The impact of COVID-19 on primary health care services in Qatar: 2 years of response and coping 2020-2021.

Background: Health care systems worldwide have rapidly responded to manage the COVID-19 pandemic by providing screening tests, contact tracing, treatment, and vaccination. However, the long duration of the pandemic has had an enormous load on the health care systems, which disrupted continuity of the essential non-covid services, long waiting time for appointments, and increase in the utilization of telemedicine services. Primary health care was established as an essential foundation for the global response to the COVID-19. In Qatar, Primary Heath Care Corporation (PHCC), the main primary care services provided played a major role in the response to the pandemic. However, its services were affected and disrupted, and new services were added. Hence, the aim of this analysis is to understand the long-term impact of the COVID-19 on the services provided by PHCC in Qatar in terms of PHCC pandemic response, change in utilization of the core, and preventative services, and the introduction of new alternative services. Methods: A retrospective data analysis was conducted for all the appointments and visits for all the PHCC health centers in the years of 2020 and 2021. The study conducted a comparison of the services utilizations using the utilization figures of PHCC services between 1st of January and 31st of December 2019 as a reference year. The differences in the utilization per service were presented in frequencies and percentages. Results: The in-person services dropped drastically in 2020 at 36% reduction in compassion to 2019. However, the newly introduced virtual consultation services in 2020 reached their highest utilization figures in 2021 at 908,965 virtual visits. The COVID-19 specific related services ranging from the COVID-19 drive-through testing to vaccine administration constituted a total number of 2,836,127 visits corresponding to 44% of the total PHCC services utilization visits in 2021. In 2021, PHCC dental services dropped by 25.2%. The most noticeable utilization drops in 2021 were among the preventative services with 53.2% and 78.9% in colorectal screening and non-communicable diseases (NCDs) risk factors annual screening services, respectively. However, mental health services have witnessed a surge in utilization at 134.1% increase in 2021 in comparison to 2019. Conclusion: The COVID-19 pandemic caused a disruption in the PHCC utilization of core services, namely dental services. Additionally, PHCC preventive services utilizations were affected drastically including cancer and NCDs risk factors annual screening. Nevertheless, PHCC managed to provide alternative virtual services and played a vital role in responding to the pandemic by leading the COVID-19 vaccination campaign in Qatar. However, future research is needed to establish which vulnerable patient groups were most affected by the pandemic, to continue to inform strategies and policies directed at mitigating the impact of future potential pandemics.

Understanding the epidemiological characteristics of the primary healthcare corporation-based COVID-19 swabbed persons in Qatar, 2020.

BACKGROUND: In March 2020, Qatar started reporting increased numbers of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causing coronavirus disease 2019 (COVID-19). National preventive measures were implemented, and a testing plan was developed to respond to the pandemic with the Primary Health Care Corporation (PHCC) as the central element. PHCC is the main public primary healthcare provider in Qatar and it operates in 27 health centers with around 1.4 million registered individuals as of January 1, 2020. The latter population was distributed across four main nationality groups; Middle Eastern and North African (51.5%), Asian (41.2%), African (2.4%), and others (5.1%). At the primary healthcare level in Qatar, this study describes the epidemiological characteristics of individuals registered at PHCC who had contracted COVID-19 in 2020 during the first wave before the vaccination phase and examines the factors associated with the positivity rate. METHODS: Retrospective data analysis was conducted for persons screened for SARS-CoV-2 in primary healthcare health centers in Qatar between March 11 and December 31, 2020. The study analyzed the demographic characteristics of the tested persons and noncommunicable disease burden, positivity rate by month, nationality, and age-group, and the factors associated with the positivity rate. RESULTS:  Between March 11 and December 31, 2020, PHCC tested 379,247 persons for SARS-CoV-2, with a median age (IQR) of 32 (21-42) years. Of these, 57.0% were from the Middle East and North Africa, and 32.5% were originally from Asia. Overall, 10.9% had diabetes mellitus and 11.3% had hypertension. The epidemiological curve showed a steep increase in the positivity rate from March till May 2020, at the highest rate of 37.5% in May 2020. The highest positivity rate was observed among Asian males at 15.7%. The positivity rate was the lowest among the age-group aged 60 years and above. It was almost the same among the tested persons for SARS-CoV-2 in the three main age groups (0-18, 19-39, 40-59) at 10.1%, 12.3%, and 12.2%, respectively. In a multi regression model, being a male was associated with a higher risk (OR 1.15; 95% CI 1.13-1.17). Asians were at higher risk than those originally from the Middle East and North Africa (OR 1.29; 95% CI 1.27-1.32). COVID-19 infection was higher among those presenting clinical symptoms than asymptomatic individuals (OR. 4.52; 95% CI 4.42-4.64). CONCLUSION: The epidemic among the PHCC-registered population predominantly affected younger ages and males, namely, coming from Asia. At the primary healthcare level, the COVID-19 infection rate was higher among those who presented with clinical symptoms. The lowest positivity rate among individuals >60 years may reflect the effectiveness of public health measures related to the high-risk group. Scaled-up testing at the primary healthcare level helped to detect more cases during the peak of the first wave and was reflected in a steady increase in the positivity rate flattened later due to the established public health measures.

Association of Serum Vitamin D level and COVID-19 infection: A Case-control Study.

BACKGROUND: Vitamin D is considered a potent modulator of the immune system, albeit its role in COVID-19 infection is a matter of debate. The present study aimed to estimate the association between serum vitamin D levels and COVID-19 among people in Qatar. METHODS: This case-control study, approved by the Institutional Review Board of Primary Health Care Corporation (PHCC) Qatar, retrospectively evaluated the principal public healthcare sector population data repository retrieved from the cloud-based Electronic Health Record (EHR) software-Cerner, during April 2020-2021. The health records of all adult patients aged >18 years who had undergone the reverse transcription-polymerase chain reaction (RT-PCR) test and whose medical records had documented serum 25-hydroxyvitamin D [25 (OH)D] levels were analyzed. RESULTS: A total of 924,173 EHRs were extracted, of which 62,451 EHR comprised of 16,446 (26.3%) COVID-19 patients and 46,005 (73.7%) negative-control group patients met the inclusion criteria. The odds ratio (OR) among different categories of vitamin D deficiency (VDD) revealed that people with mild/moderate VDD were 1.18 times (95% CI 1.126-1.258) and those with severe VDD were 1.90 times (95% CI 1.116-1.251) more likely to have COVID-19 infection when compared to the people with optimal serum vitamin D level. On applying multiple logistic regression, the odds of having COVID-19 infection were found to be 1.27 times (95% CI 1.184-1.371) higher among those with mild/moderate VDD and 1.32 times (95% CI 1.206-1.405) higher among those with severe VDD when compared to people with optimal vitamin D level (p < 0.001). CONCLUSION: Our findings demonstrated a significant association between the suboptimal serum vitamin D level and COVID-19 infection. Further studies are required to determine the effects of VDD on the severity and outcomes of COVID-19 infections.

Understanding the epidemiological characteristics of the primary healthcare corporation-based COVID-19 swabbed persons in Qatar, 2020

Background: In March 2020, Qatar started reporting increased numbers of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causing coronavirus disease 2019 (COVID-19). National preventive measures were implemented, and a testing plan was developed to respond to the pandemic with the Primary Health Care Corporation (PHCC) as the central element. PHCC is the main public primary healthcare provider in Qatar and it operates in 27 health centers with around 1.4 million registered individuals as of January 1, 2020. The latter population was distributed across four main nationality groups;Middle Eastern and North African (51.5%), Asian (41.2%), African (2.4%), and others (5.1%). At the primary healthcare level in Qatar, this study describes the epidemiological characteristics of individuals registered at PHCC who had contracted COVID-19 in 2020 during the first wave before the vaccination phase and examines the factors associated with the positivity rate. Methods: Retrospective data analysis was conducted for persons screened for SARS-CoV-2 in primary healthcare health centers in Qatar between March 11 and December 31, 2020. The study analyzed the demographic characteristics of the tested persons and noncommunicable disease burden, positivity rate by month, nationality, and age-group, and the factors associated with the positivity rate. Results: Between March 11 and December 31, 2020, PHCC tested 379,247 persons for SARS-CoV-2, with a median age (IQR) of 32 (21–42) years. Of these, 57.0% were from the Middle East and North Africa, and 32.5% were originally from Asia. Overall, 10.9% had diabetes mellitus and 11.3% had hypertension. The epidemiological curve showed a steep increase in the positivity rate from March till May 2020, at the highest rate of 37.5% in May 2020. The highest positivity rate was observed among Asian males at 15.7%. The positivity rate was the lowest among the age-group aged 60 years and above. It was almost the same among the tested persons for SARS-CoV-2 in the three main age groups (0–18, 19–39, 40–59) at 10.1%, 12.3%, and 12.2%, respectively. In a multi regression model, being a male was associated with a higher risk (OR 1.15;95% CI 1.13–1.17). Asians were at higher risk than those originally from the Middle East and North Africa (OR 1.29;95% CI 1.27–1.32). COVID-19 infection was higher among those presenting clinical symptoms than asymptomatic individuals (OR. 4.52;95% CI 4.42–4.64). Conclusion: The epidemic among the PHCC-registered population predominantly affected younger ages and males, namely, coming from Asia. At the primary healthcare level, the COVID-19 infection rate was higher among those who presented with clinical symptoms. The lowest positivity rate among individuals >60 years may reflect the effectiveness of public health measures related to the high-risk group. Scaled-up testing at the primary healthcare level helped to detect more cases during the peak of the first wave and was reflected in a steady increase in the positivity rate flattened later due to the established public health measures.

Spectrum of COVID-19 clinical characteristics among patients presenting to the primary healthcare in Qatar during the early stages of the pandemic: a retrospective multicentre cross-sectional study.

OBJECTIVES: To describe clinical characteristics and laboratory investigations of patients with COVID-19 diagnosed in primary care in Qatar and to assess predictors of hospitalisation. DESIGN: A retrospective cross-sectional study. SETTING AND PARTICIPANTS: 3515 confirmed patients with COVID-19 diagnosed in any of the 27 primary healthcare centres in Qatar between 9 April 2020 and 30 June 2020. MAIN OUTCOME MEASURES: Demographic characteristics, comorbidities, contact tracing, clinical and laboratory data, in addition to patient disposition at the time of diagnosis RESULTS: Mean age of patients was 35.5 years (±14.7). 2285 patients (65.0%) were males, 961 patients (27.3%) had a history of concomitant comorbidity and 640 patients (18.2%) were asymptomatic. Adult patients (19-64 years old) were more likely to report symptoms than children or elderly. Fever and cough were the most frequently documented symptoms affecting 1874 patients (46.7%) and 1318 patients (37.5%), respectively. Most patients had normal vital signs at presentation; however, patients who were subsequently hospitalised had higher median temperature than non-hospitalised patients (37.7°C, IQR: 37.0°C-38.4°C, and 37.2°C, IQR: 36.8°C-37.8°C, respectively). Hospitalised patients had significantly higher C reactive protein (CRP) (median CRP: 20 mg/L, IQR: 5.0-61.2 mg/L) than non-hospitalised patients (median CRP: 4.6 mg/L, IQR: 1.7-11.50 mg/L), and lower median absolute lymphocyte count (1.5×103/µL, IQR: 1.1×103/µL-2.1×103/µL, and 1.8×103/µL, IQR: 1.3×103/µL-2.4×103/µL, respectively). Predictors of hospitalisation were increasing age (adjusted OR (AOR): 2.614, 95% CI 1.281 to 5.332 for age between 50 years and 64 years, and AOR: 3.892, 95% CI 1.646 to 9.204 for age ≥65 years), presence of two or more comorbidities (AOR: 2.628; 95% CI 1.802 to 3.832) and presence of symptoms (AOR: 1.982: 95% CI 1.342 to 2.928). CONCLUSION: The majority of COVID-19 cases diagnosed in primary healthcare in Qatar were symptomatic. Most cases had normal vital signs and laboratory results at presentation. Predictors of hospitalisation were increasing age, the presence of symptoms and having two or more comorbidities.

Antibody Response to SARS-CoV-2: A Cohort Study in Qatar's Primary Care Settings.

BACKGROUND: Globally, countries are rolling out Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) quarantine policies and vaccination programs. Research studies are needed in helping understand the likelihood of acquired immunity to reinfection and identify priority groups for vaccination to inform them. This study aimed to assess period prevalence and longitudinal changes in antibody levels after SARS-CoV-2 infection in Qatari primary care settings. METHODS: A cohort study design with 2 data collection phases was undertaken-Phase 1 (conducted in July 2020) and Phase 2 (conducted in October 2020). A stratified random sampling technique by age, gender and nationality was utilized to identify the study sample. The total sample size required for the study was estimated to be 2102. Participants were invited to an appointment where they were administered a questionnaire and provided samples for polymerase chain reaction and Immunoglobulin G immunoassay tests. RESULTS: A total of 943 individuals participated in both Phase 1 and Phase 2. In this cohort, seroprevalence of SARS-CoV-2 was found to be 12% (N = 113) in Phase 1 and 17.2% (N = 162) in Phase 2. Of the 113 participants who were seropositive in Phase 1, 38.1% (CI 29.5-47.2%, N = 43) had a reduction, 54.9% (CI 45.7-63.8%, N = 62) had no change, and 7.1% (CI 3.4-12.9%, N = 8) had an increase in IgG titer in Phase 2. All (N = 18) participants aged 10 to 17 years retained their antibodies. The proportion of men who retained their antibodies was slightly higher compared to women-92.5% (N = 74) and 87.9% (N = 29) respectively. Similarly, symptomatic individuals (97.8%; N = 45) had a higher antibody retention compared with asymptomatic individuals (86.4%; N = 57). CONCLUSIONS: This study provides preliminary information on the longitudinal changes in antibody levels after SARS-CoV-2 infection. These findings will help inform quarantine policies and vaccination programs.

Risk Perception and Psychological Impact of COVID-19 Pandemic Among Healthcare Workers in Primary and Secondary Healthcare Settings in Qatar: A National Study.

INTRODUCTION: During the coronavirus disease 2019 (COVID-19) pandemic, primary and secondary healthcare workers (HCWs) have faced unprecedented stress, jeopardizing their mental well-being. AIMS: To compare risk perception and psychological distress between primary and secondary HCWs. METHOD: A cross-sectional web-based survey was conducted with HCWs in Qatar from April 5 to July 5, 2020. Psychological distress and risk perception were assessed using the Kessler Psychological Distress Scale, a perceived COVID-19 risk questionnaire, and a sociodemographic questionnaire. RESULTS: Of the 4417 participating HCWs, 3421 (90.3%) felt that their job increased their risk of COVID-19 exposure, 3759 (90.9%) accepted this as part of their job, and 3440 worried that this also increased the risk of exposure to their families. Moreover, 2911 (84.8%) believed that their employer would look after their needs if they contracted COVID-19. Moderate to severe psychological distress was present in 1346 (30.5%) HCWs. Primary HCWs were less likely to experience moderate to severe psychological distress than secondary HCWs (adjusted OR, 0.48; 95% CI 0.29-0.77, P = .003). Secondary HCWs who worked in COVID-19 designated areas had greater psychological distress. CONCLUSIONS: HCWs' exposure to outbreaks has various psychological effects, which may have long-term consequences and affect their decision-making capacity. Strategies to enhance the mental well-being of HCWs exposed to COVID-19 should be introduced immediately.

Epidemiology of SARS-CoV2 in Qatar's primary care population aged 10 years and above.

BACKGROUND: There is an urgent need to elucidate the epidemiology of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2) and characterize its potential impact. Investing in characterising the SARS-CoV2 will help plan and improve the response to the pandemic. Furthermore, it will help identify the most efficient ways of managing the pandemic, avoiding public health policies and interventions that may be unduly restrictive of normal activity or unnecessarily costly. This paper describes the design and reports findings of a population based epidemiological study undertaken to characterise SARS-CoV2 in Qatar using limited resources in a timely manner. METHODS: Asymptomatic individuals ≥10 years registered with Qatar's publicly funded primary health provider were eligible. A stratified random sampling technique was utilized to identify the study sample. Participants were invited to an appointment where they completed a questionnaire and provided samples for polymerase chain reaction and Immunoglobulin M and G immunoassay tests. Data collected were analyzed to calculate point and period prevalence by sociodemographic, lifestyle and clinical characteristics. RESULTS: Of 18,918 individuals invited for the study, 2084 participated (response rate 10.8%). The overall point prevalence and period prevalence were estimated to be 1.6% (95% CI 1.1-2.2) and 14.6% (95% CI 13.1-16.2) respectively. Period prevalence of SARS-CoV2 infection was not considerably different across age groups (9.7-19.8%). It was higher in males compared to females (16.2 and 12.7% respectively). A significant variation was observed by nationality (7.1 to 22.2%) and municipalities (6.9-35.3%). CONCLUSIONS: The study provides an example of a methodologically robust approach that can be undertaken in a timely manner with limited resources. It reports much-needed epidemiological data about the spread of SARS-CoV2. Given the low prevalence rates, majority of the population in Qatar remains susceptible. Enhanced surveillance must continue to be in place, particularly due to the large number of asymptomatic cases observed. Robust contact tracing and social distancing measures are key to prevent future outbreaks.

The COVID-19 Pandemic Impact on Primary Health Care Services: An Experience from Qatar

Introduction: Health authority in Qatar has developed an emergency action plan to respond to the COVID-19 pandemic with primary health care as the main component of that response. The aim of this study was to measure the impact of COVID 19 on primary health care in Qatar in terms of response, modifications of services, and the introduction of new alternatives. Methodology: A retrospective data analysis was conducted for all the COVID-19 swabbing activities, the services utilization volume, and utilization of the alternative services (teleconsultations and medication home delivery) across the primary health care centers. Results: Primary health care allocated testing sites for COVID-19 resulted in conducting 194,381 tests and detected 25,173 confirmed cases with a positivity rate of 12.9 %. The overall PHCC services utilization declined with an overall reduction of 50% in April 2020. Family medicine clinics represented 41.9% of the cancelled appointments. Alternative virtual and remote services were provided, telemedicine was introduced, and it made up 50% of the consultation volumes for April 2020. Medications refill home delivery managed to provide a total of 58,949 delivered prescriptions by end of August 2020. Conclusion: To decrease the risk of infection to the patients and health care workers, Primary health care in Qatar cancelled the appointments for some high-risk population. However, virtual remote services managed to make up for the in-person utilization volume and reflected acceptance in patients' behaviours. Primary health care continued in detecting positive COVID-19 cases among its targeted communities. [ABSTRACT FROM AUTHOR] Copyright of Middle East Journal of Family Medicine is the property of Medi+WORLD International Pty. Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Characterizing the Qatar advanced-phase SARS-CoV-2 epidemic.

The overarching objective of this study was to provide the descriptive epidemiology of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic in Qatar by addressing specific research questions through a series of national epidemiologic studies. Sources of data were the centralized and standardized national databases for SARS-CoV-2 infection. By July 10, 2020, 397,577 individuals had been tested for SARS-CoV-2 using polymerase-chain-reaction (PCR), of whom 110,986 were positive, a positivity cumulative rate of 27.9% (95% CI 27.8-28.1%). As of July 5, case severity rate, based on World Health Organization (WHO) severity classification, was 3.4% and case fatality rate was 1.4 per 1,000 persons. Age was by far the strongest predictor of severe, critical, or fatal infection. PCR positivity of nasopharyngeal/oropharyngeal swabs in a national community survey (May 6-7) including 1,307 participants was 14.9% (95% CI 11.5-19.0%); 58.5% of those testing positive were asymptomatic. Across 448 ad-hoc testing campaigns in workplaces and residential areas including 26,715 individuals, pooled mean PCR positivity was 15.6% (95% CI 13.7-17.7%). SARS-CoV-2 antibody prevalence was 24.0% (95% CI 23.3-24.6%) in 32,970 residual clinical blood specimens. Antibody prevalence was only 47.3% (95% CI 46.2-48.5%) in those who had at least one PCR positive result, but 91.3% (95% CI 89.5-92.9%) among those who were PCR positive > 3 weeks before serology testing. Qatar has experienced a large SARS-CoV-2 epidemic that is rapidly declining, apparently due to growing immunity levels in the population.

Qatar's Primary Health Care Medication Home Delivery Service: A Response Toward COVID-19.

The COVID-19 pandemic has strained health care systems around the world. Pharmacists have made substantial contributions to the health care operations during the COVID-19 response. The Pharmacy Department at Qatar Primary Health Care Corporation (PHCC) acted proactively to ensure that all patients received their medications and their refilled prescriptions in time and without any disruption. The Medication Home Delivery Service was introduced and implemented for all Qatar residents to prevent unnecessary visits to health centers, minimize the spread of COVID-19 to vulnerable populations, especially those with multiple comorbidities, and protect health care workers from exposure to the virus. Moreover, several other precautionary measures were taken by the PHCC to ensure uninterrupted access to health care, including moving to a virtual health care delivery model. As of September 2020, the service had served around 64,213 patients since its launch in March 2020. In total, 70,357 medications were delivered and 69,092 (98.2%) medication packages were delivered successfully to patients, with an average of 450.8 medication packages delivered per month. Despite various challenges, the PHCC is considering continuing the Medication Home Delivery Service in the long term to continue with a more effective and efficient service for patients during the coming months and years.

Psychological impact of the COVID-19 pandemic within institutional quarantine and isolation centres and its sociodemographic correlates in Qatar: a cross-sectional study.

SETTING: The State of Qatar has had one of the highest COVID-19 infection rates globally and has used state-managed quarantine and isolation centres to limit the spread of infection. Quarantine and isolation have been shown to negatively affect the mental health of individuals. Qatar has a unique population, with around 90% of the population being economic migrants and a majority being blue-collar workers and labourers. OBJECTIVES: This study was carried out to evaluate the psychological impact of institutional isolation and quarantine during the COVID-19 pandemic outbreak in Qatar. The study also explored the sociodemographic correlates of this psychological impact. DESIGN, PARTICIPANTS AND INTERVENTION: A cross-sectional study involving 748 consenting individuals in institutional quarantine and isolation in Qatar during the months of June and July 2020 was carried out. Relevant sociodemographic data along with depressive and anxiety symptomatology scores were collected from consenting adults at these facilities. RESULTS: 37.4% (n=270) of respondents reported depressive symptoms and 25.9% (n=189) reported anxiety symptoms. The scores were higher for individuals in isolation facilities and higher for migrants from poor socioeconomic group (p<0.001 for both). Within this group, although worries about infection were widely reported, lack of contact with the family was cited as one of the most important sources of distress. Respondents reported that contact with the family and reliable information were important factors that helped during the duration of isolation and quarantine. CONCLUSIONS: Our study reported significantly elevated scores for depression and anxiety during institutional quarantine, which is in keeping with emerging evidence. However, in contrast to other studies reporting mostly from native populations, this study of a population with an overwhelming majority of immigrants highlights the special mental health needs of this specific group and can inform future healthcare policies.

Estimating point prevalence of COVID-19 in Qatar's primary care registered population: an RT-PCR drive-through study protocol.

BACKGROUND: The first COVID-19 cases in Qatar were reported on 29 February 2020. As the epidemic progresses, essential epidemiological information is needed to facilitate monitoring of COVID-19 in the population and plan the pandemic response in Qatar. AIM: The primary aim of this cross-sectional study is to estimate the point prevalence of COVID-19 in Qatar's primary care registered population. DESIGN & SETTING: A cross-sectional study design will be utilised. One publicly funded health centre from each of three geographical regions in Qatar will be identified as a study location and set up to facilitate a drive-through for the study. METHOD: Primary Health Care Corporation (PHCC) is publicly funded and the largest primary care provider in Qatar. The study will include randomly selected individuals from the full list of PHCC's registered population on its electronic medical records system. The sample selection will be done using a proportional to size sampling technique stratified by age, sex, and nationality representative of the overall PHCC-registered population. Considering the total population registered in PHCC, a sample of 2080 is proposed. A questionnaire will be administered to collect sociodemographic information, and nasal and throat swab samples will be taken. Data will be analysed to report overall symptomatic and asymptomatic point prevalence of COVID-19. CONCLUSION: This study, with the help of a randomly selected representative sample from Qatar's primary care registered population, will provide results that can be applied to the entire population. This study design will closely represent a real-world scenario of the outbreak and is likely to provide important data to guide COVID-19 pandemic planning and response in Qatar.