EPIDEMIOLOGY, CLINICAL CHARACTERISTICS, AND VIROLOGIC FEATURES OF COVID-19 PATIENTS IN KAZAKHSTAN: A NATION-WIDE RETROSPECTIVE COHORT STUDY
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Date
2021-04-16
Authors
Yegorov, Sergey
Goremykina, Maiya
Ivanova, Raifa
Good, Sara V.
Babenko, Dmitriy
Shevtsov, Alexandr
MacDonald, Kelly S.
Zhunussov, Yersin
Journal Title
Journal ISSN
Volume Title
Publisher
The Lancet Regional Health - Europe
Abstract
Background: The earliest coronavirus disease-2019 (COVID-19) cases in Central Asia were announced in
March 2020 by Kazakhstan. Despite the implementation of aggressive measures to curb infection spread,
gaps remain in the understanding of the clinical and epidemiologic features of the regional pandemic.
Methods: We did a retrospective, observational cohort study of patients with laboratory-confirmed COVID-19
hospitalized in Kazakhstan between February and April 2020. We compared demographic, clinical, labora tory and radiological data of patients with different COVID-19 severities on admission. Logistic regression
was used to assess factors associated with disease severity and in-hospital death. Whole-genome SARS-CoV 2 analysis was performed in 53 patients.
Findings: Of the 1072 patients with laboratory-confirmed COVID-19 in March-April 2020, the median age was
36 years (IQR 24 50) and 484 (45%) were male. On admission, 683 (64%) participants had asymptomatic/
mild, 341 (32%) moderate, and 47 (4%) severe-to-critical COVID-19 manifestation; 20 in-hospital deaths
(1 87%) were reported by 5 May 2020. Multivariable regression indicated increasing odds of severe disease
associated with older age (odds ratio 1 05, 95% CI 1 03-1 07, per year increase; p<0 001), the presence of
comorbidities (2 34, 95% CI 1 18-4 85; p=0 017) and elevated white blood cell count (WBC, 1 13, 95% CI 1 00-
1 27; p=0 044) on admission, while older age (1 09, 95% CI 1 06-1 13, per year increase; p<0 001) and male
sex (5 63, 95% CI 2 06-17 57; p=0 001) were associated with increased odds of in-hospital death. The SARS CoV-2 isolates grouped into seven phylogenetic lineages, O/B.4.1, S/A.2, S/B.1.1, G/B.1, GH/B.1.255, GH/B.1.3
and GR/B.1.1.10; 87% of the isolates were O and S sub-types descending from early Asian lineages, while the
G, GH and GR isolates were related to lineages from Europe and the Americas.
Interpretation: Older age, comorbidities, increased WBC count, and male sex were risk factors for COVID-19
disease severity and mortality in Kazakhstan. The broad SARS-CoV-2 diversity suggests multiple importa tions and community-level amplification predating travel restriction
Description
Keywords
Type of access: Open Access, COVID-19 SARS-CoV-2, Clinical characteristics, Disease risk factors, Molecular epidemiology, Central Asia, Kazakhstan, SARS-CoV-2 genomics, Disease severity
Citation
Yegorov, S., Goremykina, M., Ivanova, R., Good, S. V., Babenko, D., Shevtsov, A., MacDonald, K. S., & Zhunussov, Y. (2021). Epidemiology, clinical characteristics, and virologic features of COVID-19 patients in Kazakhstan: A nation-wide retrospective cohort study. The Lancet Regional Health - Europe, 4, 100096. https://doi.org/10.1016/j.lanepe.2021.100096