Survival analysis of all critically ill patients with COVID-19 admitted to the main hospital in Mogadishu, Somalia, 30 March–12 June 2020: what interventions are proving effective in fragile states?

OBJECTIVES To determine risk factors for death in patients with coronavirus disease-19 (COVID-19) admitted to the main hospital in Somalia and identify interventions contributing to improved clinical outcome in a low-resource and fragile setting. METHODS We conducted a survival analysis of all COVID-19 patients admitted to the main hospital in Somalia from 30 March-12 June 2020. RESULTS Of the 131 patients admitted to the hospital for COVID-19, 52 (40%) died and 79 (60%) survived. The main factors associated with the risk of in-hospital death were age ≥ 60 years (survival probability on day 21 in patients < 60 years was 0.789 (95% confidence interval (CI): 0.658-0.874) versus 0.339 (95% CI: 0.205-0.478) in patients ≥ 60 years); cardiovascular disease (survival probability 0.478 (95% CI: 0.332-0.610) in patients with cardiovascular disease versus 0.719 (95% CI: 0.601-0.807) in patients without cardiovascular disease) and non-invasive ventilation on admission (patients who were not ventilated but received oxygen only were significantly more likely to survive than those who were ventilated, P< 0.001). CONCLUSION Considering the risk factors (advanced age, presence of cardiovascular disease and use of non-invasive ventilation) is critical when managing severe COVID-19 patients especially in low-resource settings where availability of skilled health workers for critical care units is limited. Our findings also highlight the importance of use of medical oxygen for severely ill patients and on the critical aspect of deciding whether to ventilate critical patients with SARS-COV-2 infection in such settings in order to improve the clinical outcome.