels of Ferritin (p 0.002), CRP (p<0.001), D-dimer (p<0.001) and NLR (<0.001). Serial recordings of D-dimer showed increasing values had significant association with poor outcome (p<0.001). CONCLUSION Higher values of D-dimer, ferritin, CRP and NLR were associated with higher severity of the COVID-19 disease and poor clinical outcomes including higher duration of hospital stay, higher need for mechanical ventilation and morbidity. Early stratification of disease based on biomarkers can guide early intervention to prevent bad outcomes.