The Saudi Critical Care Society practice guidelines on the management of COVID-19 in the ICU: Therapy section.

BACKGROUND: The rapid increase in coronavirus disease 2019 (COVID-19) cases during the subsequent waves in Saudi Arabia and other countries prompted the Saudi Critical Care Society (SCCS) to put together a panel of experts to issue evidence-based recommendations for the management of COVID-19 in the intensive care unit (ICU). METHODS: The SCCS COVID-19 panel included 51 experts with expertise in critical care, respirology, infectious disease, epidemiology, emergency medicine, clinical pharmacy, nursing, respiratory therapy, methodology, and health policy. All members completed an electronic conflict of interest disclosure form. The panel addressed 9 questions that are related to the therapy of COVID-19 in the ICU. We identified relevant systematic reviews and clinical trials, then used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach as well as the evidence-to-decision framework (EtD) to assess the quality of evidence and generate recommendations. RESULTS: The SCCS COVID-19 panel issued 12 recommendations on pharmacotherapeutic interventions (immunomodulators, antiviral agents, and anticoagulants) for severe and critical COVID-19, of which 3 were strong recommendations and 9 were weak recommendations. CONCLUSION: The SCCS COVID-19 panel used the GRADE approach to formulate recommendations on therapy for COVID-19 in the ICU. The EtD framework allows adaptation of these recommendations in different contexts. The SCCS guideline committee will update recommendations as new evidence becomes available.

Severe Middle East Respiratory Syndrome (MERS) Pneumonia

Middle East Respiratory Syndrome (MERS) is a viral respiratory infection, which ranges from asymptomatic infection to severe pneumonia and multiorgan failure, caused by a novel coronavirus named Middle East Respiratory Syndrome Coronavirus (MERS-CoV). Majority of cases have been reported from Saudi Arabia. MERS cases occur as sporadic cases or as clusters or hospital outbreaks. Dromedary camels are thought to be a host for MERS-CoV. Direct contact with dromedary camels within 14days prior to infection was identified as an independent risk factor for MERS. Diagnosis of MERS is based on a positive real-time reverse transcriptase polymerase chain reaction (rRT-PCR), obtained from a respiratory specimen. The mainstay of management of MERS-CoV infection is supportive care. There is no specific antiviral therapy for MERS-CoV infection at present, although several modalities of treatment options have been examined or are under investigation.

Natural History and Clinical Course of Symptomatic and Asymptomatic COVID-19 Patients in the Kingdom of Saudi Arabia.

OBJECTIVES: To analyze symptomatic and asymptomatic COVID-19 patients in Saudi Arabia in terms of initial presentation, risk factors, laboratory findings, clinical outcomes and healthcare utilization. METHODS: All laboratory-confirmed reverse transcription-polymerase chain reaction positive COVID-19 patients who had been tested at three governmental hospitals in Saudi Arabia (two in Riyadh and one in Makkah) between March 8 and May 18, 2020 were included. Demographics, COVID-19 variables, clinical characteristics and healthcare utilization variables were extracted and combined, and a descriptive analysis was conducted. Symptomatic and asymptomatic (on presentation) patients' data were compared. RESULTS: Eighty percent of the patients were males (81.4% of symptomatic and 73.2% of asymptomatic patients, P = 0.02). Moreover, 47.6% and 38.4% of symptomatic and asymptomatic patients were aged 40-64 years, respectively. Fever, cough and breathing difficulties were frequent presenting symptoms. Overall, diabetes (16.4%), hypertension (11.7%), chronic respiratory disease (7.1%) were the most frequent comorbidities, with no differences between the two groups. Symptomatic patients had higher C-reactive protein levels (3.55 vs. 0.30 mg/L; P < 0.0001) and lower total lymphocytes (1.41 vs. 1.70; P = 0.02). ICU admission and mortality were 12.1% and 4.1% in symptomatic, compared to 6.0% and 2.9% in asymptomatic patients, respectively. CONCLUSION: In the studied COVID-19 cohort, symptomatic patients tended to be older, had higher C-reactive protein and more lymphopenia with worse outcome than asymptomatic patients. This granular analysis of COVID-19 cohorts enables identification of at-risk cohorts in future waves, optimizing development of patient pathways and public health interventions.

Portable RT-PCR System: a Rapid and Scalable Diagnostic Tool for COVID-19 Testing.

Combating the ongoing coronavirus disease 2019 (COVID-19) pandemic demands accurate, rapid, and point-of-care testing with fast results to triage cases for isolation and treatment. The current testing relies on reverse transcriptase PCR (RT-PCR), which is routinely performed in well-equipped laboratories by trained professionals at specific locations. However, during busy periods, high numbers of samples queued for testing can delay the test results, impacting efforts to reduce the infection risk. Besides, the absence of well-established laboratories at remote sites and low-resourced environments can contribute to a silent spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). These reasons compel the need to accommodate point-of-care testing for COVID-19 that meets the ASSURED criteria (affordable, sensitive, specific, user-friendly, rapid and robust, equipment-free, and deliverable). This study assessed the agreement and accuracy of the portable Biomeme SARS-CoV-2 system against the gold standard tests. Nasopharyngeal and nasal swabs were used. Of the 192 samples tested using the Biomeme SARS-CoV-2 system, the results from 189 samples (98.4%) were in agreement with the reference standard-of-care RT-PCR testing for SARS-CoV-2. The portable system generated simultaneous results for nine samples in 80 min with high positive and negative percent agreements of 99.0% and 97.8%, respectively. We performed separate testing in a sealed glove box, offering complete biosafety containment. Thus, the Biomeme SARS-CoV-2 system can help decentralize COVID-19 testing and offer rapid test results for patients in remote and low-resourced settings.

The Public's Awareness and Willingness to Undergo Plastic Surgery Procedures during the COVID-19 Pandemic.

BACKGROUND: In March 2020, the Saudi Ministry of Health implemented mitigation measures to control the Coronavirus Disease 2019 (COVID-19) pandemic, including media campaigns, a nationwide lockdown, and closures of plastic surgery clinics. The aim of this study was to explore the public's knowledge of COVID-19, their willingness to undergo cosmetic surgery during the pandemic, and the factors influencing their decisions. METHODS: An internet-based cross-sectional survey was conducted. We collected data on demographic information, knowledge about COVID-19, and willingness to undergo cosmetic procedures. Participants also completed the cosmetic procedure screening questionnaire to assess body dysmorphic disorder. RESULTS: The sample included a total of 1643 participants (women, n = 1002; 61%). A total of 613 (37.3%) participants were aged between 30 and 40 years. The majority (n = 1472; 89.6%) referred to official government accounts for information regarding COVID-19. Most participants (n = 1451; 88.3%) felt that the pandemic was serious, and 1387 (85%) said they would not leave home to undergo cosmetic procedures during the outbreak. Being women, the presence of body-image concerns, and higher cosmetic procedure screening questionnaire scores were associated with an increased willingness to undergo cosmetic procedures. CONCLUSIONS: This is the first study to explore the public's willingness to undergo cosmetic procedures during the COVID-19 pandemic. The public was well educated about the pandemic, via government actions. This was reflected in participants who wished to undergo a cosmetic plastic procedure; we identified factors associated with an increased willingness to undergo procedures, which may help design awareness initiatives.

Prevalence and predictors of anxiety among healthcare workers in Saudi Arabia during the COVID-19 pandemic.

BACKGROUND: During pandemics, healthcare workers (HCWs) may be prone to higher levels of anxiety than those of the general population. This study aimed to explore the anxiety levels among HCWs in Saudi Arabia during the COVID-19 pandemic and the predictors of increased anxiety levels. METHOD: HCW participants in this cross-section study were solicited by email from the database of registered practitioners of the Saudi Commission for Health Specialties between 15 May and 18 May 2020. Sociodemographic characteristics, work-related factors, and organization-related factors were collected. RESULTS: Four thousand nine hundred and twenty HCWs (3.4%) responded. Reported levels of anxiety were low anxiety (31.5%; n = 1552), medium (36.1%; n = 1778), and high (32.3%; n = 1590). Participants reporting high anxiety levels were more likely to be unmarried (OR = 1.32, 95% CI: 1.14-1.52); nurses (OR = 1.54, 95% 1.24-1.91); workers in radiology (OR = 1.52, 95% CI: 1.01-2.28); or respiratory therapists (OR = 2.28, 95% CI: 1.14-4.54). Social factors associated with high anxiety levels were: living with a person who is elderly (p = 0.01), has a chronic disease (p < 0.0001), has immune deficiency (p < 0.0001), or has a respiratory disease (p-value <0.0001). Organization-related factors associated with a high level of anxiety were: working in an organization that hosts COVID-19 patients and working with such patients (p-value <0.0001). CONCLUSION: Self-reported medium and high levels of anxiety were present in 68.5% of HCWs in the COVID-19 pandemic. This highlights the urgent need to identify high-risk individuals to offer psychological support and provide up to date information on the pandemic. These data should help policymakers drive initiatives forward to protect and prepare HCWs psychological wellbeing.

Principles of Care for Patients with Liver Disease During the Coronavirus Disease 2019 (COVID-19) Pandemic: Position Statement of the Saudi Association for the Study of Liver Disease and Transplantation.

In December 2019, a novel coronavirus was identified in patients in Wuhan, China. The virus, subsequently named severe acute respiratory syndrome coronavirus-2, spread worldwide and the disease (coronavirus disease 2019 or COVID-19) was declared a global pandemic by the World Health Organization in March 2020. Older adults and individuals with comorbidities have been reported as being more vulnerable to COVID-19. Patients with chronic liver disease (CLD) have compromised immune function due to cirrhosis and are more susceptible to infection. However, it is unclear if patients with CLD are more vulnerable to COVID-19 and its complications than other populations. The high number of severe cases of COVID-19 has placed an unusual burden on health systems, compromising their capacity to provide the regular care that patients with CLD require. Hence, it is incredibly crucial at this juncture to provide a set of interim recommendations on the management of patients with CLD during the current COVID-19 outbreak.

Managing Oncology Services During a Major Coronavirus Outbreak: Lessons From the Saudi Arabia Experience.

Outbreaks of infectious etiology, particularly those caused by a novel virus that has no known treatment or vaccine, may result in the interruption of medical care provided to patients with cancer and put them at risk for undertreatment in addition to the risk of being exposed to infection, a life-threatening event among patients with cancer. This article describes the approach used to manage patients with cancer during a large-scale Middle East respiratory syndrome-coronavirus hospital outbreak in Saudi Arabia to ensure continuity of care and minimize harm from treatment interruption or acquiring infection. The approach taken toward managing this high-risk situation (COVID-19) could be easily adopted by health care organizations and would be helpful to ensure readiness for the occurrence of future outbreaks of different infectious etiologies like those recent episodes of new coronavirus.

Outcome of Oncology Patients Infected With Coronavirus.

PURPOSE: This study investigated the features of oncology patients with confirmed Middle East respiratory syndrome (MERS) at the Ministry of National Guard Health Affairs-Riyadh during the outbreak of June 2015 to determine the clinical course and outcome of affected patients. METHODS: The patients' demographic information, cancer history, treatment pattern, information about MERS-coronavirus (CoV) infection, history of travel, clinical symptoms, test results, and outcome were collected and analyzed as part of a quality improvement project to improve the care and safety of our patients. Only patients with confirmed infection were included. RESULTS: A total of 19 patients were identified, with a median age of 66 years (range, 16-88 years), and 12 patients (63%) were males. The most common underlying disease was hematologic malignancies (47.4%), followed by colorectal cancer (21%) and lung cancer (15.8%). Hypertension and diabetes mellitus were the most common comorbidities (57.9% and 52.6%, respectively). Infection was diagnosed by nasopharyngeal swab in all patients. All patients contracted the infection during their hospitalization for other reasons. Sixteen patients (80%) were admitted to the intensive care unit; 13 patients (81%) had acute respiratory distress syndrome, 11 were intubated (68.75%), 9 had acute renal injury (56.25%), and 3 required dialysis (18.75%). Only 3 patients (15.8%) with early-stage cancers survived. Patients with hematologic malignancies and advanced solid tumors had a 100% case fatality rate. The majority of the causes of death were due to multi-organ failure and septic shock. CONCLUSION: MERS-CoV infection resulted in a high case fatality rate in patients with malignancy. Therefore, it is critical to implement effective primary preventive measures to avoid exposure of patients with cancer to the virus.