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Introduction: Multimorbidity is the coexistence of two or more chronic medical conditions in a person. The study aims to investigate the immediate cause of death and risk factors of mortality including multimorbidity among patients hospitalized with SARS CoV2 infection in Kasaragod district in Kerala, India. Methods: A record-based case-control study was done using the hospital records and follow-up surveillance system of SARS-COV 2 patients admitted in the Kasaragod district. SARS-COV 2 patients who had expired during the study period from June to December 2020 and reported as COVID-19 deaths (N = 226) were the cases, and an equal number of hospital controls were the study participants. Results: The mean (SD) age of the cases and controls were found to be 64.6 (14.2) years and 61.5 (13.4) years, respectively. Covid pneumonia alone was reported as the cause of death in more than half (52%) of the study participants. This was followed by cardiovascular events (8.5%) and acute kidney injury (6.5%). Among individual comorbidities among people who expired, diabetes mellitus (53%) was the most common, followed by hypertension (46%) and cardiovascular diseases (23%). More than 50% were found to have multimorbidity. Logistic regression showed chronic kidney disease (CKD) (Adjusted odds ratio (AOR) = 2.18 (1.24–3.83)) and malignancy (AOR = 3.05 (1.27–7.32)) to be significantly associated with mortality as individual determinants. Hypertension–diabetes mellitus [AOR = 1.68 (1.02–2.76), P = 0.043] and hypertension–CKD [AOR = 3.49 (1.01–12.01), P = 0.48] dyads were multimorbidities significantly associated with mortality. Conclusion: Combinations of hypertension with diabetes mellitus and CKD were found to be significant determinants for mortality in hospitalized COVID-19 patients. Uniformity in death certification is required to understand the causes and contributors to death in COVID-19.

Introduction: Healthcare Workers (HCWs) have more risk of exposure, and those working in critical care units are likely to have exposure to higher viral inoculum load from aerosol generating procedures. The risk of acquisition of infection is higher in those who work in hybrid hospitals compared to those designated as Coronavirus Disease-2019 (COVID-19) hospitals. Aim: To estimate the prevalence of Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) infection among Healthcare Workers (HCWs) of a hybrid COVID-19 treatment hospital in Kerala. Materials and Methods: This cross-sectional study was conducted in the Central Biochemistry Laboratory, Government Medical College, Thiruvananthapuram, Kerala, India, during the period 8th January 2021 to 19th January 2021. Among 3550 HCWs, 979 subjects were selected and grouped into high risk and low risk category, based on their job profile in the hybrid hospital. Results: Finally, 940 HCWs were analysed in the study grouped as high risk (n=859) and low risk (n=81). SARS-CoV-2 Immunoglobulin (Ig) was detected in (19.1%) 180/940 of them. Seroprevalence among the high-risk group was 20.3% (174/859) and that in low-risk group was 7.4% (6/81) (p=0.005). In high-risk group, seropositivity was noted in 30.54% (76/249) of nurses, 19% hospital attenders (30/158), 18.9% (59/312) resident doctors and 6.4% (9/140) consultant doctors. In those with a positive history of SARS-CoV-2 infection, seropositivity was found among 75.4% (101/134). In those who were COVID-19 positive during July 2020, 33.3% (6/18) were still IgG reactive. Conclusion: The study reported 19.1% SARS-CoV-2 IgG reactivity among HCWs. Seropositivity was significantly higher in high-risk group compared to low-risk. Antibody decay kinetics was comparable to that in published literature. Infection control challenges in hybrid hospitals account for higher seropositivity in this study, compared to overall seroprevalence among HCWs in Kerala

Background and Objectives: The morbidity and mortality spectrum of the south Indian state of Kerala is dominated by chronic non-communicable diseases, yet febrile illnesses because of neglected tropical diseases and emerging viral infections are often reported. As fever deaths are mostly avoidable, understanding the determinants of mortality is essential for implementing preventive measures. Methods: A case-control study was done during an ongoing dengue outbreak in Thiruvananthapuram district, Kerala during 2017–18. Cases included all fever deaths from the line list of Integrated Disease Surveillance Program (IDSP). Data were obtained from hospital case records and by interviewing patients or care givers. The theoretical model for determinants of mortality was constructed at three levels namely sociodemographic factors, access to health care and health seeking behavior, and clinical determinants. Results: This study confirmed association of mortality with age above 40 years (P = 0.010, OR = 3.48), being heavy built (P = 0.029, OR = 13.25), clinical symptoms of breathlessness (P < 0.001, OR = 24.89), restlessness (P < 0.001, OR = 97.26), clinical signs of drowsiness (P = 0.024, OR = 7.97), hypotension (P < 0.001, OR = 42.22), complications such as ARDS (P = 0.047, OR = 171.56), and myocarditis (P = 0.012, OR = 16.59). A low occupation status of semiskilled work or less (P = 0.012, OR = 0.30), choosing a nearby hospital for treatment (P = 0.018, OR = 0.48) and shortening the time gap between onset of symptom and final diagnosis (P = 0.044, OR = 0.72) was found to be protective. Conclusion: Along with biological and clinical factors, distal determinants like social factors, health seeking behavior, and health system factors are associated with fever mortality.

Objective To understand the structures and strategies that helped Kerala in fighting the COVID-19 pandemic, the challenges faced by the state and how it was tackled.Design Qualitative descriptive study using focus group discussions and in-depth interviews.Setting State of Kerala, India.Participants 29 participants: four focus group discussions and eight in-depth interviews. Participants were chosen purposively based on their involvement in decision-making and implementation of COVID-19 control activities, from the department of health and family welfare, police, revenue, local self-government and community-based organisations. Districts, panchayats (local bodies) and primary health centres (PHCs) were selected based on epidemiological features of the area like the intensity of disease transmission and preventive/containment activities carried out in that particular area to capture the wide range of activities undertaken in the state.Results The study identified five major themes that can inform best practices viz social capital, robust public health system, participation and volunteerism, health system preparedness, and challenges. This study was a real-time exploration of the intricacies of COVID-19 management in a low/middle-income country and the model can serve as an example for other states and nations to emulate or adjust accordingly.Conclusion The study shows the impact of synergy of these themes towards more effective solutions; however, further research is much needed in examining the relationship between these factors and their relevance in policy decisions.