Mapping COVID-19 related research from Saudi Arabia, a scoping review. Between reality and dreams

Pattern of pediatric emergency dental care during COVID-19 pandemic in Saudi Arabia

Objective

At the beginning of the COVID-19 pandemic, it was recommended to provide emergency dental care and avoid aerosol-generating procedures (AGPs) when possible. This study aimed to determine how Saudi Arabian pediatric patients utilized emergency dental services at the national level at the beginning of the COVID-19 pandemic and what situations required an AGP.

Methods

Data was collected from all Ministry of Health dental facilities in Saudi Arabia between March and May 2020. All pediatric dental patients who received emergency dental care during the COVID-19 lockdown were included in this study.

Results

The majority of the 1,544 pediatric dental patients who received emergency dental care during this period received treatment for caries (77.9 %). AGPs were predominant in the treatment of urgent dental conditions (51.5 %). About 64 % of cases with pulpal inflammation and 52.4 % with abscesses underwent an AGP.

Conclusion

Emergency and urgent dental conditions were the main reason for seeking dental care during the pandemic (75.8 %), while only 24.2 % of cases were considered non-urgent. Despite the recommendations, AGPs were required for some urgent conditions to relieve the associated pain, and this comprised 46.8 % of dental treatment provided.

An Unprecedented Experience: Personal and Socio-Political Impacts of the COVID-19 Lockdown in Saudi Arabia

The COVID-19 pandemic provided an opportunity to understand the experiences of different cultures and the application of preventive measures during a pandemic. That understanding can lead to the development of important evidence to grasp the global situation and prepare for future health crises. This qualitative study explores the impact of COVID-19 lockdown measures on individuals in Saudi Arabia, focusing on personal and socio-political effects. Employing semi-structured interviews with 28 participants, the research delves into the lived experiences during the early stages of the pandemic, highlighting emotional coping mechanisms, behavioral changes, role responsibility adaptations, and perceptions of governmental actions. The findings reveal a spectrum of emotional responses, from worry and fear to acceptance and contentment, and significant shifts in behavior and societal norms. The study underscores the importance of understanding cultural contexts in pandemic responses and offers insights into the resilience and adaptability of the Saudi community. It suggests the need for tailored interventions that consider the complex interplay of emotional, behavioral, and socio-political factors in managing future health crises.

COVID-19 infections, recoveries, and mortality: an ANOVA model of locations and administrative areas in Saudi Arabia

Background

Saudi Arabia has 13 administrative areas, all of which have been seriously affected by the COVID-19 epidemic regardless of their features. Being the largest and a prominent Arab country, epidemic intensity and dynamics have importance, especially in the era of Vision 2030 where infrastructure development and growth to enhance quality of life has of prime focus.

Aims

This analysis aims to trace the differentials in COVID-19 infections, recoveries, and deaths across the country depending upon various demographic and developmental dimensions and interactions.

Data and methods

This analysis used Saudi Arabia Ministry of Health data from March 15th, 2020 to August 31st, 2022, by classifying administrative areas and locations to build a generalized linear model (3 × 3): three types of administrative areas (major, middle-sized, and others) and localities (major, medium-sized, and others). Apart from two-way ANOVA, an one-way ANOVA also carried out in addition to calculating mean values of infections, recoveries, and deaths.

Results

A total of 205 localities were affected with varying severity, which are based on local demographics. Both the administrative areas and localities had a significant number of cases of infections, recoveries, and mortality, which are influenced by relationships and interactions, leading to differential mean values and proportional distributions across various types of administrative areas and localities.

Conclusion

There is dynamism that major administrative areas have lesser threats from the epidemics whereas medium-sized ones have serious threats. Moreover, an interaction of administrative areas and localities explains the dynamics of epidemic spread under varying levels of infrastructure preparedness. Thus, this study presents lessons learned to inform policies, programs, and development plans, especially for regional, urban, and infrastructure areas, considering grassroots level issues and diversity.

Managing the COVID-19 pandemic in thirty-two policy measures in Saudi Arabia: A mixed-methods analysis

BACKGROUND

The Kingdom of Saudi Arabia has developed rigorous strategies to control and prevent the spread of COVID-19. However, the effectiveness of these measures in containing and mitigating the epidemic has yet to be studied. This paper aims to assess the efficiency of preventive policy initiatives that Saudi Arabia has taken to reduce the spread of COVID-19, which was rapid and progressive in nature. Information on the effectiveness of measures applies to help the Saudi government adjust policy responses when considering which measures to relax once the epidemic is controlled.

METHODS

Data for this study were retrieved via publicly available data sources such as the Saudi Arabia Ministry of Health and the government's official news agency-Saudi Press Agency (SPA) websites. Other datasets, such as prevention measures, were gathered from the Country Policy Tracker website. Our dataset's time component extends over 590 consecutive days from 20 January 2020-31 August 2021. Moreover, a mixed-method approach combining COVID-19 data and prevention measures was adopted to assess preventative measures practice. We compiled the dataset used in this study in a Microsoft Excel database. The significance of observed differences among implementing effective strategies was determined using ANOVA and Mixed methods approach. Noticeably, the statistical analysis was performed using the open-source statistical system R version 4.2 (available at http://cran.r-project.org).

RESULTS

Our analysis showed that only three out of the 32 (9.4%) measures significantly reduced the spread of COVID-19. Our results also show substantial variations in the spread of COVID-19 associated with preventive measures in Saudi Arabia. There was a significant positive correlation between activating and massive testing in communities and cases of COVID-19 (measure effect = 923.086 and p < 0.05). A similar result was found for complete curfew across the Kingdom and cases of COVID-19 (measure effect = 621.389 and p < 0.10). Removing slum areas interrupted the spread of Covid-19 (measure effect = 305.689 and p < 0.01). The other preventive measures did not significantly affect the COVID-19 pandemic distribution. These findings consistently concluded that activating and massive testing in communities, complete curfew across the Kingdom, and removal of slum areas were the most effective measures for reducing the impact of the COVID-19 pandemic.

CONCLUSION

Only by understanding these correlations will it be possible to control and reduce the rate of COVID-19 spread and, therefore, suggest a possible exit strategy once the epidemic is controlled.

The landscape of biomedical research progress, challenges and prospects in Saudi Arabia-A systematic review

Introduction

The main objective of this review was to synthesize the progress, challenges and prospects of biomedical research in Saudi Arabia in order to provide a holistic view to all stakeholders, such as policy makers, decision makers, and local researchers along with external collaborators interested in the field of biomedical research in this region.

Methods

A systematic review was conducted using the scientific literature for bibliometric studies in the field of biomedical research in Saudi Arabia that comprehensively covered past few decades using PubMed. The search was performed by combining verified Medical Subject Heading (MeSH) terms: "biomedical research", "bibliometrics", "Saudi Arabia" using boolean operator "AND". The data collection was done from January to June 2022 by both authors.

Results

Out of 202 articles yielded from initial search, 13 articles met all of the inclusion criteria and were examined in details. The outcome of analysis showed that with the augmentation of Research and Development (R&D) globalization in Saudi Arabia, researchers are publishing internationally and collaborating globally, academic and research centers are enriching research environment and policies, and government is taking many initiatives to bolster biomedical research; but still more improvements needs to be achieved by Saudi Arabia to be in the list of strong competitive leading nations in the global biomedical research field.

Conclusions

There were various key challenges related to biomedical publications and bibliometric aspects for Saudi Arabia that included: publishing preferences, quality of publications, indexing services, international scientific community, and importantly barriers related to planning, funding, training, resources and support at institutional and national levels. This review provided some insights and recommendations to enhance biomedical research in Saudi Arabia that included: effective policies, health priorities, building infrastructures, greater investments, high incentives, skilled recruitment, competitive training and engagement of community that can play a vital role in this context.

Clinical Characteristics, Complications, and Predictors of Poor Outcome Among Hospitalized Adult COVID-19 Patients: A Retrospective Cohort Study

Background

Many international studies have reported the outcomes and predictors of coronavirus disease 2019 (COVID-19); however, only a few national studies have reported predictors of poor outcomes among adult hospitalized patients with COVID-19. Therefore, this study aimed to describe the clinical characteristics and complications of COVID-19 and identify predictors of poor outcomes.

Methods

This was a retrospective cohort study. All adult patients confirmed with COVID-19 who were admitted at the King Abdulaziz Medical City (KAMC)-Jeddah between March 1, 2020, and December 31, 2020, were included; pediatric and pregnant patients were excluded. The clinical features and complications of COVID-19 were tested for association with poor outcomes (intensive care unit [ICU] admission or death) using chi-square and Fisher’s exact tests. In addition, logistic regression analysis was performed to identify the predictors of poor outcomes.

Results

A total of 527 patients were included in this study. Forty-two patients (8%) (6-10, 95% confidence interval [CI]) died: 13 in the general wards and 29 in the ICU. Of the 84 patients admitted to the ICU, 65 underwent invasive mechanical ventilation. Poor outcome affected 97 patients (18%) (15-22, 95% CI). Shortness of breath, oxygen saturation <92%, and abnormal chest x-ray findings were associated with poor outcomes (P-value < 0.001). In addition, lymphocyte counts were significantly lower, while c-reactive protein levels were significantly higher among patients with poor outcomes (P-value < 0.001). The most common complications were acute cardiac (83 patients, 16%), acute kidney (78 patients, 15%), and liver injuries (76 patients, 14%). Predictors of poor outcome were the updated Charlson comorbidity index (CCI) (odds ratio [OR] 1.2 [95% CI 1.1-1.4]), liver injury (OR 2.6 [95% CI 1.3-4.9]), acute kidney injury (OR 4.3 [95% CI 2.3-7.8]), and acute cardiac injury (OR 5.1 [95% CI 2.8-9.4]).

Conclusions

COVID-19 disease is associated with significant morbidity and mortality. Predictors of poor outcomes among COVID-19 hospitalized patients were the updated CCI, liver injury, acute kidney, and acute myocardial injuries. Subsequently, the risk of poor COVID-19 outcomes is increased among patients with multiple comorbidities and/or multiple COVID-19 complications.

Coronavirus disease 2019 in proportion to population: a historical analysis of Saudi Arabia

BACKGROUND

Saudi Arabia is one of the countries seriously affected by coronavirus disease 2019 (COVID-19) worldwide. With a few cases in early March, the daily spread of this disease increased to nearly 5000 at one point in time during the first wave to mid-June 2020. With committed efforts and public health interventions, it has been controlled to nearly 1000 by the end of August 2020 and less than 217 by November 28, 2020; thereafter, reporting declines and small increases. However, by December 2021, a third wave started, lasting for 2 months, during which the infection rate increased rapidly. By April 1, 2022, the number of infected persons in the country was 750,998, with 9047 deaths, 7131 active, and approximately 400 critical cases. This analysis of COVID-19 statistics of the Ministry of Health of Saudi Arabia (March 2020-April 2022) is carried out along with population data to extract patient proportions per 100,000 persons to illustrate the hypothesized social and community impact, which influences families and households.

RESULTS

The results showed a high rate of infection and mortality, but with recovery. These rates varied across localities and cities. A few cities with higher population densities are less affected by the spread of the epidemic. However, few localities and upcoming cities/townships were severely affected. These effects are explained as the percentage of the population affected, which exposes the impact on societies, families, and individual members. With concerted efforts, they are brought under control through recovery and adopting mitigation methods.

CONCLUSIONS

Localities could be classified into four categories based on the proportion of the infected population: rapidly increasing, moderately increasing, declining, and stabilizing. Moreover, differential proportions of the affected population have implications at social and familial levels. Analysis and understanding of these trends, considering the base population, are important for policy building and intervention strategies accounting for grassroots-level demographics, which might serve as a tool to enhance interventions at population and family levels. Strategies for awareness creation and compassionate care are essential to address the psychosocial impact of health emergencies, as proved by the Ministry of Health, Saudi Arabia.

COVID-19 in Saudi Arabia: An Overview

BACKGROUND

Saudi Arabia, a prominent Arabian country, has 35. 3 million persons living in 2.2 million square kilometers, undergone serious threats recently due to the COVID-19 pandemic. With the built-in infrastructure and disciplined lifestyle, the country could address this pandemic.

AIMS

This analysis of COVID-19 cases in Saudi Arabia attempts to assess the situation, explore its global percentage share, percentage of population affected, and local distribution from the beginning of infection until recently, tracing historical developments and changes.

DATA AND METHODS

This analysis made use of data released by the Ministry of Health on a daily basis for a number of parameters. They are compiled on an excel sheet on a daily basis: the dataset has undergone rigorous analysis along with the trends and patterns; proportion to the world statistics and geographic distribution.

RESULTS

COVID-19 spread rapidly in the country with periodic variations, during June-August, 2020. But, recoveries accelerated in the period, thus bridging the gap of increasing infections. In comparison with the world statistics, the country proportions are lower, while the percentage of population affected is similar. It appears that the intensity varied across all 13 administrative areas.

CONCLUSION

COVID-19 transmission since March 2020 is considered to be widespread, creating excess burden on the public health system, delineated into stages (early infection, rapid spread, declining, stabilizing, and second wave). Control measures are set, stage-wise, without impinging upon normal life but to ensure that the proportion of globally affected persons is lesser than the population share: credit goes to the Ministry of Health. Area-wise spread depends largely on population density and development infrastructure dimensions. Ultimately, the disciplined life in compliance with law and order paved the way for effective program implementation and epidemic control.

The effect of COVID-19 on the characteristics of adult emergency department visits: A retrospective cohort tertiary hospital experience in Riyadh

Background

On March 2, 2020, Saudi Arabia identified the first positive COVID-19 case. Since then, several aspects of the COVID-19 impact on Emergency Departments (EDs) use have been reported. The objective of this study is to describe the pattern and characteristics of Emergency Department visits during the COVID-19 pandemic period, compared with the same period in the previous year, including the patients’ demographic information, acuity level, length of stay, and admission rate.

Methods

Data were collected from King Abdulaziz Medical City in Riyadh, Saudi Arabia. The health records of all the patients who presented at the Emergency Department from January 2019 to September 2020 were retrospectively reviewed. The variations in the patient and the visit characteristics were described for the periods before and during COVID-19.

Results

The records of 209,954 patients who presented at the Emergency Department were retrieved. In contrast to 2019, the number of visits during the pandemic period reduced by 23%. A dramatic decrease was observed after the announcement of the first COVID-19 diagnosed case in Saudi Arabia, and subsequently the numbers gradually increased. The patients who presented at the Emergency Department during the pandemic period were slightly older (mean age, 43.1 versus 44.0 years), more likely to be older, more urgent and had a higher admission rate compared to the pre-pandemic period. There was a slight increase in visits during the daytime curfew hours and a decrease during the nighttime.

Conclusion

We report a considerable decrease in the number of Emergency Department visits. The reduction was higher in non-urgent and less urgent cases. Patients presenting at the Emergency Department during the curfew times were more likely to stay longer in the Emergency Department and more likely to be admitted, compared with the pre-pandemic period.

Characteristics and outcome of COVID-19 cases in Saudi Arabia: Review of six-months of data (March-August 2020)

BACKGROUND

This study presents the demographic, epidemiological, and clinical characteristics of Coronavirus Disease 2019 (COVID-19) in Saudi Arabia (KSA). It identifies the important predictors of the disease prognosis.

METHODS

The study reviewed and analysed a sample of 307,010 confirmed symptomatic COVID-19 cases, between March and August 2020, available in the health electronic surveillance system (HESN) of the Ministry of Health of KSA. Descriptive and univariate analyses were conducted.

RESULTS

The overall estimated prevalence of symptomatic COVID-19 cases in KSA between March and August 2020 was 6.1% . The estimated incidence proportion was 879.7 per 100,000 population. The overall case fatality ratio was 2.0%. Males represented 63.9% , with a mean age of 35.1 ± 16.6 years. Young adults (16-39 years) were the most affected ages (53.3%). Fever (90.5%) with a mean body temperature of 37.4 ± 2.0 Celsius, cough (90%), and sore throat (77.4%) were the most prevalent symptoms. A history of contact with a confirmed COVID-19 case was reported in 98.8% of patients.Males (2.1%) and elderly cases aged 65-99 years (25.6%) had the highest association with mortality (p < .001). Among the clinical characteristics investigated, low oxygen saturation (SpO2 ≤ 93%) had the highest association with hospital admission (50.8%) and mortality (19.1%) (p < .001). Cases with cardiovascular diseases (28.6%) and malignancy (28%) demonstrated the highest associations with mortality compared to other underlying diseases (p < .001).

CONCLUSIONS

In KSA, the prevalent symptoms of COVID-19 are fever, cough, and sore throat. Makkah and Almadinah regions are significantly associated with highest burden of mortality. The low level of oxygen saturation, high fever, old age, and underlying cardiovascular disease are the most important predictors for prognosis.

Perceptions towards COVID-19 and adoption of preventive measures among the public in Saudi Arabia: a cross sectional study

BACKGROUND

Effective management of the spread of a novel infectious disease, such as the COVID-19 virus can be achieved through influencing people's behavior to adopt preventive measures. The public's perceptions and attitudes towards the virus, governmental guidance and preventive measures were unknown in Saudi Arabia.

OBJECTIVES

1) investigate the public perception of COVID-19, anxiety level, the COVID-19 information sources sought, adoption of preventive measures, and ability and willingness to self-isolate during and post-lockdown periods of the COVID-19 pandemic in Saudi Arabia; 2) investigate socio-demographic factors associated with adoption of preventive measures against COVID-19 and self-isolation practices.

METHOD

Between April 22nd and June 21st 2020, Saudi adults aged ≥18 years voluntarily completed a self-administered web-based cross-sectional survey, distributed through social media (WhatsApp) and emails to representatives in education, health, business, and social sectors across all Saudi Arabian regions. The survey included questions on anxiety level, COVID-19 risk perceptions and adoption of preventive measures. Weighted percentages, Pearson's chi-square tests, and multiple logistic regression were applied to evaluate associations between these factors and socio-demographic variables.

RESULTS

A total of 2393 respondents completed the survey. A majority (74%) were worried about the COVID-19 outbreak and of those, 27% reported that it was likely that they would be infected with COVID-19; 16% believed it would be life-threatening or severe. However, only 11% of respondents reported high anxiety level. Adoption of hygiene practices and social distancing were lower among older (> 65 years) compared to younger (18-24 years) respondents (OR: 0.06; 95% CI: 0.01, 0.28 and OR 0.06; 95% CI: 0.01, 0.27 respectively). High percentages of respondents reported being able to (88%) and were willing to (82%) self-isolate. Those with the lowest gross household income and those with at least one flu symptom were less able and willing to self-isolate. A significant increase in levels of anxiety, perceived effectiveness of social distancing and hygiene practices was reported in the post-lockdown compared to during the lockdown.

CONCLUSIONS

The study reported high levels of adoption of preventive measures, willingness and perceived ability to self-isolate during the early phase of the pandemic. Vulnerable groups such as the elderly, and those with low socio-economic status reported lower adoption of preventive measures or ability and willingness to self-isolate. Tailored public health messages and interventions are needed to achieve high adherence to these preventive measures in these groups.

Clinical Efficacy of Hydroxychloroquine in Patients with COVID-19: Findings from an Observational Comparative Study in Saudi Arabia

The aim of this study was to assess the clinical effectiveness of Hydroxychloroquine-based regimens versus standard treatment in patients with the coronavirus disease admitted in 2019 to a hospital in Saudi Arabia. A comparative observational study, using routine hospital data, was carried out in a large tertiary care hospital in Al Baha, Saudi Arabia, providing care to patients with COVID-19 between April 2019 and August 2019. Patients were categorized into two groups: the Hydroxychloroquine (HCQ) group, treated with HCQ in a dose of 400 mg twice daily on the first day, followed by 200 mg twice daily; the non HCQ group, treated with other antiviral or antibacterial treatments according to protocols recommended by the Ministry of Health (MOH) at the time. The primary outcomes were the length of hospital stay, need for admission to the intensive care unit (ICU), time in ICU, and need for mechanical ventilation. Overall survival was also assessed. 568 patients who received HCQ (treatment group) were compared with 207 patients who did not receive HCQ (control group). HCQ did not improve mortality in the treated group (7.7% vs. 7.2%). There were no significant differences in terms of duration of hospitalization, need for and time in ICU, and need for mechanical ventilation among the groups. Our study provides further evidence that HCQ treatment does not reduce mortality rates, length of hospital stay, admission and time in ICU, and need for mechanical ventilation in patients hospitalized with COVID-19.

Characteristics of First Cases of Coronavirus Disease 2019 and the Effort to Prevent the Early Spread of COVID-19 in Saudi Arabia

PURPOSE

To characterize the overall trends in early cases of COVID-19 and to identify the key points of the government effort to minimize the infection.

PATIENTS AND METHODS

A retrospective review and data were retrieved through online sources and the Saudi Ministry of Health daily announcements that were available online. The data included the number of infections per day, and the gender, nationality, location, source of infection, incidence, rate of recovery, and the rate mortality of COVID-19 patients in Saudi Arabia between March 1 and March 16, 2020.

RESULTS

The incidence of COVID-19 increased in the first two weeks in Saudi Arabia, from zero cases on March 1 to more than 15 cases per day on March 16, with a total of 133 cases. The majority of patients were males (54.9%), of Saudi descent (54.9%), and had travel as their source of infection (57.1%). Most of the cases were in Makah (37.6%); however, there were increases in cases in all cities. Moreover, the Saudi government enacted several steps to minimize the spreading of infection. There was no statistical significance between source of infection with gender (p = 0.323). However, there was statistical significance between source of infection and nationality (p < 0.001).

CONCLUSION

The incidence of COVID-19 cases is expected to continue to increase. However, the efforts of the Saudi government are crucial in minimizing the spread of this infection.

COVID-19 in People with Diabetes: Perspectives from Saudi Arabia

Coronavirus disease 2019 (COVID-19) and diabetes have major impacts on the health of the population across the world. Since the beginning of the COVID-19 pandemic, people with diabetes have been identified to be more vulnerable to infection and at greater risk for hospitalization. As diabetes is one of the major health issues in Saudi Arabia, the current study describes the perspectives of COVID-19 in people with diabetes and the steps taken by the government to minimize its impact. Most patients with COVID-19 in Saudi Arabia experience mild illness, while people with diabetes are at increased risk of disease severity and mortality. The government of Saudi Arabia has taken several measures to control and mitigate the effect of the pandemic, as the Saudi population is gradually returning back to normal life. However, currently, there are limited studies from Saudi Arabia on COVID-19 among people with diabetes and the effectiveness of interventions. We emphasize the necessity for comprehensive research, which would provide a better understanding of the incidence of COVID-19 and its association with diabetes to develop evidence- based programs and policies in the country.

Increased Emergency Calls during the COVID-19 Pandemic in Saudi Arabia: A National Retrospective Study

The impact on the utilization of emergency medical services (EMS) in Saudi Arabia during the COVID-19 pandemic. We studied cumulative data from emergency calls collected from the SRCA. Data were separated into three periods: before COVID-19 (1 January-29 February 2020), during COVID-19 (1 March-23 April 2020), and during the Holy Month of Ramadan (24 April-23 May 2020). A marked increase of cases was handled during the COVID-19 period compared to the number before pandemic. Increases in all types of cases, except for those related to trauma, occurred during COVID-19, with all regions experiencing increased call volumes during COVID-19 compared with before pandemic. Demand for EMS significantly increased throughout Saudi Arabia during the pandemic period. Use of the mobile application ASAFNY to request an ambulance almost doubled during the pandemic but remained a small fraction of total calls. Altered weekly call patterns and increased call volume during the pandemic indicated not only a need for increased staff but an alteration in staffing patterns.