Pure Appl. Biol., 11(1):249-253, March, 2022 http://dx.doi.org/10.19045/bspab.2022.110026

Research Article

Recovery time of patients infected from COVID-19 in

Naseem Asghar1, Umair Khalil1, Dost Muhammad Khan1, Zardad Khan1, Akhtar Ali Khan2, Iftikhar ud Din3, Muhammad Naeem Awan4, Nasir Ali5 and Shehryar Ahmad5* 1. Department of Statistics, Abdul Wali Khan University Mardan, Pakistan 2. Pulmonology, Saidu Medical College, Swat, Pakistan 3. Community Medicine, Bacha Khan Medical College Mardan, Pakistan 4. Saidu Teaching Hospital Swat, Pakistan 5. College of Medical Technology, Bacha Khan Medical College Mardan, Pakistan *Corresponding author’s email: [email protected] Citation Naseem Asghar, Umair Khalil, Dost Muhammad Khan, Zardad Khan, Akhtar Ali Khan, Iftikhar ud Din, Muhammad Naeem Awan, Nasir Ali and Shehryar Ahmad. Recovery time of patients infected from COVID-19 in Pakistan. Pure and Applied Biology. Vol. 11, Issue 1, pp249-253. http://dx.doi.org/10.19045/bspab.2022.110026 Received: 01/03/2021 Revised: 18/05/2021 Accepted: 20/05/2021 Online First: 15/06/2021 Abstract The present study was aimed to improve the general public understanding of COVID-19 pandemic, current study aims to estimate the recovery time of patients infected from COVID- 19. Data for this retrospective study was taken from the Saidu group of teaching hospitals district Swat, , Pakistan. The study period was form March 24, 2020, to August 25, 2020. A total of 372 COVID-19 positive cases from March 2020 to August 2020 were included in the study. The entry point of each patient was the date of admission in the hospital and the event of interest was the recovery of a patient from COVID-19. Variable of interest were date of admission, date of discharge, age and gender for all patients. All 372 patients were COVID-19 positive recorded between the first positive to the first negative SARS-CoV-2 PCR test results. The Kaplan Meier estimator was used to obtain the recovery time of patients in days from COVID-19 diagnosis. Present study estimated average time of recovery from COVID-19 in district Swat which was 8 days with 0.95% C.I. (7-9) days. The difference between recovery time for males and females was not significant but the difference between recovery time for age groups was significant using the log-rank test. Keywords: COVID-19; Kaplan-Meier; Log-rank test; Recovery estimates Introduction exposed all deficiencies of powerful and Coronavirus disease 2019 (COVID-19) well-developed countries of the world [4]. started from China and consequently, The first case of COVID-19 in Pakistan was affected about 170,000 people by 2019 confirmed by the Ministry of Health, worldwide [1, 2]. On March 11, 2020, the government of Pakistan on February 26, World Health Organization declared the 2020, in Karachi, province [5]. The COVID-19 outbreak a pandemic [3]. With number of confirmed cases was over the emergence of coronavirus, no country 292,000 including 275,000 recovered and was well equipped to handle the situation 6,231 deaths by August 22, 2020. Sindh has properly even the superpowers were unable the highest number of cases with 127,691 to control it. They had not sufficient beds, confirmed cases and 4,458 deaths by ventilators, medicines, and PPEs. The virus August 2020 [6]. On October 28, 2020, the

Published by Bolan Society for Pure and Applied Biology 249 Asghar et al. government of Pakistan announced the admitted patients with their age, sex, date of second spell of Covid-19 in Pakistan due to admission, and date of discharge (including sudden increase in active cases and hospital the date of expiry of patients) during the admissions with critical cases of 93 on first wave of COVID-19 from March to ventilators across the country [7]. At August 2020. present, Pakistan has 413,191 confirmed Data collection and analyses cases with 8,303 deaths and 352,529 This study uses a non-parametric survival recoveries [8]. The difficulties confronting approach in the analysis. In this study Pakistan because of the COVID-19 are patient's discharge dates were considered as absolute, and it stays not yet clear whether event times, where event time means the huge interventions that the government recovery in days from COVID-19. 372 has embraced will be sufficient to take the SARS-CoV-2 PCR tests positive patients nation out of this pandemic effectively [9]. were included to investigate recovery from Academia worldwide working on better COVID-19. Therefore, we enlisted patients understanding of prevailing situation on to check their recovery time, infected from multiple factor including recovery time of COVID-19 in Saidu Group of Teaching the disease and meteorological i.e. daily Hospitals Swat. The results were temperature and humidity. Rationale incorporated in R and generated using the behind recovery time is to manage and survfit function. arrange the preparation and mechanism at Results early convenience. It will help to define The (Table 1) shows age and sex health and socioeconomic policy as well distribution of COVID-19 affected patients. as planning of health facility, staff, The recovery time of patients from infrastructure and equipment’s. This study COVID-19 disease calculated using Kaplan designed to ascertain COVID-19 recovery Meier product limit estimator are presented time in days during first spell of COVID-19 in (Table 2). in district Swat, Pakistan. The (Table 1) shows sex and age-wise Materials and Methods distribution of COVID-19 patients admitted Study setting at Saidu group of teaching hospitals, Swat. This study includes all confirmed COVID- Of 372 COVID-19 positive patients 251 19 cases admitted at Saidu group of (67.47%) were males and 121 (32.53%) teaching hospitals district Swat during were females. About 165 (44.35%) patients coronavirus outbreak in district Swat, have age <60 year and 204 (54.84%) Khyber Pakhtunkhwa Pakistan. patients were of age 60 or 60 and above. Ethical approval The (Fig. 1) shows that females and patients No consent was obtained from patients having ages 60 or greater are more included in this study because all cases have vulnerable to death as compared to males already happened before the study begins. and ages less than 60. Data was taken from hospital records The (Fig. 2) shows the month-wise through proper channels meaning that all distribution of COVID-19 cases during principles of ethics were followed properly. COVID-19 outbreak in district Swat. The Study duration and selection criteria 372 admitted cases from March to August Data was taken from the hospital database 2020 can be seen in (Fig. 2) and are labeled from March 2020 to August 2020. During as recovered and died respectively. A huge this time about 645 patients reported to the number of cases were admitted in June hospital and 372 were admitted. The 2020, start falling in July, and almost over admission criteria were predetermined in August 2020. criteria by the government of Pakistan The (Table 2) shows the average recovery under WHO guidelines [10]. This study time of all patients, age-wise, gender-wise, only considered 372 COVID-19 positive and age-wise (<60 or ≥60) for males and

250 Pure Appl. Biol., 11(1):249-253, March, 2022 http://dx.doi.org/10.19045/bspab.2022.110026 females separately. Gender wise recovery 19 patients in males was 8 days with 0.95% time of patients was almost the same and C.I. (7-9) days. In females, it was 8 days there was no significant difference with with 0.95% C.I. (6-11) days. In the age (Chi-square=0.7, df=1, p>0.5). The group less than 60 it was, 6 days with 0.95% recovery time of patients concerning C.I. (6-8) days, while in the age group 60 or different age groups of patients was greater the median recovery time was 9 different. The (Table 2) shows longer days with 0.95% C.I. (8-11) days. For the recovery period for age group > or = 60 and overall dataset, it was observed that a the difference was significant with (Chi- COVID-19 patient spent on average 8 days square=12.6, df=1, p<0.001) using log-rank at the hospital to recover/discharged with a test. The median of the Kaplan Meier minimum of 7 days and a maximum of 9 product limit estimator estimated that the days. average recovery time in days of COVID-

Table 1. Gender and age-wise distribution of COVID-19 patients No. of patients Attributes Total (n) Recovered (%) Died (%) Overall 213 (57.26%) 159 (42.74%) 372 Male 150 (59.76%) 101 (40.24%) 251 Gender Female 63 (52.07%) 58 (47.93%) 121 Less than 60 years 113 (68.48%) 52 (31.52%) 165 Age 60 years and above 98 (48.04%) 106 (51.96%) 204

Table 2. Average (median) recovery time of patients Patients N Events Median 95% C.I. Log-rank Overall 372 213 8 (days) 7 (days) 9 (days) ------Males 251 150 8 (days) 7 (days) 9 (days) 0.4 Female 121 63 8 (days) 6 (days) 11 (days) Less than 60 165 113 6 (days) 6 (days) 8 (days)

Greater or equal 204 98 9 (days) 8 (days) 11 (days) 0.0004 60

Figure 1. Distribution of patients for total, sex and age

251 Asghar et al.

Figure 2. Month wise distribution of COVID-19 cases

Discussion reflect a large set of population throughout COVID-19 pandemic severity and its the country. However, recovery time of impact on socioeconomic level can be COVID-19 patient with respect to gender determined using statistical models by found no statistical difference which is calculating its recovery time, mortality and similar to our findings. Our study revealed case fatality. Pandemic is usually epidemic no statistical difference using Log-rank test spread across the globe with deleterious of recovery time of disease in context of effects as in the case of COVID-19. We gender but there seems a significant used Kaplan Meier estimator to estimate the difference between age groups. Log-rank average (median) recovery probability of test shows longer recovery period for age patients at different time points as used group > or = 60 and the difference was previously [10]. In district Swat mean significant with (Chi-square=12.6, df=1, recovery time from COVID 19 has been p<0.001). The average (median) duration estimated, which was 08 days with 0.95% (in days) of hospital stay due to COVID-19 C.I. (7-11) days. For the age group less than has been conveyed in several studies in 60 years the average time of recovery was China as 10-13 days [17]. recorded 6 days with 0.95% C.I. (6-8) days Conclusion and for the age group 60 or greater it was 9 In this study, the primary event of interest days with 0.95% C.I. (8-11) days. was the average stay of COVID-19 positive Between positive to negative PCR test for patients at the hospital. The follow-up time SARS-CoV-2 there is high morbidy and for this study was five months. The results mortility reported in individuals having showed that the average stay of COVID-19 median duration of 11 days [11, 12]. The patients in the hospital was 8 days with consortium study of 1420 recovered 0.95% C.I. (6-11) days. For the age group COVID-19 patients reported a mean less than 60 years the average time was disease duration of 11.5±5.7 days [13]. recorded 6 days with 0.95% C.I. (6-8) days Also, Wu J et al. observed an average time and for the age group 60 or greater it was 9 of recovery of 10.63±1.93 for mild to days with 0.95% C.I. (8-11) days. The moderate patients [14]. M.P. Barman et al recovery time was calculated using the reported [15] average recovery time of 25 Kaplan Meier technique in R. Further days with 95% confidence Interval of 16.14 studies should calculate recovery periods days to 33.86 days. The difference is for distinct age groups in larger population. expected to be changed in geographical Authors’ contributions location and secondary source of data and Conceived and designed the experiments: well known polymorphism of angiotensin N Asghar & U Khalil, Performed the converting enzyme 2 [16]. Their findings experiments: N Ali, A Ali Khan, DM Khan

252 Pure Appl. Biol., 11(1):249-253, March, 2022 http://dx.doi.org/10.19045/bspab.2022.110026

& S Ahmad, Analyzed the data: Z khan & I & Coordination, Document code: 12- ud Din, Contributed materials/ analysis/ 01. tools: MN Awan, Wrote the paper: S 10. Kaplan EL & Meier P (1958). Non- Ahmad, N Asghar & U Khalil. parametric estimation from incomplete References observations. J Am Statist Assoc 53: 1. Barman MP, Rahman T, Bora K & 457-481. Borgohain C (2020). COVID-19 11. Chen J, Qi T, Liu L, Ling Y, Qian Z & pandemic and its recovery time of Li T et al. (2020). Clinical progression patients in India: A pilot study. of patients with COVID-19 in Diabetes & Metabolic Syndrome: Clin Shanghai, China. Journal of Infection. Res & Rev 14(5): 1205-1211. 12. Pan A, Liu L, Wang C, Guo H, Hao X 2. World Health Organization. & Wang Q, et al. (2020). Association of Coronavirus disease (2019). (COVID- public health interventions with the 19) situation report–57. Geneva, epidemiology of the COVID-19 Switzerland: World Health outbreak in Wuhan, China. Jama Organization; 2020. Available from 323(19): 1915-1923. URL:https://www.who.int/docs/default 13. Lechien JR, Chiesa Estomba CM, Place -source/coronavirus/situation- S, Van Laethem Y, Cabaraux P & Mat reports/20200317-siterep-57. Q et al. (2020). Clinical and 3. World Health Organization. epidemiological characteristics of 1,420 Coronavirus disease (2019). (COVID- European patients with mild to 19) situation report–51. Geneva, moderate coronavirus disease 2019. Switzerland: World Health Journal of internal medicine. Organization; 2020. Available from 14. Wu J, Li W, Shi X, Chen Z, Jiang B & URL: https://www.who.int/doc/default- Liu J, et al. (2020). Early antiviral source/coronavirus/situation- treatment contributes to alleviate the reports/20200311-sitrep-51. severity and improve the prognosis of 4. Zaidi SH (2020). Ethics of health care patients with novel coronavirus disease in the Corona pandemic. Editorial 7: (COVID-19). Journal of internal 70. medicine. 5. Abdul W, Khan A, Ali M, Ali A, Baset 15. Barman MP, Rahman T, Bora K & A (2020). COVID-19 outbreak: current Borgohain C (2020). COVID-19 scenario of Pakistan. New Microbes pandemic and its recovery time of and New Infections. 100681. patients in India: A pilot study. 6. Government of Pakistan. [Cited 2020 Diabetes & Metabolic Syndrome. Clin August 21]. Available from URL: Res & Rev 14(5): 1205-1211. http://www.covid.gov.pk. 16. Li W, Zhang C, Sui J, Kuhn JH, Moore 7. Junaidi I. Second Covid wave under MJ & Luo S, et al. (2005). Receptor and way in Pakistan. Dawn. 28 October viral determinants of SARS‐ 2020. https://www.dawn.com/news/15 coronavirus adaptation to human 87316. ACE2. The EMBO J 24(8): 1634-1643. 8. Government of Pakistan. [Cited 2020 17. Thai PQ, Dinh TS, Van Hoang TH, Luu December 6]. Available from URL: NM, Hung LX & Luu NH, et al. (2020). http://www.covid.gov.pk. Factors associated with the duration of 9. Clinical Management Guidelines for hospitalization among COVID-19 COVID-19 infections (2020). patients in Vietnam: A survival Government of Pakistan, Ministry of analysis. Epidemiol & Infec 10: 1-20. National Health Services, Regulations

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