Natural history and clinical course of symptomatic and asymptomatic COVID-19 patients in the Kingdom of Saudi Arabia

Objectives: To analyze symptomatic and asymptomatic COVID-19 patients in Saudi Arabia in terms of initial presentation, risk factors, laboratory findings, clinical outcomes and healthcare utilization Methods: All laboratory-confirmed reverse transcription-polymerase chain reaction positive COVID-19 patients who had been tested at three governmental hospitals in Saudi Arabia (two in Riyadh and one in Makkah) between March 8 and May 18, 2020 were included Demographics, COVID-19 variables, clinical characteristics and healthcare utilization variables were extracted and combined, and a descriptive analysis was conducted Symptomatic and asymptomatic (on presentation) patients' data were compared Results: Eighty percent of the patients were males (81 4% of symptomatic and 73 2% of asymptomatic patients, P = 0 02) Moreover, 47 6% and 38 4% of symptomatic and asymptomatic patients were aged 40-64 years, respectively Fever, cough and breathing difficulties were frequent presenting symptoms Overall, diabetes (16 4%), hypertension (11 7%), chronic respiratory disease (7 1%) were the most frequent comorbidities, with no differences between the two groups Symptomatic patients had higher C-reactive protein levels (3 55 vs 0 30 mg/L;P < 0 0001) and lower total lymphocytes (1 41 vs 1 70;P = 0 02) ICU admission and mortality were 12 1% and 4 1% in symptomatic, compared to 6 0% and 2 9% in asymptomatic patients, respectively Conclusion: In the studied COVID-19 cohort, symptomatic patients tended to be older, had higher C-reactive protein and more lymphopenia with worse outcome than asymptomatic patients This granular analysis of COVID-19 cohorts enables identification of at-risk cohorts in future waves, optimizing development of patient pathways and public health interventions