ABSTRACT
ObjectiveTo define the epidemiologic curve of COVID-19 in Qatar, determine factors associated with severe or critical illness, and study the temporal relation between public health measures and case finding DesignEpidemiologic investigation Setting and ParticipantsAll confirmed COVID-19 cases in the State of Qatar between February 28 and April 18, 2020 Main Outcome MeasuresNumber of total and daily new COVID-19 infections; demographic characteristics and comorbidity burden and severity of infection; factors associated with severe or critical illness ResultsBetween February 28 and April 18, 2020 (11:00AM local time), 5,685 cases of COVID-19 were identified. Mean age (SD) was 35.8(12.0) years, 88.9% were male and 8.7% were Qatari nationals. Overall, 83.6% had no concomitant comorbidity, and 3.0% had 3 or more comorbidities. The overwhelming majority (90.9%) were asymptomatic or with minimal symptoms, with 2.0% having severe or critical illness. Presence of hypertension or diabetes were associated with a higher risk of severe or critical illness. Seven deaths were observed during the time interval studied. The epidemiologic curve indicated two distinct patterns of infection, a larger cluster among expatriate craft and manual workers, and a smaller one among Qatari nationals returning from abroad during the epidemic. ConclusionCOVID-19 infections in Qatar started in two distinct clusters, but then became more widespread in the population through community transmission. Infections were mostly asymptomatic or with minimal symptoms and associated with very low mortality. Severe/critical illness was associated with presence of hypertension or diabetes. O_TEXTBOXArticle Summary Strengths and limitations of this study: O_LINational study with unified contact tracing and testing C_LIO_LIAll testing done at a single lab, and all tests performed in the State of Qatar during the study period were included, providing a robust national estimate of the number of infected persons among those tested C_LIO_LIComorbidities were retrieved from the electronic medical records using ICD-10 AM codes C_LIO_LIExact geographic location and contact tracing data were not included in the current report C_LIO_LIIt is possible that some persons still under care on the study end date may have progressed to more severe disease after that date C_LI C_TEXTBOX O_TEXTBOXWhat is already known on this topicAs of May 3, 2020, over 3.4 million persons have been infected with SARS-CoV-2 and over 244,000 deaths have been reported in persons with COVID-19 infection. Those at higher risk of complications include persons over age 60 years and those with chronic comorbid conditions. Mortality rate varies widely among different countries, and this can be associated both to the capacity of the health system to provide effective intensive care including ventilators as well as other factors, including demographic differences. Public health measures seem effective, but there is debate on the extent to which the measures need to be aggressive or the duration for which they should be implemented. What this study addsThis study reports on the epidemic curve in a population with a unique demographic structure, comprising an overwhelming majority of expatriates and young male craft and manual workers. This is also the first study that reports on the epidemic curve of an Arab country in the Eastern Mediterranean Region (EMR). The study also overlays major public health measures on the epidemic curve, to provide an understanding of the context in which the epidemic is progressing. Patients with confirmed COVID-19 in Qatar were young with few comorbidities. Case fatality rate was very low (only 7 deaths among 5,685 infected persons). Severe and critical illness were associated with presence of hypertension or diabetes. C_TEXTBOX
ABSTRACT
BackgroundThere are limited data on Coronavirus Disease 2019 (COVID-19) outcomes at a national level, and none after 60 days of follow up. The aim of this study was to describe national, 60-day all-cause mortality associated with COVID-19, and to identify risk factors associated with admission to an intensive care unit (ICU). MethodsThis was a retrospective cohort study including the first consecutive 5000 patients with COVID-19 in Qatar who completed 60 days of follow up by June 17, 2020. Outcomes included all-cause mortality at 60 days after COVID-19 diagnosis, and risk factors for admission to ICU. ResultsIncluded patients were diagnosed with COVID-19 between February 28 and April 17, 2020. The majority (4436, 88.7%) were males and the median age was 35 years [interquartile range (IQR) 28- 43]. By 60 days after COVID-19 diagnosis, 14 patients (0.28%) had died, 10 (0.2%) were still in hospital, and two (0.04%) were still in ICU. Fatal COVID-19 cases had a median age of 59.5 years (IQR 55.8-68), and were mostly males (13, 92.9%). All included pregnant women (26, 0.5%), children (131, 2.6%), and healthcare workers (135, 2.7%) were alive and not hospitalized at the end of follow up. A total of 1424 patients (28.5%) required hospitalization, out of which 108 (7.6%) were admitted to ICU. Most frequent co-morbidities in hospitalized adults were diabetes (23.2%), and hypertension (20.7%). Multivariable logistic regression showed that older age [adjusted odds ratio (aOR) 1.041, 95% confidence interval (CI) 1.022-1.061 per year increase; P <0.001], male sex (aOR 4.375, 95% CI 1.964-9.744; P <0.001), diabetes (aOR 1.698, 95% CI 1.050-2.746; P 0.031), chronic kidney disease (aOR 3.590, 95% CI 1.596-8.079, P 0.002), and higher BMI (aOR 1.067, 95% CI 1.027-1.108 per unit increase; P 0.001), were all independently associated with increased risk of ICU admission. ConclusionsIn a relatively younger national cohort with a low co-morbidity burden, COVID-19 was associated with low all-cause mortality. Independent risk factors for ICU admission included older age, male sex, higher BMI, and co-existing diabetes or chronic kidney disease.
