Dear Editor,

I would like to share ideas on the report, “Epidemiology of COVID-19 Infection in Oman: Analysis of the First 1304 Cases.” The authors found that on presentation, 95.9% of cases were mild, 3.6% moderate, and 0.5% severe with a case fatality rate of 0.5%.1 This trend is similar to many countries. An interesting observation is the low mortality rate compared to Western countries. Another interesting observation is the high incidence of mild COVID-19. This might imply the nature of non-severe COVID-19 in Oman, or possible natural resistance among people in Oman. In fact, this trend is observed in many Asian countries, such as those in Indochina.2 Whether there is any effect of race and severity in COVID-19 is an interesting question for further research. Also, due to the nature of the non-severe infection, there is a chance that there might be a high incidence of asymptomatic COVID-19 cases in Oman. Underdiagnosis is a possible problem in epidemiology studies of COVID-19 since many cases are mild or asymptomatic.2 Since there is no universal screening for all people, it is hard to tell the exact rate of asymptomatic COVID-19 in the community. In areas with non-severe disease, it might be necessary to have serosurveillance to actively search for mild or asymptomatic cases for early control of disease spread.

references

1. 1. Khamis F, Al Rashidi B, Al-Zakwani I, Al Wahaibi AH, Al Awaidy ST. Epidemiology of COVID-19 infection in Oman: Analysis of the First 1304 Cases. Oman Med J 2020 Jun;35(3):e145.
2. Lim JT, Dickens BSL, Choo ELW, Chew LZX, Koo JRH, Tam C, et al. Revealing regional disparities in the transmission potential of SARS-CoV-2 from interventions in Southeast Asia. Proc. R. Soc. B. 2020 Aug 26;287(1933):20201173.
3. 2. Joob B, Wiwanitkit V. Atypical presentation of COVID-19. Am J Emerg Med 2020 May.