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).
Frequency
Percentage (%)
Gender
Female
228
43.9
Male
291
56.1
Age (years)
Less or equal to 20
28
5.4
21-40
249
48
41-60
216
41.6
More or equal to 61
26
5
Weight (Kg)
Min:34 Max:170
80.29±20.57
Height (cm)
Min:140 Max:202
167.3±10.29
Waist circumference
Min:15 Max:180
59.13±34.02
Nationality
Algeria
1
0.2
Burma
2
0.4
Egypt
6
1.2
Ethiopia
2
0.4
Filipina
1
0.2
Indian
1
0.2
Indonesia
2
0.4
Jordan
3
0.6
Nigeria
1
0.2
Pakistan
6
1.2
Palestine
2
0.4
Saudi Arabia
467
90
Somali
2
0.4
South Africa
2
0.4
Sudan
1
0.2
Syria
3
0.6
Turkey
2
0.4
Educational level
Less than secondary
26
5
Secondary
85
16.5
University
293
56.8
Postgraduate
112
21.7
Marital status
Divorced or separated
18
3.5
Married
367
71.7
Single
117
22.9
Widow
10
2
Occupation
Freelance
25
4.9
Government employee
188
36.6
Private sector employee
103
20
Retired
40
7.8
Unemployed
158
30.7
Monthly income
1,000 Riyal or less per month
93
19.7
1,001-5,000 Riyal
78
16.5
5,001 - 10,000 Riyal
111
23.5
10,001-20,000 Riyal
138
29.2
More than 20,000 Riyal
52
11
Chronic diseases
No
340
67.5
Allergic diseases
24
4.8
Cancer diseases
4
0.8
Diabetes
63
12.5
Heart diseases
5
1.0
Hypertension
44
8.7
Respiratory diseases
24
4.8
History of malaria
No
502
98.2
Yes
9
1.8
Ever had flu vaccination
No
264
51.5
Yes
249
48.5
Been diagnosed with any mental illness before COVID-19
No
480
96.8
Has mental illness with same presentation
12
2.4
Has mental illness with worse presentation
39
0.8
Table 1: Socio-demographic characteristics (N=519).
Frequency
Percentage (%)
Degree of anxiety during lockdown
Never
164
32.6
Slightly
170
33.8
Average
116
23.1
Very much
26
5.2
A lot
27
5.4
Times of taking PCR
Min:0 Max:15
2.07±1.79
Been diagnosed or having symptoms of COVID-19
Diagnosed with no symptoms
65
12.7
Diagnosed with light symptoms
373
73.1
Not confirmed by laboratory and no Symptoms
39
7.6
Diagnosed and condition is critical
33
6.5
Been isolated because of COVID-19
No
170
33.7
Isolated due to COVID-19 suspicion
25
5
Isolated due to contact to infected person
27
5.3
Isolated due to COVID-19 infection
273
54.1
Isolated due to travel
10
2
Source of infection
Don’t know
185
38.0
Co-worker
30
6.2
Friends
34
7
Family member
153
31.4
Hospital or clinic
19
3.9
Relatives
58
11.9
Supermarket
8
1.6
Received Heath education from
Ministry of Health website
108
21.5
Online and social networking
300
59.6
Paper publication
5
1
Television
90
17.9
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).
Absence of Fever
Presence of Fever
p-value
Socio-demographic variables
Gender
Female
91(42.3%)
132(45.1%)
0.541
Male
124(57.7%)
161(54.9%)
Age (years)
Less or equal to 20
12(5.6%)
16(5.5%)
0.234
21-40
109(50.7%)
133(45.4%)
41-60
88(40.9%)
125(42.7%)
More or equal to 61
6(2.8%)
19(6.5%)
BMI
Underweight
6(3%)
4(1.5%)
0.146
Normal
66(32.8%)
69(26.1%)
Overweight
64(31.8%)
82(31.1%)
Obese
65(32.3%)
109(41.3%)
Educational level
Less than secondary
7(3.3%)
19(6.6%)
0.004
Secondary
35(16.3%)
50(17.2%)
University
111(51.6%)
175(60%)
Postgraduate
62(28.8%)
47(16.2%)
Monthly income
1,000 Riyal or less per month
34(16.8%)
59(22.8%)
0.207
1,001-5,000 Riyal
31(15.3%)
45(17.4%)
5,001 - 10,000 Riyal
52(25.7%)
55(21.2%)
10,001-20,000 Riyal
57(28.2%)
77(29.7%)
More than 20,000 Riyal
28(13.9%)
23(8.9%)
Comorbidities
No
153(73.6%)
180(62.9%)
0.013
Yes
55(26.4%)
106(37.1%)
History of malaria
No
208(99%)
285(%)
0.275
Yes
2(1%)
6(2.1%)
Flu vaccination
No
101(47.4%)
161(55.5%)
0.072
Yes
112(52.6%)
129(44.5%)
Lifestyle variables
Days to go out for shopping
Every two weeks
73(35.1%)
91(32.4%)
0.925
Once a week
59(28.4%)
82(29.2%)
Once every 3 days
45(21.6%)
66(23.5%)
Every day or two
31(14.9%)
42(14.9%)
Living in one of the completely isolated neighborhoods
No
202(94.4%)
275(94.2%)
0.918
Yes
12(5.6%)
17(5.8%)
Job require you to go out
No
121(57.6%)
160(58%)
0.938
Yes
89(42.4%)
116(42%)
Keen to wash hands by soap or sanitizer
No
6(2.9%)
9(3.1%)
0.464
Sometimes
30(14.4%)
54(18.6%)
Yes
172(82.7%)
228(78.4%)
Keen to wear a mask
No
6(2.9%)
10(3.4%)
0.108
Sometimes
25(12%)
55(18.8%)
Yes
177(85.1%)
227(77.7%)
Keen to wear gloves
No
88(42.3%)
122(41.9%)
0.061
In the markets and hospitals
36(17.3%)
74(25.4%)
Sometimes
47(22.6%)
44(15.1%)
Yes
37(17.8%)
51(17.5%)
Stick to social distancing
No
4(2%)
5(1.7%)
0.089
Sometimes
43(21.3%)
87(30.2%)
Yes
155(76.7%)
196(68.1%)
Education on COVID-19
Took a course on COVID-19 management
No
167(81.1%)
241(82.5%)
0.675
Yes
39(18.9%)
51(17.5%)
Received Heath education from
Ministry of Health website
45(21.6%)
58(20.4%)
0.713
Online and social networking
123(59.1%)
174(61.1%)
Paper publication
1(0.5%)
4(1.4%)
Television
39(18.8%)
49(17.2%)
Used Tawakalna application
No
30(14.3%)
50(17.4%)
0.389
Yes
180(85.7%)
238(82.6%)
Table 3: Association between Fever and different Characteristics.
Absence of Dry cough
Presence of Dry cough
p-value
Socio-demographic variables
Gender
Female
135(40.8%)
88(49.7%)
0.053
Male
196(59.2%)
89(50.3%)
Age (years)
Less or equal to 20
18(5.4%)
10(5.6%)
0.129
21-40
170(51.4%)
72(40.7%)
41-60
129(39%)
84(47.5%)
More or equal to 61
14(4.2%)
11(6.2%)
BMI
Underweight
9(3%)
1(0.6%)
<0.0001
Normal
90(29.8%)
45(27.6%)
Overweight
109(36.1%)
37(22.7%)
Obese
94(31.1%)
80(49.1%)
Educational level
Less than secondary
15(4.6%)
11(6.2%)
0.829
Secondary
54(16.5%)
31(17.5%)
University
186(56.7%)
99(55.9%)
Postgraduate
73(22.3%)
36(20.3%)
Monthly income
1,000 Riyal or less per month
67(22.2%)
26(16.4%)
0.438
1,001-5,000 Riyal
46(15.2%)
30(18.9%)
5,001 - 10,000 Riyal
72(23.8%)
35(22%)
10,001-20,000 Riyal
87(28.8%)
47(29.6%)
More than 20,000 Riyal
30(9.9%)
21(13.2%)
Comorbidities
No
232(72.5%)
101(58%)
0.001
Yes
88(27.5%)
73(42%)
History of malaria
No
321(99.1%)
172(97.2%)
0.138
Yes
3(0.9%)
5(2.8%)
Flu vaccination
No
183(56%)
79(44.9%)
0.018
Yes
144(44%)
97(55.1%)
Lifestyle variables
Days to go out for shopping
Every two weeks
104(32.5%)
60(35.5%)
0.775
Once a week
97(30.3%)
44(26%)
Once every 3 days
71(22.2%)
40(23.7%)
Every day or two
48(15%)
25(14.8%)
Living in one of the completely isolated neighborhoods
No
309(93.9%)
168(94.9%)
0.646
Yes
20(6.1%)
9(5.1%)
Job requires you to go out
No
189(59.4%)
92(54.8%)
0.321
Yes
129(40.6%)
76(45.2%)
Keen to wash hands by soap or sanitizer
No
10(3.1%)
5(2.8%)
0.47
Sometimes
59(18.3%)
25(14.1%)
Yes
253(78.6%)
147(83.1%)
Keen to wear a mask
No
9(2.8%)
7(4%)
0.59
Sometimes
49(15.2%)
31(17.5%)
Yes
265(82%)
139(78.5%)
Keen to wear gloves
No
131(40.7%)
79(44.6%)
0.834
In the markets and hospitals
74(23%)
36(20.3%)
Sometimes
60(18.6%)
31(17.5%)
Yes
57(17.7%)
31(17.5%)
Stick to social distancing
No
8(2.5%)
1(0.6%)
0.048
Sometimes
94(29.2%)
36(21.4%)
Yes
220(68.3%)
131(78%)
Education on COVID-19
Took a course on COVID-19 management
No
261(81.1%)
147(83.5%)
0.494
Yes
61(18.9%)
29(16.5%)
Received Heath education from
Ministry of Health website
71(21.9%)
32(18.9%)
0.122
Online and social networking
201(62%)
96(56.8%)
Paper publication
2(0.6%)
3(1.8%)
Television
50(15.4%)
38(22.5%)
Used Tawakalna application
No
49(15.3%)
31(17.5%)
0.513
Yes
272(84.7%)
146(82.5%)
Table 4: Association between Dry cough and different Characteristics.
Absence of Exhaustion
Presence of Exhaustion
p-value
Socio-demographic variables
Gender
Female
71(40.6%)
152(45.6%)
0.273
Male
104(59.4%)
181(54.4%)
Age (years)
Less or equal to 20
13(7.4%)
15(4.5%)
0.429
21-40
86(49.1%)
156(46.8%)
41-60
69(39.4%)
144(43.2%)
More or equal to 61
7(4%)
18(5.4%)
BMI
Underweight
1(0.6%)
9(2.9%)
0.011
Normal
53(34%)
82(26.5%)
Overweight
57(36.5%)
89(28.8%)
Obese
45(28.8%)
129(41.7%)
Educational level
Less than secondary
6(3.4%)
20(6.1%)
0.144
Secondary
37(21.1%)
48(14.5%)
University
99(56.6%)
186(56.4%)
Postgraduate
33(18.9%)
76(23%)
Monthly income
1,000 Riyal or less per month
37(22%)
56(19.1%)
0.904
1,001-5,000 Riyal
26(15.5%)
50(17.1%)
5,001 - 10,000 Riyal
39(23.2%)
68(23.2%)
10,001-20,000 Riyal
46(27.4%)
88(30%)
More than 20,000 Riyal
20(11.9%)
31(10.6%)
Comorbidities
No
128(75.7%)
205(63.1%)
0.004
Yes
41(24.3%)
120(36.9%)
History of malaria
No
165(97.6%)
328(98.8%)
0.452
Yes
4(2.4%)
4(1.2%)
Flu vaccination
No
87(50.9%)
175(52.7%)
0.697
Yes
84(49.1%)
157(47.3%)
Lifestyle variables
Days to go out for shopping
Every two weeks
53(32.1%)
111(34.3%)
0.718
Once a week
51(30.9%)
90(27.8%)
Once every 3 days
34(20.6%)
77(23.8%)
Every day or two
27(16.4%)
46(14.2%)
Living in one of the completely isolated neighborhoods
No
157(90.2%)
320(96.4%)
0.005
Yes
17(9.8%)
12(3.6%)
Job require you to go out
No
100(60.6%)
181(56.4%)
0.372
Yes
65(39.4%)
140(43.6%)
Keen to wash hands by soap or sanitizer
No
3(1.8%)
12(3.6%)
0.293
Sometimes
33(19.5%)
51(15.5%)
Yes
133(78.7%)
267(80.9%)
Keen to wear a mask
No
4(2.4%)
12(3.6%)
0.73
Sometimes
26(15.5%)
54(16.3%)
Yes
138(82.1%)
266(80.1%)
Keen to wear gloves
No
79(47%)
131(39.6%)
0.346
In the markets and hospitals
31(18.5%)
79(23.9%)
Sometimes
31(18.5%)
60(18.4%)
Yes
27(16.1%)
61(18.4%)
Stick to social distancing
No
4(2.4%)
5(1.6%)
0.815
Sometimes
45(26.6%)
85(26.5%)
Yes
120(71%)
231(72%)
Education on COVID-19
Took a course on COVID-19 management
No
140(84.3%)
268(80.7%)
0.323
Yes
26(15.7%)
64(19.3%)
Received Heath education from
Ministry of Health website
31(18.9%)
72(21.9%)
0.137
Online and social networking
110(67.1%)
187(56.8%)
Paper publication
1(0.6%)
4(1.2%)
Television
22(13.4%)
66(20.1%)
Used Tawakalna application
No
26(15.2%)
54(16.5%)
0.706
Yes
145(84.8%)
273(83.5%)
Table 5: Association between Exhaustion and different Characteristics.
Absence of Pains and Aches
Presence of Pains and Aches
p-value
Socio-demographic variables
Gender
Female
91(40.4%)
132(46.6%)
0.162
Male
134(59.6%)
151(53.4%)
Age (years)
Less or equal to 20
16(7.1%)
12(4.2%)
0.015
21-40
117(52%)
125(44.2%)
41-60
87(38.7%)
126(44.5%)
More or equal to 61
5(2.2%)
20(7.1%)
BMI
Underweight
6(3%)
4(1.5%)
0.335
Normal
63(31.5%)
72(27.2%)
Overweight
64(32%)
82(30.9%)
Obese
67(33.5%)
107(40.4%)
Educational level
Less than secondary
9(4%)
17(6%)
0.709
Secondary
38(17%)
47(16.7%)
University
130(58.3%)
155(55%)
Postgraduate
46(20.6%)
63(22.3%)
Monthly income
1,000 Riyal or less per month
44(21.1%)
49(19.4%)
0.555
1,001-5,000 Riyal
36(17.2%)
40(15.9%)
5,001 - 10,000 Riyal
43(20.6%)
64(25.4%)
10,001-20,000 Riyal
66(31.6%)
68(27%)
More than 20,000 Riyal
20(9.6%)
31(12.3%)
Comorbidities
No
165(75.5%)
168(60.9%)
<0.0001
Yes
53(24.3%)
108(39.1%)
History of malaria
No
217(98.6%)
276(98.2%)
1
Yes
3(1.4%)
5(1.8%)
Flu vaccination
No
119(53.4%)
143(51.1%)
0.609
Yes
104(46.6%)
137(48.9%)
Lifestyle variables
Days to go out for shopping
Every two weeks
74(34.6%)
90(32.7%)
0.877
Once a week
60(28%)
81(29.5%)
Once every 3 days
46(21.5%)
65(23.6%)
Every day or two
34(15.9%)
39(14.2%)
Living in one of the completely isolated neighborhoods
No
208(92.9%)
269(95.4%)
0.223
Yes
16(7.1%)
13(4.6%)
Job requires you to go out
No
127(59.1%)
154(56.8%)
0.619
Yes
88(40.9%)
117(43.2%)
Keen to wash hands by soap or sanitizer
No
5(2.3%)
10(3.6%)
0.616
Sometimes
35(16%)
49(17.5%)
Yes
179(81.7%)
221(78.9%)
Keen to wear a mask
No
7(3.2%)
9(3.2%)
0.898
Sometimes
33(15.1%)
47(16.7%)
Yes
178(81.7%)
226(80.1%)
Keen to wear gloves
No
95(43.6%)
115(40.9%)
0.601
In the markets and hospitals
42(19.3%)
68(24.2%)
Sometimes
40(18.3%)
51(18.1%)
Yes
41(18.8%)
47(16.7%)
Stick to social distancing
No
6(2.8%)
3(1.1%)
0.232
Sometimes
51(24.2%)
79(28.3%)
Yes
154(73%)
197(70.6%)
Education on COVID-19
Took a course on COVID-19 management
No
181(83.4%)
227(80.8%)
0.45
Yes
36(16.6%)
54(19.2%)
Received Heath education from
Ministry of Health website
45(20.9%)
58(20.9%)
0.796
Online and social networking
129(60%)
168(60.4%)
Paper publication
1(0.5%)
4(1.4%)
Television
40(18.6%)
48(17.3%)
Used Tawakalna application
No
40(18.1%)
40(14.4%)
0.269
Yes
181(81.9%)
237(85.6%)
Table 6: Association between Pains and aches and different Characteristics.
Absence of Headache
Presence of Headache
p-value
Socio-demographic variables
Gender
Female
79(34.5%)
144(51.6%)
<0.0001
Male
150(65.5%)
135(48.4%)
Age (years)
Less or equal to 20
12(5.2%)
16(5.7%)
0.981
21-40
108(47.2%)
134(48%)
41-60
97(42.4%)
116(41.6%)
More or equal to 61
12(5.2%)
13(4.7%)
BMI
Underweight
4(2%)
6(2.3%)
0.601
Normal
54(26.3%)
81(31.2%)
Overweight
70(34.1%)
76(29.2%)
Obese
77(37.6%)
97(37.3%)
Educational level
Less than secondary
12(5.3%)
14(5%)
0.464
Secondary
35(15.4%)
50(18%)
University
124(54.6%)
161(57.9%)
Postgraduate
56(24.7%)
53(19.1%)
Monthly income
1,000 Riyal or less per month
39(18.1%)
54(22%)
0.702
1,001-5,000 Riyal
36(16.7%)
40(16.3%)
5,001 - 10,000 Riyal
47(21.9%)
60(24.4%)
10,001-20,000 Riyal
68(31.6%)
66(26.8%)
More than 20,000 Riyal
25(11.6%)
26(10.6%)
Comorbidities
No
157(69.5%)
176(65.7%)
0.37
Yes
69(30.5%)
92(34.3%)
History of malaria
No
219(98.6%)
274(98.2%)
1
Yes
3(1.4%)
5(1.8%)
Flu vaccination
No
104(46.2%)
158(56.8%)
0.018
Yes
121(53.8%)
120(43.2%)
Lifestyle variables
Days to go out for shopping
Every two weeks
75(34.1%)
89(33.1%)
0.413
Once a week
63(28.6%)
78(29%)
Once every 3 days
55(25%)
56(20.8%)
Every day or two
27(12.3%)
46(17.1%)
Living in one of the completely isolated neighborhoods
No
213(93.4%)
264(95%)
0.458
Yes
15(6.6%)
14(5%)
Job require you to go out
No
135(60.5%)
146(55.5%)
0.264
Yes
88(39.5%)
117(44.5%)
Keen to wash hands by soap or sanitizer
No
5(2.3%)
10(3.6%)
0.489
Sometimes
41(18.5%)
43(15.5%)
Yes
176(79.3%)
224(80.9%)
Keen to wear a mask
No
6(2.7%)
10(3.6%)
0.026
Sometimes
25(11.3%)
55(19.8%)
Yes
191(86%)
213(76.6%)
Keen to wear gloves
No
91(41.2%)
119(42.8%)
0.026
In the markets and hospitals
54(24.4%)
56(20.1%)
Sometimes
48(21.7%)
43(15.5%)
Yes
28(12.7%)
60(21.6%)
Stick to social distancing
No
5(2.3%)
4(1.5%)
0.697
Sometimes
59(27.4%)
71(25.8%)
Yes
151(70.2%)
200(72.7%)
Education on COVID-19
Took a course on COVID-19 management
No
179(81%)
229(82.7%)
0.629
Yes
42(19%)
48(17.3%)
Received Heath education from
Ministry of Health website
51(23.1%)
52(19.1%)
0.528
Online and social networking
126(57%)
171(62.9%)
Paper publication
3(1.4%)
2(0.7%)
Television
41(18.6%)
47(17.3%)
Used Tawakalna application
No
32(14.4%)
48(17.4%)
0.369
Yes
190(85.6%)
228(82.6%)
Table 7: Association between Headache and different Characteristics.
Absence of losing sense of taste
Presence of losing sense of taste
p-value
Socio-demographic variables
Gender
Female
85(37.6%)
138(48.9%)
0.011
Male
141(62.4%)
144(51.1%)
Age (years)
Less or equal to 20
11(4.9%)
17(6%)
0.504
21-40
101(44.7%)
141(50%)
41-60
103(45.6%)
110(39%)
More or equal to 61
11(4.9%)
14(5%)
BMI
Underweight
4(1.9%)
6(2.3%)
0.746
Normal
64(31.1%)
71(27.4%)
Overweight
60(29.1%)
86(33.2%)
Obese
78(37.9%)
96(37.1%)
Educational level
Less than secondary
12(5.4%)
14(5%)
0.82
Secondary
38(17%)
47(16.7%)
University
130(58%)
155(55.2%)
Postgraduate
44(19.6%)
65(23.1%)
Monthly income
1,000 Riyal or less per month
41(19.6%)
52(20.6%)
0.531
1,001-5,000 Riyal
28(13.4%)
48(19%)
5,001 - 10,000 Riyal
52(24.9%)
55(21.8%)
10,001-20,000 Riyal
63(30.1%)
71(28.2%)
More than 20,000 Riyal
25(12%)
26(10.3%)
Comorbidities
No
137(62.6%)
196(71.3%)
0.04
Yes
82(37.4%)
79(28.7%)
History of malaria
0.308
No
215(97.7%)
278(98.9%)
Yes
5(2.3%)
3(1.1%)
Flu vaccination
No
116(52%)
146(52.1%)
0.978
Yes
107(48%)
134(47.9%)
Lifestyle variables
Days to go out for shopping
Every two weeks
70(31.7%)
94(35.1%)
0.645
Once a week
61(27.6%)
80(29.9%)
Once every 3 days
54(24.4%)
57(21.3%)
Every day or two
36(16.3%)
37(13.8%)
Living in one of the completely isolated neighborhoods
No
208(92.4%)
269(95.7%)
0.126
Yes
17(7.6%)
12(4.3%)
Job require you to go out
No
123(56.4%)
158(59%)
0.581
Yes
95(43.6%)
110(41%)
Keen to wash hands by soap or sanitizer
No
6(2.8%)
9(3.2%)
0.549
Sometimes
41(18.9%)
43(15.2%)
Yes
170(78.3%)
230(81.6%)
Keen to wear a mask
No
9(4.1%)
7(2.5%)
0.151
Sometimes
28(12.8%)
52(18.5%)
Yes
182(83.1%)
222(79%)
Keen to wear gloves
No
95(43.6%)
115(40.9%)
0.827
In the markets and hospitals
44(20.2%)
66(23.5%)
Sometimes
41(18.8%)
50(17.8%)
Yes
38(17.4%)
50(17.8%)
Stick to social distancing
No
6(2.7%)
3(1.1%)
0.057
Sometimes
67(30.6%)
63(23.2%)
Yes
146(66.7%)
205(75.6%)
Education on COVID-19
Took a course on COVID-19 management
No
177(81.6%)
231(82.2%)
0.854
Yes
40(18.4%)
50(17.8%)
Received Heath education from
Ministry of Health website
42(19.3%)
61(22.2%)
0.17
Online and social networking
138(63.3%)
159(57.8%)
Paper publication
0(0%)
5(1.8%)
Television
38(17.4%)
50(18.2%)
Used Tawakalna application
No
38(17.2%)
42(15.2%)
0.539
Yes
183(82.8%)
235(84.8%)
Table 8: Association between losing sense of taste and different Characteristics.
Absence of losing sense of smell
Presence of losing sense of smell
p-value
Socio-demographic variables
Gender
Female
81(37.7%)
142(48.5%)
0.015
Male
134(62.3%)
151(51.5%)
Age (years)
Less or equal to 20
10(4.7%)
18(6.1%)
0.241
21-40
93(43.3%)
149(50.9%)
41-60
100(46.5%)
113(38.6%)
More or equal to 61
12(5.6%)
13(4.4%)
BMI
Underweight
1(0.5%)
9(3.3%)
0.026
Normal
68(35.1%)
67(24.7%)
Overweight
56(28.9%)
90(33.2%)
Obese
69(35.6%)
105(38.7%)
Educational level
Less than secondary
13(6.1%)
13(4.5%)
0.829
Secondary
37(17.4%)
48(16.4%)
University
119(55.9%)
166(56.8%)
Postgraduate
44(20.7%)
65(22.3%)
Monthly income
1,000 Riyal or less per month
45(23%)
48(18.1%)
0.141
1,001-5,000 Riyal
23(11.7%)
53(20%)
5,001 - 10,000 Riyal
45(23%)
62(23.4%)
10,001-20,000 Riyal
58(29.6%)
76(28.7%)
More than 20,000 Riyal
25(12.8%)
26(9.8%)
Comorbidities
No
136(64.8%)
197(69.4%)
0.287
Yes
74(35.2%)
87(30.6%)
History of malaria
No
205(98.1%)
288(98.6%)
0.725
Yes
4(1.9%)
4(1.4%)
Flu vaccination
No
115(54.2%)
147(50.5%)
0.408
Yes
97(45.8%)
144(49.5%)
Lifestyle variables
Days to go out for shopping
Every two weeks
65(31.3%)
99(35.2%)
0.03
Once a week
51(24.5%)
90(32%)
Once every 3 days
51(24.5%)
60(21.4%)
Every day or two
41(19.7%)
32(11.4%)
Living in one of the completely isolated neighborhoods
No
201(93.9%)
276(94.5%)
0.776
Yes
13(3.1%)
16(5.5%)
Job require you to go out
No
116(56.9%)
165(58.5%)
0.717
Yes
88(43.1%)
117(41.5%)
Keen to wash hands by soap or sanitizer
No
7(3.4%)
8(2.7%)
0.174
Sometimes
42(20.4%)
42(14.3%)
Yes
157(76.2%)
243(82.9%)
Keen to wear a mask
No
8(3.8%)
8(2.7%)
0.765
Sometimes
34(16.3%)
46(15.8%)
Yes
166(79.8%)
238(81.5%)
Keen to wear gloves
No
83(39.9%)
127(43.6%)
0.796
In the markets and hospitals
48(23.1%)
62(21.3%)
Sometimes
41(19.7%)
50(17.2%)
Yes
36(17.3%)
52(17.9%)
Stick to social distancing
No
6(2.9%)
3(1.1%)
0.113
Sometimes
62(29.7%)
68(24.2%)
Yes
141(67.5%)
210(74.7%)
Education on COVID-19
Took a course on COVID-19 management
No
167(80.7%)
241(82.8%)
0.54
Yes
40(19.3%)
50(17.2%)
Received Heath education from
Ministry of Health website
37(17.9%)
66(23.1%)
0.046
Online and social networking
137(66.2%)
160(55.9%)
Paper publication
0(0%)
5(1.7%)
Television
33(15.9%)
55(19.2%)
Used Tawakalna application
No
35(16.7%)
45(15.6%)
0.755
Yes
175(83.3%)
243(84.4%)
Table 9: Association between losing sense of smell and different Characteristics.
No symptoms N=50
1-5 symptoms N=242
More than 6 symptoms N=227
p-value
Socio-demographic variables
Gender
Female
26(11.4%)
82(36%)
120(52.6%)
<0.0001
Male
24(8.2%)
160(55%)
107(36.8%)
Age (years)
Less or equal to 20
3(10.7%)
13(46.4%)
12(42.9%)
0.729
21-40
29(11.6%)
116(46.6%)
104(41.8%)
41-60
16(7.4%)
103(47.7%)
97(44.9%)
More or equal to 61
2(7.7%)
10(38.5%)
14(53.8%)
BMI
Underweight
1(10%)
5(50%)
4(40%)
<0.0001
Normal
28(19.7%)
58(40.8%)
56(39.4%)
Overweight
9(6.1%)
77(52.4%)
61(41.5%)
Obese
7(4%)
79(44.6%)
91(51.4%)
Educational level
Less than secondary
3(11.5%)
7(26.9%)
16(61.5%)
0.279
Secondary
9(10.6%)
37(43.5%)
39(45.9%)
University
24(8.2%)
146(49.8%)
123(42%)
Postgraduate
14(12.5%)
50(44.6%)
48(42.9%)
Monthly income
1,000 Riyal or less per month
8(8.6%)
45(48.4%)
40(43%)
0.242
1,001-5,000 Riyal
7(9%)
34(43.6%)
37(47.4%)
5,001 - 10,000 Riyal
17(15.3%)
48(43.2%)
46(41.4%)
10,001-20,000 Riyal
9(6.5%)
78(56.5%)
51(37%)
More than 20,000 Riyal
7(13.5%)
22(42.3%)
23(44.2%)
Comorbidities
No
38(11.2%)
166(48.8%)
136(40%)
0.016
Yes
9(5.5%)
70(42.7%)
85(51.8%)
History of malaria
No
41(8.2%)
240(47.8%)
221(44%)
0.015
Yes
3(33.3%)
1(11.1%)
5(55.6%)
Flu vaccination
No
21(8%)
125(47.3%)
118(44.7%)
0.616
Yes
26(10.4%)
116(46.6%)
107(43%)
Lifestyle variables
Days to go out for shopping
Every two weeks
13(7.8%)
80(48.2%)
73(44%)
0.039
Once a week
18(12.3%)
60(41.1%)
68(46.6%)
Once every 3 days
16(13.9%)
53(46.1%)
46(40%)
Every day or two
1(1.4%)
43(58.9%)
29(39.7%)
Living in one of the completely isolated neighborhoods
No
42(8.6%)
228(46.9%)
216(44.4%)
0.03
Yes
7(22.6%)
14(45.2%)
10(32.3%)
Job require you to go out
No
27(9.5%)
127(44.9%)
129(45.6%)
0.694
Yes
21(9.9%)
103(48.4%)
89(41.8%)
Keen to wash hands by soap or sanitizer
No
2(12.5%)
7(43.8%)
7(43.8%)
0.653
Sometimes
9(10.6%)
34(40%)
42(49.4%)
Yes
33(8.1%)
198(48.4%)
178(43.5%)
Keen to wear a mask
No
1(6.3%)
9(56.3%)
6(37.5%)
0.03
Sometimes
5(6.2%)
27(33.3%)
49(60.5%)
Yes
38(9.2%)
205(49.5%)
171(41.3%)
Keen to wear gloves
No
18(8.4%)
97(45.1%)
100(46.5%)
0.598
In the markets and hospitals
11(9.7%)
50(44.2%)
52(46%)
Sometimes
9(9.8%)
50(54.3%)
33(35.9%)
Yes
5(5.6%)
44(48.9%)
41(45.6%)
Stick to social distancing
No
1(5.6%)
5(27.8%)
12(66.7%)
0.401
Sometimes
11(8%)
67(48.6%)
60(43.5%)
Yes
33(9.3%)
168(47.3%)
154(43.4%)
Education on COVID-19
Took a course on COVID-19 management
No
30(7.2%)
197(47.6%)
187(45.2%)
0.219
Yes
12(12.6%)
44(46.3%)
39(41.1%)
Received Heath education from
Ministry of Health website
15(13.9%)
49(45.4%)
44(40.7%)
0.120
Online and social networking
22(7.3%)
153(51%)
125(41.7%)
Paper publication
0(0%)
1(20%)
4(80%)
Television
6(6.7%)
37(41.1%)
47(52.2%)
Used Tawakalna application
No
10(12.2%)
31(37.8%)
41(50%)
0.161
Yes
37(8.7%)
209(48.9%)
181(42.4%)
Table 10: Association between number of symptoms and other factors.
1-5 symptoms N=242
More than 6 symptoms N=227
OR
90% CI
p-value
OR
90% CI
p-value
Gender
Female
0.605
0.27-1.3
0.214
1.56
0.7-3.47
0.266
Male
Reference
-
-
Reference
-
-
BMI
Underweight
0.2
0.01-2.8
0.236
0.3
0.02-3.33
0.327
Normal
0.23
0.08-0.62
0.004
0.16
0.06-0.45
<0.001
Overweight
0.8
0.26-2.47
0.7
0.51
0.16-1.59
0.251
Obese
Reference
-
-
Reference
-
-
Comorbidities
No
0.684
0.26-1.78
0.437
0.42
0.16-1.08
0.074
Yes
Reference
-
-
Reference
-
-
History of malaria
No
16.22
0.85-309.1
0.064
3.95
0.35-44.3
0.264
Yes
Reference
-
-
Reference
-
-
Days to go out for shopping
Every two weeks
1.85
0.6-5.72
0.281
1.55
0.49-4.82
0.449
Once a week
0.43
0.16-1.16
0.097
0.53
0.19-1.44
0.214
Every day or two
7.11
0.7-71.82
0.096
7.16
0.7-72.4
0.095
Once every 3 days
Reference
-
-
Reference
-
-
Living in one of the completely isolated neighborhoods
No
2.63
0.71-9.64
0.144
3.21
0.86-11.95
0.082
Yes
Reference
-
-
Reference
-
-
Keen to wear a mask
No
5x107
-
0.997
2x107
-
1
Sometimes
0.97
0.28-3.37
0.965
2.02
0.06-6.76
0.252
Yes
Reference
-
-
Reference
-
-
Used Tawakalna application
No
0.54
0.2-1.46
0.231
0.77
0.03-2.01
0.606
Yes
Reference
-
-
Reference
-
-
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.
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