COVID-19 experience in Kuwait: A high prevalence of asymptomatic cases and increased mortality in smokers

Emerging information adds to our knowledge that may help in dealing with the current pandemic of coronavirus disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2). In EClinicalMedicine, Almazeedi and Colleagues [1] have reported a retrospective analysis with regards to the patient’s characteristics of more than thousand confirmed COVID-19 from a single large hospital of Kuwait, studied over a period of about 2 months. Authors have found that nearly half of patients were of Indian origin working as manual laborer in Kuwait, and one-fourth of them had a history of recent travel from the place where COVID-19 was highly prevalent at that point of time. This study also found nearly half of them were asymptomatic at the time of admission, majority had no signs of any infection on clinical examination, and all were diagnosed during the routine mass screening on behalf of Kuwaiti government. Most of COVID-19 patients were young (mean age 41 year) male, of which 22% were obese and only 30% had comorbidities, of which, hypertension and or diabetes contributed nearly one-third. At admission, 90% had normal white blood cell count including absolute lymphocyte count and two-third had a normal chest X-ray. Multivariable analysis found the risk factors that were significantly associated with an increased risk of severity requiring ICU admission were elevated procalcitonin, C-reactive protein, smoking and older age (>50 years). The risk factors that were significantly associated with an increased risk of death include smoking, elevated procalcitonin and asthma. Authors must be applauded for reporting the clinical characteristics of COVID-19 patients of a whole country of Kuwait in Middle-East, since all patients were admitted in this only single large COVID-19 hospital, as per governmental law. In addition, this study carries a special importance since one homogeneous protocol was applied for every patient with regards to diagnosis, treatment, prognosis and discharge.