Clinical and epidemiological spectrum of coronavirus disease 2019 in Central Kerala: a retrospective case series

Ronnie Thomas, Bins M. John, Joe Thomas Koothapally, Sanjeev Kumar, Supriya Adiody, Venu Balachandran, Chithra Valsan, Praveenlal Kuttichira


Kerala state in India was known for its early response to the Covid-19 pandemic by public health mitigation measures through science-based advocacy. The objective of this study was to analyze epidemiological and clinical characteristics of COVID-19 patients admitted to a tertiary care center in central Kerala. This retrospective case series was undertaken by reviewing the medical records and extracting the epidemiological data, clinical symptoms and laboratory findings of consecutive patients admitted between April 1st and September 31, 2020. Clinical and demographic parameters of hospitalized patients were analyzed regarding their association with the severity of disease. The mean age of the patients was 35.8 years with significant male predominance. Shopkeepers represented 15.6% of the patients and healthcare workers represented 12.5%. Primary contact with a known case was documented in 62.5% of the patients. Asymptomatic patients constituted 25% of the patients and the most commonly experienced symptoms were fever, cough, breathlessness and diarrhea. Three patients had atypical presentations in the form of generalized seizures, intussusception and generalized anxiety with suicidal ideation. Neutrophilia and Lymphopenia were the most dominant laboratory finding. The clinical spectrum of COVID-19 in the study population is wider than previously described in literature.


COVID-19, Kerala, Clinical spectrum, Epidemiological profile, Case series

Full Text:



Coronavirus disease 2019 (COVID-19) was declared a global pandemic by the World Health Organization (WHO) on 12 March 2020.

Zhu J, Ji P, Pang J, Zhong Z, Li H, He C, et al. Clinical characteristics of 3,062 COVID‐19 patients: a meta‐analysis. J Med Virology. 2020.

Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. New England J Med. 2020;382(18):1708-20.

Ulahannan JP, Narayanan N, Thalhath N, Prabhakaran P, Chaliyeduth S, Suresh SP, et al. Collective for Open Data Distribution-Keralam (CODD-K) consortium. A citizen science initiative for open data and visualization of COVID-19 outbreak in Kerala, India. J Am Med Inform Assoc. 2020;27(12):1913-20.

Valsan N, Thomas R, Kuttichira P, Valsan C, James A. Willingness and psychological preparedness to attend to COVID-19 patients among healthcare workers in a tertiary care private hospital in Kerala-A mixed method study. Kerala J Psychiatry. 2020.

Siordia JA. Epidemiology and clinical features of COVID-19: A review of current literature. J Clinical Virology. 2020.

Sarangi B, Reddy VS, Oswal JS, Malshe N, Patil A, Chakraborty M, et al. Epidemiological and clinical characteristics of COVID-19 in Indian children in the initial phase of the pandemic. Indian pediatrics. 2020;57(10):914-7.

Lechien JR, Chiesa‐Estomba CM, Place S, Van Laethem Y, Cabaraux P, Mat Q, et al. Clinical and epidemiological characteristics of 1,420 European patients with mild‐to‐moderate coronavirus disease 2019. J Internal Med. 2020.

Makrinioti H, MacDonald A, Lu X, Wallace S, Jobson M, Zhang F, et al. Intussusception in 2 children with severe acute respiratory syndrome coronavirus-2 infection. J Pediatric Infectious Diseases Society. 2020;9(4):504-6.

Vohora D, Jain S, Tripathi M, Potschka H. COVID‐19 and seizures: Is there a link? Epilepsia. 2020;61(9):1840-53.

Czeisler ME, Lane RI, Petrosky E, Wiley JF, Christensen A, Njai R, et al. Mental health, substance use, and suicidal ideation during the COVID-19 pandemic United States, June 24-30, 2020. Morbidity and Mortality Weekly Report. 2020;69(32):1049.

Wang B, Li R, Lu Z, Huang Y. Does comorbidity increase the risk of patients with COVID-19: evidence from meta-analysis. Aging. 2020;12.

Zhou Y, Chi J, Lv W, Wang Y. Obesity and diabetes as high‐risk factors for severe coronavirus disease 2019 (Covid‐19). Diabetes/Metabolism Research Reviews. 2020:e3377.

Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. Jama. 2020.

Henry BM, Cheruiyot I, Vikse J, Mutua V, Kipkorir V, Benoit J, et al. Lymphopenia and neutrophilia at admission predicts severity and mortality in patients with COVID-19: a meta-analysis. Acta Bio Medica: Atenei Parmensis. 2020;91(3):e2020008.

Rodriguez-Morales AJ, Cardona-Ospina JA, Gutiérrez-Ocampo E, Villamizar-Peña R, Holguin-Rivera Y, Escalera-Antezana JP, et al. Clinical, laboratory and imaging features of COVID-19: A systematic review and meta-analysis. Travel medicine infectious disease. 2020:101623.

Lippi G, Plebani M, Henry BM. Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: a meta-analysis. Clinica Chimica Acta. 2020.

Vial MR, Peters A, Pérez I, Spencer-Sandino M, Barbé M, Porte L, et al. COVID-19 in South America: clinical and epidemiological characteristics among 381 patients during the early phase of the pandemic in Santiago, Chile. BMC infectious diseases. 2020;20(1):1-8.