Introduction
The rapid spread of the new type of coronavirus named novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-COV-2) from Wuhan (China) in the world determined the World Health Organization (WHO) to declare novel coronavirus disease (2019 COVID-19 or nCOVID-19) a pandemic on March 11, 20201,2.
The first confirmed case in Romania was on February 26, 2020, and, by April 20 2020, 8936 confirmed case, 2017 healed cases and 520 deaths had been recorded, 88 cases with missing data and 98,491 tests were done3. The case definitions, as well as the therapies applied by the Romanian physicians, were also used in Italy, Spain and France4–7. The diagnostic was established based on the clinical symptomatology like cough, temperature, breathing difficulty without a prescribed etiology, on patient's direct exposure to SARS-COV-2, and the corroboration by testing with the RT-PCR method8,9.
The Romanian government took strict measures to limit the outbreak, and a Coronavirus task force was set up to coordinate this effort under the direct supervision of the Ministry of Health (MS). Even though some cases of intra-hospital or community infection arose, they were isolated and contained with the help of special hygiene measures, social distancing and a very tight lockdown imposed by the authorities. However, a large number of deaths were confirmed among the adult population with no patient under 20 years of age dying because of COVID-19. Hence, issues regarding the COVID-19 mortality, especially the relationship with the comorbidities and the burden of disease are of great importance for the medical community8.
Several studies about the comorbidities of the patients infected with SARS-COV-2 indicate hypertension, diabetes, obesity, neoplasms, chronic kidney disease and chronic obstructive pulmonary disease (COPD) as leading risk factors for a lethal evolution of the disease10–12. Romania holds a top place in Europe for deaths caused by cardiovascular diseases with hypertension affecting over 45% of the adult population. Almost half of the population aged over 65 has at least one chronic disease, and 1 in 5 adults smokes daily (32% men as compared to 18% women)13. Moreover, Romania has a record number of deaths due to preventable causes like ischemic cardiac disease, pulmonary cancer or alcoholism14. The prevalence of diabetes is approximately 11.6% and doubles for prediabetes as confirmed by Predatorr study15 and Mentor study16. Therefore, it is expected that a high number of infections with SARS-CoV-2 in Romania to have a severe course of the disease or to end deadly.
To investigate the comorbidity profiles for SARS-CoV2 deaths, an observational retrospective study was conducted starting from the official public communications of Romanian Ministry of Internal Affairs (MAI) regarding the fatalities declared as COVID-19 deaths by the National Institute of Public Health (INSP)4,8. Additionally, data from the National Center for Statistics and Informatics in Public Health were utilized to run a case-case study between the COVID-19 death population and the fatalities due to hospital pneumonia between March 22 and April 20 in the years 2016–2018 in Romania. As far as we know, this is the first study in Eastern Europe that investigates patterns of comorbidities for SARS-COV-2 fatalities.
Our principal research question is to generate hypothesis about comorbidity and burden of disease in the population deceased because of the COVID-19 virus and to investigate their association with gender and age. Additionally, the comparison between the fatalities due to COVID-19 and to pneumonia in terms of gender, age and comorbidity profiles allows us to characterize the specific medical pre-conditions of COVID-19 population.