Mumbai mayhem of COVID-19 pandemic reveals important factors that influence susceptibility to infection

Abstract

Background: COVID-19 severity is disproportionately high in the elderly and people with comorbidities. However, other factors that predispose individuals to increased chances of infection are unclear.

Methods: Data from 18,600 people screened for COVID-19 in Mumbai during the outbreak's initial phase, March 7 to June 30, 2020, were used to assess risk factors associated with COVID-19 using the odds ratio analysis.

Findings: Males aged ≥60 years having both diabetes and hypertension were at the highest risk of COVID-19 infection (M vs. F OR=2.5, 95% CI=1.34-4.67, p = 0.0049). People having both diabetes and hypertension in ≥20 years (OR=4.11, 95% CI=3.26-5.20, p <0.0001), diabetes and hypertension independently in 20-39 (OR=4.13, 95% CI=2.22-7.70, p <0.0001, OR=4.32, 95% CI=2.10-8.88, p = 0.0001) and ≥60 years (OR=2.69, 95% CI=1.87-3.87, p <0.0001, OR=2.03, 95% CI=1.46-2.82, p <0.0001), chronic renal disease in 20-39 years (OR=5.38, 95% CI=1.91-15.09, p = 0.0007) age groups had significantly higher risk of COVID-19 infection than those without comorbidity. Quarantined people had significantly lower positive odds (OR=0.59, 95% CI=0.53-0.66, p <0.001) than non-quarantined people.

Interpretation: Our research indicates that the risk of getting COVID-19 disease is not equal. When considering sex, age, and comorbidity together, we found that males aged ≥60 years and having both diabetes and hypertension had a significantly high risk of COVID-19 infection. Therefore, remedial measures such as vaccination programs should be prioritized for at-risk individuals.

Funding: SERB, India: SB/S1/COVID-2/2020 and Seed grant RD/0520-IRCCHC0-006 from IRCC, IIT Bombay.

Fig. 1.

Features of the study population. RT-PCR test summary-(a) distribution across months and (b) overall test positivity rate. (c) Age-wise distribution of the study population. (d) Distribution of study population based on gender, quarantine status, and occupation (healthcare worker involved in managing COVID-19 patients). (e) Distribution of comorbidities reported across the study population. (f) Distribution of symptoms reported across the study population.

Fig. 2.

Odds of age on COVID-19 infection with symptoms, sex, and comorbidities (a) The odds of test positivity and symptoms across age groups. The cytokine and interferon response-driven symptoms of fever, cough, and breathlessness appear to increase with age, with a marked preponderance in patients aged more than 40. An asterisk marks the significant groups. (b) The odds ratio of males vs. females and comorbidities across age groups. Diabetes alone and in combination with hypertension appear to be high-risk factors for getting infected with COVID-19 in the younger population, while renal diseases elevate the risk on elderly males.