Introduction Predominantly, studies on COVID-19 report quantitative data that often miss the social implications and other determinants of health. The objective of this study was to explore the experiences and perceptions of health care workers (HCWs) in primary health care in the management of COVID-19 with respect to medical response experiences, socio-cultural and religious reforms, psychological impressions, and lessons learned. Methods This was a qualitative study using an empirical phenomenological approach. Six focus group discussions were conducted across various stakeholders working frontline in the management of COVID-19 (managerial, public health/field/community and primary care health centers). They participated in semi-structured, in-depth group discussions from 11th to 20th May 2020. All discussions were audio-recorded, transcribed verbatim and analyzed using thematic analysis. Results Forty participants were involved in this study. Three themes emerged related to the medical response experiences, including the rapid re-structuring of the PHC services, use of technology and challenges of working on COVID-19. Perceptions on the socio-cultural and religious reforms included changes in social and religious norms, and anticipated gaps in accessing health care among the vulnerable groups (elderly, expatriates, and individuals with low economic status). Perceptions on psychological disturbances were themed as consequences of social distancing, management of dead bodies, exhaustion among the health care workers, and risk of exposure. Finally, lessons learned were centered around building on the existing epidemiological and public health capacities, improving access to health care and overcoming resistance to change. Most participants labelled their experience in COVID-19 as an “experience of wisdom” in which learning was a continuous process. Conclusion This qualitative study amongst primary HCWs revealed certain aspects of response to COVID-19 in Muscat, Oman. Results has unfolded various aspects of COVID-19. The situation was perceived by primary HCWs as a new experience that challenged the primary health care; enforced the utilization of public health/epidemiological skills, and linked to unfavorable socio-religious and psychological events.

Introduction There have been studies revealing hypocalcemia in severe covid-19 and low vitamin D levels that warranted further studies. Objective Our study investigates the correlation between calcium levels at presentation as a primary endpoint, and pre-existing calcium levels as a secondary endpoint, to severity of disease presentation and progression. Method Observational cohort study in adults admitted with COVID-19 from March till September 2020. Multiple clinical scales, laboratory parameters, were used to correlate corrected calcium and vitamin D associations with risk factors and outcomes. Results Around 445 patients were included in the study. Hypocalcemic patients had more abnormal laboratory parameters and longer hospitalization duration. Hypocalcemia was in 60-75% of all age groups (p-value 0.053), for which 77.97% were ICU admissions (p-value 0.001) and 67.02% were diabetic (p-value 0.347). There were non-significant correlations between Vitamin D and almost all the parameters except for chronic respiratory diseases with P value of 0.024. Conclusion It can be concluded that hypocalcemia is a significant and reliable marker of disease severity and progression regardless of underlying comorbidities. Meanwhile, Vitamin D levels fail to reflect correlation with severity of COVID-19 infections.

Background : Identifying immune cells involved in COVID-19 disease progression and predictors of poor outcomes is important to manage patients adequately. Methods : A prospective observational cohort study enrolled 53 mild non-hospitalized and 48 hospitalized confirmed COVID-19 patients to a tertiary hospital in Oman. Results : Hospitalized patients were older (58 years vs 36 years, p <0.001) and had more comorbid conditions like diabetes (65 % Vs 21% p <0.001). Hospitalized patients had significantly higher inflammatory markers ( p <0.001); C-reactive protein (CRP) (114 vs 4 mg/L), Interleukin-6 (IL-6) (33 vs 3.71pg/ml), lactate dehydrogenase (LDH) (417 vs 214 U/L), ferritin (760 vs 196 ng/mL), fibrinogen (6 vs 3 g/L), D-dimer (1.0 vs 0.3 mcg/mL), disseminated intravascular coagulopathy (DIC) score (2 vs 0) and neutrophil/lymphocyte ratio (4 vs 1.1), ( p <0.001). In multivariate regression analysis, statistically significant independent early predictors of ICU admission or death were higher levels of IL-6 (OR 1.03, p =0.03), frequency of large inflammatory monocytes (CD14+CD16+) (OR 1.117, p =0.010) and frequency of circulating naïve CD4+ T cells (CD27+CD28+CD45RA+CCR7+) (OR 0.476, p =0.03). Conclusion : IL-6, frequency of large inflammatory monocytes, and circulating naïve CD4 T cells can be used as independent immunological predictors of poor outcomes in COVID-19 patients to prioritize critical care and resources.

Background: In December 2018, routine surveillance identified an autochthonous outbreak of dengue fever in Muscat Governorate, Oman, a region previously free of dengue fever. Methods: Routine surveillance confirmed locally acquired cases in the second week of December, leading to a rapid public health response including case management guidance and epidemiological investigations. The main activity was the vector survey using systematic sampling to assess extent of previously unreported Aedes aegypti presence followed by a campaign aimed to eliminate breeding sites of A. aegypti". Results: During a 5-month period, 343 suspected cases were reported from Muscat Governorate with 122 from the outbreak affected area. Out of 207 probable cases eligible for laboratory testing as per guidelines issued, 59 cases were confirmed. The vector elimination campaign started on January 8, 2019 after a media advocacy using television and social media and concluded on January 23. By the end of campaign, the case load had decreased significantly in the affected area with no reports of locally acquired cases from adjoining areas of Muscat Governorate, indicating no further spread. Conclusions: Rapid notification and early community-wide, extensive vector control activities effectively contained the autochthonous dengue fever virus outbreak.

Objectives: As coronavirus disease (COVID-19) was pervading different parts of the world, little has been published regarding responses undertaken within primary health care (PHC) facilities in Arabian Gulf countries. This paper describes such responses from January to mid-April 2020 in PHC, including public health measures in Muscat, Oman. Methods: This is a descriptive study showing the trends of the confirmed positive cases of COVID-19 and the undertaken responses to the evolving epidemiological scenario. These responses were described utilizing the World Health Organizations’ building blocks for health care systems: Leadership and governance, Health workforce, Service delivery, Medical products and technologies, and health information management. Results: In mid-April 2020, cases of COVID-19 increased to 685 (particularly among non-nationals). As the cases were surging, the PHC responded by executing all guidelines and policies from the national medical and public health response committees and integrating innovative approaches. These included adapting comprehensive and multi-sectoral strategies, partnering with private establishments, and strengthening technology use (in tracking, testing, managing the cases, and data management). Conclusions: Facilities in the Muscat governorate, with the support from national teams, seemed to continuously scale-up their preparedness and responses to meet the epidemiological expectations in the management of COVID-19.