Association between Patient Characteristics and Lifestyle and Symptoms in Saudi Confirmed COVID-19 Cases

Research Article

Austin J Public Health Epidemiol. 2023; 10(4): 1153.

Association between Patient Characteristics and Lifestyle and Symptoms in Saudi Confirmed COVID-19 Cases

Anas Dablool*

Associate Professor of Medical Microbiology, Public Health Department, Faculty of Health Sciences, Al-leeth, Umm Al-Qura University, Saudi Arabia

*Corresponding author: Anas Dablool Associate Professor of Medical Microbiology, Public Health Department, Faculty of Health Sciences, Al-leeth, Umm Al-Qura University, Saudi Arabia. Email: dr.dablool.tqm@gmail.com

Received: September 27, 2023 Accepted: October 24, 2023 Published: October 31, 2023

Abstract

Background: The most common symptoms being reported are fever, fatigue, dry cough, and other upper respiratory symptoms which are considered less common symptoms. Given that there is still a dire need to define a proper relationship between these risks and COVID-19; we also assessed the factors associated with the manifestations of these signs and symptoms.

Methodology: It’s an observational descriptive cross-sectional study based on a questionnaire sent to the participants via Whatsapp application focusing on COVID-19 related information between the end of 2020 and November 2021.

Results: The most reported symptoms during COVID-19 infection were exhaustion (65.6%), fever and losing the sense of smell (57.7% each), pains/aches and losing the sense of taste (55.7% and 55.5%).

Conclusion: The severity of the novel coronavirus ranges from mild symptoms (majority of cases) to severe respiratory tract infection. The most susceptible population involves the elderly and individuals with underlying medical conditions, especially obesity and diabetes. Symptoms in COVID-19 patients were mainly associated with presence of comorbidities, BMI, sex, and older age.

Keywords: COVID-19; SARS-CoV-2; Obesity; Diabetes mellitus; Symptoms

Abbreviations: BMI: Body Mass Index; COVID-19: Coronavirus Disease 2019; ICU: Intensive Care Unit; MOF: Multi-Organ Failure; SARS: Severe Acute Respiratory Syndrome; SARS CoV-2: Severe Acute Respiratory Syndrome Coronavirus 2; SPSS: Statistical Package for Social Sciences

Introduction

The novel COVID-19 pandemic, caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS CoV-2), leads to severe respiratory diseases. The SARS CoV-2 belongs to a large family of coronaviruses that have been known to cause respiratory tract infections in humans [1]. Ever since its dawn in the city of Wuhan, China in December 2019, it has spread all over the world and has become a global health emergency [2].

The morbidity and mortality of SARS-CoV-2 are more prevalent in older subjects who present different comorbidities [3]. The clinical onset of SARS-CoV-2 infection is variable from mild self-limited influenza-like symptoms to a Severe Acute Respiratory Syndrome (SARS) with a conceivable relationship of Multi-Organ Failure (MOF) as a result of cytokine storm or hemophagocytic syndrome [4]. The most common symptoms being reported are fever (some early cases may not have fever only respiratory symptoms), fatigue, dry cough, dyspnea, nasal congestion, runny nose or sputum, and other upper respiratory symptoms which are considered less common symptoms. All of the infected patients had at least one symptom. Fever and cough were the dominant symptoms whereas upper respiratory symptoms and gastrointestinal symptoms were rare [5]. Most reported cases experienced mild disease symptoms and may not present positive signs (have the coronavirus but are asymptomatic) [6]. Patients in severe conditions may have shortness of breath, moist rales in lungs, weakened breath sounds, and dullness on the percussion, septic shock, and irreversible metabolic acidosis in a matter of a short period of time [7]. It has also been noted that COVID-19 has detrimental effects, especially in patients suffering from other comorbidities like diabetes mellitus, hypertension, and malignancies [8]. Patients already suffering from cardiovascular diseases are at a higher risk of suffering from a serious adverse effect, those without pre-existing cardiovascular conditions are also predisposed to cardiovascular complications, one of the most common of which is a thrombotic complication [9].

During the rapid escalation of the COVID-19 pandemic in March and April 2020, we conducted an online survey on the lifestyle during COVID-19 pandemic and the symptoms by Saudi adults for acquiring COVID-19 information. Given that there is still a dire need for a substantial number of studies to be done so that a proper relationship between these risks and COVID-19 can be defined; we also assessed the factors associated with the manifestations of these signs and symptoms.

Materials and Methods

Study Design and Participants

It’s an observational descriptive cross-sectional study based on a questionnaire sent to the participants as a Google document via Whatsapp application focusing on COVID-19 related information between the end of 2020 (after the first wave of COVID-19) and November 2021. All adults aged more than 18 years and living in the western region of Saudi Arabia were included in this study.

Ethical Considerations

The study was approved by our IRB committee (BIOMED-E-8-2020) on 17/9/2020. Due to the retrospective nature of the study, informed consent from the participating individuals was not required by the ethical review board. This research received no specific grant from any funding agency in public, commercial, or nonprofit sectors.

Data Collection

Patients received a Google document via Whatsapp application using a newly developed questionnaire that inquired about:

- Socio-demographic and economic information: age, gender, education, occupation, income.

- Medical information: comorbidities, malaria, anxiety.

- Lifestyle information in the pandemic context: hand-washing, mask and gloves wear.

- Different symptoms related to COVID-19 infection: fever, exhaustion, pain, and many others with duration, severity and recovery

- Information regarding COVID-19 infection: testing, diagnosis, transmission, and education.

Statistical Analysis

All statistical analyses were performed by using SPSS (Statistical Package for social sciences version 24.0). Descriptive results are presented as mean±Standard Deviation for all quantitative variables (such as age), whereas number (percentage) is reported for all categorical variables (such as gender). All statistical analysis was done using two-tailed tests and an alpha error of 0.05. A P-value less than 0.05 was considered to be statistically significant. Chi-squared analyses were used as appropriate to evaluate the relationships between participants’ characteristics and different symptoms. Multinomial logistic regression was used to test the association between number of symptoms and risk factors while adjusting to multiple variables.

Results

Table 1 shows the socio-demographic characteristics of the patients with slightly higher proportion of men (56.1%). Almost half of the participants are aged between 21-40 years (48%) followed by those aged between 41-60 years (41.6%). The mean weight was 80.29±20.57 Kg. The majority is from Saudi Arabia (90%), married (71.7%) with no comorbidities (67.5%) (Figure 1). A total of 249 had their flu vaccination (Figure 2). Regarding lifestyle characteristics during COVID-19 pandemic presented in Figure 3, only 6% live in an isolated neighborhood and almost the half go out because of work. The majority reported that they are keen to wash their hands (80.2%), mostly by soap (74.2%). Similarly, 81% wear their mask regularly, 71.9% keep social distancing while only 17.6% keen wear gloves.

Figure 1: Lifestyle characteristics during COVID-19 pandemic.

Figure 2: COVID-19 symptoms and severity.

Figure 3: Symptoms evolution.

The most reported symptoms during COVID-19 infection were exhaustion (65.6%), fever and losing the sense of smell (57.7% each), pains/aches and losing the sense of taste (55.7% and 55.5% respectively). Most of the symptoms were not very severe for majority of patients, the highest proportion suffered from severe aches and pain (36.4%). The symptoms lasted for one week mainly (59%) and resumed after one week for half of the participants (47.9%). Only 4 patients were admitted to the ICU (Figure 4-5).

Figure 4: Additional COVID-19 characteristics.

Figure 5: Usefulness of different types in reducing COVID-19 infection.

Table 2 describes general information related to COVID-19. A large proportion did not suffer or suffered slightly from anxiety because of isolation (32.6% and 33.8% respectively). The majority were previously tested for COVID-19 (86.5%) and diagnosed with light symptoms (73.1%). A total of 273 participants were isolated due to COVID-19 infection where they mostly don’t know its source (38%). More than the half-received health education from online and social networking (59.6%) followed by the Ministry of Health website (21.5%). Almost half of participants had one of their family members, relative or companion died from COVID-19 (Figure 6). The majority believed that Tawakalna and Asefni applications were useful (Figure 7).

Table 1: Socio-demographic characteristics (N=519).

Table 2: COVID-19 general characteristics.

Table 3 to 9 reported associations between different symptoms and patient characteristics and lifestyle. In all statistically significant associations between presence of comorbidities and different symptoms, those with comorbidities presented more symptoms except for losing sense of taste. Higher educational level was associated significantly with lower fever presentation (University 60%). As for dry cough, obese participants had higher presentation dry cough (49.1% vs 31.1%), in addition, those who had flu vaccination presented higher rate of fever (2.8% vs 0.9%) yet lower headache manifestations (43.2% vs 53.8%). In table 5, underweight and obese participants had higher presentation of exhaustion (2.9% vs 0.6% and 41.7% vs 28.8% respectively) and those living in isolated neighborhood had lower exhaustion signs. For pains and aches (Table 8) participants aged more than 40 years had significantly higher rate of manifestations (44.5% vs 38.7% and 7.1% vs 2.2%). Females have significantly suffered more of headaches (51.6% vs 34.5%) and losing sense of taste (48.9% vs 37.6%) and smell (48.5% vs 37.7%). In addition, keen to wear mask and gloves was associated with lower headache manifestation. Losing sense of smell was more seen in under/overweight and obese participants (Table 9). When dividing the number of symptoms into 3 categories only gender and BMI in socio-demographic factors were significantly associated where females and obese individuals had higher number of symptoms (Table 10). Table 11 shows the multiple logistic regression after adjusting on multiple factors. Regarding clinical factors, having comorbidities or a history of malaria was associated with higher number of COVID-19 signs. Going out for shopping once a week or once every 3 days compared to other categories was more associated with lower score of symptoms (12.3% and 13.9% with no symptoms). Those living in an isolated neighborhood had lower number of symptoms compared to those who are not. Interestingly, individuals who sometimes wear their mask were the most associated with more reported symptoms (60.5% had more than 6 symptoms).

Table 3: Association between Fever and different Characteristics.

Table 4: Association between Dry cough and different Characteristics.

Table 5: Association between Exhaustion and different Characteristics.

Table 6: Association between Pains and aches and different Characteristics.

Table 7: Association between Headache and different Characteristics.

Table 8: Association between losing sense of taste and different Characteristics.

Table 9: Association between losing sense of smell and different Characteristics.

Table 10: Association between number of symptoms and other factors.

Table 11: Multinomial logistic regression (Group with no symptoms was the reference group).

Discussion

The world has been and is still involved with a pandemic created by the novel coronavirus where community transmission became an important issue as numerous countries forced progressive lockdown measures in response to the increasing number of COVID-19 cases. Currently, the novel coronavirus caused unprecedented alteration in lifestyle routines with a social significance, and beyond including mask wearing, quarantine, self-isolation when suspected of infection and disruption of personal and social activities.

Clinical manifestations of COVID-19 cases may progress rapidly, and severe cases may develop hypoxia, concomitant organ failure, and even death [10]. Despite the fact that early identification of potentially critical patients helps in controlling the disease, no definitive way to predict the prognosis and severity of the disease has been developed [11].

Females were significantly more affected by some symptoms such as headache as compared to males participants synchronizing with results of multiple studies while contrasting with the findings of a few [12]. More specifically, a previous study found that female sex and having comorbidities were more frequent in patients with headache which was also the case in our case [13].

All ages are susceptible; however, individuals with underlying medical conditions or the elderly are at a much higher risk [14]. This aligns with our results where, in almost all symptoms, participants with comorbidities presented more these signs and manifestations. Specifically, previous investigations reported diabetes and hypertension as the most distinctive comorbidities in COVID-19 cases [15,16]. It was also reported in present findings: the higher percentage of comorbidity was diabetes, and some symptoms (including dry cough, exhaustion, losing sense of smell) were more presented in obese participants. In addition, our results showed that those aged more than 40 years had significantly suffered more from pains and aches.

The most common symptoms being reported are exhaustion, fever, pains and aches and losing sense of smell and taste. Previous evidence showed that most of these manifestations were the dominant symptoms whereas upper respiratory symptoms and gastrointestinal symptoms were rare [5]. In this study sample, 55.5% and 57.7% of the participants reported taste and smell dysfunction slightly lower than previous evidence 17. In accordance with some studies and dis-concordance with others in the literature, there was a significant association between losing sense of smell and taste and female domination that may be due to gender-related differences in the inflammatory reaction process [18-20].

Previous Saudi investigations provided similar finding with new insights on the impact of different factors on symptoms on the COVID-19 patients, yet, they focused on a group of factors such as comorbidities or radiographic and laboratory characteristics [21,22].

The most reported information source was online and social media, followed by ministry of health website, this was also seen in a previous cross-sectional study that showed the most common source of information was the internet (89.3%) including social media handles, websites, blogs, and social media [23].

The present study showed a descriptive scope of the current COVID-19 symptomatology and its associated factors on a representative sample. However, there are some limitations to our study. Our study’s limitations include its cross-sectional design, which is less potent than a cohort study. For example, a follow-up longitudinal study can assess the causal relationship between risk factors and the symptoms. The most important limitation is that the information has been gathered by whatsapp from the participants without direct access to medical records; therefore, clinical data may be misreported. In addition, some lifestyle questions such as keen to wash hands and wear masks can be biased due to social desirability bias therefore reporting more positive answers.

Conclusion

The severity of the novel coronavirus ranges from mild symptoms (majority of cases) to severe respiratory tract infection. The most susceptible population involves the elderly and individuals with underlying medical conditions, especially obesity and diabetes. Symptoms in COVID-19 patients were mainly associated with presence of comorbidities, BMI, sex, and older age.

Author Statements

Conflict of Interest

The authors declare that there is no conflict of interest regarding the publication of this article.

Data Access

The dataset used and analysed during the current study is available from the corresponding author on reasonable request.

Funding Source

No any external funding was received for this project. Self- funded project.

Ethical Approval

Competing Interest for all authors: Author declare that he has no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Data Availability Statement

Author confirms that the data supporting the findings of this research paper are available within the article and/or its supplementary materials.

References

  1. COVID-19 vaccines advice. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/covid-19-vaccines/advice.
  2. Helmy YA, Fawzy M, Elaswad A, Sobieh A, Kenney SP, Shehata AA. The COVID-19 pandemic: A comprehensive review of taxonomy, genetics, epidemiology, diagnosis, treatment, and control. J Clin Med. 2020; 9: 1225.
  3. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020; 395: 1054-62.
  4. Roberto P, Francesco L, Emanuela C, Giorgia G, Pasquale N, Sara D. Current treatment of COVID-19 in renal patients: hope or hype? Intern Emerg Med. September 2020; 15: 1389-98.
  5. Guo YR, Cao QD, Hong ZS, Tan YY, Chen SD, Jin HJ, et al. The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak – an update on the status. Mil Med Res. 2020; 7: 11.
  6. Jin YH, Cai L, Cheng ZS, Cheng H, Deng T, Fan YP, et al. A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version). Mil Med Res. 2020; 7: 4.
  7. Nie S, Han S, Ouyang H, Zhang Z. Coronavirus disease 2019-related dyspnea cases difficult to interpret using chest computed tomography. Respir Med. 2020; 167: 105951.
  8. Guan WJ, Liang WH, Zhao Y, Liang HR, Chen ZS, Li YM, et al. Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis. Eur Respir J. 2020; 55: 2000547.
  9. Bikdeli B, Madhavan MV, Jimenez D, Chuich T, Dreyfus I, Driggin E, et al. COVID-19 and thrombotic or thromboembolic disease: implications for prevention, antithrombotic therapy, and follow-up: JACC state-of-the-art review. J Am Coll Cardiol. 2020; 75: 2950-73.
  10. Liu F, Li L, Xu M, Wu J, Luo D, Zhu Y, et al. Prognostic value of interleukin-6, C-reactive protein, and procalcitonin in patients with COVID-19. J Clin Virol. 2020; 127: 104370.
  11. Zhao Q, Meng M, Kumar R, Wu Y, Huang J, Lian N, et al. The impact of COPD and smoking history on the severity of COVID-19: A systemic review and meta-analysis. J Med Virol. 2020; 92: 1915-21.
  12. Asghar MS, Haider Kazmi SJ, Ahmed Khan N, Akram M, Ahmed Khan S, Rasheed U, et al. Clinical profiles, characteristics, and outcomes of the first 100 admitted COVID-19 patients in Pakistan: A single-center retrospective study in a tertiary care hospital of Karachi. Cureus. 2020; 12: e8712.
  13. Trigo J, García-Azorín D, Planchuelo-Gómez Á, Martínez-Pías E, Talavera B, Hernández-Pérez I, et al. Factors associated with the presence of headache in hospitalized COVID-19 patients and impact on prognosis: a retrospective cohort study. J Headache Pain. 2020; 21: 94.
  14. Xu XW, Wu XX, Jiang XG, Xu KJ, Ying LJ, Ma CL, et al. Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-Cov-2) outside of Wuhan, China: retrospective case series. BMJ. 2020; 368: m606.
  15. Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. February 2020; 8: 475-81.
  16. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. February 2020; 382: 1708-20.
  17. Kavaz E, Tahir E, Bilek HC, Kemal Ö, Deveci A, Aksakal Tanyel E. Clinical significance of smell and taste dysfunction and other related factors in COVID-19. Eur Arch Otorhinolaryngol. 2021; 278: 2327-36.
  18. Lechien JR, Chiesa-Estomba CM, Place S, Van Laethem Y, Cabaraux P, Mat Q, et al. Clinical and epidemiological characteristics of 1420 European patients with mild-to-moderate coronavirus disease 2019. J Intern Med. 2020; 288: 335-44.
  19. Klopfenstein T, Kadiane-Oussou NJ, Toko L, Royer PY, Lepiller Q, Gendrin V, et al. Features of anosmia in COVID-19. Med Mal Infect. 2020; 50: 436-9.
  20. Meini S, Suardi LR, Busoni M, Roberts AT, Fortini A. Olfactory and gustatory dysfunctions in 100 patients hospitalized for COVID-19: sex differences and recovery time in real-life. Eur Arch Otorhinolaryngol. 2020; 277: 3519-23.
  21. Alali AS, Alshehri AO, Assiri A, Khan S, Alkathiri MA, Almohammed OA, et al. Demographics, comorbidities, and outcomes among young and middle-aged COVID-19 patients in Saudi Arabia. Saudi Pharm J. 2021; 29: 833-42.
  22. AlJishi JM, Alhajjaj AH, Alkhabbaz FL, AlAbduljabar TH, Alsaif A, Alsaif H, et al. Clinical characteristics of asymptomatic and symptomatic COVID-19 patients in the Eastern Province of Saudi Arabia. J Infect Public Health. 2021; 14: 6-11.
  23. Erinoso O, Wright KO, Anya S, Kuyinu Y, Abdur-Razzaq H, Adewuya A. Predictors of COVID-19 information sources and their perceived accuracy in Nigeria: online cross-sectional study. JMIR Public Health Surveill. 2021; 7: e22273.

Citation: Dablool A. Association between Patient Characteristics and Lifestyle and Symptoms in Saudi Confirmed COVID-19 Cases. Austin J Public Health Epidemiol. 2023; 10(4): 1153.