Comorbidities and Vaccination Status of COVID-19 All-Cause Mortality at a Tertiary Care Center of Western India

Abstract

Introduction: COVID-19 vaccines have been found to be efficacious for preventing severe disease, yet breakthrough infections and deaths have occurred in a small proportion of vaccinated individuals. This study aimed to describe the vaccination status and comorbidities of COVID-19 all-cause deaths.Methods: This descriptive observational study was conducted at a tertiary care center in western India. A total of 310, RT-PCR positive COVID-19 deaths, aged 45 years and above irrespective of the cause of death (all-cause mortality), were included in the study. Death after breakthrough infection was defined as death in patient with disease onset after 14 days of the second dose of vaccine.Results: Diabetes was the most common comorbidity found in 17.1% of the deaths, followed by hypertension. Cardiovascular disease and renal disease were other common comorbidities seen in 8.7% and 4.83% deaths respectively. Other less common comorbidities include neurological disorders, HIV, autoimmune disorders. Out of these 310 deaths, 21.4% of patients developed disease within 14 days of the first dose. Death after true breakthrough infection (after 14 days of both doses) was seen in only two patients (0.6%). One of these two patients was aged 60 years and had diabetes, while the other was aged 72 years and had a history of smoking.Conclusion: Diabetes and hypertension were the most common comorbidities, indicating a higher risk of mortality among comorbid patients. Only a small proportion of deaths (0.6%) occurred after breakthrough infection beyond 14 days of two doses. COVID-19 vaccines have shown promising efficacy against severe disease, thus high vaccination coverage needs to be achieved to prevent morbidity and mortality.

Assessment of Clinical Profile and Treatment Outcome in Vaccinated and Unvaccinated SARS-CoV-2 Infected Patients

“…Diabetes mellitus, hypertension, ischemic heart diseases, and chronic kidney diseases were the most common comorbidities reported by COVID-19 patients [ 85 , 86 ]. A recent study evaluating the possible reasons for the mortality following COVID-19 vaccination found that the deaths are due to pre-existing comorbidities and not due to the vaccination or the failure of vaccines to extend the protection [ 87 ].…”

Death from COVID-19 in a Fully Vaccinated Subject: A Complete Autopsy Report

“…Nevertheless, in general, the reduced efficacy of the COVID-19 vaccine in the general population has now been established, due to the combination of various factors including the increase in variants, the reduction of the vaccination campaign, and the loss of efficacy of the vaccine over time [ 36 , 37 , 38 ]. Moreover, the presence of comorbidities in elderly subjects could influence vaccine efficacy [ 39 , 40 ]. The increase in SARS-CoV-2 variants is also referred to as "immune evasion" and could increasingly lead to a decrease in the effectiveness of anti-viral strategies, as well as that of the vaccine [ 41 , 42 , 43 ].…”

Virtual autopsy in SARS-CoV-2 breakthrough infection: a case report

“…Some studies have published data about the cause of death in fatal cases of breakthrough SARS-CoV-2 infection [ 2 , 3 , 15 ]. A study from 2021 included patients fully vaccinated with Pfizer/BioNTech and the mortality rate was 22%, death occurring in individuals with a high rate of co-morbidities predisposing to severe COVID-19 disease, including hypertension (71%), diabetes (48%), congestive heart failure (27%), chronic kidney and lung diseases (24% each) [15] .…”

“…Furthermore, diabetes was the most common comorbidity found in 17.1% of the deaths, followed by hypertension in the study of Verma et al [3] assessing comorbidities and vaccination status of COVID-19-related deaths at a Tertiary Care Center of Western India.…”

“…A breakthrough SARS-CoV-2 infection is defined as the detection of severe acute respiratory SARS-CoV-2 ribonucleic acid (RNA) or antigen in a respiratory specimen collected from a person ≥14 days after receiving all recommended doses of COVID-19 vaccines [1] . Indeed, fully vaccinated individuals can still develop SARS-CoV-2 infection and symptomatic COVID-19 disease [2] , especially elderly patients with comorbidities 3 , 4 , 5 . However, it has been demonstrated that the risk of infection is much lower among vaccinated individuals, and, in case of breakthrough infection, the vaccination reduces the disease severity 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 .…”