Natural history and clinical course of symptomatic and asymptomatic COVID-19 patients in the Kingdom of Saudi Arabia
Rasha A Almubark1, Ziad A Memish2, Hani Tamim3, Thamer H Alenazi4, Mohammed Alabdulla5, Faisal M Sanai6, Nasser F BinDhim7, Sarah Alfaraj8, Saleh A Alqahtani9
1 Scientific Affairs Department, Sharik Association for Health Research, Riyadh, Saudi Arabia
2 Research and Innovation Center, King Saud Medical City, Ministry of Health; College of Medicine, Al-Faisal University, Riyadh, Saudi Arabia; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
3 Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
4 Department of Medicine, King Abdulaziz Medical City; College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
5 Department of Transplant Infectious Disease, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia
6 Department of Medicine, Gastroenterology Unit, King Abdulaziz Medical City, Jeddah, Saudi Arabia
7 Scientific Affairs Department, Sharik Association for Health Research; College of Medicine, Al-Faisal University, Riyadh, Saudi Arabia; CEO Office, Saudi Food and Drug Authority, Rollins School of Public Health, Emory University, Atlanta, GA, USA
8 Infection Control and Corona Center, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia
9 Liver Transplantation Unit, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia; Division of Gastroenterology and Hepatology, John Hopkins University, Baltimore, USA
Rasha A Almubark
6996 Abi Baker As Siddiq Road, Yasmin Dis, Riyadh 13326
Objectives: To analyze symptomatic and asymptomatic COVID-19 patients in Saudi Arabia in terms of initial presentation, risk factors, laboratory findings, clinical outcomes and healthcare utilization.
Methods: All laboratory-confirmed reverse transcription–polymerase chain reaction positive COVID-19 patients who had been tested at three governmental hospitals in Saudi Arabia (two in Riyadh and one in Makkah) between March 8 and May 18, 2020 were included. Demographics, COVID-19 variables, clinical characteristics and healthcare utilization variables were extracted and combined, and a descriptive analysis was conducted. Symptomatic and asymptomatic (on presentation) patients' data were compared.
Results: Eighty percent of the patients were males (81.4% of symptomatic and 73.2% of asymptomatic patients, P = 0.02). Moreover, 47.6% and 38.4% of symptomatic and asymptomatic patients were aged 40–64 years, respectively. Fever, cough and breathing difficulties were frequent presenting symptoms. Overall, diabetes (16.4%), hypertension (11.7%), chronic respiratory disease (7.1%) were the most frequent comorbidities, with no differences between the two groups. Symptomatic patients had higher C-reactive protein levels (3.55 vs. 0.30 mg/L; P < 0.0001) and lower total lymphocytes (1.41 vs. 1.70; P = 0.02). ICU admission and mortality were 12.1% and 4.1% in symptomatic, compared to 6.0% and 2.9% in asymptomatic patients, respectively.
Conclusion: In the studied COVID-19 cohort, symptomatic patients tended to be older, had higher C-reactive protein and more lymphopenia with worse outcome than asymptomatic patients. This granular analysis of COVID-19 cohorts enables identification of at-risk cohorts in future waves, optimizing development of patient pathways and public health interventions.