COVID-19 inpatient treatments and outcomes during the conflict in Syria: an observational cohort study

Antoun, Ibrahim; Aboud, Y; Alkhayer, H; Kotb, Ahmed; Alkhayer, A; Barker, Joseph; Somani, Riyaz; Ng, G. André

doi:10.1016/j.ijregi.2022.12.009

Cited by 4 publications

(6 citation statements)

References 10 publications

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“…These results agree with the mathematically simulated findings of Watson and colleagues who estimated that about 99% of COVID-19 deaths were not reported 34. This selectivity in the hospitalisation criteria restricted the possibility of comparing our findings with studies worldwide46 53 67 68 (e.g., 5% of hospitalised patients in a Chinese study needed ICU admission in comparison with 44% in ours69). Nevertheless, similar findings were reported from the northeast and northwest regions of Syria40 52 as well as Latakia,53 proving that the circumstances of the pandemic in the whole country were still poorer than neighbouring countries70 71 including Lebanon, which also suffers from grave economic and political instability 4 72 73…”

Section: Discussionsupporting

confidence: 90%

“…This might be the reason why about half of the variability in the extreme mortality rate we found67 68 could be predicted using only few demographic characteristics and vital signs upon presentation. Overall, this suggests that there is significant room for supporting the incapacitated Syrian healthcare system with human and physical assistance after modulating its organisation to face the burden of current and future challenges, like the recent earthquake 3 53 57 79 80…”

Section: Discussionmentioning

confidence: 99%

“…46 The worrisome hospitalisation capacity available for the Syrian population amplified the international panic about the progress of the pandemic in Syria, 33 47-50 especially with the undersupply and hesitancy in the Syrian population regarding vaccination later on. 51 52 Few original articles were published about COVID-19 in Syria and they either present mathematical simulations of the situation due to limited access to data, 34 40 had too small of a sample size 53 or focused on studying mortality risk factors for just PCR-positive cases. 54 55 Therefore, further works are needed to unveil the gravity of the COVID-19 challenge in Syria and to draw out the lessons that can be learnt.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

“…Few original articles were published about COVID-19 in Syria and they either present mathematical simulations of the situation due to limited access to data,34 40 had too small of a sample size53 or focused on studying mortality risk factors for just PCR-positive cases 54 55. Therefore, further works are needed to unveil the gravity of the COVID-19 challenge in Syria and to draw out the lessons that can be learnt 56.…”

Section: Introductionmentioning

confidence: 99%

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Lessons learnt from the first wave of COVID-19 in Damascus, Syria: a multicentre retrospective cohort study

Hanafi,

Alzamel,

Alnabelsi

et al. 2023

BMJ Open

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ObjectivesThe decade-long Syrian war led to fragile health infrastructures lacking in personal and physical resources. The public health of the Syrian population was, therefore, vulnerable to the COVID-19 pandemic, which devastated even well-resourced healthcare systems. Nevertheless, the officially reported incidence and fatality rates were significantly lower than the forecasted numbers.DesignA retrospective cohort study.SettingThe four main responding hospitals in Damascus, which received most of the cases during the first pandemic wave in Syria (i.e., June–August 2020).ParticipantsOne thousand one hundred eighty-four patients who were managed as inpatient COVID-19 cases.Primary and secondary outcome measuresThe records of hospitalised patients were screened for clinical history, vital signs, diagnosis modality, major interventions and status at discharge.ResultsThe diagnostic and therapeutic preparedness for COVID-19 was significantly heterogeneous among the different centres and depleted rapidly after the arrival of the first wave. Only 32% of the patients were diagnosed based on positive reverse transcription-PCR tests. Five hundred twenty-six patients had an indication for intensive care unit admission, but only 82% of them received it. Two hundred fifty-seven patients needed mechanical ventilation, but ventilators were not available to 14% of them, all of whom died. Overall mortality during hospitalisation reached 46% and no significant difference was found in fatality between those who received and did not receive these care options.ConclusionsThe Syrian healthcare system expressed minor resilience in facing the COVID-19 pandemic, as its assets vanished swiftly with a limited number of cases. This forced physicians to reserve resources (e.g., ventilators) for the most severe cases, which led to poor outcomes of in-hospital management and limited the admission capacity for milder cases. The overwhelmed system additionally suffered from constrained coordination, suboptimal allocation of the accessible resources and a severe inability to informatively report on the catastrophic pandemic course in Syria.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Lessons learnt from the first wave of COVID-19 in Damascus, Syria: a multicentre retrospective cohort study

Hanafi,

Alzamel,

Alnabelsi

et al. 2023

BMJ Open

View full text Add to dashboard Cite

show abstract

“…For highincome countries, a study of COVID-19 patients in England, revealed a hospital mortality rate of 25% [25]. However, a different study conducted in Syria found that the fatality rate in Lattakia -Syria, was also great, at 48% [26]. The effect of the crisis on the healthcare system, as well as a lack of human resources, medications, and vaccination (8.9% in our study), are potential reasons for the high mortality rate in Syrian healthcare institutions.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of some laboratory parameters and their diagnostic and prognostic role in COVID-19 patients admitted to Syrian hospitals

Akkari,

AL-Kayali,

Ibrahim

2023

Zagazig Journal of Pharmaceutical Sciences

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A serious threat to global health is posed by COVID-19, particularly to the health system in Syria, which has been decimated by the protracted war. COVID-19 in Syria has resulted in a significant number of cases that need hospitalization and intensive monitoring. COVID-19 causes a multisystem failure of many organs, mainly, heart disease. Therefore, our study aims to evaluate the role of inflammatory laboratory parameters and cardiac enzymes of COVID-19 patients at several phases of follow-up in order to evaluate their importance in deciding whether patients will be remained to the hospital or discharged. The study included the measurement Ferritin, CRP, CK-MB and AST levels in 45 COVID-19 patients in two hospitals in Syria and 30 volunteers as a control group. This study found that odds ratio (OR) for CRP was the highest among the studied indicators. Ferritin levels were different between the surviving and deceased patients in the admission sample, and there was a significant difference between ferritin and CRP at the admission and discharge samples for the patients who were still alive. Interestingly, 42.2% of patients had elevated CK-MB and AST levels that were higher than normal values. The most crucial criterion for the diagnosis of COVID-19 infection was CRP, while ferritin was the most significant signal for the prognosis of death.

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Thirty-day unplanned readmissions following hospitalization for atrial fibrillation in a tertiary Syrian center: A real-world observational cohort study

Antoun,

Alkhayer,

Aljabal

et al. 2024

Heart Rhythm O2

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COVID-19 inpatient treatments and outcomes during the conflict in Syria: an observational cohort study

Cited by 4 publications

References 10 publications

Lessons learnt from the first wave of COVID-19 in Damascus, Syria: a multicentre retrospective cohort study

Lessons learnt from the first wave of COVID-19 in Damascus, Syria: a multicentre retrospective cohort study

Evaluation of some laboratory parameters and their diagnostic and prognostic role in COVID-19 patients admitted to Syrian hospitals

Thirty-day unplanned readmissions following hospitalization for atrial fibrillation in a tertiary Syrian center: A real-world observational cohort study

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