Manuscript ID number:

355188

Title of paper:
Time to Severity of Covid-19 and Its Predictors among Covid-19 Patients in Dilla University Referral Hospital Covid-19
Treatment Center, Southern Ethiopia: A Retrospective Cohort Study

Reviewer 1
Title & Abstract
1. Do the title and abstract cover the main aspect of the work?
The abstract should provide more numerical data, especially on the survival analysis.

2. Does the introduction provide background and information relevant to the study?
Yes

Material and Methods

3. Are the methods clear and replicable? Do all the results presented match the methods described?
Only patients whose charts were available were included in the analysis. Kindly provide an estimate on how many patients
were excluded for having missing information.
How can censoring "represent patients with moderate and mild COVID-19"?
Severe COVID is not well defined.

Results
4. If relevant are the results novel? Does the study provide an advance in the field? Is the data plausible?
Results are not novel. The relationship of comorbidities with severe COVID is well known.

Discussion
5. Do the findings described by the author correlate with the results? Are the findings relevant?
Please avoid repetition of the results in the discussion.

Conclusion
6. Do the conclusions correlate to the results found?
Yes

Figures & Tables

7. If the author has provided figures and tables are the figures and tables clear and legible? Are the figures free from
unnecessary modification?
One figure including all KM curves can be included.

8. Does the paper raise any concerns?

I could not find any ethical concerns.

Competing interest
9. Do any of the authors' competing interests raise concerns about the validity of the study i.e. have the authors'
competing interests created a bias in the reporting of the results and conclusions?
None

English editing
10. Do you think the manuscript requires English editing to correct the grammar or flow?
No

Recommendations to the Editor

Additional comments
Major issues:
Only patients whose charts were available were included in the analysis. Kindly provide an estimate on how many patients
were excluded for having missing information.
How can censoring "represent patients with moderate and mild COVID-19"?
One figure including all KM curves can be included.

Minor issues:
Please use only one of "COVID-19", covid, covid19, and others to maintain uniformity.
The abstract should provide more numerical data, especially on the survival analysis.
The English sounds too informal at places. Kindly re-check with someone proficient in the language.
How was informed consent obtained in a retrospective study using chart review?
"X-ray" is electromagnetic radiation. How can be it unilateral or bilateral?
Acknowledgement should be updated to include only individuals/institutes who made significant contributions to the
manuscript but will not meet criteria for authorship. Individuals should be named.
Reviewer 2
Title & Abstract
1. Do the title and abstract cover the main aspect of the work?
This study aims to assess the predictors of morbidity and mortality in COVID-19 by performing a retrospective chart review
leading to a model generation.

2. Does the introduction provide background and information relevant to the study?
The introduction does provide relevant information. However, part of the information like COVID-19 being a pandemic, its
origin, the declaration by WHO, is common knowledge and is redundant.

Material and Methods

3. Are the methods clear and replicable? Do all the results presented match the methods described?
The methods are clear and replicable. However, the Achilles heel of this study is the absence of an appropriate sample size
calculation to power the study. This flaw leads the resultant findings meaningless.

Results
4. If relevant are the results novel? Does the study provide an advance in the field? Is the data plausible?
The results are not novel. Multiple studies with larger sample sizes, better power, and sample size calculation, and better
methodology are available. Hence, it would not add much to the existing literature.

Discussion
5. Do the findings described by the author correlate with the results? Are the findings relevant?
The findings do correlate to the results. However, they should be taken with a pinch of salt due to the absence of a sample
size calculation that would power the study.

Conclusion
6. Do the conclusions correlate to the results found?
The conclusions do relate to the results.

Figures & Tables

7. If the author has provided figures and tables are the figures and tables clear and legible? Are the figures free from
unnecessary modification?
The tables are clear and legible.

8. Does the paper raise any concerns?

The concerns regarding sample size are already mentioned. Furthermore, there is a significant amount of missing data
secondary to "chart loss" which may skew the results.

Competing interest
9. Do any of the authors' competing interests raise concerns about the validity of the study i.e. have the authors'
competing interests created a bias in the reporting of the results and conclusions?
No competing interests.

English editing
10. Do you think the manuscript requires English editing to correct the grammar or flow?
Yes

Recommendations to the Editor

Additional comments
Dear Gizaw Sisay and Authors,

Thank you for sending this manuscript for review.

There are multiple grammatical errors. "COVID-19" has been spelled as Covid-19 or covid-19 or covid-1 multiple times.
Pandemic is a "worldwide" occurrence by definition.
The source of the definition for disease severity is unclear.
Several abbreviations are not described by their full-form e.g., ICU, IHMS, DURH, IQR, etc.
I wish you the best of luck with this manuscript and any future endeavors.
Reviewer 3
Title & Abstract
1. Do the title and abstract cover the main aspect of the work?
The Title indicate the study's design and explain what the authors will do The abstract provide a balanced summary of what
was done and what was found.
I just want mention one thing: the number of patients included in this study corresponds to results part not in the methods

2. Does the introduction provide background and information relevant to the study?
The authors explain the scientific background and rationale for the investigation being reported and they state specific
objectives.
There are errors in the references 6 and 7 -
"Jordan RE, Adab P, Cheng K. Covid-19: risk factors for severe disease and death. British Medical Journal Publishing Group;
2020". The correct form is: Jordan RE, Adab P, Cheng KK. Covid-19: risk factors for severe disease and death. BMJ. 2020 Mar
26;368:m1198. doi: 10.1136/bmj.m1198. PMID: 32217618.
"Smith RG. A Summary Overview of the Pharmacotherapy for COVID-19" (I don't find this reference)
"of Epidemiology KS. Report on the epidemiological features of coronavirus disease 2019 (COVID-19) outbreak in the
Republic of Korea from January 19 to March 2, 2020. Journal of Korean medical science. 2020;35(10):e112" Who are the
authors???
In the paragraph: "According to the WHO, patients with mild infections can expect to recover in two weeks, while those with
serious illnesses can expect to recover in three to six weeks. Therefore, evidence that shows the duration of severity and
death by COVID-19 in different contexts and settings is crucial in formulating preventive measures and optimizing treatment
options" (I miss the reference)

Material and Methods

3. Are the methods clear and replicable? Do all the results presented match the methods described?
The authors described study design, they described the setting, periods of recruitment and data collection.
They give the eligibility criteria, and the sources and methods of selection of participants.
Don't describe the variables.
They describe all statistical methods.

Results
4. If relevant are the results novel? Does the study provide an advance in the field? Is the data plausible?
The results aren't novel but they are interesting to improve the knowledge of COVID-19 in Africa but this section requires a
major revision because there are some mistakes.
For example:
A total of "313" COVID-19 patients were admitted "337" of the patients (93.6 %) were from Dilla town (337 of 313???)
53 (20.9%) showed unilateral infiltration, and 21 (8.3%) showed unilateral infiltration
191(75.5%) had chest??
64 (24.9%) died (data in the text)
Death 63(24.9) 0(0.0) 63(100) (data in the table)

Discussion
5. Do the findings described by the author correlate with the results? Are the findings relevant?
The findings aren't relevant. The discussion is a repetition of the results.

Conclusion
6. Do the conclusions correlate to the results found?
The conclusions correlate to the results found.

Figures & Tables

7. If the author has provided figures and tables are the figures and tables clear and legible? Are the figures free from
 unnecessary modification?
There are some mistakes in the tables. I recommend to check the tables and the data in the text.

8. Does the paper raise any concerns?

The ethical aspects are correct. The statistical analysis is appropriate.
Some references aren't relevant and in the incorrect style (They must check all of the references).

Competing interest
9. Do any of the authors' competing interests raise concerns about the validity of the study i.e. have the authors'
competing interests created a bias in the reporting of the results and conclusions?
The authors don't have competing interest.

English editing
10. Do you think the manuscript requires English editing to correct the grammar or flow?
Yes

Recommendations to the Editor

Additional comments
No additional comments

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