The battle against Coronavirus disease 2019 (COVID-19) in the Kingdom of Saudi Arabia: Public health perspective

Coronavirus disease 2019 (COVID-19) which was initially reported in the Chinese city of Wuhan has now spread unprecedented all over the world, including the Kingdom of Saudi Arabia (KSA). The World Health Organization declared this outbreak as a public health emergency of international concern during late January 2020 while the announcement of this viral infectious condition was made as COVID-19 disease during February 2020. As of late May 2020, the global death rate due to COVID-19 was 357,714 and 441 in KSA alone. This review provides an overview of COVID-19 and the public health measures adopted by KSA in the context of COVID-19.     

Clinical and epidemiological characteristics of COVID-19 mortality in Saudi Arabia

Objectives:To analyze the clinical and epidemiological characteristics for 224 of in-hospital coronavirus disease 2019 (COVID-19) mortality cases. This study’s clinical implications provide insight into the significant death indicators among COVID-19 patients and the outbreak burden on the healthcare system in the Kingdom of Saudi Arabia (KSA).Methods:A multi-center retrospective cross-sectional study conducted among all COVID-19 mortality cases admitted to 15 Armed Forces hospitals across KSA, from March to July 2020. Demographic data, clinical presentations, laboratory investigations, and complications of COVID-19 mortality cases were collected and analyzed.Results:The mean age was 69.66±14.68 years, and 142 (63.4%) of the cases were male. Overall, 30% of the COVID-19 mortalities occurred in the first 24 hours of hospital admission, while 50% occurred on day 10. The most prevalent comorbidities were diabetes mellitus (DM, 73.7%), followed by hypertension (HTN, 69.6%). Logistic regression for risk factors in all mortality cases revealed that direct mortality cases from COVID-19 were more likely to develop acute respiratory distress syndrome (odds ratio [OR]: 1.75, confidence intervel [CI: 0.89-3.43]; p=0.102) and acute kidney injury (OR: 1.01, CI: [0.54-1.90]; p=0.960).Conclusion:Aging, male gender and the high prevalence of the underlying diseases such as, DM and HTN were a significant death indicators among COVID-19 mortality cases in KSA. Increases in serum ferritin, procalcitonin, C-reactive protein (CRP), and D-dimer levels can be used as indicators of disease progression.     

Role of the Coronavirus Disease 2019 (COVID-19) pandemic in the upgrading of personal hygiene. A cross-sectional study in Saudi Arabia

Objectives:To assess the role of the Coronavirus Disease 2019 (COVID-19) pandemic in improving personal hygiene in Saudi Arabia.Methods:We administered a questionnaire distributed online between 19 and 28 May 2020 to determine alterations in personal hygiene practices during this pandemic compared to the pre-pandemic phase.Results:We included 211 respondents from the Kingdom of Saudi Arabia (KSA) in this study. Improvement at different levels was detected in all examined personal hygiene items compared to the pre-pandemic stage. The percentages of respondents who always washed their hands after coming back home (34.1%), used soap to wash their hands (58.8%), used a hand sanitizer outside (5.2%), wore a face masks while outside (1.4%) and washed their hands before preparing and/or eating food (74.9%) was increased before the pandemic to 89.6%, 90%, 63.5%, 59.2% and 89.1% during the pandemic, respectively. The percentage of respondents who never shake hands with people they know increased from 0% before the pandemic to 62.6% during the pandemic. The mean duration of washing hands with soap significantly increased from 13.31 seconds before the pandemic to 28.01 seconds during the pandemic (p<0.0001).Conclusion:The COVID-19 pandemic resulted in a noticeable improvement in the personal hygiene habits in Saudi Arabia mainly those related to COVID-19 prevention.     

Advancing mass spectrometry-based clinical proteomics in Saudi Arabia. Establishing a Saudi Proteomics Society

Rapid developments in the field of mass spectrometry-based quantitative proteomic technologies holds great promise in the search for clinically useful protein biomarkers for early detection, diagnosis, and prognosis of disease in general, and for monitoring response to therapy. Proteomics may contribute to finding novel drug targets and unravel molecular pathways associated with disease. Despite the application of clinical proteomics to a wide spectrum of disease research globally, however, there is lack of data with regard to quantitative proteomics in the Kingdom of Saudi Arabia (KSA) for the diseases common to the Saudi population. In this review therefore, we will discuss some aspects of clinical proteomics with regard to the occurrence of common diseases, and outline our perspectives and vision in the context of KSA. Furthermore, we aim to introduce the concept of a national Saudi Proteomics Society in the Kingdom as part of an advanced research and development program.     

Advantages and disadvantages of telemedicine during the COVID-19 pandemic era among physicians in Taif,Saudi Arabia

Objectives:To evaluate the advantages and disadvantages of telemedicine among physicians during the COVID-19 pandemic. To assess the awareness about telemedicine among physicians and determine their opinions about telemedicine in the post-pandemic era.Methods:A cross-sectional study was conducted at government hospitals (King Faisal Medical Complex [KFMC]-King Abdulaziz Specialist Hospital [KASH]) in Taif, Kingdom of Saudi Arabia (KSA), from May-August 2020. Taif is a small city in the western region of KSA with a population of 689,000 and 2 main hospitals (KFMC & KASH) which also serve rural areas close to Taif city. A total of 36 physicians practiced telemedicine, only 25 physicians accepted to participate in this study.Results:Thirty-six percent of the responders believed that telemedicine could improve the effectiveness of therapeutic intervention and 44% believed that the quality of care was enhanced using telemedicine. Difficulty in reaching the correct diagnosis due to the lack of physical examination was one of the disadvantages that faced the participants.Conclusion:Telemedicine should be part of medical services but should not completely replace physicians’ personal interaction. Telemedicine could be continued for stable remotely residing patients even after the COVID-19 pandemic.     

Clinical Practice Guidelines for Liver Transplantation in Saudi Arabia

The demand for liver transplantation in the Kingdom of Saudi Arabia (KSA) is associated with the country’s high burden of liver disease. Trends in the epidemiology of liver transplantation indications among recipients in KSA have changed over 20 years. Non-alcoholic steatohepatitis has eclipsed the hepatitis C virus in the country due to the effective treatment strategies for HCV. Risk factors for NASH, like type 2 diabetes mellitus, obesity, and hyperlipidemia, are becoming a major concern and a leading indication for liver transplantation in the KSA. There is also a significantly increased prevalence and incidence of genetic adult familial liver diseases in KSA. New immunosuppressive agents and preservation solutions, improved surgical capabilities, and early disease recognition and management have increased the success rate of liver transplant outcome but concerns about the side effects of immunosuppressive therapy can jeopardise long-term survival outcomes. Despite this, indications for liver transplantation continue to increase, resulting in ongoing challenges to maximize the number of potential donors and reduce patient mortality rate while expecting to get transplanted. The Saudi Center of Organ Transplant is the recognized National Organ Donation Agency for transplantation, which renders important support for procurement and allocation of organs. This guidance document aims to help healthcare providers in managing patients in the liver transplant setting.     

Clinical otorhinolaryngological presentation of COVID-19 patients in Saudi Arabia: A multicenter study

Objectives:To assess the otorhinolaryngological (ORL) symptoms, including their prevalence, severity, and early presentations among coronavirus disease-19 (COVID-19) patients in the Saudi population.Methods:This was a multicentric, cross-sectional study carried out on severe acute respiratory syndrome coronavirus-2 positive patients at 3 COVID-19 centres; Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, ALKhobar, Qatif Central Hospital, AlQatif, and Ohud Hospital, Al Madinah Al Munawarah, Saudi Arabia. The validated survey consisted of sociodemographic data, general symptoms of COVID-19, and ORL manifestations.Results:A total of 1734 COVID-19 positive patients were included in the study (mean age: 37.7±11.6 years). Most of the cases were mild (51.8%), followed by moderate (45.6%), and severe (2.6%) cases. Approximately 33.7% were asymptomatic. Severity of symptoms was significantly associated with male gender (p=0.017), higher age-group (p=0.04), and smoking (p<0.001). The most common initial ORL presentations were sore throat (20.9%), anosmia (15.5%), hyposmia (10%), and loss of taste (11.4%). Overall, 79.5% showed ORL symptoms as the initial presenting symptoms for COVID-19, with anosmia and sore throat being the most common symptoms.Conclusion:This study confirmed the prevalence of ORL symptoms among COVID-19 patients in Saudi Arabia. Moreover, these symptoms could also be considered for early detection of COVID-19 as they might appear prior to other symptoms.     

Genito-urinary cancer in Saudi Arabia

The incidence of Genito-urinary cancer (GUC) in the Kingdom of Saudi Arabia (KSA) increases with age and is 5-fold higher in men than in women. Genito-urinary cancer accounts for only 9.2% of all cancers in KSA, while the rate in the United States of America (USA) is as high as 24.1%. An epidemiological search on GUC in KSA revealed a relatively low incidence compared to developed countries. This is more evident in prostatic cancer, which is 50 times lower than in the USA. The most common GUC in KSA is bladder, followed by the prostate, kidney, and testicular cancer. Penile cancer is extremely rare. Genito-urinary cancer is not among the 10 most common cancer in KSA, however, bladder cancer ranking tenth. Reviewing the National Cancer Registry data in addition to the available literature on GUC in KSA for the past 50-years showed the changing pattern of this disease over time.     

Sickle cell hemoglobin C disease in Saudi Arabia

Sickle cell hemoglobin C (HbSC) is a disease confined to people of West African ancestry and it has not been reported in the Kingdom of Saudi Arabia (KSA). We are reporting 2 patients with HbSC disease from the western province of KSA (Madinah); one patient presented with severe form of the disease which include transient hypertension.     

Prevalence and characteristics of abnormal Papanicolaou smear in Central Saudi Arabia

Objectives:

To assess the prevalence and characteristics of abnormal pap smear in the central region of Saudi Arabia.

Methods:

In this retrospective case control study conducted in the Departments of Obstetrics and Gynecology, and Histopathology at King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia, all pap smears screened for Saudi women between 2008 and 2011 were reviewed. Approximately 5000 pap smears are screened annually at King Abdulaziz Medical City utilizing the Bethesda III System (2001). All abnormal smears patients’ data were collected and compared to the data of randomly selected 200 normal smears’ patients.

Results:

Abnormal pap smear prevalence was found to be 4.3% (841/19,650 Saudi patients were found with atypical epithelial cells abnormalities). Its prevalence in the years 2008 was 5.7%, 2009 was 4.9%, 2010 was 4.2%, and 2011 was 2.5%. Abnormal smear patients have lower parity (p=0.001), and were less likely to use intra-uterine devices (p=0.03) compared with normal smear patients. Presence of abnormal cervical appearance was associated with increased epithelial cell abnormalities (p=0.045). The only positive history that has characterized patients with epithelial cell abnormalities was their previous history of abnormal pap smear (p=0.001). Squamous cell abnormalities were identified in 91% of the patients (767/841), and glandular cell abnormalities were identified in 9% of the patients (74/841).

Conclusion:

Prevalence of abnormal pap smears in central Saudi Arabia is relatively low, while advanced glandular abnormalities prevalence was observed to be high.Cervical intraepithelial neoplasia (CIN) and invasive cervical carcinoma (CC) are documented to be less common in Saudi Arabian women community, as compared with some western communities.1-4 This observation was based on studies carried out in Al Baha in the southern region, and Jeddah in the western region of the Kingdom of Saudi Arabia (KSA). No similar recent study was performed in the central region of KSA that allows a clear view on the prevalence of the disease and its characteristics. It is important to mention here that up-to-date, CC screening program has not been implemented in KSA, and pap smear screening is still performed on an opportunistic basis. Moreover, CIN is known to be related to high risk human papilloma virus (HPV) infections, in particular HPV types 16 and 18.5,6 These particular infections are proven to be preventable by available tested vaccines.6 However, there is not enough published data on the prevalence of HPV and its genotypes in KSA that justify cervical cancer preventive vaccination program. Over the last few decades, the financial status of the Saudi population has improved,7 resulting in change in lifestyle, higher mean female age, and more expatriates are mixing with the Saudi population.8 We believe that the prevalence of abnormal pap smear in KSA might be increasing. National alertness and governmental work for preventive program implementation might be an urgent requirement. Such preventive program may assist in early detection and mortality/morbidity reduction of CC.9,10 In this research, we aimed to report an assessment of the prevalence of abnormal pap smears in the central region of KSA, smears cytology findings, and the clinical and personal characteristics of patients who were diagnosed with abnormal pap smears.     

Evaluation of COVID-19 myths in Saudi Arabia

Objectives:To examine the awareness level of COVID-19 and to highlight the frequency of myths and misconceptions among Saudi Arabia’s population.Methods:We conducted a cross-sectional study from June 13 to 20, 2020 by distributing a 16-item online Google forms questionnaire among adults (18-65 years old) living in Saudi Arabia. We utilized the convenience sampling. Data analysis was performed using Chi-square and multiple regression analysis on Jamovi.Results:A total of 1436 responses were analyzed with 43.5% males and 56.5% females. Most respondents (89.1%) thought that only the elderly above 60 years old are considered at high risk of contracting COVID-19. Most respondents (86.5%) agreed that people with other health conditions could be more affected by COVID-19. Approximately 97.2% agreed that wearing a mask and avoiding touching eyes, nose, and mouth with unwashed hands was the leading preventive action. Most participants (99.4%) chose fever as an associated symptom. Respondents from the healthcare sector presented statistically higher scores than those in non-healthcare sectors (p<0.001). Higher education and higher salary were important predictors of better COVID-19 knowledge.Conclusion:Public health officials need to increase awareness measures on COVID-19 to limit myths and misconceptions and reduce psychological distress associated with it.     

Sleep quality and insomnia during the COVID-19 lockdown among the Saudi public: A cross-sectional study

Objectives:To measure the Saudi population’s sleep quality during the lockdown of COVID-19.Methods:An internet-based questionnaire that was performed during the lockdown of the COVID-19 pandemic among the Saudi population over 2 weeks from April 1 to April 15, 2020. We used the instant messaging application WhatsApp and Twitter to reach the targeted population. Saudi citizens and non-Saudi residents who can read and understand the questionnaire were recruited. Data were analyzed using Stata and SPSS.Results:A total of 790 responses were included. The majority of participants were the Saudi population 735 (92.9%). The prevalence of insomnia and poor sleep quality were 54.4% and 55.5%, respectively. Saudi citizenship was associated with longer sleep duration (p=0.031). Female gender and being married were associated with worse global PSQI, sleep quality, sleep distribution, sleep latency, and daytime dysfunction.Conclusion:Our findings showed that during the COVID-19 pandemic, the Saudi population had a high prevalence of insomnia and poor sleep quality. Routine monitoring of the psychological impact of life-threatening outbreaks and the adoption of effective early mental health actions should be considered.     

Health care worker burnout during the COVID-19 pandemic: A cross-sectional survey study in Saudi Arabia

Objectives:To estimate the prevalence of burnout among health care workers (HCWs) who are working in Saudi Arabia during the Coronavirus disease 2019 (COVID-19) pandemic, and explore individual and work-related factors associated with burnout in this population.Methods:In this cross-sectional study conducted between June to August of 2020, we invited HCWs through social channels to complete a questionnaire. The questionnaire inquired about demographics, factors related to burnout, and used the Copenhagen Burnout Inventory scale to indicate burnout. A total of 646 HCWs participated.Results:The mean (SD) age of participants was 34.1 (9.5) years. Sixty-one percent were female. The prevalence of burnout among HCWs was 75%. Significant factors associated with burnout were age, job title, years of experience, increased working hours during the pandemic, average hours of sleep per day, exposure to patients with COVID-19, number of times tested for COVID-19, and perception of being pushed to deal with COVID-19 patients.Conclusion:Health care workers as frontline workers, face great challenges during this pandemic, because of the nature of their work. Efforts should be made to promote psychological resilience for HCWs during pandemics. This study points out the factors that should be invested in and the factors that may not be influential.     

Peptic ulcer associated with COVID-19 in Saudi Arabia

To describe a patient’s condition and clinical progress, admitted to King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia with Coronaviruses disease-19 (COVID-19) infection who presented initially with gastrointestinal symptoms. The novel COVID-19 disease does not only affect the respiratory tract but also affects other parts of the body. A 23-year old male patient came to the emergency room suffering from acute abdominal pain and vomiting. The patient appeared to have a complicated course of infection with gastrointestinal manifestations and a perforated duodenal ulcer without any respiratory symptoms. Laboratory and radiographic investigations revealed positive results for COVID-19. The chest CT showed a ground-glass appearance. Accordingly, the patient was referred for an emergency laparotomy and was treated mainly for a perforated duodenal ulcer. Unfortunately, the patient died due to several complications. Patients presenting with gastrointestinal symptoms during this pandemic should be assessed for COVID-19 infection, even if respiratory symptoms are absent.     

COVID-19 in patients with end stage kidney disease at a large community hospital in Eastern Saudi Arabia. A prospective study

Objectives:To report the outcome of patients with end stage kidney disease (ESKD) who were diagnosed with COVID-19 at a large community hospital in Eastern Saudi Arabia.Methods:A single center, prospective observational study at Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia. Patients with ESKD who were maintained on dialysis and developed COVID-19 between June 15, 2020 and October 31, 2021 were enrolled.Results:In total, 30 patients with ESKD were diagnosed with severe acute respiratory syndrome coronavirus 2 infection. Twenty two (73%) patients developed the disease prior to COVID-19 vaccine rollout. The median age of the cohort was 63 (55-75) years. Most patients were diabetic (73%), hypertensive (97%) and had a median body mass index of 28 kg/m ² . Twenty seven (90%) patients required admission, 16 (52%) patients developed pneumonia, and 5 (17%) patients required mechanical ventilation. Patients who developed pneumonia were older, and the majority had diabetes mellitus and coronary artery disease. Five patients died with a total mortality of 17%.Conclusion:Patients with ESKD who developed COVID-19 had a poor outcome with high mortality compared to the general population. Presence of diabetes mellitus, coronary artery disease and older age were associated with a higher risk of severe disease. There was a sharp decline in the number of positive cases following implementation of the vaccination program.     

Online sources of health statistics in Saudi Arabia

Researchers looking for health statistics on the Kingdom of Saudi Arabia (KSA) may face difficulty. This is partly due to the lack of awareness of potential sources where such statistics can be found. The purpose of this paper is to review various online sources of health statistics on KSA, and to highlight their content, coverage, and presentation of health statistics. Five bibliographic databases where local research can be found are described. National registries available are summarized. Governmental agencies, as well as societies and centers where the bulk of health statistics is produced are also described. Finally, some potential international sources that can be used for the purpose of comparison are presented.     

The Saudi Critical Care Society extracorporeal life support chapter guidance on utilization of veno-venous extracorporeal membrane oxygenation in adults with acute respiratory distress syndrome and special considerations in the era of coronavirus disease 2019

Extracorporeal membrane oxygenation (ECMO) is considered as a supportive treatment that provides circulatory and ventilatory support and can be thought off as a bridge to organ recovery. Since 2009, it has been applied as a rescue treatment for patients with severe adult respiratory distress syndrome (ARDS) mainly due to viral causes. In December 2019, several patients presented with a constellation of symptoms of viral pneumonia in China. A new strain of the corona virus family, called COVID-19, has been discovered to be the cause of this severe mysterious illness that was named severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2). This new virus continued to spread across the globe leading to the World Health Organization announcing it as a pandemic in the early 2020. By the end of March 2021, the number of COVID-19 cases worldwide exceeded 126 million cases. In Saudi Arabia, the first confirmed case of COVID-19 was reported in the 2nd March 2020. By the end of March 2021, the total number of confirmed COVID-19 cases in Saudi Arabia is just above 360,000. In anticipation of the need of ECMO for the treatment of patients with SARS‑CoV‑2 based on the previous Middle East respiratory syndrome coronavirus pandemic experience, the Saudi Extra-Corporeal Life Support (ECLS) chapter that is under the umbrella of the Saudi Critical Care Society (SCCS) convened a working group of ECMO experts. The mission of this group was to formulate a guidance for the use of ECMO as a last resort for patients with severe ARDS, especially with COVID-19 based on available evidence. The ECLS-SCCS chapter wanted to generate a document that can be used to simple guide, with a focus on safety, to provide ECMO service for patients with severe ARDS with a special focus on SARS‑CoV‑2.     

Histopathological features of breast cancer in Al-Madinah region of Saudi Arabia

Objectives:

To observe the frequency of breast cancer among Saudi patients and to highlight the age variations and features of advanced cancer.

Methods:

A retrospective study of breast cancer biopsies from all Saudi patients performed between January 2006 and December 2013 in King Fahad Hospital, Al-Madinah, Kingdom of Saudi Arabia. All the available demographic and tumor related data was analyzed.

Results:

Of 1005 breast tissues reviewed, 982 specimens were from female, and 23 from male patients. In females, 398 specimens (40.5%) were diagnosed as malignant. Invasive ductal carcinoma (IDC) (85.2%) was most common, followed by ductal carcinoma in situ (8%), and invasive lobular carcinoma (2.7%). The mean age of Saudi females with IDC was 46.9 years. Approximately 48.7% IDC were Grade III tumors. A tumor size >2.5 cm was found in 61.1% patients, whereas axillary nodal metastasis was present in 57.1% and lymphovascular invasion in 64.1% who underwent axillary nodal dissection. In males, 4 specimens (17.4%) were malignant (all IDC).

Conclusion:

Our finding are consistent with previous reports of breast cancer being diagnosed in younger age group, in advanced stages, and with features of aggressive behavior; which signals the urgency for implementation of breast screening programs.Breast cancer (BC) is the second most common cancer in the world, and most frequent cancer among women with an estimated 1.67 million new cancer cases diagnosed in 2012 (25% of all cancers).1 As reported by GLOBOCAN,1 in both, the less developed (883,000 cases) and the more developed regions (794,000 cases), it is the most common cancer in women. The American Cancer Society estimated 232,340 new cases of invasive BC in women, and approximately 2,240 new cases among men in the US during 2013.2 In the United Kingdom (UK), BC mortality is however, the second to lung cancer, accounting for 11,684 deaths in 2011.3 In the Kingdom of Saudi Arabia (KSA), BC is most prevalent cancer in Saudi females as reported in Saudi Tumour Registry Report 2012.4 In 2008, previous study3 from Jeddah, KSA compared the cancer statistics for the KSA and USA; with the aim to study the future cancer burden in Saudi Arabia. They concluded that the cancer rates demonstrate a considerable increase and enormous demands on healthcare resources, in the future.5 Al Diab et al,6 reported 80 articles on BC from KSA. They concluded that it is most common in the Central region of KSA, and least common in the Northern region, with Eastern, Western, and Southern regions falling in the middle.6 In our present, hospital based, retrospective study, we cited and compared similar recent studies from around the world; such as from India,7,8 Nigeria,9 Pakistan,10 and Yemen.11 The KSA medical literature also has a number of similar relevant hospital based studies available for comparison.12-15 There is however, only one article in the local literature for hospital-based cancer data for Al-Madinah, which was carried out almost 20 years back.16 Although there has been some very recent hospital-based research publications from Al-Madinah; these articles have reported general disease patterns and cancers in many different organs such as large bowel,17,18 prostate,19 lymph nodes,20 and thyroid,21 but no data is available for this common and important disease, namely BC. We will be investigating this important problem of BC in the rapidly growing and advancing region of Al-Madinah; based on the histopathology diagnosis of biopsies and mastectomies/axillary dissections performed in the local population; and compare our data with previous international and national studies.     

The use of neutrophil-to-lymphocyte ratio (NLR) as a marker for COVID-19 infection in Saudi Arabia: A case-control retrospective multicenter study

Objectives:To assess the neutrophil-to-lymphocyte ratio (NLR) diagnostic and prognostic value in the context of Coronavirus disease-2019 (COVID-19) infection in Saudi Arabia.Methods:A case-control study in which 701 confirmed COVID-19 patients (of which 41 were intensive care unit [ICU]-admitted) and 250 control subjects were enrolled. The study was conducted retrospectively in October on patients admitted to 3 separate hospitals in Saudi Arabia namely: King Abdullah Bin Abdulaziz University Hospital (Riyadh), Ohud Hospital (Madinah), and Nojood Medical Center (Madinah) between May and September 2020. Neutrophil-to-lymphocyte ratio was calculated based on absolute neutrophil and lymphocyte count. Institutional ethical approval was obtained prior to the study.Results:Patients (median age 35 years), of which 54.8% were females, were younger than the control cohort (median age 48 years). Patients had significantly higher NLR compared to the control group. Intensive care unit admitted patients had significantly higher platelet, WBC and neutrophil counts. The ICU patients’ NLR was almost twice as of the non-intensive patients. The NLR value of 5.5 was found to be of high specificity (96.4%) and positive predictive value (91.4%) in diagnosing COVID-19. Furthermore, it had a very good sensitivity (86.4%) in predicting severe forms of disease, such as, ICU admission.Conclusion:Neutrophil-to-lymphocyte ratio is an important tool in determining the COVID-19 clinical status. This study further confirms the prognostic value of NLR in detecting severe infection, and those patients with high NLR should be closely monitored and managed.