Prevalence and epidemiological trends in mortality due to COVID-19 in Saudi Arabia.

OBJECTIVES: This article describes the prevalence and epidemiological trends of COVID-19 mortality in the largest registry in the Kingdom of Saudi Arabia (KSA). STUDY DESIGN: A prospective epidemiological cohort study using data from all healthcare facilities in KSA collected between March 23, 2020, and April 30, 2022. Data on the number of daily deaths directly related to COVID-19 were gathered, analyzed, and reported. METHOD: Data analysis was carried out using national and regional crude case fatality rate and death per 100,000 population. Descriptive statistics using numbers and proportions were used to describe age, gender, nationality, and comorbidities. The mortality trend was plotted and compared with international figures. In addition, the most common comorbidities associated with mortality and the proportion of patients who received COVID-19 vaccine were reported. RESULTS: The total reported number of deaths between March 23, 2020, and April 30, 2022, was 9085. Crude case fatality rate was 1.21%, and death per 100,000 population was 25.38, which compared favorably to figures reported by several developed countries. The highest percentages of deaths were among individuals aged between 60 and 69 years, males (71%), and individuals with diabetes (60%). Only 2.8% of mortalities occur in patients who received COVID-19 vaccine. Diabetes, hypertension, and heart failure had the highest attributable risk of mortality among patients who died due to COVID-19. CONCLUSION: Case fatality rate and death per 100,000 population in KSA are among the lowest in the world due to multiple factors. Several comorbidities have been identified, namely, diabetes, hypertension, obesity, and cardiac arrhythmias.

Tele-Health Implementation During Covid19 Pandemic in Liver Transplant Population: A Focus on Medication Adherence, Patient Satisfaction, Clinical Outcomes and Possible Cost Impact

Purpose: The COVID-19 pandemic affected many aspects of health care, including the provision of care in ambulatory care clinics, necessitating the utilization of telehealth. For example, we implemented phone clinics in our hospital to ease access to health care for liver transplant patients. This study aims to assess the impact of phone clinics on patients' perception, adherence to medication, and potential cost reduction. Method(s): This prospective observational study utilized validated questionnaires: the telehealth usability questionnaire (TUQ) and Morisky Medication Adherence Scale (MMAS-8), to assess patients' perception of telehealth and medication adherence, respectively. We included all liver transplant patients who received their care through phone clinics from June 1st, 2020, to December 31st, 2020. In addition, clinical outcomes were assessed, such as emergency room visits, development of biopsy-proven rejection, need for hospital admissions, and derangement of enzymes as secondary endpoints. Result(s): We had 422 patients served through phone clinics;416 met the inclusion criteria. The majority of patients were males (61.5%), lived outside Riyadh (63%), used 5-10 medications per day (71%), and were above the age of 60 years (43.7%). The average overall adherence scale was 7.2 (+/-0.91 SD), where 94.5% scored to have medium adherence (score of 6-8), followed by 5.5% with low adherence, while no one had high adherence score. Patients perception scores averages toward the utilization of phone clinic were: 1.5 (+/-0.76 SD) for the usefulness of telehealth, 1.4 (+/-0.7 SD) for the ease of use and learnability, 1.54 (+/-0.8 SD) for the interface quality, 1.45 (+/-0.8 SD) for the interaction quality, 2.07 (+/-1.17 SD) for the reliability, and 1.59 (+/-0.88 SD) for satisfaction and future use. The estimated average direct outof- pocket cost savings per patient was 703 SAR (187 USD) per person, with a total reduction of 292,630 SAR (78,033 USD) in all served patients. For clinical outcomes, 31 patients (7.45%) had emergency room visits three months after the phone clinic. Likewise, five patients (1.20%) developed a biopsy-proven rejection, 14 patients (3.36%) were admitted to hospitals, and 50 patients (12.01%) had derangements of enzymes requiring intervention during the specified period. Conclusion(s): Our results show that the utilization of phone clinics in the liver transplant settings was associated with a high satisfaction rate among the served patients with a medium score of medication adherence and potential cost reduction impact.

Safety and Immunogenicity of BNT-162b2 versus Chadox1 Vaccine in Solid Organ Transplant Recipients: Prospective Study

Purpose: Data showed seroconversion after different SARS-CoV-2 vaccination platforms might yield diminished response in transplant recipients. However, it is unknown whether different vaccination platforms could offer a specific grade of protection against SARS-CoV-2. Method(s): we prospectively studied adult kidney & liver recipients who received who had no previous COVID-19 infection, and received either ChAdOx1 or BNT- 162b2 vaccines between January 2021 to September 2021, with an assessment of IgM/IgG spike (S) antibodies. Result(s): Our cohort is composed of kidney (n=235) or liver (n=217) patients, who have received either ChAdOx1 (N=157) or BNT-162b2 (n=295). The response was higher with mRNA vaccine. Unresponsiveness is found to be mainly linked to diabetes and older age. Side effects were similar to those reported in clinical trials. Conclusion(s): mRNA vaccines might elicit a higher humoral immunity response as compared with ChAdOx1 in immunosuppressed transplant patients.