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Correlates of COVID-19 mortality: Considerations in clinical epidemiology?


 Department of Community Medicine, Dr DY Patil University, Pune, Maharashtra, India; Department of Tropical Medicine, Hainan Medical University, Haikou, China; Department of Biological Science, Joseph Ayobabalola University, Ikeji-Arakeji, Nigeria

Date of Submission16-Jun-2020
Date of Decision30-Jun-2020
Date of Acceptance30-Jun-2020

Correspondence Address:
Viroj Wiwanitkit,
Department of Community Medicine, Dr DY Patil University, Pune, Maharashtra

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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mjdrdypu.mjdrdypu_341_20



How to cite this URL:
Wiwanitkit V. Correlates of COVID-19 mortality: Considerations in clinical epidemiology?. Med J DY Patil Vidyapeeth [Epub ahead of print] [cited 2021 Dec 6]. Available from: https://www.mjdrdypv.org/preprintarticle.asp?id=322312



COVID-19 is an emerging disease that causes a worldwide problem. There are many infected persons and deaths worldwide. The reports on COVID-19 infection and death are usually interesting and regularly reported worldwide. The infection and death might be different by time and place; it might range from null to many cases. In clinical medicine, COVID-19-related death draws attention from medical practitioners around the world. The article on “correlates of COVID-19 Mortality” in Med J Dr. DY Patil Univ gives an interesting epidemiological reflection on death and possible related factors among patients with COVID-19.[1] Of several factors, underlying illness is usually reported as a risk. Indeed, personal illness is usually mentioned as a risk factor for any medical problem. The effect of concomitant medical illness is an interesting issue that should be discussed in the clinical epidemiology aspect. In the clinical study, it might not conclude on a single risk personal illness without analysis on other possible comorbidity. In addition, it is necessary to recognize the background death rate among the patient with a personal illness but without COVID-19. The “cure point,” specific time point at which the mortality risk reaches the same level as the general population, is a parameter that should be assessed in clinical epidemiology analysis on the mortality rate of a disease.[2] It should also note that most pioneer reports on COVID-19 mortality are usually observational studies, and there is no standard epidemiological assessment on risk analysis.[3]

Second, the morbidity in COVID-19 is also associated with the treatment and time of the first treatment. Since there is still no standard treatment, the management of the patients might be supportive care or the use of alternative trial medication. Furthermore, the result from early or delayed treatment of disease should be recognized. Hence, there is a requirement to assess co-effect from different mode of treatment as well as the time of the first treatment. Third, there is also a chance that there might be a coincidence that leads to death. For example, a COVID-19 found to have COVID-19, but he died of motorcycle accident.[4] Last, the analysis on mortality rate is usually a retrospective analysis based on primary reported data. The problem with the reliability of the primary report should be recognized. In many developing settings, the primary report rate of infection and death might not be reliable. Some settings might attempt to disclose the situation to try to present that there is a good disease control in that setting. Some nondemocratic setting might imply legal control to block any information on disease. A surprising situation on discrepancies of infection and death rates between developed countries in Europe and America and poor developing countries is a good example. It is questionable on why there are high rates in some areas compared with unbelievable rates in other areas.

Finally, the point that is usually forgotten is the reliability of the diagnosis of disease. The diagnosis error, such as false-positive and false-negative is possible. In addition, when a diagnosis is related to an activity, there is usually a pitfall in assumption. For example, an infection or death in one who works in a specific occupation might be a result from occupational exposure or nonoccupational daily activities.[5] Scientifically, it is necessary to have molecular diagnosis to prove the source of pathogen and existence of the same pathogen in patient to make a conclusive diagnosis of disease transmission and risk.[5]



 
  References Top

1.
Haldar D, Maji B, Ray SK, Mondal T, Mandal PK, Haldar P. Correlates of COVID-19 mortality: A descriptive study. Med J DY Patil Vidyapeeth [Epub ahead of print] [cited 2021 Jul 22].  Back to cited text no. 1
    
2.
Jakobsen LH, Andersson TM, Biccler JL, Poulsen LØ, Severinsen MT, El-Galaly TC, et al. On estimating the time to statistical cure. BMC Med Res Methodol 2020;20:71.  Back to cited text no. 2
    
3.
Parohan M, Yaghoubi S, Seraji A, Javanbakht MH, Sarraf P, Djalali M. Aging Male. Risk factors for mortality in patients with Coronavirus disease 2019 (COVID-19) infection: A systematic review and meta-analysis of observational studies. Aging Male. 2020 Jun 8;1-9. [doi: 10.1080/13685538.2020.1774748]. Online ahead of print.  Back to cited text no. 3
    
4.
Saithong C. Motorcycle accident, vertebral fracture, COVID-19 and death. Case Study Case Rep 2020;10:19-21.  Back to cited text no. 4
    
5.
Sriwijitalai W, Wiwanitkit V. COVID-19 in forensic medicine unit personnel: Observation from Thailand. J Forensic Leg Med 2020;72:101964.  Back to cited text no. 5
    




 

 
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