EC Pulmonology and Respiratory Medicine

Background: COVID-19, caused by the SARS-CoV-2 virus, is a highly contagious disease that has spread globally since its outbreak in Wuhan, China in late 2019.The pandemic has resulted in millions of confirmed cases and deaths, as well as significant economic and social impacts. The main objective was to assess the clinical characteristics of COVID-19 patients during the peak of COVID-19 pandemic in Gaza Strip.

Methods: This study was a descriptive prospective design. This study was conducted at a main center for COVID-19 inpatients, Turkish-Palestinian Friendship Hospital. The study was conducted during September 2020 to February 2021. Population of this study were COVID-19 patients admitted to Turkish-Palestinian Friendship Hospital. Participants who were intubated or admitted to intensive care unit (ICU) and patients who died during the follow up were excluded from the study.

Results: Among 1235 patients, there were 766 males (62%) and 469 females (38%). The mean age among study participants was 37 ± 14 years and ranged from 16 to 57 years. The prevalence of obesity among study participants was 38.5%. The most frequent symptoms were loss of taste (n = 1148, 92.9%) and loss of smell (n = 1037, 83.9%). Respiratory symptoms included shortness of breath among 283 participants (22.9%) and cough among 783 participants (63.4%). Female gender (OR = 1.35, 95%CI: 0.17 - 2.46, P = 0.035), older age group (OR = 2.67, 95%CI: 1.15 - 2.52, P = 0.010), participants with one comorbid condition (OR = 3.43, 95%CI: 1.8 - 4, P = 0.003) and participants with more than one comorbid conditions (OR = 5.61, 95%CI: 2.41 - 15.17, P < 0.001) all were risk factors for more severe and longer duration of symptoms.

Conclusion: Hospitalized COVID-19 individuals were studied. One third of individuals smoked and had comorbidities such diabetes, hypertension, heart disease, lung illness, and others. Taste and smell loss were the most prevalent COVID-19 symptoms reported by all individuals. Some symptoms developed within days after diagnosis, whereas others came later in the illness and lasted longer. Female gender, older age, and comorbidities increased the intensity and duration of symptoms.

 Keywords: COVID-19; Clinical; Signs; Symptoms; Gaza Strip

1. Huang CL., et al. “Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China”. Lancet 10223 (2020): 497-506.
2. Li Q., et al. “Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia”. New England Journal of Medicine13 (2020): 1199-1207.
3. Liu YX., et al. “Clinical and biochemical indexes from 2019-nCoV infected patients linked to viral loads and lung injury”. Science China Life Sciences 3 (2020): 364-374.
4. Zhu N., et al. “A novel coronavirus from patients with pneumonia in China, 2019”. New England Journal of Medicine 8 (2020): 727-733.
5. Niu PH., et al. “A novel human mAb (MERS-GD27) provides prophylactic and postexposure efficacy in MERS-CoV susceptible mice”. Science China Life Sciences 10 (2018): 1280-1282.
6. Yousif MY., et al. “Clinical characteristics and risk factors associated with severe disease progression among covid‐19 patients in Wad Medani isolation centers: a multicenter retrospective cross‐sectional study”. Health Science Reports2 (2022): e523.
7. COVID-19 Reports. “World Health Organization in Occupied Palestinian Territories” (2023).
8. Coronavirus Population. Worldometer (2023).
9. Corman VM., et al. “Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR”. Eurosurveillance 3 (2020): 2000045.
10. Li XG., et al. “Potential of large ‘first generation’ human-to-human transmission of 2019-nCoV”. Journal of Medical Virology 4 (2020): 448-454.
11. Joseph TW., et al. “Nowcasting and forecasting the potential domestic and international spread of the 2019-nCoV outbreak originating in Wuhan, China: a modelling study”. Lancet 10225 (2020): 689-697.
12. Onder G., et al. “Case-fatality rate and characteristics of patients dying in relation to COVID-19 in Italy”. Journal of the American Medical Association 18 (2020): 1775-1776.
13. Fisher D and Heymann D. “Q& A: the novel coronavirus outbreak causing COVID-19”. BMC Medicine 1 (2020): 57.
14. Rossella P., et al. “Similarity in case fatality rates (CFR) of COVID-19/SARS-COV-2 in Italy and China”. Journal of Infection in Developing Countries 2 (2020): 125-128.
15. Feng Y., et al. “COVID-19 with different severities: a multicenter study of clinical features”. American Journal of Respiratory and Critical Care Medicine 11 (2020): 1380-1388.
16. Liu K., et al. “Clinical features of COVID-19 in elderly patients: a comparison with young and middle-aged patients”. Journal of Infection6 (2020): e14-e18.
17. Wei M., et al. “Novel coronavirus infection in hospitalized infants under 1 year of age in China”. Journal of the American Medical Association13 (2020): 1313-1314.
18. Dong Y., et al. “Epidemiology of COVID-19 among children in China”. Pediatrics6 (2020): e20200702.
19. Alsofayan YM., et al. “Clinical characteristics of COVID-19 in Saudi Arabia: a national retrospective study”. Journal of Infection and Public Health 7 (2020): 920-925.
20. Khamis F., et al. “Clinical characteristics and outcomes of the first 63 adult patients hospitalized with COVID-19: an experience from Oman”. Journal of Infection and Public Health 7 (2020): 906-913.
21. Zheng Z., et al. “Risk factors of critical & mortal COVID-19 cases: a systematic literature review and meta-analysis”. Journal of Infection 2 (2020): e16-e25.
22. Zhou F., et al. “Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study”. Lancet (Lond, England)10229 (2020): 1054-1062.
23. Aggarwal S., et al. “Clinical features, laboratory characteristics, and outcomes of patients hospitalized with coronavirus disease 2019 (COVID-19): early report from the United States”. Diagnosis (Berlin, Germany) 2 (2020): 91-96.
24. Docherty AB., et al. “Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study”. British Medical Journal 369 (2020): m1985.
25. Channappanavar R., et al. “Sex-based differences in susceptibility to severe acute respiratory syndrome coronavirus infection”. Journal of Immunology 10 (2017): 4046-4053.
26. Jaillon S., et al. “Sexual dimorphism in innate immunity”. Clinical Reviews in Allergy and Immunology 3 (2019): 308-321.
27. Huang C., et al. “Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China”. Lancet10223 (2020): 497-506.
28. Zhou J., et al. “Human intestinal tract serves as an alternative infection route for Middle East respiratory syndrome coronavirus”. Science Advances 11 (2017): eaao4966-eaao.
29. Chan JFW., et al. “Middle East respiratory syndrome coronavirus: another zoonotic betacoronavirus causing SARS-like disease”. Clinical Microbiology Reviews 2 (2015): 465-522.
30. Tang A., et al. “Detection of novel coronavirus by RT-PCR in stool specimen from asymptomatic child, China”. Emerging Infectious Diseases 6 (2020): 1337-1339.
31. Zhang H., et al. “Digestive system is a potential route of COVID-19: an analysis of single-cell coexpression pattern of key proteins in viral entry process”. Gut6 (2020): 1010-1018.
32. Han C., et al. “Digestive symptoms in COVID-19 patients with mild disease severity: clinical presentation, stool viral RNA testing, and outcomes digestive symptoms in COVID-19 patients with mild disease severity: clinical presentation, stool viral RNA testing, and outcomes”. American Journal of Gastroenterology 6 (2020): 916-923.
33. Emami A., et al. “Prevalence of underlying diseases in hospitalized patients with COVID-19: a systematic review and meta-analysis”. Archives of Academic Emergency Medicine 1 (2020): e35.
34. Sanita EISd. Epidemiology for public health (2023).
35. Wang X. “Firth logistic regression for rare variant association tests”. Frontiers in Genetics 5 (2014): 187.
36. News A. 70% of Saudis are obese, says study 2014 (2023).
37. Kass DA., et al. “Obesity could shift severe COVID-19 disease to younger ages”. Lancet10236 (2020): 1544-1545.
38. Unterborn J. “Pulmonary function testing in obesity, pregnancy, and extremes of body habitus”. Clinics in Chest Medicine4 (2001): 759-767.
39. Honce R and Schultz-Cherry S. “Impact of obesity on influenza a virus pathogenesis, immune response, and evolution”. Frontiers in Immunology 10 (2019): 1071.