Epidemiological and clinical characteristics of patients with suspected COVID-19 admitted in Metro Manila, Philippines

Eumelia P Salva; Jose Benito Villarama; Edmundo B Lopez; Ana Ria Sayo; Annavi Marie G Villanueva; Tansy Edwards; Su Myat Han; Shuichi Suzuki; Xerxes Seposo; Koya Ariyoshi; Chris Smith

doi:10.1186/s41182-020-00241-8

Epidemiological and clinical characteristics of patients with suspected COVID-19 admitted in Metro Manila, Philippines

Trop Med Health. 2020 Jun 22;48(1):51. doi: 10.1186/s41182-020-00241-8.

Authors

Eumelia P Salva¹, Jose Benito Villarama¹, Edmundo B Lopez¹, Ana Ria Sayo¹, Annavi Marie G Villanueva², Tansy Edwards^{2

3}, Su Myat Han^{2

4}, Shuichi Suzuki², Xerxes Seposo², Koya Ariyoshi^{2

4}, Chris Smith^{5

6}

Affiliations

¹ San Lazaro Hospital, Manila, Philippines.
² School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.
³ MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK.
⁴ Institute of Tropical Medicine, Nagasaki University, Nagasaki, 852-8523, Japan.
⁵ School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan. christopher.smith@lshtm.ac.uk.
⁶ Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK. christopher.smith@lshtm.ac.uk.

Abstract

Background: Coronavirus disease 2019 (COVID-19) has spread to almost every region and country in the world, leading to widespread travel restrictions and national lockdowns. Currently, there are limited epidemiological and clinical data on COVID-19 patients from low and middle-income countries. We conducted a retrospective single-center study of the first 100 individuals with suspected COVID-19 (between Jan. 25 and Mar. 29, 2020) admitted to San Lazaro Hospital (SLH), the national infectious diseases referral hospital in Manila, Philippines.

Results: Demographic data, travel history, clinical features, and outcomes were summarized and compared between COVID-19 confirmed and non-confirmed cases. The first two confirmed cases were Chinese nationals, admitted on Jan. 25. The third confirmed case was a Filipino, admitted on Mar. 8. Trends toward confirmed COVID-19 cases not reporting international travel and being admitted to SLH from the densely populated area of Manila city were observed during Mar. 8-29. All 42 of the 100 confirmed COVID-19 cases were adults, 40% were aged 60 years and above and 55% were male. Three were health workers. Among individuals with suspected COVID-19, confirmed cases were more likely to be older, Filipino, not report international travel history and have at least one underlying disease, particularly diabetes, report difficulty in breathing, and a longer duration of symptoms. In over 90% of non-COVID-19 cases, the alternative diagnosis was respiratory. Nine (21%) confirmed cases died. The median duration from symptoms onset to death was 11.5 (range: 8-18) days.

Conclusions: Imported COVID-19 cases have reduced but local transmission persists and there is a trend toward cases being admitted to SLH from densely populated areas. This study highlights the difficulty in diagnosing COVID-19 on clinical grounds and the importance of diagnostic capacity in all settings. Difficulty of breathing was the only symptom associated with COVID-19 infection and should alert clinicians to the possibility of COVID-19. Clinical characteristics of confirmed COVID-19 cases and a hospital case fatality rate of 21% are comparable with other settings.

Keywords: COVID-19; Case fatality rate; Coronavirus; Epidemiology; Manila; Philippines; SARS-CoV-2.