Asymptomatic individuals positive for SARS-CoV-2 RNA constitute a significant proportion of the infected population and play a role in the transmission of the virus. We describe a healthcare worker who presented with fever and malaise and was diagnosed with mild COVID-19. The symptoms resolved within 4 days but there was persistent positivity of viral RNA in the upper respiratory tract for more than 58 days, which is the longest reported duration of persistence of SARS-CoV-2 in a healthcare worker. In this case report, we discuss clinical and administrative issues such as the role of asymptomatic cases in the transmission of the virus to patients and coworkers as an occupational hazard, interpretation of persistent positivity of nucleic acid test, duration of isolation and return-to-work guidelines pertinent to researchers and global health policymakers.

ObjectivesPrimary objective was to study the clinicodemographic profile of hospitalised COVID-19 patients at a tertiary-care centre in India. Secondary objective was to identify predictors of poor outcome.SettingSingle centre tertiary-care level.DesignRetrospective cohort study.ParticipantsConsecutively hospitalised adults patients with COVID-19.Primary and secondary outcome measuresPrimary outcome variable was in-hospital mortality. Covariables were known comorbidities, clinical features, vital signs at the time of admission and on days 3–5 of admission, and initial laboratory investigations.ResultsIntergroup differences were tested using χ2 or Fischer’s exact tests, Student’s t-test or Mann-Whitney U test. Predictors of mortality were evaluated using multivariate logistic regression model. Out of 4102 SARS-CoV-2 positive patients admitted during 1-year period, 3268 (79.66%) survived to discharge and 834 (20.33%) died in the hospital. Mortality rates increased with age. Death was more common among males (OR 1.51, 95% CI 1.25 to 1.81). Out of 261 cases analysed in detail, 55.1% were in mild, 32.5% in moderate and 12.2% in severe triage category. Most common clinical presentations in the subgroup were fever (73.2%), cough/coryza (65.5%) and breathlessness (54%). Hypertension (45.2%), diabetes mellitus (41.8%) and chronic kidney disease (CKD; 6.1%) were common comorbidities. Disease severity on admission (adjusted OR 12.53, 95% CI 4.92 to 31.91, p<0.01), coagulation defect (33.21, 3.85–302.1, p<0.01), CKD (5.67, 1.08–29.64, p=0.04), high urea (11.05, 3.9–31.02, p<0.01), high prothrombin time (3.91, 1.59–9.65, p<0.01) and elevated ferritin (1.02, 1.00–1.03, p=0.02) were associated with poor outcome on multivariate regression. A strong predictor of mortality was disease progression on days 3–5 of admission (adjusted OR 13.66 95% CI 3.47 to 53.68).ConclusionCOVID-19 related mortality in hospitalised adult patients at our center was similar to the developed countries. Progression in disease severity on days 3–5 of admission or days 6–13 of illness onset acts as ‘turning point’ for timely referral or treatment intensification for optimum use of resources.

Introduction: Meconium is the first gastrointestinal discharge of a neonate. Most neonates usually pass first urine and meconium within 24 and 48 hours of birth respectively. Delayed passage of urine and stool is considered a pointer of gastrointestinal/ genitourinary structural or motility disorder and are a cause of worry for parents. There is a lack of studies in Indian babies. Also, previous studies have relied on mother’s recall of the event. Therefore, through this study, we embarked to identify the timing of passage of first urine and stool in newborns delivered at our center by reviewing their input/output charts. Methodology: This was a single-center, cross-sectional study conducted after obtaining IEC approval at a tertiary-care health center in Eastern India. The eligible newborns delivered in labour room/OT of AIIMS, were prospectively enrolled observed.Result: Approximately two third newborns passed first urine (69.7%) and meconium (62.7%) within 6 hours after delivery. The median time of passage of first urine was 4 [95% C.I. 1-7] hours of life. The median time of passage of meconium was 4 [1-8] hours of life, which was significantly higher for male [5 (6), (p= 0.036)] and preterm new born [6.3 (9), (p= 0.001)]. Conclusion: Median time of passage of first urine was 4 [1-7] hours of life; which was not influenced by the gender, gestation at birth and birth weight categories. Median time of passage of meconium was 4 [1-8] hours of life, which was significantly higher for male baby and preterm new born but no difference across the birth weight categories of the newborns.