Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : December | Volume : 16 | Issue : 12 | Page : OC01 - OC04 Full Version

Vaccination Status and Outcome of Patients at a Dedicated COVID-19 Centre, Delhi, India: A Retrospective Study


Published: December 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/59610.17216
Anshuman Srivastava, Abha Sharma, Rajat Jhamb, Subhash Giri, Nikunj Aggarwal

1. Assistant Professor, Department of General Medicine, University College of Medical Sciences, Delhi, India. 2. Assistant Professor, Department of General Medicine, University College of Medical Sciences, Delhi, India. 3. Professor, Department of General Medicine, UCMS and GTB Hospital, Delhi, India. 4. Director Professor, Medical Director, Department of General Medicine, UCMS and GTB Hospital, Delhi, India. 5. Senior Resident, Department of Orthopaedics, UCMS and GTB Hospital, Delhi, India.

Correspondence Address :
Dr. Rajat Jhamb,
Professor, Department of General Medicine, UCMS and GTB Hospital, Delhi, India.
E-mail: drabhaucms@gmail.com

Abstract

Introduction: Coronavirus Disease-2019 (COVID-19) vaccine provides strong protection against transmission, serious illness, hospitalisation, and death. As India carried out robust vaccination drive covering more than two third of its population, the study was aimed to highlight the effects of vaccination status of patient on the outcome of COVID-19 infection.

Aim: To describe the relation of vaccination with disease severity and its outcome during the third wave of COVID-19.

Materials and Methods: It was a single-centre retrospective, cross-sectional study conducted in a dedicated COVID-19 Hospital (Guru Tegh Bahadur Hospital) in Delhi, India. A total of 257 patients were admitted between 10th January 2022 to 9th February 2022, and 246 were included in the study. For each individual, demographic, and clinical data was collected. Vaccination data was extracted via the CoWin platform which included vaccine type, as well as date of administration. The profile of patients was established based on clinical examination, laboratory data, nursing record and radiological record during the course of hospitalisation. The clinical outcome was described as discharge, length of hospital stays, and in-hospital death in relation to the vaccination status. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS), version 22.0.

Results: Total of 246 patients were divided into three groups- 97 were fully vaccinated, 46 were partially vaccinated and 103 were unvaccinated. Both vaccinated and unvaccinated groups had similar percentage of co-morbidities i.e. 61.3% vs 63.5%. Those who were fully vaccinated were more likely to maintain saturation at room air 30.9% vs 26.1% vs 3.9%, had lesser requirements of mechanical ventilation (6.2% vs 15.2% vs 21.4%), shorter duration of hospital stay (4.2 vs 5.3 vs 7.2 days), and lesser mortality (9.3% vs 21.7% vs 33%) as compared to the partially vaccinated and unvaccinated patients respectively.

Conclusion: The beneficial effect of the vaccination was observed in severity, mortality, morbidity, and lesser number of hospitalisations. Hence, vaccination coverage was critical in reducing the severity in reducing the and the hospitalisation in third wave of COVID-19.

Keywords

Coronavirus disease-2019, Hospital stay, Mechanical ventilation, Mortality, Severe acute respiratory syndrome coronavirus-2

Even as the COVID-19 treatment protocols evolved leading to better management and outcomes, prevention still seems to be the best and most effective way of combating COVID-19. Social distancing, hand hygiene, and wearing masks, these time tested methods for prevention of a respiratory illness proved to be effective in breaking the chain, even in this current pandemic. Vaccines, as public health tool, have an undisputable track record in helping eradicate many diseases. Since the beginning of the pandemic, it was believed that despite all the measures taken to curb the contagion, a vaccine will be the most effective tool in preventing the spread and complications of COVID-19 pandemic and achieve a state of normalcy (1),(2),(3).

In India, the vaccination drive was kicked off on 16th January 2022, and since, then more than two billion doses of vaccine had been administered up till September 2022 (4). The COVID-19 vaccines provide strong protection against serious illness, hospitalisation, and death. There is also evidence that vaccinated individuals were less likely to transmit the virus on to others (5). Data also suggests that although COVID-19 was usually milder, if contracted after vaccination than in unvaccinated individuals, mortality remained high in hospitalised individuals (6),(7). A few studies have mentioned that the mortality rate in the hospitalised individuals with COVID-19, even after vaccination were similar to mortality rate in 2020 during the first wave of COVID-19 (8),(9).

As COVID-19 variants, with the potential to reduce vaccine efficacy, continue to emerge worldwide, more data is required regarding the real world effectiveness of current mass vaccination efforts (10). In Delhi, more than half of the population was either partially or fully vaccinated, but it was still unclear, why the number of cases had risen so dramatically during the third wave in January 2022 (11). As India was carrying out robust vaccination drive, which has covered more than two third of the population, the present study aimed to describe the relation of vaccination with disease severity and its outcome during the third wave of COVID-19.

Material and Methods

The single-centre retrospective, cross-sectional study was conducted from 10th January 2022 to 9th February 2022, in a dedicated COVID-19 Hospital (Guru Tegh Bahadur Hospital) in Delhi, India. The study was approved by Institutional Ethical Committee (CTRI no. ECR/510/INST/DL/2014/RR-20).

Inclusion criteria: All the patient data who were admitted in dedicated COVID-19 facility of Guru Tegh Bahadur Hospital, Delhi, India, with Real Time-Polymerase Chain Reaction (RT-PCR) positive for Severe Acute Respiratory Syndrome Coronavirus-2 (SARS CoV-2) and who were more than 18 years of age, were included in the study.

Exclusion criteria: Patients with the history of COVID-19 infection and unknown vaccination status were excluded from the study. A total of 257 patients were admitted and after excluding 11 patients, 246 patients were included in the study.

Study Procedure

Demographic, therapeutic, clinical data including various co-morbidities and outcomes data were recorded. Vaccination data was extracted via the CoWin platform 9, which included vaccine type as well as date of administration. The patients who had received only one dose of vaccination were considered to partially vaccinated and those who had taken both the doses were considered fully vaccinated. The type of vaccine taken was not disclosed in the study. Medical records of patients were retrospectively reviewed to retrieve demographic and clinical data which included age, gender, race, and zip code of residence, details of vaccine type and date of administration, existing medical records of patients were retrospectively reviewed to retrieve demographic, clinical data, details of vaccine type and course during hospital stay. The profile of patients was based on clinical examination, laboratory data, nursing record and radiological findings during the course of hospitalisation. All the data of admitted patients was filled in clinical case proforma and subsequently transcribed to Microsoft Excel.

The clinical outcome was described as discharge, length of hospital stay, and in hospital death. The data related to initial hospital admission unit {regular medical or surgical floor, progressive floor, Intensive Care Unit (ICU)}, change in unit type during admission, oxygen therapy (none, nasal cannula, supplemental high flow oxygen, ventilator), requirement of high flow oxygen, ventilator, specific inpatient medical therapies, hospital length of stay, and disposition from hospital (home, rehabilitation unit, death) was also assessed. However, as the primary aim of the study was to describe the relation between vaccination status and outcome of the COVID-19 patients, hence, the study was focused on mainly on the outcome after vaccination.

Statistical Analysis

Data was tabulated using Microsoft Excel 2019 and pivot tables were made. Statistical analysis was done using SPSS version 22.0 software. Chi-square test was applied to analyse the nominal variables and p-value of <0.05 was considered statistically significant.

Results

Demography: The data of 246 patients were recorded and analysed. Mean age of the patients was 53.9±18.12 years; 55.69% (n=137) of the patients were males and 44.3% (n=109) were females.

Vaccination and its observed effects: Overall, majority (41.9%, 103) were unvaccinated. The subjects were further divided according to disease severity as per Ministry of Health and Family Welfare (MOHFW) guidelines (11) as shown in (Table/Fig 1).

It was found that n=30 (30.9%) of the fully vaccinated patients were able to maintain their saturation at room air, whereas, n=12 (26.1%) of the partially vaccinated, and only n=4 (3.9%) of unvaccinated patients were able to do so.

The percentage of patients requiring oxygen supplementation and mechanical ventilation was found to be more in unvaccinated patients as compared to the partially vaccinated (Table/Fig 2). Also, the average duration of stay in hospital for the patients, who were successfully discharged was shortest for fully vaccinated patients and longest for unvaccinated patients (Table/Fig 3).

Out of the 246 patients, 53 succumbed to the illness, while 193 patients were successfully discharged. Vaccination status and the outcome was analysed in these patients and it was found that those who had taken complete course of vaccination had a better chance of survival. It was observed that among the admitted patients i.e. moderate to severe category or mild category with co-morbidities, the percentage of death among fully vaccinated group was 9 (9.3%), whereas 88 (90.7%) of fully vaccinated patients were discharged from the hospital. As compared to that, in the partially vaccinated group of patients 10 (21.7%) expired and 36 (78.3%) were discharged from hospital while in unvaccinated patients 34 (33%) succumbed to death and 69 (67%) of the patients were discharged from the hospital (Table/Fig 3). Among the 53 deaths in hospital, death percentage was maximum in unvaccinated patients, followed by partially vaccinated patients and fully vaccinated patients.

In terms of co-morbidities, the vaccinated and unvaccinated groups did not show any major difference in i.e., 61.3% of the patients who were fully vaccinated had one or more co-morbidities, whereas 63.5% patients in the unvaccinated group had one or more co-morbidity. Notably, it was observed that all the patients who were fully vaccinated patients but did not survive had either one or more than one co-morbidity, whereas it was not in the case of partially and unvaccinated groups table, Chi-square test was applied which showed a p-value of 0.074 (Table/Fig 4).

Discussion

Since, the time when COVID-19 was declared a pandemic, all of the world’s hopes were pinned on the effectiveness of the vaccine for the disease so that the normalcy can be achieved again. The vaccination drive in India began in January 2021, with the healthcare workers getting vaccinated and by February, vulnerable populations like the elderly and those who had one or the other co-morbidity were also included in the beneficiaries. During the second wave of COVID-19 in India there was a surge in COVID-19 cases so the governments took extra measures to cater to the sick patients who required admission in hospital while accelerating the process of vaccination so that future waves of the pandemic can be prevented. By the time of third wave of COVID-19 in India, 1.57 billion COVID-19 vaccine doses were administered (4). To describe the effects of vaccination (fully or partially) with respect to COVID-19 associated hospitalisation was the purpose of the present study. In the tertiary care hospital, the relationship between vaccination status and disease severity was analysed and a positive trend was observed. However, it was not statistically significant which could be due to Berksonian bias as the patients with milder disease were less likely to require hospital admission and were managed at home. Hence, lower percentage of those under milder category was being reflected. It was observed that most of the admitted patients had one or other risk factor like hypertension, diabetes, pregnancy, obesity, tuberculosis, malignancy etc. and amongst the patients who had severe illness, 62% were more than 55 years of age. The breakthrough COVID-19 infection was reported to be more common in patients with co-morbidity, immunocompromised state and elderly age group owing to immunosuppression and low immunogenecity despite vaccination (2),(11),(12).

Vaccination may have had a role in four major aspects- decrease in the number of admissions, decreased severity of illness, decreased morbidity and cost of healthcare in terms of reduced days of admission and decreased mortality in vaccinated individuals. To begin with, the change in the number of individuals admitted and hospitalised before and after vaccination in this tertiary centre was substantial. As per data, peak hospitalisation in April 2021 was 16418 while in January 2022 it was 2424 i.e., a decrease of 85% in the number of admissions during subsequent COVID-19 “waves” in the city (4). It could be due to the robust vaccination drive which “covered” almost 90% of adults under partial vaccination state and 70% under fully vaccination state. Although, genetic mutation of the virus leading to low virulence and milder disease and complicationscausing decreased Institutional care was a factor confounding this trend. But still it can be inferred that vaccinations were an important factor in the substantial decrease in the number of cases (11),(13),(14),(15).

It was observed that need of mechanical ventilation, the duration of stay in hospital and mortality rates was lower in patients who were fully or partially vaccinated as compared to unvaccinated patients as was reported by other studies (15),(16),(17),(18) and it can be attributed to the protective effect of vaccination in high-risk population. An early increase in acute phase reactants like C-Reactive Protein (CRP), procalcitonin and D-dimer was found to be associated with the severity of hypoxia, multiorgan failure and need for ICU admission (16). Whether vaccination leads to decrease in acute phase reactants by the virtue of decreased virulence and subsequent immune response is a relevant question which arose from this trend.

The decrease in duration of stay, not only eased the morbidity of patients but in a pandemic it mitigated the burden on the limited resources, leading to better care for critically-ill patients, further decreasing the mortality rates. In this study it was found that most of the patients who did not survive had one or other co-morbidity, but as the focus was mainly on outcome of the patients, the risk of mortality by type of co-morbidity was not explained as it was shown by a study by Wahil MSA et al., who described the association of mortality with risk factors and co-morbidities. Similar studies also found that the patients who succumbed to COVID-19, had a relatively rapid progression to sepsis, coagulopathy, acute respiratory distress syndrome, metabolic acidosis etc., (19),(20). The extensive data would have added more information on effects of vaccine on patients with co-morbid conditions and their outcome.

Limitation(s)

Genotyping of viral samples could not be assessed, retrospectively and the antibody titre levels of the patients could not be assessed to correlate with the severity of illness. Further, the data of outcome with the type of vaccine, was not studied. Also, the correlation with individual co-morbidity or deranged laboratory parameters were not drawn. But, despite these limitations the study observed a positive effect of vaccination on COVID-19 related severity and complications, indicating the stance of the healthcare system of India.

Conclusion

The study observed the beneficial effect of vaccination on reduction in the number of admissions, severity of disease, oxygen requirements, morbidity (duration of stay) and mortality (disease outcome) in patients of COVID-19 during the third wave in India. Hence, vaccination coverage was critical to reduce severity of disease and reduce hospitalisation in third wave of COVID-19.

References

1.
Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. China novel coronavirus investigating and research team. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382(8):727-33. [crossref] [PubMed]
2.
https://covid19.who.int. (last accessed on 29th September 2022).
3.
Blake P, Wadhwa D. 2020 Year in Review: The impact of COVID-19 in 12 charts. December 14, 2020.
4.
https://www.mohfw.gov.in.Ministry of health and family welfare, Government of India official website. (last accessed on 29th September 2022).
5.
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DOI and Others

DOI: 10.7860/JCDR/2022/59610.17216

Date of Submission: Aug 10, 2022
Date of Peer Review: Sep 16, 2022
Date of Acceptance: Nov 15, 2022
Date of Publishing: Dec 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Aug 12, 2022
• Manual Googling: Nov 02, 2022
• iThenticate Software: Nov 14, 2022 (10%)

ETYMOLOGY: Author Origin

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