The First COVID-19 Mortality in Batu Pahat, Johor: Lesson Learnt

COVID-19 had been declared as a global pandemic on 11 March 2020. This case report is about Severe Acute Respiratory Infection (SARI) due to COVID-19 (Corona Virus-19). A 68-yearold lady with underlying hypertension and congestive cardiac failure presented with fever and productive cough for 5 days duration. One week before her presentation, she had travelled to Kluang, Johor for a wedding gathering which was later found to have contributed to a cluster of COVID-19 cases. Otherwise, she denied any sick or known COVID-19 contact. Respiratory examination revealed left lower zonecrepitations. She was tachypnoeic on a high flow mask 15 L and hypotensive (BP 90/70 mm Hg) on arrival at the hospital. Chest radiograph showed bilateral asymmetrical consolidations. There was a presence of lymphopenia while her dengue serology result was negative. She was treated as SARI secondary to pneumonia with septic shock and required mechanical ventilation due to respiratory failure. Nasopharyngeal swab for SARS CoV-2 (Severe Acute Respiratory Syndrome Corona Virus-2) was taken as positive for COVID-19 on the third day of admission. Apart from supportive andintensive care measures, she was commenced on oral hydroxychloroquine, subcutaneous Interferon Beta and syrup lopinavir/ritonavir per local guidelines during that period. Unfortunately, she developed acute respiratory distress syndrome (ARDS) on day 3 of admission and passed away due to respiratory failure. Clinicians should pay attention to the COVID-19 critical disease profile and mortality risks. By identifying high-risk patients early, medical resources can be administered in an organized way and timely way to improve the efficacy of the healthcare services.