African Covid-19 Critical Care Outcomes Study

The infectious disease COVID-19, caused by coronavirus SARS-CoV-2 (severe acute respiratory
syndrome coronavirus 2), has been declared a pandemic and an international healthcare
emergency by the World Health Organization (WHO). It has spread across the globe,
overwhelming healthcare systems by causing high rates of critical illness. Mortality from
COVID-19 exceeds 4%, with older people with comorbidities being extremely vulnerable.It is
expected that between 50-80% of the world's population may contract SARS-CoV-2 over the next
two years.

It is expected the outcomes to be potentially worse in Africa, because firstly, there is a
limited workforce, and secondly there are limited intensive care facilities and critical care
resources across Africa to provide sufficient care. It is estimated that there are 0.8 (95%
confidence interval 0.3 to 1.45) critical care beds per 100,000 population in Africa. It is
likely that the volume of unplanned admissions associated with COVID-19 will further
adversely affect critical care outcomes in Africa,especially as the ability of healthcare
systems in Africa to adapt and expand during the pandemic to meet the clinical workload is
unknown. Furthermore, the patient outcomes in critical care is poorly documented in this
under-resourced environment.

Most countries in Africa are still in the early phase of the epidemic which provides the
opportunity to study the utilization of critical care resources and their impact on patient
outcomes. It is important therefore to establish what resources, comorbidities and
interventions are potentially associated with either mortality or survival in Africa. Rapid
dissemination of these findings may help inform appropriate resource prioritisation and
utilisation during the COVID-19 pandemic in Africa. These points provide the rationale for
the African Covid-19 Critical Care Outcomes Study (ACCCOS).

Research questions

Primary outcome The primary outcome is in-hospital mortality in adult patients referred to
intensive care or high-care units following suspected or known COVID-19 infection in Africa.

Secondary outcomes To determine the risk factors (resources, comorbidities and interventions)
associated with mortality in adult patients with suspected or known COVID-19 infection in
Africa.

The study is an African national multi-centre prospective observational cohort study of adult
(≥18 years) patients referred to intensive care or high-care units in Africa with suspected
or known COVID-19 infection in Africa. Patient follow up will be for a maximum of 30 days
in-hospital.

This study will run between May to December 2020, with an interim analysis after 250 to 300
deaths registered in the study, or in June or July 2020 if this number of deaths has not been
reported in the study. The reason for the interim analysis, is to potentially provide data
which may be associated with improved outcomes in Africa, in timeous manner for possible
implementation during this COVID-19 pandemic.