Initial experiences regarding COVID19 mortality in Punjab-A mixed method analysis

Context: The spread of COVID-19 pandemic poses a great challenge to health care organizations and unprecedented need for information. This study aims to identify possible factors causing delay and losing precious time during diagnosis and treatment of COVID-19 at home and health facility level. It also aims to highlight perceptions and experiences of family members of deceased regarding diagnosis and treatment of COVID-19 infection in hospital. Methods: A retrospective study was done to review COVID-19 deaths from 18th March to 5th June 2020 in Punjab, India. A total of 48 laboratory confirmed (RT-PCR) COVID-19 deaths were reported during this period. Socio demographic profile, sequence of events including clinical symptoms, medical aid taken, time of confirmation of diagnosis and treatment before death were noted from the records on a predesigned proforma. Family members of deceased were also interviewed and asked open-ended questions regarding their experiences at various health facilities. Descriptive statistics was presented in percentages, mean, and median. Results: Mean age of subjects was 56.3 ± 18.3 years. Majority (82.2%) had three or more than three comorbidities. Median time from appearance of first symptom to first medical contact and confirmation of diagnosis was 1 and 5 days, respectively. On the basis of interview with deceased's relative, various themes like delay in diagnosis and treatment, dissatisfied with hospital system and lack of communication between relative and patient were generated. Conclusion: Presence of comorbidities was the most important risk factor. Health seeking behavior of patients immediately after appearance of symptoms was found to be satisfactory.