Preliminary findings of COVID-19 infection in health workers in Somalia: A reason for concern.

BACKGROUND: Somalia, a country with a long history of instability, has a fragile healthcare system that is consistently understaffed. A large number of healthcare workers (HCWs) have become infected during the coronavirus disease-19 (COVID-19) pandemic. OBJECTIVE: This report presents the preliminary findings of COVID-19 infection in Somali HCWs, the first of such information from Somalia. METHODS: This preliminary retrospective study analysed available data on infection rates among Somali HCWs. RESULTS: As of 30 September 2020, 3700 cases of COVID-19, including 98 deaths, had been reported in Somalia; 191 (5%) of these cases were HCWs. During the first 180 days of the outbreak, 311 HCWs were tested for COVID-19 and 191 tested positive (positivity rate: 61%). During the epidemic's peak, HCWs represented at least 5% of cases. Of the 191 infected cases, 52 (27%) were doctors, 63 (33%) were nurses, seven (4%) were laboratory technicians, and 36% were other staff. CONCLUSION: More information must be sought to put measures in place to protect the health and safety of HCWs in Somalia's already understaffed and fragile healthcare system.

Survival analysis of all critically ill patients with COVID-19 admitted to the main hospital in Mogadishu, Somalia, 30 March to 12 June 2020: what interventions are proving effective?

OBJECTIVESTo determine risk factors for death in patients with COVID-19 admitted to the main public sector hospital in Somalia and identify interventions contributing to improved clinical outcome in a low-resource and fragile setting. SETTINGMain public sector tertiary hospital in Mogadishu, Somalia. PARTICIPANTSAll 131 laboratory-confirmed COVID-19 patients admitted to the main public tertiary hospital in Somalia between 30 March and 12 June 2020. MAIN OUTCOME MEASURESWe extracted demographic and clinical data from hospital records of all 131 COVID-19 patients admitted to hospital until their death or recovery. We used Kaplan-Meier statistics to estimate survival probabilities and the log-rank test to assess significant differences in survival between groups. We used the Cox proportional hazard model to estimate likelihood of death and assess the effect of risk factors on survival. RESULTSOf the 131 patients, 52 (40%) died in the hospital and 79 (60%) survived to discharge. The factors independently associated with increased risk of in-hospital death were: age [≥] 60 years - survival probability on day 21 in patients < 60 years was 0.789 (95% confidence interval (CI): 0.658-0.874) compared with 0.339 (95% CI: 0.205-0.478) in patients [≥] 60 years; cardiovascular disease (survival probability 0.478 (95% CI: 0.332-0.610) in patients with cardiovascular disease compared with 0.719 (95% CI: 0.601-0.807) in patients without cardiovascular disease); and non-invasive ventilation on admission - patients who were not ventilated were significantly more likely to survive than those who were (P < 0.001). CONCLUSIONOur study, which includes the largest cohort of COVID-19 patients admitted to a single hospital in a sub-Saharan African country, confirms that underlying conditions and age are associated with increased risk of in-hospital death in patients with COVID-19. Our results show the advantage of medical oxygen over non-invasive ventilation in the treatment of patients with severe COVID-19 symptoms.