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BackgroundQatar experienced a large severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic that disproportionately affected the craft and manual workers (CMWs) who constitute 60% of the population. This study aimed to investigate level of immunity in communities within this population as well as infection exposure required to achieve herd immunity. MethodsAnti-SARS-CoV-2 seropositivity was assessed in ten CMW communities between June 21 and September 9, 2020. PCR positivity, infection positivity (antibody and/or PCR positive), and infection severity rate were also estimated. Associations with anti-SARS-CoV-2 positivity were investigated using regression analyses. ResultsStudy included 4,970 CMWs who were mostly men (95.0%) and <40 years of age (71.5%). Seropositivity ranged from 54.9% (95% CI: 50.2-59.4%) to 83.8% (95% CI: 79.1-87.7%) in the different CMW communities. Pooled mean seropositivity across all communities was 66.1% (95% CI: 61.5-70.6%). PCR positivity ranged from 0.0% to 10.5% (95% CI: 7.4-14.8%) in the different CMW communities. Pooled mean PCR positivity was 3.9% (95% CI: 1.6-6.9%). Median cycle threshold (Ct) value was 34.0 (range: 15.8-37.4)--majority (79.5%) of PCR-positive individuals had Ct value >30 indicative of earlier rather than recent infection. Infection positivity (antibody and/or PCR positive) ranged from 62.5% (95% CI: 58.3-66.7%) to 83.8% (95% CI: 79.1-87.7%) in the different CMW communities. Pooled mean infection positivity was 69.5% (95% CI: 62.8-75.9%). Only five infections were ever severe and one was ever critical--an infection severity rate of 0.2% (95% CI: 0.1-0.4%). ConclusionsBased on an extended range of epidemiological measures, active infection is rare in these communities with limited if any sustainable infection transmission for clusters to occur. At least some CMW communities in Qatar have reached or nearly reached herd immunity for SARS-CoV-2 infection at a proportion of ever infection of 65-70%.
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The study was conducted at Hamad Medical Corporation in Qatar, a national healthcare system with 14 hospitals and over 28,000 employees. A total of 16,912 staff members were tested for SARS-CoV-2 between March 10 and June 24, 2020 with 1,799 (10.6%) testing positive. Nurses and midwives had the highest number of infections (33.2% of all infected HCWs) followed by non-clinical support service staff (31.3%), administrative staff (14.6%), allied health professionals (12.7%), physicians (5.2% and other clinical support staff (2.9%). Among 671 infected HCW surveyed by the infection prevention and control team immediately after the positive COVID-19 test was reported, exposure to a family member or roommate with confirmed infection each were reported by 9.5%. Two-thirds of the infected HCWs were symptomatic with fever (34.6%), cough (32.2%) and sore throat (15.8%) being the most commonly reported symptoms. Among the survey respondents, 78 (11.6%) were hospitalized, 9 (1.3%) required supplemental oxygen, 4 (0.6%) were admitted to the intensive care unit) and 2 (0.3%) required mechanical ventilation. There were no deaths. To understand the transmission dynamics and impact of facility designation as COVID-19 or non-COVID-19 facility, we conducted a focused follow-up telephone survey on 393 COVID-19 positive HCW 1-6 weeks after diagnosis. Only 5% of respondents reported acquiring the virus from working at a COVID-19 designated facility while the remaining 95% reported working at a non-COVID-19 facility and acquired the infection from accidental exposure to a colleague (45%) or to a patient (29%). Among infected HCW at COVID-19 designated facilities, 82% reported used full PPE at all times while 68% of infected HCW at non-COVID-19 facilities reported using PPE as directed.
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BackgroundA decrease in Emergency Department (ED) visits for cardiac conditions has recently been reported from the US and Western Europe due to the COVID-19 pandemic. The data are still scant, and the correlation between cardiac symptoms and confirmed diagnoses are not available. There are no reports on changes in ED volumes at a national level, or from countries in the Asia-Middle Eastern region. MethodsWe report data from national referral centers for tertiary care and cardiac care centers in Qatar, which see >80% of cardiac emergencies in the country. ResultsWe analyzed 102,033 ED visits in the COVID-era (March-April 2020 and 2019) and determined the proportion presenting for cardiac symptoms and their confirmed diagnoses. We observed a 16-37% decline in ED volumes overall, with a 25-50% decline in patients presenting with cardiac symptoms in March-April 2020 compared with March-April 2019. Among those presenting with cardiac symptoms, we observed a 24-43% decline in cardiac diagnoses. ConclusionsA sharp decline in patients presenting with cardiac symptoms was observed in the COVID-era. A post-COVID surge in patients with these conditions may be anticipated and preparations should be made to address it.
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BackgroundImpact of COVID-19 upon acute care admission rates and patterns are unknown. We sought to determine the change in rates and types of admissions to tertiary and specialty care hospitals in the COVID-19 era compared with pre-COVID-19 era. MethodsAcute care admissions to the largest tertiary care referral hospital, designated national referral centers for cardiac, cancer and maternity hospital in the State of Qatar during March 2020 (COVID-19 era) and January 2020 and March 2019 (pre-COVID-19 era) were compared. We calculated total admissions, and admissions for eight specific acute care conditions, in-hospital mortality rate and length of stay at each hospital. ResultsA total of 18,889 hospital admissions were recorded. A sharp decline ranging from 9%-75% was observed in overall admissions. A decline in both elective and non-elective surgeries was observed. A decline of 9%-58% was observed in admissions for acute appendicitis, acute coronary syndrome, stroke, bone fractures, cancer and live births, while an increase in admissions due to respiratory tract infections was observed. Overall length of stay was shorter in the COVID-19 period possibly suggesting lesser overall disease severity, with no significant change in in-hospital mortality. Unadjusted mortality rate for Qatar showed marginal increase in the COVID-19 period. ConclusionsWe observed a sharp decline in acute care hospital admissions, with a significant decline in admissions due to seven out of eight acute care conditions. This decline was associated with a shorter length of stay, but not associated with a change in in-hospital mortality rate.
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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
