key: cord-0893159-5paogo69
authors: Vijay Anand, V.; Arunkumar Yogaraj, G.; Priya, S.; Priya Raj, P.; Brinda Priyadharshini, C.; Sridevi, P.N.
title: A cross-sectional study on COVID19 mortality among people below 30 years of age in Tamilnadu-2020
date: 2021-06-30
journal: Clin Epidemiol Glob Health
DOI: 10.1016/j.cegh.2021.100827
sha: e3074e079bd7978b7464190f879038d682b69234
doc_id: 893159
cord_uid: 5paogo69

INTRODUCTION: The COVID19 pandemic has turned out to be one of the public health* burdens in 2020. The fear of deaths due to COVID19 has surmounted even in developed countries and hasn't spared young age. This study aims in assessing the mortality due to COVID19 among patients below 30years of age in TamilNadu. METHODS: The data was collected from a publicly available secondary data source(www.stopcorona.tn.gov.in)which is an official COVID19 state dashboard. Details of the young COVID19 deaths* under 30yrs of age, their gender, symptoms, Co-morbidities, date of symptoms, date of admission, and death were collected till October 2020. A total of 158 deaths were included in the analysis. Fischer exact test and Mann Whitney U test* were used and p-value <0.05 was considered significant. RESULTS: Among the 158 COVID19 deaths under 30 years of age, the median age affected was 25 years(IQR-7) and 70.3% (n-111) had at least one co-morbidity*. The median time interval between symptom onset and hospital admission was 3 days (IQR-3) and between admission and death was 4 days(IQR-7).There was a significant association of myocarditis, refractory seizures, Central nervous system involvement as the cause of death in the age group 0–15years, compared with 16–30years(p < 0.05). The majority of deaths occurred with a late presentation, also patients with higher age were admitted after 2 days of symptoms and the results were statistically significant(p < 0.05). CONCLUSION: Understanding the age-dependent risk gradient and their trend of this new virus at young age* is essential for public health planning and prevent future deaths, future research gateways.

COVID-19 with its human-human spread, droplet transmission, as well as through global transport hubs with a huge number of inbound and outbound passengers resulted in a major disastrous pandemic (2) . On 27 th January 2020, India reported its first case in Kerala, a 20year-old female who traveled from Wuhan city, due to the COVID-19 outbreak situation (3) .

Later, despite precautionary measures, due to population migration, several clusters were formed and the disease spread nationwide. Daily several new COVID19 cases and deaths were reported with mounting pressure in the health care system. India, as of 31 October 2020, roughly 1.2 lakh deaths had occurred among the 81,83,394 COVID19 positive cases.

TamilNadu reported 11,122 deaths among the 7,24,522 cases (4) . Figure 1 shows the gradual rise in the number of COVID19 cases in Tamil Nadu from the 12 th of April and the weekly total COVID19 deaths. The peak was attained in the 15 th -18 th week and then the infection rate and deaths slowed a decline from the 25 th week.

In early 2020, the focus was mainly on elderly friable individuals and the risk of dying of non-elderly individuals was small. In stark contrast, as J o u r n a l P r e -p r o o f months passed, many new stories started to emerge focussing on the demise of young people causing panic and horror which are largely reverberated stories (5) . In comparison to 14

European countries and 13-United States locations which were the epicenters of the COVID19 pandemic, the overall risk of non-elderly individuals (<60 years) in India and Mexico was only 10 fold lower (6) . Joan.P.A.Ioannidis et al. mentioned that until May 21, the proportion of COVID19 deaths for less than 40 years of age was 14.4% (n=3435). The absolute risk of COVID19 deaths of the non-elderly population was 5 per million in India (6) . Now, it's been nearly a year since the SARS-COV2 virus emerged. Data suggested that young age death also contributed a significant ratio. They are the future workforce of the country. Losing this fraction of the population at any cause will have a greater impact on the Nation's economy [Gross National Product(GNP) and Gross Domestic Product (GDP) ]. Only a few studies have described COVID19 deaths in younger age groups globally.

A descriptive analysis is essential for understanding the trends and the most common factors involved in the deaths of this new disease. Such details will form the base of future analytical research, extrapolating the risk factors, treating these individuals, formulating new guidelines, and in the planning of the health system for a strategic approach towards the disease.

J o u r n a l P r e -p r o o f

The data was collected from the Government of Tamil Nadu COVID19 daily media bulletin release (www.stopcorona.tn.gov.in/ ) which is a secondary data source and publicly available in the official COVID19 dashboard of the state. Information on the COVID19 deaths such as each patient's sociodemographic details, date of Rt-PCR positivity, date of admission at the isolation facility, date and cause of death, symptoms and its onset and co-morbidities were collected from March to October 2020. 15.94%-29.44%) with cardio-respiratory arrest (16.5%) being common. Other than the respiratory and cardiac causes, Sepsis and Coagulopathy/ Thromboembolic cause amounts to nearly 14.6% (n=23, 95% C.I:9.46% -21.04%) and 7.6% (n=12, 95% C.I:3.99% -12.89%) respectively. Renal cause (with Acute kidney injury n=8, 5.1%), metabolic causes and Central nervous system involvement (with Refractory seizures n=4, 2.5%) all amounts to 6.3% (n=10, 95% C.I: 3.08 -11.33) of total COVID19 deaths under 30years of age. Renal disorder 24.3% (n=27, 95% C.I: 16.68% -33.38%) was the most common comorbidity associated COVID19 deaths under 30 years of age among which19.8% (n=22, 95% C.I:12.86% -28.46%) had Chronic Kidney Disease. Central nervous system disorder 22.5% (n=25, 95% C.I: 15.14 %-31.43%) was the second most common comorbidity with seizure disorder contributing about 11.7% (n=13, 95% C.I: 6.39 -19.19). Diabetes and Hypertension accounts for about 18% and 13.5% respectively. 15.3% had Haematological/coagulation disorder with anemia (n=7, 6.3%, 95% C.I: 2.57 -12.56) being most common among them. Leukemia (n= 6, 5.4%, 95% C.I: 2.01 -11.39) was the common among the cancers (n=13, 11.7%, 95% C.I: 6.39% -19.19%) as co-morbidity.

Table2: The median age among, COVID19 deaths below 30 years of age was 25 years (IQR-7), with not much difference in the gender [Males-26yrs (IQR-6) and

Females-25yrs (IQR-9.5)]. The median time interval between symptom onset and hospital admission was 3 days (IQR-3) and was slightly less when compared with the median time interval between admission and death which, 4days (IQR-7). health authorities to report systematic data on each of the major comorbidities according to age strata (6) . We believe this article would contribute the data for further analytical research on risk factors of young age COVID19 deaths.

With such a rapid global spread of the coronavirus (COVID19) mutations, antigenic shift and drift are very common and can turn into favorable or unfavorable outcome at any moment. Investigating the susceptibility to infection in the general public is highly impractical because many COVID19 cases are asymptomatic, or mildly symptomatic and some even don't know they had the disease. So, understanding the age-dependent risk gradient and their trend of this new virus in young is also essential to understand the disease and act accordingly. Young people are more prone to COVID19 infections due to high exposure certainty when compared with the elderly. Adequate COVID-19 testing, management of the underlying co-morbidity effectively, comprehensive treatment plans, diverting needed health resources towards young COVID 19 patients will help to save these lives. Also, draconian measures of personal and public hygiene with good infection J o u r n a l P r e -p r o o f prevention control activities are ultimately essential in the drastic reduction of deaths due to COVID19.

Full death details were not available for 474 deaths ( 444 deaths which were notified on 22 nd July 2020 after the report of Death reconciliation Committee in Greater Chennai Corporation and details of first 30 deaths). There was no comparison group of the non-morbid COVID19 individuals of the same age group for analysis. J o u r n a l P r e -p r o o f 

The outbreak of COVID-19: An overview

Nowcasting and forecasting the potential domestic and international spread of the 2019-nCoV outbreak originating in Wuhan, China: a modelling study

First confirmed case of COVID-19 infection in India: A case report

Hundreds of young Americans have now been killed by the coronavirus, data shows

Population-level COVID-19 mortality risk for non-elderly individuals overall and for non-elderly individuals without underlying diseases in pandemic epicenters

Who is dying from COVID-19 and when? An Analysis of fatalities in Tamil Nadu, India. Clinical Epidemiology and Global Health

Clinical Characteristics of Hospitalized Individuals Dying With COVID-19 by Age Group in

The Journals of Gerontology: Series A

Extrapolation of mortality in COVID-19: Exploring the role of age, sex, co-morbidities and health-care related occupation

Monaldi Arch Chest Dis

Multisystem inflammatory syndrome in children and adolescents temporally related to COVID-19

Severe COVID-19 in children and young adults in the Washington, DC metropolitan region

Hyperinflammatory shock in children during COVID-19 pandemic. The Lancet

COVID-19 and Kawasaki Disease: Novel Virus and Novel Case

Age-Related Morbidity and Mortality among Patients with COVID-19

Severe Acute Respiratory Syndrome in Children

Middle East Respiratory Syndrome Coronavirus and Children: What Pediatric Health Care Professionals Need to Know

Middle East respiratory syndrome coronavirus in children

Middle East Respiratory Syndrome Coronavirus Disease in Children

Epidemiology of COVID-19 Among Children in China