17 Days in Warsan, Dubai, UAE, for COVID-19

Dear Editor, As the head of the Cardiology Department at Dubai Hospital I was asked to nominate a cardiologist and electrocardiogram technician to attend Warsan COVID-19 isolation and quarantine center (WHCC). The major task of these technicians are reading electrocardiograms for patients taking hydroxychloroquine. On April 11, 2020, a Sunday morning, I took the drive from RAK city to Warsan (20 km away from Dubai). On the road, I received an email from the Head Quarter that I would be the Medical Director of WHCC. I stayed in Warsan from April 11 to April 28, 2020, and I would like to share my short experience at the isolation center with my colleagues taking care of COVID-19 cases. In Lombardy, among 1,958 patients, common comorbidities included hypertension (49% of the patients), cardiovascular disease (21%), and hypercholesterolemia (18%), and the mortality was lower in younger versus older patients [1]. The criteria for admitting patients at WHCC were male, age < 55 years, no chronic illnesses such as diabetes mellitus, hypertension, chronic kidney disease, and cardiac diseases. In spite of these criteria, we had 1–2 hospital shifts per day to a hospital facility for the deterioration of patients’ clinical status. I noticed that patients with hypertension and diabetes mellitus (types 1 and 2) developed symptoms of shortness of breath and oxygen desaturations. Surprisingly, upon chest auscultation, the lungs were clear, whereas peripheral pulse oximeter showed O2 saturation 85–90%. Such patients responded well to low-flow oxygen 2–4 L/min initially, and their saturation improved over 3–4 h. Out of the 12 cases I had during this period, 8 cases (75%) needed to be transferred to a hospital facility. There was also a significant incidence of gastrointestinal tract symptoms such as diarrhea and vomiting in a high number of patients, but most of them did not require hospital transfer, and their symptoms could have had food-related causes. Do these observations lead to the conclusion that downstream low-flow oxygen is effective in COVID cases with comorbid medical conditions, and does arterial blood gas analysis in these patients give us a clue about their oxygenation status, and further treatment with low-flow oxygen would be of help? Most of the young patients aged < 40 years without medical comorbidities had nil respiratory symptoms of any kind. They had a silent COVID-19 course. They spent the whole 14-day isolation period without a single com-