WHO urges Mideast states to prepare for 'things going wrong'

CAIRO - The World Health Organization is urging Middle East and North African governments to "seize the opportunity" to combat the coronavirus while numbers of cases in the region are still relatively low.

"We have to seize the opportunity to act in the region because the rise in cases was not so rapid," Yvan Hutin, director of the communicable diseases department at WHO's Eastern Mediterranean office in Cairo, told AFP news agency in an interview.

In the region at large, which for the WHO stretches to Afghanistan, around 111,000 cases of the novel coronavirus have been recorded and more than 5,500 deaths.

That accounts for a small proportion of the more than two million cases and over 140,000 deaths declared worldwide from the pandemic.

The exception is Iran, the hardest hit in the region and where the official toll stands at 78,000 cases and nearly 5,000 deaths. A parliamentary report released earlier this week said the coronavirus death toll might be almost double the figures announced by Iran's health ministry, and the number of infections eight to 10 times more given a lack of widespread testing.

On Friday, the country marked its national Army day by parading disinfection vehicles, mobile hospitals and other medical equipment.  It was a far cry from the typical Army Day parades, which normally feature spectacles of infantry, missiles, submarines and armoured vehicles, with warplanes flying overhead.

According to a recent opinion poll, 40 percent of residents in the greater Tehran region do not take the coronavirus seriously, the head of the government-led Coronavirus Taskforce of Tehran, Alireza Zali, said on Friday.

Inter-related responses

Hutin said it is hard to pinpoint a specific reason for the discrepancy between the wider Middle East region and the extent of the outbreak in the rest of the world.

"There may be demographic factors at play because we are dealing with youthful populations" in the region, he said, referring to the heavier death toll from COVID-19 among the elderly.

In conflict-ridden countries or "emergency situations" such as Libya, Syria and Yemen, low numbers have been reported, but a contributing factor may be difficulty in conducting widespread testing.

Many people in areas particularly hard-hit by violence, such as Syrians displaced in the north of the country, simply cannot afford to take the appropriate measures against the coronavirus, while others see it as a minimal threat compared to the horrors of war that they have endured.

According to the epidemiologist, "just because we avoided a difficult situation the first time around, that doesn't mean that it will stay like this".

In Egypt, where Hutin led an assessment team last month, "it is clear that we have more transmissions now than a few weeks ago. But it still hasn't reached an exponentially proliferating rate of transmission".

To avoid a situation comparable to Europe or the United States with tens of thousands of deaths, Hutin said several inter-related responses were needed.

These include "community engagement, mobilising entire health systems and preparation of hospitals for the arrival of severe cases".

"The things that can be done are not necessarily very complicated," he said, such as isolating patients with mild symptoms "in hotels, schools or army dormitories".

For severe cases, "there is a lot that can be done such as transforming conventional hospital beds into intensive care ones".

Things going wrong

Another measure to avoid an explosion of COVID-19 cases in the region would be to increase the capacity for testing.

This can be done with "small machines that can give quick test results", Hutin said.

Last week, WHO warned of a shortage of health workers in the region and of underreporting of coronavirus cases, as elsewhere across the globe.

Hutin stressed "the potential seriousness and ability of this virus to bring the healthcare system to its knees" if the region fails to take action.

Middle East and North African governments must prepare "for the possibility of things going wrong".

With the Muslim holy month of Ramadan starting next week, when people gather to break daytime fasts, WHO has published a string of recommendations urging that social distancing be maintained.

Those recommendations are beginning to be echoed by religious authorities, including Saudi Arabia's Grand Mufti Sheikh Abdulaziz Al al-Sheikh, the highest religious authority in the country where Islam's holiest sites are located.

The Grand Mufti said that Muslim prayers during Ramadan and for the subsequent Eid al-Fitr feast should be performed at home if the coronavirus outbreak continues, Saudi's Okaz newspaper reported on Friday.

Saudi Arabia in mid-March stopped people performing their five daily prayers and the weekly Friday prayer inside mosques as part of efforts to limit the spread of the coronavirus. On Thursday, the Prophet's Mosque in the holy city of Medina said it was banning events which dispense evening meals in the mosque to those in need during Ramadan to break their daily fast.