Management of Mild COVID-19: Policy Implications of Initial Experience in India

Background: The ongoing pandemic of coronavirus disease 2019 (COVID-19) has spread across all geographies of the world. The clinical characteristics and outcomes reported across different countries are variable. This study presents clinical characteristics and outcomes of admitted patients with mild COVID-19 illness in the initial phase of pandemic in India. Methods: It is a retrospective study conducted at COVID-19 facilities of AIIMS, New Delhi. Adult admitted patients with laboratory-confirmed SARS-CoV-2 infection and mild disease at presentation were included. Data regarding demography, comorbidities, clinical features, laboratory parameters, outcomes in terms of progression to moderate-severe disease were collected. Findings: Out of 231 cases included, majority were males (78·3%) with a mean age of 39·8 years. Comorbidities were present in 21.2% of patients, diabetes mellitus and hypertension being most common. The most common symptoms were dry cough (81, 35%), fever (64, 27·7%), sore throat (36, 15·6%), and dyspnoea (24, 10·4%); asymptomatic infection course was seen in 108 (46.8%) patients. Presence of comorbidities was an independent predictor of symptomatic disease (OR-2·66; 95% CI 1·08-6·53, p= 0·03). None of the patients developed features of moderate to severe COVID-19 during hospital stay. Four patients required shifting for management of underlying comorbidities. There were no deaths in this cohort. Interpretation: Patients with mild disease at presentation had a stable disease course and can be managed outside hospital setting, provided the comorbidities are under control. A large proportion of patients remained asymptomatic throughout the course of infection and those with comorbidities are more likely to be symptomatic. Funding Statement: No funding received Declaration of Interests: No conflicts of interest declared by any of the authors. Ethics Approval Statement: The permission for the study was obtained from the Institute Ethics Committee.