Vaporized nicotine in utero results in reduced birthweight, increased locomotion, and decreased voluntary exercise, dependent on sex and diet in offspring.

Rationale Clinical research has shown that prenatal exposure to nicotine may result in increased obesity risk later in life. Preclinical research has corroborated this finding, but few studies have investigated inhaled nicotine or the interaction with diet on obesity risk. Objective The aim of this study was to investigate the effects of prenatal nicotine exposure on both direct and indirect obesity measures, with both sex and diet as factors. Methods Pregnant rats were exposed to either vehicle or nicotine vapor (24 mg/mL or 59 mg/mL) throughout the entire gestational period. Offspring from each treatment group were given either a normal diet or a high fat diet starting at postnatal day 22. Caloric intake, body weight, spontaneous locomotion, sleep/wake activity, and voluntary exercise were measured throughout adolescence. Pregnancy weight gain and pup birthweights were collected to further measure developmental effects of prenatal nicotine exposure. Results Both maternal weight gain during pregnancy and pup weight at birth were decreased with prenatal nicotine exposure. Early adolescent males showed increased spontaneous activity in the open field following prenatal nicotine exposure compared to vehicle counterparts, particularly those given high-fat diet. Additionally, high dose nicotine prenatal treated males ran significantly less distance on the running wheel in late adolescence compared to vehicle counterparts, in the normal diet group only. Conclusion The results presented here show decreased birthweight, hyperactivity, and decreased voluntary exercise in adolescence following prenatal nicotine exposure in dose, sex, and diet dependent manners, which could lead to increased obesity risk in adulthood.

Efficacy of povidone-iodine nasal rinse and mouth wash in COVID-19 management: a prospective, randomized pilot clinical trial (povidone-iodine in COVID-19 management).

OBJECTIVES/HYPOTHESIS: To assess the efficacy of 0.23% povidone-iodine (PVP-I) nasal rinses and mouth washes on detectability of the coronavirus disease 2019 (COVID-19) virus and cycle threshold (Ct) values in nasopharyngeal swabs. STUDY DESIGN: This was an open-label, prospective, randomized, placebo-controlled clinical trial. SETTING: The study was conducted in King Saud University Medical City, Riyadh, Saudi Arabia, from August 2021 to July 2022. METHODS: Participants diagnosed with SARS-CoV-2 were randomly assigned to one of three groups, with participants receiving either 0.23% PVP-I, 0.9% normal saline (NS) nasal rinses and mouth washes, or no intervention (control group). Nasopharyngeal swabs were taken 4, 8, 12, and 18 days after the first swab to measure the detectability of the virus and the Ct. RESULTS: A total of 19 participants were involved in this study. The mean viral survival was 9.8, 12, and 12.6 days for the PVP-I, NS, and control groups, respectively, with a statistically significant difference (p = 0.046). The Ct mean values were 23 ± 3.4, 23.5 ± 6.3, and 26.3 ± 5.9 at the time of recruitment and 25.2 ± 3.5, 15 ± 11.7, and 26.9 ± 6.4 after 4 days for the PVP-I, NS, and control groups, respectively. CONCLUSIONS: When used continuously at a concentration of 0.23%, PVP-I showed promising results in terms of decreasing the pandemic burden by reducing the period of infectiousness and viral load. However, the use of PVP-I did not result in significantly different changes in the quality-of-life parameters in recently vaccinated and mild COVID-19 patients.

Strengthening global health security through health early warning systems: A literature review and case study.

Disease transmission is dependent on a variety of factors, including the characteristics of an event, such as crowding and shared accommodations, the potential of participants having prolonged exposure and close contact with infectious individuals, the type of activities, and the characteristics of the participants, such as their age and immunity to infectious agents [1-3]. Effective control of outbreaks of infectious diseases requires rapid diagnosis and intervention in high-risk settings. As a result, syndromic and event-based surveillance may be used to enhance the responsiveness of the surveillance system [1]. In public health, surveillance is collecting, analyzing, and interpreting data across time to inform decision-making and aid policy implementation [1]. In this review article we aimed to provide an overview of the principles, types, uses, advantages, and limitations of surveillance systems and to highlight the importance of early warning systems in response to the information received by disease surveillance. The study conducted a comprehensive literature search using several databases, selecting, and reviewing 78 articles that covered different types of surveillance systems, their applications, and their impact on controlling infectious diseases. The article also presents a case study from the Hajj gathering, which highlighted the development, evaluation, and impact of early warning systems on response to the information received by disease surveillance. The study concludes that ongoing disease surveillance should be accompanied by well-designed early warning and response systems, and continuous efforts should be invested in evaluating and validating these systems to minimize the risk of reporting delays and reducing the risk of outbreaks.

Vaporized Δ9-THC in utero results in reduced birthweight, increased locomotion, and altered wake-cycle activity dependent on dose, sex, and diet in the offspring.

AIMS: Preclinical studies have found that chronic ∆9-tetrahydrocannabinol (THC) treatment is directly associated with weight gain when introduced during adolescence and adulthood, but the effect of prenatal THC is unclear. Clinical studies have demonstrated prenatal exposure to THC is a prospective predictor of increased health risks associated with obesity. Our study aims to examine prenatal THC impact on obesity risks in males and females throughout adolescence using a clinically relevant inhalation model. METHODS: Pregnant rats were exposed to one of the following from gestational day 2 through birth: 10 mg THC, 40 mg THC, or air. Daily 10-min inhalations were conducted in each animal from 0900 to 1200. Offspring from each treatment group were given either a high-fat diet (HFD) or a normal diet (ND). Food and bodyweights were collected daily, while circadian activity, locomotion, and exercise were measured periodically (PND 21-60). Pregnancy weight gain and birth weight were collected to determine early-life developmental effects. RESULTS: Rats prenatally treated with low-dose THC (LDTHC) generally had lower dark-cycle activity compared with control counterparts, but this altered activity was not observed at the higher dose of THC (HDTHC). In terms of open-field activity, THC doses displayed a general increase in locomotion. In addition, the LDTHC male rats in the ND showed significantly greater exploratory behavior. Prenatal THC had dose-dependent effects on maternal weight gain and birth weight. CONCLUSIONS: Overall, our findings indicate there are some activity-related and developmental effects of prenatal THC, which may be related to obesity risks later in life.

Healthcare policies, precautionary measures and outcomes of mass gathering events in the era of COVID-19 pandemic: Expedited review.

With the onset of the COVID-19 pandemic in early 2020, several countries suspended or restricted mass gathering (MG) events to mitigate the risk of superspreading events. Prohibiting MGs aimed to lessen the likelihood of highly infectious persons coming into close contact with many others. Now that the world has opened its doors wide and removed most of precautionary measures, many questions arise. In this review, we aimed to summarize the current evidence regarding the policies and regulations that were implemented for the safe return of MG events. Besides, we highlighted the impact of the return of MG events during 2021 on the trajectory of COVID-19 spread. Canceling MG events can carry religious, societal, economic, and public negative consequences necessitating the safe return of these events. The experience with the COVID-19 pandemic was the foundation for the recommendations for the safe conduction of MG events during the pandemic by international public health bodies. When policymakers adequately applied precautionary measures and strategic approaches, we witnessed the safe holding of huge MG events without aggravating the COVID-19 situation or increasing the number of new cases beyond the capacity and readiness of the national healthcare system.

Application of Automated External Defibrillators Among the Public: A Cross-Sectional Study of Knowledge, Attitude, Practice, and Barriers of Use in Saudi Arabia.

Background: The likelihood of survival of an out-of-hospital cardiac arrest quadruples with the rapid application of basic life support (BLS). The public's ability to perform cardiopulmonary resuscitation (CPR) and use automated external defibrillators (AEDs) is extremely important. This study aimed to assess the public knowledge, attitudes, and practices (KAP) of utilizing AEDs and to understand barriers to AED application. Methods: We conducted a cross-sectional study from March 1-30, 2022. An electronic questionnaire was constructed and validated to measure the KAP for public AED utilization and its barriers. Results: Of the 406 participants, 244 (60.10%) were males. Male respondents had 17% less knowledge and poorer attitude towards using an AED as compared to female respondents. Knowledge and attitudes on using AEDs were low (70.7%) among Saudi nationals compared to those of foreign nationals. Those who were BLS/CPR trained had a 2.5 times greater understanding and willingness to use AEDs in public than those who were not. Barriers to AEDs in CPR/BLS-trained participants were: (1) accidentally hurting the victim (14.3%), (2) duty as a bystander to just call the ambulance and wait for help (12.1%), (3) never taught what to do (n = 41, 18.4%), (4) did not want to be scolded if performed wrong (3.1%), and (5) never witnessed such a situation (51.6%). Conclusion: There is a strong association between knowledge of and willingness to use AEDs in emergency situations among the public. Misconceptions about AEDs hinder their use. This calls for urgent training programs through accessible technology to reach the public.

The Prevalence and Utilization of Prehospital IV Access in Critically Ill Patients in the Emergency Department.

BACKGROUND: Despite the pivotality of emergency medical services (EMS) in prehospital care for patient stabilization, prehospital intravenous (IV) access, a standard practice, remains an ambiguity in Saudi Arabia in terms of its prevalence of placement, justification, and utilization. OBJECTIVES: In this study, we aim to estimate the prevalence and utilization rate of prehospital IV access placement in patients transported to King Khalid University Hospital (KKUH) Emergency Medicine Department in Riyadh by EMS and determine the relationship between the prevalence and utilization rate of prehospital IV access in Canadian Triage and Acuity Scale (CTAS) levels 1 and 2 in trauma and non-trauma patients. METHODS: This observational cross-sectional study was conducted over six months. A total of 181 cases of CTAS levels 1 and 2 adult patients were included. Data were collected by trained nurses using convenient sampling through an author-developed questionnaire. RESULTS:  The prevalence of prehospital IV line placement was 28.7%, with a utilization rate of 50%, and was notably higher among CTAS level 1 cases (69.2%). Additionally, trauma cases had a higher prevalence of prehospital IV access (53.5%) compared to medical cases (odds ratio (OR): 4.73, 95% confidence interval (CI): 4.73, 4.73, p<0.05). Among patients with prehospital IV lines, the majority (92.3%) were patent and functional. Upon arrival, 73.1% of patients had their prehospital IV line replaced, with hospital protocol being the most common reason for the replacement (73.7%). CONCLUSION: A minority of the patients had prehospital vascular access, and of those, half remained unused. Trauma cases and CTAS level 1 patients had a higher prevalence and utilization of prehospital IV access. Furthermore, trauma cases were more associated with prehospital IV access establishment and utilization.

Determination of critical-sized defect of mandible in a rabbit model: Micro-computed tomography, and histological evaluation.

Objective: To evaluate a rabbit model of mandibular box-shaped defects created through an intraoral approach and determine the minimum size defect that would not spontaneously heal during the rabbit's natural life (or critical-sized defect, CSD). Methods: Forty-five 6-month-old rabbits were randomly divided into five defect size groups (nine each). Mandibular box-shaped defects of different sizes (4, 5, 6, 8, and 10 mm) were created in each hemimandible, with the same width and depth (3 and 2 mm, respectively). Four, 8, and 12 weeks post-surgery, three animals per group were euthanized. New bone formation was assessed using micro-computed tomography (MCT) and histomorphometric analyses. Results: Box-shaped defects were successfully created in the buccal region between the incisor area and the anterior part of the mental foramen in rabbit mandibles. Twelve weeks post-surgery, MCT analysis showed that the defects in the 4, 5, and 6 mm groups were filled with new bone, while those in the 8 and 10 mm groups remained underfilled. Quantitative analysis revealed that the bone mass recovery percentage in the 8 and 10 mm groups was significantly lower than that in the other groups (p < 0.05). There was no significant difference in the bone mass recovery percentage between the 8 and 10 mm groups (p > 0.05). Histomorphometric analysis indicated that the area of new bone formation in the 8 and 10 mm groups was significantly lower than that in the remaining groups (p < 0.05). There was no significant difference in the new bone area between the 8 and 10 mm groups (p > 0.05). Conclusions: The dimensions of box-shaped CSD created in the rabbit mandible through an intraoral approach were 8 mm × 3 mm × 2 mm. This model may provide a clinically relevant base for future tissue engineering efforts in the mandible.

Alternative patterns of deep brain stimulation in neurologic and neuropsychiatric disorders.

Deep brain stimulation (DBS) is a widely used clinical therapy that modulates neuronal firing in subcortical structures, eliciting downstream network effects. Its effectiveness is determined by electrode geometry and location as well as adjustable stimulation parameters including pulse width, interstimulus interval, frequency, and amplitude. These parameters are often determined empirically during clinical or intraoperative programming and can be altered to an almost unlimited number of combinations. Conventional high-frequency stimulation uses a continuous high-frequency square-wave pulse (typically 130-160 Hz), but other stimulation patterns may prove efficacious, such as continuous or bursting theta-frequencies, variable frequencies, and coordinated reset stimulation. Here we summarize the current landscape and potential clinical applications for novel stimulation patterns.

Chemical, Biological, Radiological, and Nuclear Preparedness of Public Hospitals in Riyadh.

OBJECTIVES: Chemical, biological, radiological, and nuclear (CBRN) incidents are those that involve chemical or biological warfare agents or toxic radiological or nuclear materials. These agents can cause disasters intentionally or accidentally. Hospitals play a crucial role in handling CBRN disasters. This study aimed to assess the CBRN preparedness of government hospitals in Riyadh. METHODS: A descriptive cross-sectional study was conducted across government hospitals in Riyadh. All government hospitals with more than 100 inpatient beds and an emergency department met the inclusion criteria. Hospital preparedness was assessed using an adaptation of the CBRNE (chemical, biological, radiological, nuclear, or explosive event) Plan Checklist. This adaptation was chosen due to the inclusion of explosive events in hospital disaster readiness, and its structural composition of key clinical guidelines necessary for a comprehensive disaster and readiness plan. Results were described in frequencies across several domains such as foundational considerations and planning which are used to assess plan preparedness using readiness tools, training, and awareness among staff members in accordance to a pre-established emergency plan, placed procedures and their implementation, and modules for preparing for a biological incident, a chemical incident, and a radiological or nuclear incident. RESULTS: Of the 11 eligible hospitals, 10 participated in the study. Furthermore, CBRN considerations were included in the disaster plans of 7 hospitals. Drills had been conducted in collaboration with local agencies in only 2 hospitals. The staff had been trained to recognize the signs and symptoms of exposure to class (A) biological agents in less than half of the hospitals. Eight of the hospitals had antidotes and prophylactics to manage chemical incidents, but only half of them had radiation detection instruments. Personal protective equipment was available in all hospitals, but rapid access to stockpiles of medications was available in only half of them. CONCLUSIONS: Government hospitals in Riyadh demonstrated insufficient CBRN preparedness as per the CBRNE Plan Checklist. Overall, there was a lack of preemptive planning, application of pre-established policies and procedures, and adequate staff training. Furthermore, several hospitals had insufficient stockpiles of medications and in concrete plans on accessing government stockpiles in the case of an emergency. Therefore, their staffs should be trained to manage CBRN emergencies, and local drills should be conducted to improve their preparedness.

Public Health Challenges in Saudi Arabia during the COVID-19 Pandemic: A Literature Review.

Similar to most countries, Saudi Arabia faced several challenges during the novel coronavirus disease 2019 (COVID-19) pandemic, some of which were related to the religious position of the country. The main challenges included deficits in knowledge, attitudes, and practices toward COVID-19, the negative psychological impacts of the pandemic on the general population and healthcare workers, vaccine hesitancy, the management of religious mass gatherings (e.g., Hajj and Umrah), and the imposition of travel regulations. In this article, we discuss these challenges based on evidence from studies involving Saudi Arabian populations. We outline the measures through which the Saudi authorities managed to minimize the negative impacts of these challenges in the context of international health regulations and recommendations.

Human tolerance to extreme heat: evidence from a desert climate population.

BACKGROUND: Ambient temperatures exceeding 40 °C are projected to become common in many temperate climatic zones due to global warming. Therefore, understanding the health effects of continuous exposure to high ambient temperatures on populations living in hot climatic regions can help identify the limits of human tolerance. OBJECTIVE: We studied the relationship between ambient temperature and non-accidental mortality in the hot desert city of Mecca, Saudi Arabia, between 2006 and 2015. METHODS: We used a distributed lag nonlinear model to estimate the mortality-temperature association over 25 days of lag. We determined the minimum mortality temperature (MMT) and the deaths that are attributable to heat and cold. RESULTS: We analyzed 37,178 non-accidental deaths reported in the ten-year study period among Mecca residents. The median average daily temperature was 32 °C (19-42 °C) during the same study period. We observed a U-shaped relationship between daily temperature and mortality with an MMT of 31.8 °C. The total temperature-attributable mortality of Mecca residents was 6.9% (-3.2; 14.8) without reaching statistical significance. However, extreme heat, higher than 38 °C, was significantly associated with increased risk of mortality. The lag structure effect of the temperature showed an immediate impact, followed by a decline in mortality over many days of heat. No effect of cold on mortality was observed. IMPACT STATEMENT: High ambient temperatures are projected to become future norms in temperate climates. Studying populations familiar with desert climates for generations with access to air-conditioning would inform on the mitigation measures to protect other populations from heat and on the limits of human tolerance to extreme temperatures. We studied the relationship between ambient temperature and all-cause mortality in the hot desert city of Mecca. We found that Mecca population is adapted to high temperatures, although there was a limit to tolerance to extreme heat. This implies that mitigation measures should be directed to accelerate individual adaptation to heat and societal reorganization.

Carriage of Neisseria meningitidis among travelers attending the Hajj pilgrimage, circulating serogroups, sequence types and antimicrobial susceptibility: A multinational longitudinal cohort study.

BACKGROUND: Travel to international mass gatherings such as the Hajj pilgrimage increases the risk of Neisseria meningitidis transmission and meningococcal disease. We investigated carriage and acquisition of N. meningitidis among travelers to Hajj and determined circulating serogroups, sequence types and antibiotic susceptibility among isolates. METHOD: We conducted a multinational longitudinal cohort study among 3921 traveling pilgrims in two phases: Pre-Hajj and Post-Hajj. For each participant, a questionnaire was administered and an oropharyngeal swab was obtained. N. meningitidis was isolated, serogrouped, and subjected to whole genome sequence analysis and antibiotic susceptibility testing. RESULTS: Overall carriage and acquisition rates of N. meningitidis were 0.74% (95%CI: 0.55-0.93) and 1.10% (95%CI: 0.77-1.42) respectively. Carriage was significantly higher Post-Hajj (0.38% vs 1.10%, p = 0.0004). All isolates were nongroupable, and most belonged to the ST-175 complex and were resistant to ciprofloxacin with reduced susceptibility to penicillins. Three potentially invasive isolates (all genogroup B) were identified in the Pre-Hajj samples. No factors were associated with Pre-Hajj carriage. Suffering influenza like illness symptoms and sharing a room with >15 people were associated with lower carriage Post-Hajj (adjOR = 0.23; p = 0.008 and adjOR = 0.27; p = 0.003, respectively). CONCLUSION: Carriage of N. meningitidis among traveler attending Hajj was low. However, most isolates were resistant to ciprofloxacin used for chemoprophylaxis. A review of the current meningococcal disease preventive measures for Hajj is warranted.

Clinical observation of concentrated growth factor (CGF) combined with iliac cancellous bone and composite bone material graft on postoperative osteogenesis and inflammation in the repair of extensive mandibular defects.

PURPOSE: To evaluate the effects of concentrated growth factor (CGF), combined with a mixture of iliac cancellous and composite bone materials, on the repair of extensive mandibular defects. PATIENTS AND METHODS: This clinical trial involved patients with mandibular defects caused by large cystic lesions. The test group comprised 16 patients who underwent CGF combined with iliac cancellous bone and composite bone materials to repair extensive mandibular defects, whereas the control group comprised eight patients who underwent vascularised free fibula grafts for mandibular segmental defects. Postoperative exudatum was collected from patients on the 1st, 2nd, 3rd, and 4th days postoperatively, and osteogenic factor, including alkaline phosphatase (ALP), osteocalcin (BGP), and procollagen type I N-terminal propeptide (PINP), and inflammatory cytokines were performed. Additionally, regular cone beam computed tomography (CBCT) scans were conducted before and after surgery. RESULTS: On postoperative days 1-4, the expression levels of ALP, BGP, and PINP were higher in the test group, while those of IL-1α, IL-1ß, IL-6, IL-8, and TNF-α, which were identified as co-differentially expressing inflammatory cytokines, were all down-regulated in the exudatum of the test group. Regular CBCT radiological scans revealed a significant osteogenic effect in the test group. CONCLUSION: The use of CGF combined with iliac cancellous bone and composite bone materials to repair extensive mandibular jaw defects facilitates bone formation and reductions in inflammation in the defect area in the short term, which deserves further research in clinical practice.

Association of Ambient Temperature with Mortality in Resident and Multiethnic Transient Populations in a Desert Climate, 2006-2014.

BACKGROUND: Although the association between ambient temperature and mortality in local populations is evident, this relationship remains unclear in transient populations (e.g., due to immigration, mass gatherings, or displacement). The holy city of Mecca annually shelters two populations comprising its residents and the transitory Hajj pilgrims (>2 million people from >180 countries). Both live side by side in a hot desert climate, rendering the development of evidence-based heat-protective measures challenging. OBJECTIVES: We aimed to characterize the ambient temperature-mortality relationship and burden for the Mecca resident and Hajj transient populations, which have distinct levels of adaptation to ambient temperature. METHODS: We analyzed daily air temperature and mortality data for Mecca residents and pilgrims over nine Hajj seasons between 2006 and 2014, using a fitted standard time-series Poisson model. We characterized the temperature-mortality relationship with a distributed lag nonlinear model with 10 d of lag. We determined the minimum mortality temperature (MMT) and attributable deaths for heat and cold for the two populations. RESULTS: The median average daily temperature during the Hajj seasons was 30°C (19°C-37°C). There were 8,543 and 10,457 nonaccidental deaths reported during the study period among Mecca residents and pilgrims, respectively. The MMT was 2.5°C lower for pilgrims in comparison with the MMT for Mecca residents (23.5°C vs. 26.0°C). The temperature-mortality relationship shape varied from inverted J to U shape for the Mecca and pilgrim populations, respectively. Neither hot nor cold temperatures had a statistically significant association with mortality in Mecca residents. In contrast, for pilgrims, elevated temperatures were associated with significantly high attributable mortality of 70.8% [95% confidence interval (CI): 62.8, 76.0]. The effect of heat on pilgrims was immediate and sustained. DISCUSSION: Our findings indicate that pilgrims and Mecca residents exposed to the same hot environmental conditions exhibited distinct health outcomes. This conclusion suggests that a precision public health approach may be warranted to protect against high environmental temperature during mass gatherings of diverse populations. https://doi.org/10.1289/EHP9838.

Newborn Care Practices and Associated Factors Influencing Their Health in a Northern Rural India.

INTRODUCTION: In developing countries, neonatal mortality is the most neglected health issue by the health system, leading to its emergence as a public health problem. A study was undertaken to assess the influence of factors and newborn care practices influencing newborn health in the rural area of Bareilly district. METHODOLOGY: The descriptive cross-sectional study was organized in the rural areas of Bareilly. Study participants were selected based on the mothers who gave birth to a baby during the last six months. The mothers who delivered in that area within six months were included and, using the semi-structured questionnaire, data were collected. Data were analyzed using Microsoft Excel and SPSS 2021 version for windows. RESULTS: Out of 300 deliveries, nearly one-quarter of the deliveries, 66 (22%), were happening in homes, and most of the deliveries, 234 (78%), happened in hospitals. It was observed that unsafe cord care practices were observed more among nuclear families, 8 (53.4%), than joint families, 7 (46.6%), and it was found to be statistically insignificant. The Unsafe feed was given 48 (72.7%) more commonly among home deliveries than institutional deliveries 56 (23.9%). Mothers' initiation of delayed breastfeeding was nearly the same in both home and hospital deliveries. Delayed bathing was observed in nearly three-fourths of mothers, 125 (70.1%), aged 24-29 years, followed by 29 (16.8%) in the age period of 30-35 years. CONCLUSION: The practice of essential newborn care still needs to improve in Bareilly; there is a need to create awareness among the mothers and family members on newborn and early neonatal care aspects, such as promoting exclusive and early initiation of breastfeeding and delayed bathing practices.

Municipal wastewater viral pollution in Saudi Arabia: effect of hot climate on COVID-19 disease spreading.

The viral RNA of SARS-Coronavirus-2 is known to be contaminating municipal wastewater. We aimed to assess if COVID-19 disease is spreading through wastewater. We studied the amount of viral RNA in raw sewage and the efficiency of the sewage treatment to remove the virus. Sewage water was collected before and after the activated sludge process three times during summer 2020 from three different sewage treatment plants. The sewage treatment was efficient in removing SARS-CoV-2 viral RNA. Each sewage treatment plant gathered wastewater from one hospital, of which COVID-19 admissions were used to describe the level of disease occurrence in the area. The presence of SARS-CoV-2 viral RNA-specific target genes (N1, N2, and E) was confirmed using RT-qPCR analysis. However, hospital admission did not correlate significantly with viral RNA. Moreover, viral RNA loads were relatively low, suggesting that sewage might preserve viral RNA in a hot climate only for a short time.