Ben Fredj Manel, Gara Amel, Kacem Meriem, Dhouib Wafa, Ben Hassine Donia, Bennasrallah Cyrine, Zemni Imen, Ben Alaya Nissaf, Derouiche Sondes, Maatouk Amani, Bouanene Ines, Abroug Hela, Belguith Sriha Asma
Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia.
Department of Preventive Medicine and Infection Control, Hospital Haj Ali Soua of Ksar-Hellal, Monastir, Tunisia.
Arch Public Health. 2025 Apr 1;83(1):86. doi: 10.1186/s13690-024-01485-0.
The global impact of the COVID-19 pandemic was remarkably diverse, unfolding with multiple waves that have touched countries and continents in distinctive ways, leading to varying rates of mortality. The objectives of this study were to examine the characteristics and in-hospital fatality rates of COVID-19 patients hospitalized in the Monastir governorate over two years, with an overall analysis and a wave-specific breakdown throughout the pandemic's progression.
We carried out a two-year longitudinal study, enrolling all COVID-19-infected patients admitted to both public and private health facilities in the governorate of Monastir from March 2020 to March 2022. The study covered six complete infection waves. Patients were followed from their first day of admission to their outcome in hospital. The data were collected using a questionnaire manually completed by well-trained residents. The data were globally analyzed across all hospitalized patients and then compared based on the different waves.
Overall, 5176 were hospitalized. The cumulative in-hospital case fatality rate (CFR) over the study period was 21.4%. After the first wave (W1), the in-hospital CFR followed a gradual increase, reaching its peak at 27.5% during W4 (alpha variant). Later, it decreased to 21.8% during W5 (delta variant), and further declined to 19.5% during W6, associated with the Omicron variant (overall p < 0.001). W5 exhibited the highest proportions of infections, hospitalizations, and in-hospital deaths. W6 featured a low hospitalization rate of 2.8% and a decline in severe cases. Nevertheless, there was a significant surge in hospitalizations among both the pediatric (≤ 18 years) and geriatric (≥ 75 years) populations, with a pronounced impact on the elderly with chronic conditions. This surge resulted in an increase in fatalities among the elderly. The length of stay (LoS) decreased throughout the course of the pandemic, declining from 13 days [10;14] in W1 to 4 days [2;9] in W6 with almost half of them had a LoS less than seven days (55.6%).
This study underscores the critical interplay of variant-specific disease severity, patient demographics, and evolving healthcare responses in managing COVID-19's impact on hospital outcomes.
新冠疫情的全球影响极为多样，疫情呈多波态势发展，以独特方式波及各个国家和大洲，导致不同的死亡率。本研究的目的是调查在两年时间里，在莫纳斯提尔省住院的新冠患者的特征及院内死亡率，并在疫情发展过程中进行总体分析和按波次细分分析。
我们开展了一项为期两年的纵向研究，纳入了2020年3月至2022年3月期间在莫纳斯提尔省公立和私立医疗机构收治的所有新冠感染患者。该研究涵盖了六次完整的感染波次。对患者从入院首日起进行随访直至其在医院的结局。数据通过训练有素的住院医师手动填写的问卷收集。对所有住院患者的数据进行总体分析，然后根据不同波次进行比较。
总体而言，有5176人住院。研究期间的累积院内病死率（CFR）为21.4%。在第一波疫情（W1）之后，院内CFR呈逐渐上升趋势，在第四波疫情（阿尔法变异株）期间达到峰值27.5%。随后，在第五波疫情（德尔塔变异株）期间降至21.8%，在第六波疫情（奥密克戎变异株）期间进一步降至19.5%（总体p<0.001）。第五波疫情的感染、住院和院内死亡比例最高。第六波疫情的住院率较低，为2.8%，重症病例有所下降。然而，儿科（≤18岁）和老年（≥75岁）人群的住院人数显著增加，对患有慢性病的老年人影响尤为明显。这种增加导致了老年人死亡人数的上升。住院时间（LoS）在疫情期间呈下降趋势，从第一波疫情的13天[10；14]降至第六波疫情的4天[2；9]，其中近一半患者的住院时间少于7天（55.6%）。
本研究强调了特定变异株的疾病严重程度、患者人口统计学特征以及不断演变的医疗应对措施在管理新冠疫情对医院结局影响方面的关键相互作用。
