Epidemiology, clinical characteristics, and virologic features of COVID-19 patients in Kazakhstan: A nation-wide retrospective cohort study

Yegorov S. Goremykina M. Ivanova R. Good S.V. Babenko D. Shevtsov A. MacDonald K.S. Zhunussov Y.
May 2021 Elsevier Ltd

The Lancet Regional Health - Europe
2021 #4

Background: The earliest coronavirus disease-2019 (COVID-19) cases in Central Asia were announced in March 2020 by Kazakhstan. Despite the implementation of aggressive measures to curb infection spread, gaps remain in the understanding of the clinical and epidemiologic features of the regional pandemic. Methods: We did a retrospective, observational cohort study of patients with laboratory-confirmed COVID-19 hospitalized in Kazakhstan between February and April 2020. We compared demographic, clinical, laboratory and radiological data of patients with different COVID-19 severities on admission. Logistic regression was used to assess factors associated with disease severity and in-hospital death. Whole-genome SARS-CoV-2 analysis was performed in 53 patients. Findings: Of the 1072 patients with laboratory-confirmed COVID-19 in March-April 2020, the median age was 36 years (IQR 24–50) and 484 (45%) were male. On admission, 683 (64%) participants had asymptomatic/mild, 341 (32%) moderate, and 47 (4%) severe-to-critical COVID-19 manifestation; 20 in-hospital deaths (1•87%) were reported by 5 May 2020. Multivariable regression indicated increasing odds of severe disease associated with older age (odds ratio 1•05, 95% CI 1•03-1•07, per year increase; p<0•001), the presence of comorbidities (2•34, 95% CI 1•18-4•85; p=0•017) and elevated white blood cell count (WBC, 1•13, 95% CI 1•00-1•27; p=0•044) on admission, while older age (1•09, 95% CI 1•06-1•13, per year increase; p<0•001) and male sex (5•63, 95% CI 2•06-17•57; p=0•001) were associated with increased odds of in-hospital death. The SARS-CoV-2 isolates grouped into seven phylogenetic lineages, O/B.4.1, S/A.2, S/B.1.1, G/B.1, GH/B.1.255, GH/B.1.3 and GR/B.1.1.10; 87% of the isolates were O and S sub-types descending from early Asian lineages, while the G, GH and GR isolates were related to lineages from Europe and the Americas. Interpretation: Older age, comorbidities, increased WBC count, and male sex were risk factors for COVID-19 disease severity and mortality in Kazakhstan. The broad SARS-CoV-2 diversity suggests multiple importations and community-level amplification predating travel restriction. Funding: Ministry of Education and Science of the Republic of Kazakhstan.

Central Asia , Clinical characteristics , COVID-19 , Disease risk factors , Disease severity , Kazakhstan , Molecular epidemiology , SARS-CoV-2 , SARS-CoV-2 genomics

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School of Sciences and Humanities, Nazarbayev University, 53 Kabanbay Batyr Ave, Nur-Sultan, 010000, Kazakhstan
Department of Rheumatology and Non-Infectious Diseases, Semey Medical University 103 Abai street, Semey, 071400, Kazakhstan
Department of Biology, University of Winnipeg, 599 Portage Avenue, Winnipeg, R3B2E9, MB, Canada
Research Centre, Karaganda Medical University, 40 Gogol St, Karaganda, Kazakhstan
National Centre for Biotechnology, 13/5 Kurgalzhynskoye road, Nur-Sultan, 010000, Kazakhstan
Departments of Medicine, Microbiology & Immunology, Max Rady College of Medicine, University of Manitoba, 745 Bannatyne Avenue, Winnipeg, R3E 0J9, MB, Canada
JC Wilt Infectious Diseases Research Centre, Public Health Agency of Canada, 745 Logan Avenue, Winnipeg, R3E3L5, MB, Canada
Department of Public Health, Semey Medical University, 103 Abai street, Semey, 071400, Kazakhstan
Institute for Infectious Disease Research, Faculty of Health Sciences, McMaster University, 1280 Main St. West, Hamilton, L8S 4L8, ON, Canada

School of Sciences and Humanities
Department of Rheumatology and Non-Infectious Diseases
Department of Biology
Research Centre
National Centre for Biotechnology
Departments of Medicine
JC Wilt Infectious Diseases Research Centre
Department of Public Health
Institute for Infectious Disease Research

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