Clinical and epidemiological characteristics of the first 150 patients with COVID-19 in Lebanon: a prospective descriptive study

Background: Clinical features of confirmed COVID-19 cases cover a wide spectrum. Aims: To study the clinical, radiological and virological features of the first 150 patients with COVID-19 in Lebanon. Methods: Our university hospital was designated as the primary COVID-19 care centre in Lebanon. Between 21 February 2020, the date of the first confirmed case of COVID-19 in Lebanon, and 3 April 2020, our team treated 150 patients diagnosed with COVID-19. In this prospective descriptive study, we present our experience in treating these patients, specifically the diagnostic criteria, outcome, and demographic, clinical, radiological and biological characteristics. Results: Ninety-five (63.33%) of the patients were male and 55 (36.67%) were female. Most patients (58%) were aged > 50 years, and 8 (5.33%) were healthcare workers. Diagnosis was based on reverse transcription polymerase chain reaction, and patients were classified as mild, moderate or critical. Fifteen (10%) patients had a critical presentation and fever was the most prominent symptom at presentation. One hundred and thirty-eight (92%) patients underwent radiological evaluation. The most common laboratory findings were lymphocytopenia (34.38%), followed by neutropenia (28.13%), but leukocytosis was not prevalent (1.56%). Old age and comorbidity were significant indicators in patient risk stratification. Chest computed tomography was an invaluable method of diagnosis and management. Our radiological findings were consistent with the published literature. Conclusion: Our study underlines the variable presentation of COVID-19, the difference in severity, and the diverse methods of diagnosis. This suggests the need for a tailored approach, taking into consideration the wide spectrum of presentation.

Predicting COVID-19 Incidences from Patients Viral Load using Deep-Learning (preprint)

The transmission of the contagious COVID-19 is known to be highly dependent on individual viral dynamics. Since the cycle threshold (Ct) is the only semi-quantitative viral measurement that could reflect infectivity, we utilized Ct values to forecast COVID-19 incidences. Our COVID-19 cohort (n=9531), retrieved from a single representative cross-sectional virology test center in Lebanon, revealed that low daily mean Ct values are followed by an increase in the number of national positive COVID-19 cases. A subset of the data was used to develop a deep neural network model, tune its hyperparameters, and optimize the weights for minimal mean square error of prediction. The final models accuracy is reported by comparing its predictions with an unseen dataset. Our model was the first to capture the interaction of the previously reported Ct values with the upcoming number of COVID-19 cases and any temporal effects that arise from population dynamics. Our model was deployed as a publicly available and easy-to-use estimator to facilitate prospective validation. Our model has potential application in predicting COVID-19 incidences in other countries and in assessing post-vaccination policies. Aside from emphasizing patient responsibility in adopting early testing practices, this study proposed and validated viral load measurement as a rigid input that can enhance outcomes and precision of viral disease predicting models.

In vivo evaluation of the virucidal efficacy of Chlorhexidine and Povidone-iodine mouthwashes against salivary SARS-CoV-2. (preprint)

BackgroundThe oral cavity is potentially high-risk transmitter of COVID-19. Antimicrobial mouthrinses are used in many clinical pre procedural situations for prophylactic purposes. An evident-based investigation for an effective mouthwash solution against salivary SARS-CoV-2 is urgently required for the exposure reduction during dental procedures. AimsThis study aimed to evaluate in vivo virucidal efficacy of 2 mouthwashes: 1% Povidoneiodine and 0.2% Chlorhexidine as a dental preprocedural oral disinfection against salivary SARS-CoV-2. Materials and MethodsIn this randomized-controlled clinical trial, studied group comprised laboratory-confirmed COVID-19 positive patients through nasopharyngeal swabs. Participants were divided into 3 groups. For 30 seconds, group A gargled with 1% Povidone-iodine, group B mouthrinsed with 0.2% Chlorhexidine and control group C mouthrinsed with distilled water. Saliva samples were collected before and 5 minutes after mouthwash. SARS-CoV-2 rRT-PCR was then performed for each sample. Evaluation of the efficacy was based on difference in Ct value. The analysis of data was carried out using GraphPad Prism version 5 for Windows. Paired t test and unpaired t test were used. A probability value of less than 0.05 was regarded as statistically significant. ResultsSixty-one compliant participants (36 female and 25 male) with a mean age 45.3 {+/-} 16.7 years-old were enrolled. A significant mean Ct value difference (p < 0.0001) between the paired samples in group A (n = 25) and also in group B (n = 27) (p < 0.0001) was found. In contrast, no significant difference (p = 0.566) existed before and after the experiment in the control group C (n = 9). Moreover, a significant difference was noted between the delta Ct of distilled water wash and each of the 2 solutions 1 % Povidone-iodine (p = 0.012) and Chlorhexidine 0.2% (p = 0.0024). No significant difference was found between the delta Ct of patients using 1% Povidone-iodine and Chlorhexidine 0.2% solutions (p = 0.24). ConclusionChlorhexidine 0.2% and 1% Povidone-iodine oral solutions are effective preprocedural mouthwashes against salivary SARS-COV-2 in dental treatments. Their use as a preventive strategy to reduce the spread of COVID-19 during dental practice should be systematically implemented.

The Lebanese Cohort for COVID-19; A Challenge for the ABO Blood Group System (preprint)

A sudden outbreak of pneumonia caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has rapidly spread all over the world facilitating the declaration of the resultant disease as a pandemic in March,2020. In Lebanon, the fast action of announcing a state of emergency with strict measures was among the factors that helped in achieving a successful containment of the disease in the country. Predisposing factors for acquiring COVID-19 and for developing a severe form of this disease were postulated to be related to epidemiological and clinical characteristics as well as the genomics signature of a given population or its environment. Biological markers such as the ABO blood group system was amongst those factors that were proposed to be linked to the variability in the disease course and/or the prevalence of this infection among different groups. We therefore conducted the first retrospective case-control study in the Middle-East and North Africa that tackles the association between the blood group types and the susceptibility as well as the severity of SARS-CoV2 infection. Opposing to the current acknowledged hypothesis, our results have challenged the association significance of this system with COVID-19. Herein, we highlighted the importance of studying larger cohorts using more rigorous approaches to diminish the potential confounding effect of some underlying comorbidities and genetic variants that are known to be associated with the ABO blood group system.