Arab countries brace against COVID-19

“We know there are undetected cases out there. We don’t know how big the tip of the iceberg is,” says epidemiologist Cyrus Shahpar, director of the Prevent Epidemics Team at Resolve to Save Lives, an organisation that provides catalytic funding to countries interested in improving epidemic preparedness. “There is a huge variation in testing capabilities.”

Currently, the region is reporting far fewer cases than other regions, including Europe and Asia. As of March 17, 17 Arab countries have reported COVID-19 cases on their government portals and through official state media: Qatar: 439 cases; Egypt: 166 cases and 4 deaths; Bahrain: 147 cases and 1 death; Kuwait: 130 cases; Iraq: 124 cases and 9 deaths; Lebanon: 109 cases and 3 deaths; Saudi Arabia: 103 cases; UAE: 98 cases; Algeria: 48 cases and 4 deaths; Palestine: 39 cases; Morocco: 37 cases and 1 death; Oman: 24 cases; Tunisia: 18 cases; Jordan: 12 cases; Sudan: one case and one death; Somalia: one case; Mauritania: one case.

One country of particular concern is Egypt. According to University of Toronto infectious disease specialist Isaac Bogoch who, with colleagues, analysed flight data, travellers’ data, and infection rates, the real figure could be significantly greater than official reports. 

“There is a huge variation in testing capabilities.” Cyrus Shahpar

Dozens of tourists tested positive after returning home from visiting Luxor, Egypt. Yet tourist sites remained open for weeks following the outbreak in a country where tourism is the cornerstone of the economy. 

In a sign that the government has revised its strategy, Egypt has suspended schools and universities for two weeks, like many other countries in the region, and, on March 19, will close its airspace until the end of the month. 

Egypt’s move to cancel air traffic mirrors what some countries in the region are doing. Saudi Arabia and Qatar have also suspended international flights for two weeks, while the UAE has forbidden entry to non-residents and has suspended flights to many countries. Jordan, Lebanon and Iraq are sealing their borders too, and will reportedly close their airports within days. 

But travel restrictions will only achieve so much if countries do not have the healthcare infrastructure to deal with an influx of cases. 

“The Middle East generally does not have strong healthcare infrastructure. Hospitals don’t have enough beds or isolation units like you see in higher income countries,” says epidemiologist Amira Roess of George Mason University, USA, who studies global zoonotic infectious diseases. 

However, Roess stresses this is not the case in Arabian Gulf countries, which had previously been affected by Middle East Respiratory Syndrome coronavirus (MERS-CoV) and have, as a result, stronger preparedness and response mechanisms in place. MERS-CoV was first identified in Saudi Arabia in 2012 and could have been transmitted to humans by camels.

“MERS-CoV caused a lot of countries in the region to ramp up response protocols and revitalise their health systems, so they do now have protocols in place,” she says. “Other countries in the region are doing what others across the world are: shutting down borders, limiting movement and imposing self-quarantine.” 

“The Middle East generally does not have strong healthcare infrastructure. What that means is that hospitals don’t have enough beds or isolation units like you see in higher income countries.” Amira Roess

Qatar University microbiologist Susu Zughaier says Qatar was well prepared for the pandemic, having readied itself long before any cases were confirmed in the country. While the outbreak was starting in Wuhan, Qatar stopped all flights to and from China and the Ministry of Public Health began a preparedness campaign for healthcare workers about the symptoms of COVID-19 and infection prevention and control measures, she says.

At Hamad International Airport in Doha, thermal cameras were set up and, by mid-January, community education had begun. 

“In my opinion, Qatar is doing all it needs to combat COVID-19. It provides free testing, free healthcare and continues to be highly transparent about the number of cases,” Zughaier says.

But the pandemic took a worrying turn in Qatar and Bahrain last week after both countries reported confirmed cases among migrant labourers. In one day, 238 migrants in a single residential compound in Qatar tested positive for the virus. There are fears that the same situation will be repeated across other parts of the Gulf where migrants live and work in cramped conditions, making social distancing virtually impossible. 

“Many migrants are worried they will be deported if they test positive for COVID-19, so there is a fear that they will not report symptoms or go get tested, feeling compelled to work with the virus and imperilling their own health and that of others,” says Elizabeth Frantz, whose work at the Open Society International Migration Initiative aims to prevent exploitative labour practices affecting migrants and refugees. 

“The Gulf States have well developed healthcare systems, but for a variety of reasons, a sizeable number of migrant workers have restricted access. This includes fears of reporting ailments to their supervisors, and limited transportation from work sites to health facilities. In some cases, employers fail to issue health cards to their employees,” she adds.

Meanwhile, there is growing concern that Syria and Yemen may face an outbreak, which would further undermine both countries, whose healthcare systems are crumbling.  

“Refugees and internally displaced peoples, and those in the middle of a war-torn setting, are living in crowded areas, are already stressed, and access to healthcare is really limited,” says Roess. 

As the pandemic continues to spread, the region should brace itself for a difficult time ahead. 

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