The Pattern of COVID-19 Patients at King Salman Specialist Hospital, Hail Region, Saudi Arabia

Introduction: Coronavirus is arguably the most significant pandemic in recent human history that changed the way healthcare providers understand respiratory diseases. The presented study focused on exploring the effectiveness of the strategies integrated by Saudi Healthcare professionals in mitigating and controlling the disease.

Methodology: The research integrated a retrospective case series study of the King Salman Specialist Hospital. The inquiry evaluated all patients admitted to the facility for COVID-19 symptoms. The research integrated a consecutive non-random sampling in selecting the participants.

Results: A total of 1,213 patients were selected for the study with an average age of 46 years. Fever, fatigue, and coughs were the main symptoms (68%), and 830 of the patients had severe symptoms. Further, 64% of the patients were male and 36.6% female. High prevalence in males was associated with old age.

Conclusion: Controlling COVID-19 has been challenging, and monitoring the effectiveness of interventions helps determine the progression of the pandemic towards its eradication.

Introduction

Coronavirus, also known as COVID-19, is a disease that originated in Wuhan, a city in China. The disease abbreviation has the number 19 because its first incidence was recorded in December 2019. The disease spread rapidly across many countries and was declared a global pandemic in early 2020. The causative agent of the illness was labelled as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [1]. The origin of the disease is associated with human association with bats and is transferable from person to person through respiratory fluids. The condition is spread by having close contact with the infected persons and coming in contact with respiratory fluids that become present in the atmosphere when an infected person sneezes or coughs. Fluids such as saliva from an infected person can cause transmission when they speak.

The disease was declared a pandemic on March 11, 2020. Like all other infectious diseases, the disease has an incubation stage, which lasts for 1–14 days, after which the infected individual starts experiencing the signs and symptoms of the disease. The disease’s pathophysiology is based on the epithelial cells of the respiratory system, whereby the virus binds with receptors for Angiotensin-Converting Enzyme 2. Various infected individuals do not show the signs or develop general signs and symptoms of respiratory illness [1]. The main clinical presentations of COVID-19 disease include shortness of breath, fatigue, non-productive coughs, and malaise. The disease severity worsens in the presence of comorbidities such as acute respiratory distress syndrome and pneumonia that affect the same body systems. Comorbidity has also been proven to increase the mortality rates for COVID-19, especially in elderly patients.

The disease is diagnosed clinically by testing the viral RNA using a nasopharyngeal swab. The development of diagnostic criteria was an effective strategy for isolating the disease and compiling its statistics. Treatment strategies mainly target the symptoms of the disease since there is no distinct cure for the virus [2]. It is also supportive, monitoring and managing the patient’s vitals. For example, most patients with symptomatic COVID-19 are placed under ventilation or ICU care.

The COVID-19 outbreak has become an international concern as all governments are implementing measures to control the incidence and spread of the disease. It is, therefore, critical to analyze the issues surrounding COVID-19, especially in healthcare facilities, to establish the demographics of the disease. Healthcare facilities are tasked with screening, vaccination, and managing the disease [1]. Conducting an epidemiologic study in a hospital is easier because the records help determine the disease’s characteristics and the affected patients. Record keeping allows health workers to perform stratification, identifying the most affected areas or groups.

This research is focused on issues relating to prevalence in a hospital in Saudi Arabia. Studies indicate that the Kingdom managed the disease’s prevalence by implementing protocols that aimed at controlling the disease. These protocols were implemented during the first two months of the pandemic outbreak [2]. The government declared curfews, travel restrictions, and household quarantines used worldwide to manage the spread of COVID-19. The region also reported lower mortality rates because of the relatively lower population than other continents, such as Europe and Asia.

All the implemented preventative and management strategies were less effective than anticipated. The incident rates have exponentially increased in Saudi Arabia, and the increased confirmed cases were mostly recorded during the first two months but gradually decreased by the end of May [2]. This improvement may have been attributed to the advancement in treatments that lead to more recoveries from the disease.

The Saudi Arabian government invested in their healthcare system, which could be one of the reasons why the spread of the disease was easily slowed. The healthcare system provides its clients with quality services that reduce fatal complications associated with COVID-19. As much as the situation was well-controlled across the Kingdom, the impact of the restrictions varied across its cities. Some affected cities include Riyadh, Mecca, Jeddah, and Medina. It may be an issue with the health care system, but research suggests that it resulted from non-adherence to the stated guidelines [2]. Other factors contributing to the differences are cultural diversity, practices, and population density in the different cities. Diversity was one of the major contributors because it is directly related to acquiring knowledge through pre-existing beliefs and attitudes.

Problem Statement

Several strategies have been implemented to curb the incidence and prevalence of COVID-19. Medications to deal with the disease have been set aside, and the recovery rates have increased exponentially. Vaccines to curb the occurrence and prevalence of the disease have been created, and a majority of the Saudi Arabian population has received them. The purpose of vaccines is usually to prevent the occurrence of disease by exposing the body to its inactive form. To date, there are new confirmed cases of the disease. This research seeks to explore the issues contributing to the patterns of COVID-19 in King Salman Specialist Hospital in Salman, Saudi Arabia. The research aims to analyze the risk factors of the disease while discussing the contribution of cultural diversity, nationality, and comorbidity. Analyzing these factors may indicate the insistent incidence and morbidity in the presence of evidence-based strategies to curb the disease.

Justification

Previous studies have been conducted to determine the risk factors for the disease. They showed that a majority of the reported COVID-19 cases are adults, with a percentage of 89%. The incidence rates are more common in adults than children and the elderly [3] and epidemiological studies regard them as the most vulnerable group to the pandemic. Previous studies also indicate that COVID-19 mortality is directly linked to age.

About 80% of the reported mortalities in China involved adults aged 60 years and above. In the United States, the trend is similar because, in the total number of mortalities in adults, 15% were aged above 70 years. In the United Kingdom, a report covering 17 million patients indicated that patients above 60 are at a higher risk of mortality. The COVID-19 association with age may be due to physiological changes that occur as people age [3]. The immune system reduces effectiveness when individuals grow older, possibly due to exposure to other diseases. Studying the risk factors of COVID-19 helps us to isolate factors that contribute to the occurrence of the disease, even in the presence of vaccines and various effective treatments.

Significance of the Study

This study will examine the issues surrounding COVID-19 in Saudi Arabia and determine the effectiveness of the strategies used by healthcare systems to control the disease.

Use of Digital Response for COVID-19 in Saudi Arabia

The study conducted in this section aimed to discuss how Saudi Arabia implemented digital systems in its COVID-19 responses. Digital systems were used in different institutions to undertake various functions, such as public health and education. The study also investigated the importance of digitalizing responses in telehealth and commerce. The research paper used on this topic collected its information by synthesizing data from press releases, announcements, news, and peer-reviewed journals and articles [4]. The study results indicated that Saudi Arabia developed an average of 19 applications to educate the masses and control the spread of COVID-19 by promoting awareness and personal protection systems. The apps could perform health services in the comfort of people’s homes.

Some of the systems implemented during Covid-19 were developed in earlier years. For instance, Mawid (Appointment) and the online application for making healthcare appointments were formed in 2018. The Sehhaty (My Health) application was introduced in 2019 with the aim of health promotion by encouraging lifestyle and behavior changes for better health. The app used challenges and gamification to achieve its objectives [4]. These two applications came in handy because new systems were incorporated to indicate the symptoms of COVID-19, and the suspecting individuals could make contact with specialized COVID-19 clinics. Another successfully integrated system was drive-through COVID-19 testing clinics, whereby people could get tested without any physical interaction.

Digitalization was applicable in testing and managing the disease and overall surveillance of the disease patterns. Health Electronic Surveillance Network (HESN) is one such system that provides timely information on the incidence, prevalence, and mortality rates of the disease. HESN was developed in 2012, and its main aim was to facilitate a cultural event in Saudi Arabia called Hajj [4]. Taqasi (Patient Tracing Unit) was also developed in 2020 to promote patient and disease tracking during the pandemic.

Like all the other countries, Saudi Arabia has local publications and guidelines on managing mild symptoms of COVID-19. The publications emphasized the importance of social distancing to minimize the spread and were useful in safely lifting the lockdown strategies. The Saudi Arabian software developers also released two specialized applications purposely to raise curfew and lockdown strategies [4]. The two smartphone apps, namely Tawakkalna and Tabaud, can restrict movement within the hour of curfew, and the other can alert individuals if they are in close contact with a confirmed disease.

Delivery of Healthcare in Saudi Arabia

The Ministry of Health (MOH) in Saudi Arabia must provide timely, reliable, and accurate information on all aspects of COVID-19 in the region. The Ministry is deemed the most authentic source of information throughout the Kingdom [4]. It works with other sectors, such as the Ministry of Defense, learning institutions (teaching and referral hospitals), and private corporations.

Saudi Arabia has also established primary, secondary, and tertiary institutions to manage and treat COVID-19 among citizens and non-citizens. A motion was passed in the Kingdom in 2011 to promote the usage of electronic information systems to enhance service delivery through telecommunication. The objective of this vision was to improve the quality of life for all patients by preventing diseases and improving the accessibility to quality services [4]. The vision illuminated the importance of e-health or telehealth in controlling all diseases, including the COVID-19 pandemic.

Strengths and Weaknesses of the Strategies for COVID-19 in Saudi Arabia

This discusses a study to map published literature on COVID-19 in Saudi Arabia. The researchers for the article performed a comprehensive analysis of Medline and Cochrane databases while selecting articles relevant to the topic of study as stated in the PRISMA protocol. The researchers utilized 53 articles that mainly cited the preventative and control mechanisms against COVID-19. The main issues discussed in the articles included the importance and ways to minimize personal contact in preventing and spreading the virus [5]. One of the most significant strategies was the cancellation of Hajj and Umra, which are important celebrations in Saudi Arabia. The studies also highlighted the importance of preventing disease spread across different healthcare facilities departments. Some of the articles discussed the medical strategies that could potentially treat the disease and the methods of managing patients in healthcare facilities.

Given the timing of the study (March-April 2020), most of the articles were based on personal experience, with only two being experimental. One of the empirical studies was expansive and was specifically a multinational healthcare trial citing management strategies for outbreaks of pneumonia and COVID-19. The study was implemented in European countries first before including Saudi Arabia. The study results showed that Saudi Arabian researchers focused on collaborative studies, especially on COVID-19 [5]. There was a limited contribution of researchers in Saudi Arabia about general disease issues. The researchers found the lack of experimental studies particularly concerning, given the critical nature of the disease.

During the onset of the disease, there was limited information on the treatment strategies for the disease. This issue may have been because there was no established pathophysiology and etiology of the disease. Medical personnel had to tiptoe around the pharmacokinetics and dynamics of the symptoms of the disease while hoping to treat the virus [5]. The study also showed that there was limited information on the social and economic aspects of the disease, but epidemiologic studies were present.

Strategies in Healthcare Facilities to Control COVID-19

Healthcare facilities play the role of creating and implementing effective strategies for disease management and prevention. Data analysis is essential in assessing the available methods and whether they are effective. The COVID-19 virus emerged in late 2019 and has had deteriorating effects on most regions’ socioeconomic status [6]. At first, healthcare facilities did not have specified disease management protocols. They focused on addressing the symptoms by using ventilators that gave the patients oxygen support.

The Saudi Arabian government implemented various approaches in the community and healthcare facilities to prevent the spread of the virus. As much as the government responded immediately to the virus, some strategies were ineffective in reducing the morbidity and mortality related to the disease. The article reviewed in this section states various defining elements for an effective healthcare approach, including processes, health policies, context, and content. The Kingdom of Saudi Arabia was among the first regions to mitigate the spread of the disease before its occurrence [6]. This is because it had established early warning systems against diseases like COVID-19. One such system was the Middle East Respiratory System (MERS).

At the beginning of 2020, KSA formed a committee to discuss the possible occurrence of the disease and the mitigation strategies against it. The committee involved various ministries such as defence, interior, and health. Some effective strategies included banning tourists, especially from China, as it was the known origin of the disease. The country also barred people from attending social events and introduced a nationwide curfew [6]. These strategies have provided general benchmarks for controlling the disease and have become common procedures in preventing and managing COVID-19 in healthcare facilities.

Methods and Materials of the Study

Study Design: A retrospective case-series study was the best study design to be used for this study.

Study period: April 2020 to December 2020.

Study Area/Setting: King Salman Specialist Hospital in Hail governmental hospital of the Ministry of Health.

Study Subjects: All positively tested the COVID-19 patients at the King Salman Specialist Hospital.

Sample Size: A total of 1,213 positively tested patients were considered as the sample size of this study.

Sampling Technique: A consecutive non-random sampling was used to include all patients who were admitted from April to December 2020.

Methods: This retrospective case-series study was conducted at the King Salman Specialist Hospital-Hail. It was carried out by reviewing the medical records at this hospital. The data collected included the patient’s age, gender, nationality, COVID-19 results, and result date.

Data Collection Method: The data was collected using a structured data collection form

Study Variables: The study variables include socio-demographic characteristics (age, gender sex, nationality).

Data Management and Statistical Analysis: Data will be analyzed using SPSS 26.0 version statistical software (IBM, USA Descriptive statistics mean, standard deviation, frequencies, and percentages) were used to describe the quantitative and categorical variables. Pearson’s chi-square test for trend and homogeneity was used to compare the positive number of cases across age groups, gender, and nationality. A p-value of <= 0.05 was used to report the statistical significance of the results.

Results

Demographic Characteristics of the Respondents

A sample of 1,213 patients positively diagnosed with COVID-19 participated in the study. The youngest and oldest patients were less than a year and 106 years, respectively. The average age of the respondents was 46.80 years (SD = 17.002).

Out of the 1,213 patients taking part in the study, 36.6% (f = 444, 95% CI [33.9, 39.3]), while 63.4% (f = 769, 95% CI [60.7, 66.1]) were identified as male. There were fewer (0.4%) male than female (0.7%) COVID-19 patients aged below 10. Patients aged between 31 and 40 years constituted the majority of male (24.4%) and female (20.5%) COVID-19 patients admitted at King Salman Specialist Hospital in the Hail Region of Saudi Arabia. Table I shows the distribution of patients’ ages by gender at the hospital.

Table I. Gender by Age of the Respondents

Gender		Age Group
		0–10	11–20	21–30	31–40	41–50	51–60	61–70	Above 70
Female	%	0.7%	2.0%	20.0%	20.5%	13.1%	19.6%	11.3%	12.8%
	f	3	13	107	188	171	141	80	66
Male	%	0.4%	1.7%	13.9%	24.4%	22.2%	18.3%	10.4%	8.6%
	f	6	22	196	279	229	228	130	123

COVID-19 Severity by Gender

The majority (68.4%) of the patients combined fever, coughs, and tiring as the main symptoms of COVID-19, amongst whom 572 were male and 258 were female. Only 0.1% of the patients reported fever and coughs as the only symptoms. A notable percentage (31.5%) reported fever as the only symptom (Table II).

Table II. Gender by Signs and Symptoms Reported Among Patients

		Signs and symptoms			Total
	Fever	Fever + cough	Fever + cough + tired
Female	Count	186	0	258	444
	% within Gender	41.9%	0.0%	58.1%	100.0%
Male	Count	196	1	572	769
	% within Gender	25.5%	0.1%	74.4%	100.0%
Total	Count	382	1	830	1,213
	% within Gender	31.5%	0.1%	68.4%	100.0%

The Severity of COVID-19 Infections by Gender and Nationality of the Patients

Fig. 1 shows the distribution of genders by nationality of the COVID-19 patients at King Salman Specialist Hospital in the Hail Region of Saudi Arabia. The figure reveals that there were fewer female COVID-19 patients across all nationalities. Saudi Arabians were hard hit by the pandemic. This observation can be attributed to a high population ratio of the Kingdom’s citizens to foreigners.

Fig. 1. COVID-19 infections by Gender and Nationality.

The severity of COVID-19 Infections by Age of the Respondents

Table III shows the severity of the COVID-19 infections reported at King Salman Specialist Hospital by age. A majority (830 out of 1,213) of the patients diagnosed with COVID-19 at the hospital had severe symptoms, combining fever, coughs, and tire. Most (26.6%) of the patients who reported severe infection with all three symptoms were aged between 31 and 40 years. The least affected age group in this category of signs and symptoms were children 10 years and below. Fever was the only reported symptom among 382 patients. The “fever only” symptom was almost equally prevalent among patients aged between 21 and 106 years. A significant majority (19.4%) of those reporting fevers were aged between 41 and 50 years.

Table III. Severity of COVID-19 Infections by Age

		Age category								Total
		0–10	11–20	21–30	31–40	41–50	51–60	61–70	Above 70
Fever	Count	2	10	60	57	74	63	58	58	382
	% within signs and symptoms	0.5%	2.6%	15.7%	14.9%	19.4%	16.5%	15.2%	15.2%	100.0%
Fever +	Count	0	0	0	1	0	0	0	0	1
cough	% within signs and symptoms	0.0%	0.0%	0.0%	100.0%	0.0%	0.0%	0.0%	0.0%	100.0%
Fever +	Count	4	12	136	221	155	165	72	65	830
cough + tired	% within signs and symptoms	0.5%	1.4%	16.4%	26.6%	18.7%	19.9%	8.7%	7.8%	100.0%
Total	Count	6	22	196	279	229	228	130	123	1,213
	% within signs and symptoms	0.5%	1.8%	16.2%	23.0%	18.9%	18.8%	10.7%	10.1%	100.0%

COVID-19 Time Series at King Salman Specialist Hospital

Fig. 2 is a time series chart of the COVID-19 positivity rate at King Salman Specialist Hospital. The first case of COVID-19 infection in the Kingdom of Saudi Arabia was reported on March 2, 2020 [7]. Since then, the number of infections increased rapidly to reach 788,292 positive cases by mid-June 2022. Fig. 2 shows a somewhat similar trend of COVID-19 infections at King Salman Specialist Hospital. The hospital recorded the highest positivity rate between May 5, 2020, and August 24, 2020, after which the positivity rate kept declining. The severity and impact of the COVID-19 pandemic at the King Salman Specialist Hospital in Hail, Saudi Arabia, were highest between May 30 and June 11, 2020.

Fig. 2. Time trend of COVID-19 cases.

Association of COVID-19 Infections with Age and Gender

Among the female patients, 1.4% were 20 years or younger, 20% were between 21 and 30 years, 20.5% were between 31 and 40 years, 13.1% were between 41 and 50 years, 19.6% were between 51 and 60 years, 11.3% was between 61 and 70 years, while 12.8% was above 70 years. The distribution of male patients by age was slightly different from that of female patients. Among the 769 male COVID-19 patients, 0.4% were aged below 10, 1.7% were aged between 11 and 20, and 13.9% were aged between 21 and 30. The majority (24.4%) of the male COVID-19 patients at the hospital were aged between 31 and 40, while 22.2%, 18.3%, 10.4%, and 8.6% were in the age categories of between 41 and 50, 51 and 60 years, 61 and 70, and above 70 years, respectively (Table IV). A chi-square independence test was performed to determine if COVID-19 infections by gender (male/female) were associated with the positivity rate by age. A χ² (7) = 27.104 with an asymptotic significance p-value = 0.000 confirms a statistically significant association between COVID-19 infections by gender (male/female) and the positivity rate by age. Phi = 0.149 and Cramer’s V = 0.149 with an approximate significance of 0.000 test the strength of association between gender and age in terms of COVID-19 positivity rate. The strength of association between the variables is very strong. A higher COVID-19 positivity rate was recorded among male patients across all age categories.

Table IV. COVID-19 Infections by Age and Gender

			Gender		Total
			Female	Male
Age category	0–10	Count	3	3	6
		% within age category	50.0%	50.0%	100.0%
		% within gender	0.7%	0.4%	0.5%
		% of total	0.2%	0.2%	0.5%
	11–20	Count	9	13	22
		% within age category	40.9%	59.1%	100.0%
		% within Gender	2.0%	1.7%	1.8%
		% of total	0.7%	1.1%	1.8%
	21–30	Count	89	107	196
		% within age category	45.4%	54.6%	100.0%
		% within gender	20.0%	13.9%	16.2%
		% of total	7.3%	8.8%	16.2%
	31–40	Count	91	188	279
		% within age category	32.6%	67.4%	100.0%
		% within gender	20.5%	24.4%	23.0%
		% of total	7.5%	15.5%	23.0%
	41–50	Count	58	171	229
		% within age category	25.3%	74.7%	100.0%
		% within gender	13.1%	22.2%	18.9%
		% of total	4.8%	14.1%	18.9%
	51–60	Count	87	141	228
		% within age category	38.2%	61.8%	100.0%
		% within gender	19.6%	18.3%	18.8%
		% of total	7.2%	11.6%	18.8%
	61–70	Count	50	80	130
		% within age category	38.5%	61.5%	100.0%
		% within gender	11.3%	10.4%	10.7%
		% of total	4.1%	6.6%	10.7%
	Above 70	Count	57	66	123
		% within age category	46.3%	53.7%	100.0%
		% within gender	12.8%	8.6%	10.1%
		% of total	4.7%	5.4%	10.1%
Total		Count	444	769	1,213
		% within age category	36.6%	63.4%	100.0%
		% within gender	100.0%	100.0%	100.0%
		% of total	36.6%	63.4%	100.0%

Fig. 3 shows the distribution of the COVID-19 positivity rate by age and nationality. The majority of the infections reported at the hospital were Saudi Arabians aged 21 years and above. A chi-square test of association was conducted to determine if COVID-19 infections by age were associated with the positivity rate by nationality. A Pearson χ² (196) = 476.4, p-value = 0.000 indicates there is a statistically significant association between COVID-19 infections by age and the positivity rate by nationality. Phi = 0.627 and Cramer’s V = 0.237, with an approximate significance of 0.000, show that the strength of the association between the variables is very strong. COVID-19 positivity rate recorded among patients from different nationalities and all age categories is strongly associated.

Fig. 3. Distribution of cases by age and nationality. Nationalities with less than 20 cases (Palestine, bordering across Turkey, Burundi, Eritrea, Greece, Kuwait, Myanmar, Nigeria, Oman, Bahrain, El Salvador, Uganda, Jordan, Indonesia, Sri Lanka, Nepal, Yemen and the Syrian Arab Republic).

Association of COVID-19 Infections between Nationality and Gender

The distribution of COVID-19 Infections by nationality and gender is cross-tabulated in Table V. The COVID-19 positivity rate among males was higher across all nationalities. A chi-square test of association was conducted to determine if COVID-19 infections by gender were associated with the positivity rate by nationality. A Pearson χ² (28) = 188.014, p-value = 0.000 indicates there is a statistically significant association between COVID-19 infections by gender and the positivity rate by nationality. Phi = 0.394 and Cramer’s V = 0.394 with an approximate significance of 0.000 shows that the strength of the association between the variables is very strong. More male than female COVID-19 positivity rates were diagnosed at the hospital across all nationalities.

Table V. Distribution of COVID-19 Infections between Nationality and Gender

		F	M		F	M		F	M
Afghanistan	% Nationality	0.0%	100.0%	Jordan	50.0%	50.0%		47.5%	52.5%
	% Gender	0.0%	4.2%		0.5%	0.3%		71.8%	45.8%
Bahrain	% Nationality	0.0%	100.0%	Kuwait	100.0%	0.0%	Sri Lanka	33.3%	66.7%
	% Gender	0.0%	0.3%		0.2%	0.0%		0.5%	0.5%
Bangladesh	% Nationality	3.7%	96.3%	Myanmar	0.0%	100.0%	Sudan	24.1%	75.9%
	% Gender	0.9%	13.4%		0.0%	0.1%		1.6%	2.9%
Burundi	% Nationality	100.0%	0.0%	Nepal	0.0%	100.0%	Sweden	0.0%	100.0%
	% Gender	0.2%	0.0%		0.0%	1.3%		0.0%	0.1%
Egypt	% Nationality	17.3%	82.7%	Nigeria	100.0%	0.0%	Syrian Arab Republic	36.8%	63.2%
	% Gender	3.2%	8.7%		0.2%	0.0%		1.6%	1.6%
El Salvador	% Nationality	0.0%	100.0%	Oman	0.0%	100.0%	Tribes bordering across	100.0%	0.0%
	% Gender	0.0%	0.3%		0.0%	0.1%		0.2%	0.0%
Eritrea	% Nationality	100.0%	0.0%	Others	0.0%	100.0%	Turkey	0.0%	100.0%
	% Gender	0.2%	0.0%		0.0%	0.1%		0.0%	0.1%
Greece	% Nationality	100.0%	0.0%	Pakistan	0.0%	100.0%	Uganda	100.0%	0.0%
	% Gender	0.2%	0.0%		0.0%	4.6%		0.7%	0.0%
India	% Nationality	30.8%	69.2%	Palestine	0.0%	100.0%	Yemen	22.2%	77.8%
	% Gender	8.3%	10.8%		0.0%	0.1%		0.9%	1.8%
Indonesia	% Nationality	80.0%	20.0%	Philippines	61.4%	38.6%	Total	36.6%	63.4%
	% Gender	0.9%	0.1%		7.9%	2.9%		100.0%	100.0%
	% of Total	0.3%	0.1%		2.9%	1.8%		36.6%	63.4%

Discussion and Conclusion

Age

From the results, COVID-19 is susceptible to all ages in Saudi Arabia. It was found that the youngest participant was less than 1 year old, while the oldest was 106 years old. Ideally, COVID-19 is a highly contagious virus that causes severe illness and death in all age groups. In Saudi Arabia, individuals aged between 31 and 40 show a high disease rate. While older adults and those with pre-existing medical conditions appear at higher risk of developing more severe symptoms, no age group is immune to the virus [8]. All individuals should take the necessary precautions to reduce their risk of infection, including social distancing, hand washing, and wearing a face mask in public. Vaccinated individuals should still take COVID-19 precautions because the vaccine does not completely protect against the virus. Vaccinated individuals are susceptible to new variants since the virus constantly changes.it is important to continue taking precautions to reduce exposure and transmission risk across all ages.

The results show that people over 30 years old are more susceptible to the disease than those under 10. Different factors determine the susceptibility of individuals to the disease. For instance, older individuals develop more severe illnesses from the virus than younger individuals. The aged are more susceptible to COVID-19 because their immune systems are typically weaker due to age-related changes. As people age, their immune systems become less efficient at combating infections and develop underlying medical conditions that make them more vulnerable to the virus [9]. Despite the treatments and vaccinations, the aged have lower immune systems. The infection rate is still optimum at this age.

Gender

Based on gender prevalence, there is a higher rate of infection among males than females in Saudi Arabia across all nationalities. This finding is due to differences in access to healthcare, gender roles, and behaviors that increase the risk of infection. For instance, men engage in activities outside the home, such as work, which increases their exposure to the virus. Cultural and religious norms in Saudi Arabia limit women’s mobility outside and women usually wear face covering (Niqaab), making their exposure less than males [10]. Individuals exposed to the virus, either through contact with an infected individual or through environmental sources, are more likely to become ill. Poor hygiene practices, such as not washing hands regularly, increase the risk of becoming ill from the virus. From Table III, many females express signs of fever, cold, and tiredness more than males in Saudi Arabia. Hormonal differences between males and females could play a role and differences in how men and women access healthcare, thus the difference in the demography. The disease shows coughing, fever, and tiredness as the primary symptoms. The virus causes airway inflammation, leading to a dry, persistent cough. Women are more susceptible to fever than males, while males indicate a high percentage of fever, cold, and tiredness in Saudi Arabia.

Nationality

The results show fewer female than male patients across all nations in Saudi Arabia. Saudi Arabia shows a high infectious rate compared with other countries. This effect is due to the country’s large population, dense urban areas, and cultural norms involving close physical contact between people. Other nationalities show minimum infections due to their small population size compared to the host nationality in the country. The illness among Saudi Arabians surpasses that of other nationals due to congestion in workplaces, schools, and other public facilities. Vaccinated individuals can contract the virus and experience mild or no symptoms [11]. This mass congregation encourages the spread of the virus among Saudi Arabians rather than among other nationals since they are in small population sizes and dispersed. The country has experienced several mass religious gatherings, increasing the risk of infection. The country has seen many coronavirus-related outbreaks in workplaces and other settings, contributing to the high infection rate.

Effectiveness of Strategies Used by Healthcare Systems

The strategies used by healthcare systems and professionals to control the COVID-19 disease have been largely effective in curbing the spread of the disease [12]. These strategies include heightened hygiene practices, social distancing, vaccine administration, and contact tracing. Hygiene practices such as frequent hand washing, wearing face masks, and avoiding touching one’s face have been critical to controlling the spread of the virus. Hygiene practices play an important role in controlling the spread of COVID-19, and they include frequent handwashing with soap and water, using hand sanitizer, avoiding touching eyes, nose, and mouth, covering nose and mouth when sneezing or coughing, cleaning and disinfecting surfaces, and avoiding close contact with the sick. Washing hands often and thoroughly helps remove virus particles from the skin while avoiding contact with infected people helps prevent virus particles from spreading through the air or on surfaces [13]. Also, cleaning and disinfecting surfaces help remove virus particles that may have been left behind.

Social distancing has been an effective tool in controlling the spread of COVID-19 disease. By reducing contact with people outside of our immediate family or household, we are limiting the potential for transmission of the virus [13]. Social distancing measures such as staying home, avoiding large gatherings, wearing face masks in public, and maintaining a distance from others when in public have all been effective in slowing the spread of the virus. Frequent and proper handwashing and disinfecting of frequently touched surfaces can help reduce the risk of infection. Social distancing effectively reduces the spread of COVID-19 and should continue to be practiced until the risk of transmission is reduced.

Healthcare professionals’ effectiveness of vaccine administration in controlling COVID-19 disease depends on several factors. Vaccines help the body recognize and fight off the virus if it is encountered, but it does not guarantee that a person will not get infected [11]. It is important to understand that vaccines are not 100% effective, and it is still possible to get infected with COVID-19 despite being vaccinated. Healthcare professionals play an important role in controlling the spread of the virus by vaccinating eligible individuals. Vaccinating many people reduces the virus’s spread and severity, especially among vulnerable populations. The practice also helps to create herd immunity. When a large proportion of the population is vaccinated, it is more difficult for the virus to spread and infect people. It is also important to note that vaccination should be accompanied by other preventive measures such as social distancing, wearing masks, and good hand hygiene. Vaccines are an important tool to help control the spread of COVID-19, but they are not guaranteed against infection. Vaccines are most effective when used in conjunction with other preventive measures.

Treatment of COVID-19 is supportive and involves providing oxygen, fluids, and other medications to relieve the symptoms. In some cases, healthcare providers offer antivirals to help reduce the severity of the illness.

The disease shows coughing, fever, and tiredness as the primary symptoms. The virus causes airway inflammation, leading to a dry, persistent cough. This type of cough is different than the common cold and flu, which usually produce a wet, productive cough. Fever is also prevalent since it is the body’s natural response to fighting an infection. When a virus such as COVID-19 enters the body, the immune system begins to produce antibodies to attack the virus [11]. This response triggers the body to release cytokines, which in turn cause inflammation and an increase in body temperature, resulting in a fever. COVID-19 is caused by a virus that affects the respiratory system. This effect causes inflammation and lung damage, leading to fatigue. Other symptoms of COVID-19, such as fever, can also contribute to fatigue as the body works harder to fight the infection.

Contact tracing by healthcare professionals has been an important tool in controlling the spread of COVID-19. By identifying people who may have had contact with someone who has tested positive for the virus, contact tracing helps to identify new cases and prevent further virus spread. When contact tracing is done effectively, it helps to quickly identify and isolate people who have had contact with an infected person, thus reducing the risk of further disease transmission [14]. It also allows healthcare professionals to provide medical care to those who may be infected quickly. The practice also allows healthcare professionals to provide important information to those exposed to the virus, such as self-isolation, and reduce their risk of transmitting the disease.