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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 15  |  Issue : 1  |  Page : 81-86

Assessment of different risk factors associated with SARS-CoV-2 infection among young adults of a relatively vulnerable district of West Bengal, India: A retrospective study


1 Department of Microbiology, Burdwan Medical College, Kolkata, West Bengal, India
2 Department of Microbiology, ICMR-DHR Virus Research and Diagnostic Laboratory, Burdwan Medical College and Hospital, Kolkata, West Bengal, India
3 Department of Microbiology, Virus Research and Diagnostic Laboratory, Burdwan Medical College and Hospital, Kolkata, West Bengal, India
4 West Bengal University of Health Sciences, Kolkata, West Bengal, India

Date of Submission20-Nov-2021
Date of Decision13-Dec-2021
Date of Acceptance27-Dec-2021
Date of Web Publication24-Jan-2022

Correspondence Address:
Mr. Aroni Chatterjee
Department of Microbiology, ICMR-DHR Virus Research and Diagnostic Laboratory, Burdwan Medical College and Hospital, Purba Bardhaman, West Bengal - 713 104
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kleuhsj.kleuhsj_252_21

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  Abstract 

INTRODUCTION: The observed increased infectivity among young adults in the last few months has made it evident that the SARS-CoV-2 is not only capable of infecting younger adults but can also exhibit severe symptoms in them. The exact role of different risk factors in case of COVID infected young is still very much under debate.
OBJECTIVE: In this study, we tried to identify different epidemiological and clinical risk factors which might be responsible for increasing the chance of infection among young adults with confirmed SARS-CoV-2 infection.
MATERIALS AND METHODS: A total of 198 young adults from 18 to 29 years of age who were tested COVID-19 positive by the reverse transcription polymerase chain reaction at Burdwan Medical College and hospital during January 2021 to July 2021 were included in this retrospective observational study.
RESULTS: The total population of individuals were divided into two different groups for statistical analysis, first group with 65 individuals (32.8%) who were admitted to the hospital and the second group with 133 (67.2%) patients who were not hospitalized and discharged after preliminary examination. 30.8% of the hospitalized patients required admission to intensive care unit (ICU), while 56.9% patients among those hospitalized required respiratory support and 29.2% required mechanical ventilation.
DISCUSSION: Our study showed that diabetes and hypertension conjugated with obesity are quite common comorbidities associated with the hospitalized young adults. We have also pointed out that asymptomatic patients and those with mild symptoms presented a relatively stable clinical course, quite similar to that observed in other studies. Furthermore, our patients had a high rate of ICU admission per hospitalization which may be a reflection of a variety of social determinants that influence health outcomes.
Conclusion: Our study by providing an exhaustive data set from the hospitalized and non-hospitalized SARS-CoV-2 infected young adult patients will surely provide a better understanding of the prevalence and effect of COVID among this vulnerable fraction of the population.

Keywords: COVID-19, disease severity, epidemiological risk factors, hospitalized, retrospective study, SARS-CoV-2, young adults


How to cite this article:
Biswas T, Chattopadhyay S, Dasgupta A, Chatterjee A, Roy D, Paul S. Assessment of different risk factors associated with SARS-CoV-2 infection among young adults of a relatively vulnerable district of West Bengal, India: A retrospective study. Indian J Health Sci Biomed Res 2022;15:81-6

How to cite this URL:
Biswas T, Chattopadhyay S, Dasgupta A, Chatterjee A, Roy D, Paul S. Assessment of different risk factors associated with SARS-CoV-2 infection among young adults of a relatively vulnerable district of West Bengal, India: A retrospective study. Indian J Health Sci Biomed Res [serial online] 2022 [cited 2022 May 22];15:81-6. Available from: https://www.ijournalhs.org/text.asp?2022/15/1/81/336305




  Introduction Top


SARS-CoV-2 infected has affected almost all the countries in the world irrespective of their annual GDP affecting individuals belonging to all classes of societal structure.[1] The exposure and outcome of the disease are very much dependent on the individual as well as the type of society he/she resides in.[2] COVID has been most profoundly described as one mostly affecting people of old age or older adults and so very limited number of studies have focussed on the young adults as a population of interest. Thus the knowledge on the potential clinical course of SARS-CoV-2-infected young adults is mostly unknown.[3] A recent study with a population cohort of young adults has shown that about 20% of the hospitalized patients were critically infected and required admission to the intensive care. Out of them about 2% died even after treatment.[4] The observed increased infectivity among young adults in the last few months has made it evident that the SARS-CoV-2 is not only capable of infecting younger adults but can also exhibit severe symptoms among them.[5] The rate of these cases is rapidly increasing throughout the world and the probable causes may be that the young generation is not properly following the mitigation behaviors such as hand washing, wearing masks, and social distancing owing either to some misinformation or peer pressure.[6] After the onset of the second wave, the percentage of infected young adults in the population was raised considerably.[7] The infection among young adults has been presented as cases with a wide range of clinical outcomes including asymptomatic cases, cases with only mild respiratory tract infections, cases with severe pneumonia requiring immediate hospitalization, critical cases with respiratory failure, and death.[8],[9] In the general population affected with COVID, age and various comorbidities have been identified as the essential risk factors by a large number of studies but only a few studies had till date described the demographic and clinical risk factors associated with COVID affected young adults.[10] In this retrospective cohort study, we used data from direct interviews with the patients and available medical records to identify different epidemiological and clinical risk factors which might be responsible for increasing the chance of infection among young adults with confirmed SARS-CoV2 infection. This study was therefore performed to ascertain the pattern and effect of SARS-CoV-2 infectivity among the young adult population in Burdwan district of West Bengal. Here we tried to identify statistically significant demographic and clinical parameters which define the need for hospitalization of the young adult patients. In this regard certain parameters with significant P values were identified which act as potential markers for predicting the severity or outcome of the disease (to be or not to be hospitalized). This study was in general aimed to implicate the fact that SARS-CoV-2 infection is quite common among individuals of young age and can lead to severe complications in some.


  Materials and Methods Top


Patient selection

A retrospective study was conducted in a tertiary care COVID referral hospital at Burdwan town of West Bengal with young adult individuals attending the outdoor unit of Burdwan Medical College and hospital for COVID testing between the time span of January 2021 to July 2021. A total of 198 individuals between 18 and 29 years of age who were tested COVID 19 positive by reverse transcription polymerase chain reaction (RT-PCR) at Burdwan Medical College during the span of this study were selected from the total positive population. Follow-up data for individual patient were collected starting from the time they were tested positive to the final outcome i.e., till they again test negative.

Sample collection

Naso/oro pharyngeal swabs were collected into the viral transport mediums and transported immediately to the COVID-19 referral lab for RTPCR test.

Data collection

We collected data on socio-demography, epidemiology, clinical characteristics, laboratory findings, comorbidities, management, and outcome of our study population by communicating with the patients or their family members and from the available medical records. All data were recorded in a prepiloted health counseling form. Disaggregated data by age groups and reported disease severity were extracted where available. Disease severity was classified as per the national guidelines. Symptomatic analysis of the patients were done and recorded in the health counseling form.

Data extraction

We recorded fever, cough, cold, sore throat, respiratory distress, and skin manifestations. For diagnosis, we followed the diagnostic criteria as published by the World Health Organization. In case of patients who required hospitalization, the following data were collected: Need for mechanical ventilation, admission to the intensive care unit (ICU), hypoxia, multi-organ failure, and need for oxygen support.

Data analyses

Chi-square test and Fisher's exact test were used to analyze and compare the categorical variables reported as percentages. Odd ratios (ORs) were calculated at a confidence interval of 95% (95% CI). The P value for significance was set at 0.05. The continuous or discrete variables were expressed either as mean ± standard deviation (SD) or as median with inter-quartile ranges, if not normally distributed. All data were analyzed using SPSS ver 16.0 (IBM SPSS statistics, Armonk, New York, U.S.).


  Results Top


A total of 198 COVID RT-PCR positive young adult individuals within age ranging from 18 to 29 years were selected for this study. Among them the age of 114 individuals ranged from 18 years to 23 years and those of 84 individuals ranged from 24 years to 29 years. Sex distribution showed that 113 (57%) were male and 85 (43%) were female (OR 2.21 95% CI 1.36–2.62, P = 0.51). The total population of 198 individuals were divided into two different groups for statistical analysis, first group with 65 individuals (32.8%) who were admitted to the hospital and the second group with 133 (67.2%) patients who were not hospitalized and discharged after preliminary examination. 55.4% of the individuals belonging to the hospitalized group were male while the not hospitalized group had a male prevalence of 58.6%. Percentages of female patients were low in both groups compared to the male population. Among the hospitalized and nonhospitalized groups, 76.9% and 85.7% of the individuals were of Bengali ethnicity. 72.3% of the patients in the hospitalized group and 72.9% patients belonging to the nonhospitalized group were living in an urban locality. 64.6% of patients in the hospitalized group had at least one infected family member and 58.5% individuals in this group were employed. Among the hospitalized group 67.7% patients were smokers, whereas the percentage of smokers in the nonhospitalized group was considerably lower (39.1%). 73.8% of the hospitalized patients and 69.2% of the discharged patients had a proper prior knowledge about COVID-19 and its implications. 66.2% of the hospitalized patients and 70.7% of the nonhospitalized patients vouched about following all mitigation behaviors such as sanitization, wearing masks, and handwashing strictly. The detailed analysis is presented in [Table 1].
Table 1: Sociodemographic characteristics of the COVID-positive young adults at presentation

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The mean ± SD for the Ct values (Measure for detection of SARS-CoV-2 RNA by real time PCR) of the young adult patients belonging to the hospitalized groups was 23.3 ± 2.9 and 25.2 ± 3.6 respectively. Among the hospitalized patients, 38.5% had leucopenia, 29.2% had lymphopenia, and 16.9% had thrombocytopenia. Computed tomography (CT) scan infective changes were visible in 63.1% of hospitalized patients and 16.6% of the discharged or nonhospitalized patients. Mean concentration of D-Dimer (1.4 ± 0.8 mg/ml) and C-reactive protein (CRP) (8.1 ± 1.5 mg/dl) was considerably high in case of the hospitalized patients compared to those of the discharged group. Mean hemoglobin concentration was significantly less in case of the hospitalized patients compared to the nonhospitalized patients. 67.7% of the patients belonging to the hospitalized group and 39.8% of the patients belonging to the nonhospitalized group had comorbidities such as obesity, diabetes, cardiac, renal and respiratory diseases. 30.8% of the hospitalized patients required admission to ICU, while 56.9% patients among those hospitalized required respiratory support and 29.2% required mechanical ventilation. Among the hospitalized patients 35.4% were moderately symptomatic, 43.1% presented severe complications, and 21.5% had a critical presentation. All the patients belonging to the nonhospitalized group were either asymptomatic (42.1%) or presented mild symptoms (57.9%). Three individuals out of the 65 admitted to the hospital and 2 out of the 133 nonhospitalized individuals died during the course of this study.

Among the sociodemographic parameters, only smoking habit was a statistically significant parameter that differed among hospitalized and nonhospitalized patients (P value: 0.04). Among the clinical parameters, D-Dimer and CRP both were significantly elevated in case of hospitalized patients (P values: 0.034 and 0.001, respectively). Leukopenia and CT scan infective changes were observed in a large number of hospitalized patients and both of these parameters show statistical significance while compared to nonhospitalized patients (P values: 0.031 and 0.02 respectively). The detailed analysis is presented in [Table 2].
Table 2: Clinical characteristics and disease severity of the COVID-positive young adults at presentation

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  Discussion Top


This article has tried to present a concise picture of the prevalence of SARS-CoV-2 infection among the tested young adults of Burdwan District of West Bengal, India simultaneously describing the risk factors and outcomes in a cohort of 198 young adults diagnosed with the disease. Data from a recently published study in the US have shown that in the studied population cohort of 3000 COVID positive and hospitalized young adults about 21% were admitted to ICU and 10% required oxygen support.[11] Our data show that new SARS-CoV-2 infections have indeed increased among the younger adults of the community. Although most of these cases were either asymptomatic or mild, but moderate to severe cases were observed in about 33% of the total cohort. The deaths were relatively rare, indicating that some symptomatic cases can easily turn dangerous and life threatening. Our patients had a higher rate of ICU admission per hospitalization (30.8%) and respiratory support (18.6%) than previously described, which may be a reflection of a variety of social or clinical determinants that influence health outcomes. Recently, public health experts and medical practitioners have issued multiple statements asking the young adult groups to seriously consider their actions while dealing with COVID. The younger generation has been made aware about the consequences of the infection in their life and how it will impact the society.[12] Due to the decreasing strength of the immune system with increasing age, older adults pose higher risks of contracting COVID, but the virus is also infecting young adults with strong immune systems which is a bit perplexing. Another study has revealed that as with older patients, younger adults with preexisting health conditions, including chronic heart disease, chronic renal diseases, obesity, and type-2 diabetes, are more vulnerable to severe COVID-19.[12] Our study showed that diabetes and hypertension conjugated with obesity are quite common comorbidities associated with the hospitalized young adults. We have also pointed out that asymptomatic patients and those with mild symptoms presented a relatively stable clinical course, quite similar to that observed in other studies. Furthermore, our patients had a high rate of ICU admission per hospitalization which may be a reflection of a variety of social determinants that influence health outcomes and needs special attention. Our study has pointed out that smoking habit among the young population is a considerable determinant of the disease severity and outcome. Smokers are prone to severe complications and needs hospitalization. Patients with significant decrease in white blood cell count and elevated CRP immediately following COVID infection are more prone to a deteriorating health effect and needs to be admitted.


  Conclusion Top


Here we have presented a retrospective observational data from a single, urban, academic medical center, unique to a region and with a limited sample size, predisposing to type II statistical error, a major limitation to our study. However, as COVID-19 is a relatively new disease with limited number of data resources available for the infected population of the young adult age group, especially from India, our study by providing this exhaustive data set from the hospitalized and nonhospitalized patients of age 18–29 years will surely provide a better understanding of the scenario.

Ethical considerations

The objectives and methodologies used in this study have been duly approved by the Institutional Ethics Committee of Burdwan Medical College and Hospital and falls in in accordance with the 1964 Helsinki declaration. This study includes medical questionnaires, clinical reports, past medical history of the patients, and detailed demographic and health data for each patient as provided by the patients themselves or their family members in the presence of the medical practitioner on duty. Confidentiality of all the collected information was maintained properly as per the standard guidelines. Ethical Clearance was obtained from Burdwan Medical College Institutional Ethics Committee with Ref no BMC/IEC/252 dated 07.06.2021.

Data availability

All datasets discussed in this article has been provided herewith.

Acknowledgment

The authors would like to acknowledge the role of Indian Council of Medical Research, and Department of Health and family Welfare, Government of West Bengal for providing the support and amenities required to carry on this study. We would also like to acknowledge the role of the administrative personnel at Burdwan Medical College for supporting us in every possible way.

Financial support and sponsorship

The work presented here is a retrospective observational study and hence no additional funds were required for any kind of research work.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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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.  Back to cited text no. 3
    
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Kim C, Kim W, Jeon JH, Seok H, Kim SB, Choi HK, et al. COVID-19 infection with asymptomatic or mild disease severity in young patients: Clinical course and association between prevalence of pneumonia and viral load. PLoS One 2021;16:e0250358.  Back to cited text no. 4
    
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Theocharis P, Wong J, Pushparajah K, Mathur SK, Simpson JM, Pascall E, et al. Multimodality cardiac evaluation in children and young adults with multisystem inflammation associated with COVID-19. Eur Heart J Cardiovasc Imaging 2021;22:896-903.  Back to cited text no. 5
    
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van der Made CI, Simons A, Schuurs-Hoeijmakers J, van den Heuvel G, Mantere T, Kersten S, et al. Presence of genetic variants among young men with severe COVID-19. JAMA 2020;324:663-73.  Back to cited text no. 6
    
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Meyerowitz-Katz G, Merone L. A systematic review and meta-analysis of published research data on COVID-19 infection fatality rates. Int J Infect Dis 2020;101:138-48.  Back to cited text no. 7
    
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DeBiasi RL, Song X, Delaney M, Bell M, Smith K, Pershad J, et al. Severe coronavirus disease-2019 in children and young adults in the Washington, DC, Metropolitan Region. J Pediatr 2020;223:199-203.e1.  Back to cited text no. 8
    
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Altonen BL, Arreglado TM, Leroux O, Murray-Ramcharan M, Engdahl R. Characteristics, comorbidities and survival analysis of young adults hospitalized with COVID-19 in New York City. PLoS One 2020;15:e0243343.  Back to cited text no. 9
    
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Price-Haywood EG, Burton J, Fort D, Seoane L. Hospitalization and mortality among black patients and white patients with COVID-19. N Engl J Med 2020;382:2534-43.  Back to cited text no. 10
    
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Cunningham JW, Vaduganathan M, Claggett BL, Jering KS, Bhatt AS, Rosenthal N, et al. Clinical outcomes in young US adults hospitalized with COVID-19. JAMA Intern Med 2020;181:379-81.  Back to cited text no. 11
    
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Abbasi J. Younger adults caught in COVID-19 crosshairs as demographics shift. JAMA 2020;324:2141-3.  Back to cited text no. 12
    



 
 
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  [Table 1], [Table 2]



 

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