Perceptions, motivation factors, and barriers to a COVID-19 booster immunization in a subpopulation of KSA: A cross-sectional study

The current cross-sectional survey was designed to evaluate the perception, motivation factors and barriers to a COVID-19 booster immunization in a subpopulation of the Kingdom of Saudi Arabia. A total of 520 respondents were selected by a simple random sampling method. The questionnaire was designed in multiple languages and categorized as;demographic details, perceptions, motivation factors, and barriers to acceptance of a booster dose of COVID-19 vaccine among the respondents. Both anonymous, self-administered, closed-ended online, and paper-based questionnaire was used to assess the above parameters. A higher proportion of the respondents were females (55.2%) with an age range of 36.7 ± 7.7 years. About 36.2% of respondents had a poor perception of the booster dose. Significant differences in the levels of perceptions were found among different age groups and also among the respondents with or without chronic medical conditions. Nearly 49.8% of respondents had hesitation about the booster dose, 58.8% of respondents recommended others to get the booster vaccine at the earliest and 49.8% preferred to develop natural immunity to infection. The hesitation for the booster was more among the female respondents and the older age groups (≥ 60 years) though a large number (43.2%) believe that the booster vaccination is going to end the pandemic worldwide. Further nationwide studies involving different subpopulations are recommended. Public health education is the need of the hour to reduce such barriers and hesitancy.

Too early for admission? A Telemedicine follow up comparison of mild COVID-19 patients from the Emergency Department and Clinics.

OBJECTIVE: Mildly symptomatic COVID-19 patients may seek medical attention either in the Emergency Department (ED) or Ambulatory Clinics (AC). However, it is unclear if ED patients have different characteristics and outcomes than AC patients when discharged under telemedicine surveillance, which we explored in this study. METHODS: Patients with mild or asymptomatic COVID-19 disease referred to a multidisciplinary Telemedicine clinical service (TM-CS) program in an urban tertiary-care hospital, between June 2020 and February 2021, were evaluated. Those referred from ED were labeled "ED Group" and ones from AC as "AC Group." Their characteristics, clinical features and outcomes including telemedicine parameters, subsequent ED visits, hospital admission, oxygen requirements, intensive care unit (ICU) admission, and mortality were compared. RESULTS: Out of 1132 confirmed non-admitted COVID-19 patients, 526 with mild (89%) or asymptomatic (11%) disease were enrolled in TM-CS. Majority of these were referred from ED (n = 370; 70%) and rest (n = 156, 30%) from the AC. Patients in the ED group compared to AC group, had higher BMI (28.9 vs. 27.5), higher Charlson Comorbidity Index (1.4 vs. 0.9), and higher incidence of comorbidities (50% vs. 22%), P ≤ 0.01. However, there were no differences in the ED and AC groups in subsequent ED visits (26% vs. 24%), hospital admission (18% vs. 15%), oxygen requirements (5% vs. 4%), ICU admission (1% vs. 2%), and mortality (0.3% vs. 0.6%), respectively (P > 0.40). CONCLUSION: Significant number of mild COVID-19 patients head to the ED for initial assistance but have similar outcomes to AC patients. TM-CS could be a safe alternative for follow-up monitoring of these patients.

Outcome of COVID19 in Patients With Osteogenesis Imperfecta: A Retrospective Multicenter Study in Saudi Arabia.

Background: Although genetic diseases are rare, children with such conditions who get infected with COVID-19 tend to have a severe illness requiring hospitalization. Osteogenesis imperfecta (OI) is a rare genetic disorder of collagen resulting in fractures and skeletal deformities. Kyphoscoliosis, restrictive lung disease, and pneumonia worsen the prognosis of patients with OI. The use of bisphosphonate improves bone mineral density (BMD) and reduces fractures in OI. There is no literature describing the impact of COVID-19 in patients with OI. Methodology: A retrospective multi-center study was performed in three hospitals in Jeddah and Riyadh, Saudi Arabia, from March 1st, 2020, until August 31st, 2021, aiming to evaluate the outcome of COVID-19 in patients with OI. Demographics, vaccination status, underlying kyphoscoliosis, functional status, use of bisphosphonate, BMD, and COVID-19 severity, and course were recorded for all patients. Results: Twelve cases of confirmed COVID-19 were identified among 146 patients with OI. 9 (75%) of patients were less than 18 years, 6 (50%) were male, 5 (41%) had kyphoscoliosis, and 5 (41%) were wheelchair-bound. 6 (50%) received bisphosphonate, and 7(58%) had normal BMD. All patients had mild disease and did not require hospitalization. None of OI the patients with COVID-19 were fully vaccinated before the infection, and some were ineligible for vaccination. Conclusion: Patients with OI and COVID-19 in our study recovered without complications, unlike patients with other genetic diseases. Young age and mild illness contributed to the favorable outcome. Half of the patients received bisphosphonate and had normal BMD.

Characteristics and outcome of tertiary care critically ill COVID-19 patients with multiple comorbidities admitted to the intensive care unit.

PURPOSE: We conducted this study to evaluate the characteristics and outcomes exclusively in high-risk coronavirus disease 2019 (COVID-19) tertiary care patients with multiple comorbidities, as very few have reported outcomes in this specific cohort. METHODS: All patients, with two or more risk factors for COVID-19 and Charlson Comorbidity Index (CCI) of >2, who were admitted to intensive care unit (ICU) between March and December 2020 were included. Their characteristics, ICU course, and outcomes as well as differences between nonsurvivors and survivors were evaluated. The primary outcome was all-cause 28-day mortality. RESULTS: Out of 1152 COVID-19 patients, 101 met the inclusion criteria. The patients had an average of 4 or more comorbidities with a very high CCI of 5. The 28-day all-cause mortality was 23% and inhospital mortality was 32%. Among all risk factors, only age > 70 years, male gender, and chronic kidney disease were significant determinants of mortality (P < 0.03). Admission PaO2/FiO2 ratio and elevated inflammatory markers were same among survivors and nonsurvivors (P > 0.66). The mean time from presentation to ICU admission (59 vs. 38 h), APACHE II score (20.5 vs. 17), ICU length of stay (25 vs. 12 days), and hospital length of stay (28 vs. 20 days) were all higher in nonsurvivors as compared to survivors, respectively (P < 0.03). Fifty-four percent of the patients were intubated and had higher 28-day (40%) and inhospital (55%) mortality. CONCLUSION: Tertiary care patients with multiple comorbidities have higher mortality than what is reported for mixed populations. Further studies are needed to determine realistic mortality benchmarks for these patients.

From Epidemic to Pandemic: Comparing Hospital Staff Emotional Experience Between MERS and COVID-19.

Objective: Both Middle East Respiratory Syndrome (MERS) and Coronavirus Disease 2019 (COVID-19) have an emotional toll on healthcare workers (HCWs), but the difference of the impact between the two diseases remains unknown.Design: A cross sectional descriptive survey.Setting: A tertiary care hospital.Participants: 125 HCWs who worked during the 2014 MERS as well as the 2020 COVID-19 outbreaks in high-risk areas of the hospital including critical care, emergency room and COVID-19 clinics.Methods: The comprehensive survey comprised 5 sections and 68 questions and was administered to HCWs before availability of the COVID-19 vaccine. The survey evaluated hospital staff emotions, perceived stressors, external factors that reduced stress, personal coping strategies, and motivators for future outbreaks. The participants rated each question for MERS and COVID-19 simultaneously on a scale from 0-3. The responses were reported as mean and standard deviation, while Wilcoxon signed-rank test was used to calculate the difference in responses.Results: There were 102 (82%) participants who returned the questionnaire. The ritual of obsessive hand washing, emotional and physical fatigue, ongoing changes in infection control guidelines, fear of community transmission, and limitations on socialization and travel were the major stressors that were significantly worse during COVID-19 compared to MERS (P<0.05) and led to HCWs adoption of additional 'personal' coping strategies during COVID-19. There was no difference between COVID-19 and MERS, however, among preferences for 'external' factors made available to HCWs that could reduce stress or in their preferences for motivators to work in future outbreaks (P>.05).Conclusion: Both the MERS and COVID-19 outbreaks were emotionally draining for HCWs. However, COVID-19 was a relatively more stressful experience than MERS for HCWs and led to greater personal, behavioral, and protective adaptations by the hospital staff.

Telemedicine monitoring of high-risk coronavirus disease 2019 (COVID-19) patients by family medicine service after discharge from the emergency department.

BACKGROUND: Up to 25% of the total coronavirus disease 2019 (COVID-19) admissions comprise patients with comorbidities who present to the emergency department (ED) with only mild-to-moderate disease. It is unclear whether as an alternative to hospitalization, telemedicine can be used to monitor these "high-risk" comorbid patients. The aim of our study was to answer this question by comparing the outcome of such patients discharged under a family medicine service (FMS) telemonitoring program and those admitted to hospital. MATERIALS AND METHODS: Patients with three or more risk factors for progression to severe COVID-19 disease were designated as "high-risk" in our study. In the absence of acute indication for hospitalization, these high-risk patients with mild-to-moderate disease were discharged home under the supervision of FMS led telemonitoring between October 2020 and February 2021 and were labelled as "Telemedicine group." They were compared to similar patients who were admitted to hospital between March-August 2020 before the implementation of telemedicine service (TMS) and were taken as "Control group." Outcome measures included intubation, number of inpatient days, 28-day mortality and cost analysis for the two groups. RESULTS: Out of 572 COVID-19 patients who presented to the ED, 70 met the inclusion criteria for the "Telemedicine Group" and 35 were included in the "Control Group". In the Telemedicine group, 21 (30.0%) patients were brought back to ED for re-evaluation and 16 (22.9%) were eventually admitted to the hospital. There was no difference in terms of oxygen requirements, intubation, and intensive care unit admission (P > 0.74) between the groups, and none of the study patients died. The Family Medicine-led TMS saved 77% inpatient admissions and on average 4.4 hospital days and $3400 per patient (P < . 0001). CONCLUSION: Family medicine-led telemonitoring of high-risk COVID-19 patients presenting to the ED with mild-to-moderate disease is a feasible and cost-effective alternative to hospitalization.

Test-based de-isolation in COVID-19 immunocompromised patients: Cycle threshold value versus SARS-CoV-2 viral culture.

BACKGROUND: Immunocompromised patients with coronavirus disease 2019 (COVID-19) have prolonged infectious viral shedding for more than 20 days. A test-based approach is suggested for de-isolation of these patients. METHODS: The strategy was evaluated by comparing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load (cycle threshold (Ct) values) and viral culture at the time of hospital discharge in a series of 13 COVID-19 patients: six immunocompetent and seven immunocompromised (five solid organ transplant patients, one lymphoma patient, and one hepatocellular carcinoma patient). RESULTS: Three of the 13 (23%) patients had positive viral cultures: one patient with lymphoma (on day 16) and two immunocompetent patients (on day 7 and day 11). Eighty percent of the patients had negative viral cultures and had a mean Ct value of 20.5. None of the solid organ transplant recipients had positive viral cultures. CONCLUSIONS: The mean Ct value for negative viral cultures was 20.5 in this case series of immunocompromised patients. Unlike those with hematological malignancies, none of the solid organ transplant patients had positive viral cultures. Adopting the test-based approach for all immunocompromised patients may lead to prolonged quarantine. Large-scale studies in disease-specific populations are needed to determine whether a test-based approach versus a symptom-based approach or a combination is applicable for the de-isolation of various immunocompromised patients.

Comparison of characteristics and ventilatory course between coronavirus disease 2019 and Middle East respiratory syndrome patients with acute respiratory distress syndrome.

BACKGROUND: Both coronavirus disease 2019 (COVID-19) and Middle East respiratory syndrome (MERS) can cause acute respiratory distress syndrome (ARDS); however, their ARDS course and characteristics have not been compared, which we evaluate in our study. METHODS: MERS patients with ARDS seen during the 2014 outbreak and COVID-19 patients with ARDS admitted between March and December 2020 in our hospital were included, and their clinical characteristics, ventilatory course, and outcomes were compared. RESULTS: Forty-nine and 14 patients met the inclusion criteria for ARDS in the COVID-19 and MERS groups, respectively. Both groups had a median of four comorbidities with high Charlson comorbidity index value of 5 points (P>0.22). COVID-19 patients were older, obese, had significantly higher initial C-reactive protein (CRP), more likely to get trial of high-flow oxygen, and had delayed intubation (P≤0.04). The postintubation course was similar between the groups. Patients in both groups experienced a prolonged duration of mechanical ventilation, and majority received paralytics, dialysis, and vasopressor agents (P>0.28). The respiratory and ventilatory parameters after intubation (including tidal volume, fraction of inspired oxygen, peak and plateau pressures) and their progression over 3 weeks were similar (P>0.05). Rates of mortality in the ICU (53% vs. 64%) and hospital (59% vs. 64%) among COVID-19 and MERS patients (P≥0.54) were very high. CONCLUSIONS: Despite some distinctive differences between COVID-19 and MERS patients prior to intubation, the respiratory and ventilatory parameters postintubation were not different. The higher initial CRP level in COVID-19 patients may explain the steroid responsiveness in this population.

Comparison of Clinical Characteristics and End-of-Life Care Between COVID-19 and Non-COVID-19 Muslim Patients During the 2020 Pandemic.

BACKGROUND: Little is known about end-of-life care among Muslim patients, particularly during Coronavirus disease 2019 (COVID) pandemic, which we report here. METHODS: The clinical characteristics, end-of-life care and resuscitation status of Muslim patients who died in the ICU of our tertiary care hospital in year 2020 from COVID were compared to Non-COVID patients. RESULTS: There were 32 patients in COVID and 64 in the Non-COVID group. A major proportion, mainly of Non-COVID patients, already had a hospice eligible terminal disease at baseline (p=.002). COVID patients were admitted to the ICU sooner after hospitalization (2.2 vs. 17 days), had prolonged duration of mechanical ventilation (18.5 vs. 6 days) and longer ICU stay (24 vs. 8 days) than non-COVID patients, respectively (p<.001). Almost all patients were "Full Code" initially. However, status was eventually changed to 'do-not-attempt resuscitation' (DNAR) in about 60% of the cohort. COVID patients were made DNAR late in their ICU stay, predominantly in the last 24 hours of life (p=.04). Until the very end, patients in both groups were on tube feeds, underwent blood draws and imaging, required high dose vasopressors, with few limitations or withdrawal of therapies. Family members were usually not present at bedside at time of death. There was minimal involvement of chaplain and palliative care services. CONCLUSIONS: Muslim COVID-19 patients had prolonged mechanical ventilation and ICU stay and a delayed decision to DNAR status than non-COVID Muslim patients. Limitation or withdrawal of therapy occurred infrequently. The utilization of chaplain and palliative care service needs improvement.