Coronavirus: Egypt’s flexible approach seems to be winning
Although Egypt is currently second only to South Africa in the number of infections in Africa, rapid and well thought-out measures appear to have stemmed the tide of new infections without causing major upheavals during the holy month of Ramadan. Report by Ahmed Fouad.
Currently, Egypt comes second in Africa, after South Africa, in terms of the numbers of people infected with Covid-19. However, its experience in combating the outbreak of the virus may later turn into a model for many neighbouring countries which are similar in terms of population structure and medical system capacities.
According to officials, the first case involved a Chinese man, in his mid 30s, residing in Egypt. It is believed he became infected by a Chinese female who was on a business trip to Egypt in early February. This was before the Egyptian authorities banned flights to and from China.
Since then, the Egyptian authorities have taken progressive steps to counter the outbreak of the virus. In addition to the gradual transformation of 47 hospitals specialising in the treatment of fevers and chest issues nationwide into isolation hospitals, the Egyptian government closed down schools and universities on 15 March.
On 19 March, the Egyptian government decided to reduce the working hours of restaurants and cafes; they had to be closed at 5pm although home delivery services were allowed throughout the day.
Despite the measures, the total confirmed cases continued to increase gradually, to 402 cases on 24 March.
The government subsequently decided to impose a partial night curfew from 7pm until 6am for a period of 15 days, starting from 25 March, allowing only physicians, pharmacists, police and armed forces officers and home delivery workers to move during the curfew hours.
Since then, the ban has been extended three times, by a new period of 15 days on each occasion. The curfew hours were reduced, with a start time of 8pm, and subsequently 9pm for the beginning of Ramadan on 24
April.
Also, on 25 March the government announced the suspension of work in some of its headquarters and service-providing centres, such as the state registries, passport offices and traffic facilities in charge of renewing and issuing driving and vehicle licences. The courts and prosecution headquarters were also closed.
Along with the governmental measures, the private sector reduced the number of in-house employees, expanding the dependence on remote working via the internet in sectors where this was possible.
Reducing the infection rate
The governmental and private measures combined to help create a 40% decline in the movement of Egyptians in the streets during the first 15 days of implementing the curfew and reduced working hours, according to Google data and statistics obtained by the government and announced, on 2 May, by the Egyptian Minister of Health.
Evaluating governmental and private sector measures to reduce crowds and encourage social distancing depends on exploring many factors, such as the infection rate (R), which is the average rate at which the virus is transmitted from infected cases to other areas during the period of precautionary measures (which is the most important criterion, according to many experts in epidemic control). Other factors include recovery and mortality rates.
The infection rate during the period 9-24 March (the 15 days prior to imposing the precautionary measures), amounted to 7.31 new cases per patient, as the total number of patients increased in that period from 55, on 9 March, to 402, on 24 March. In other words, each of the first 55 cases transmitted the infection to about 7.31 new cases, bringing the total number to 402.
After seven weeks of imposing the curfew and the protective measures, the average 15-day infection rate declined by 72.6% from 7.31 to 2, as the total number of patients increased from 5,537 cases, on 30 April, to 11,228, on 15 May.
In this context, Islam Annan, a professor of epidemiology at Ain Shams University, believes that recording ‘zero’ cases isn’t related to the decline of numbers of infected people as much as being related to infection rates.
He said: “A country may record 1,000 cases in a day, but thanks to the precautionary measures and social distancing, the infection rate may reach 0, so that those cases won’t transmit infection to others, and subsequently the disease may end completely”.
Regarding the situation in Egypt, Annan said: “The infection rate in Egypt is promising in light of its continuous decline, but measures must be developed to lead to further declines in shorter periods, so as to make sure that the increase in cases won’t put pressure on the medical sector in Egypt.”
The precautionary measures, including the expansion of converting fever and chest hospitals into isolation hospitals, contributed to improving the capacity of the health sector in Egypt to treat patients.
The recovery rate increased from 24.9%, on 24 March, to 30%, on 15 May, when 3,363 patients had recovered from a total of 11,228 infected cases, while the daily recovery numbers reached the peak of 173 patients leaving isolation hospitals and centres on 15 May; when it had been 12 patients on 24 March.
The average mortality rate decreased to 5.9% of the total cases on 8 May, as the total deaths came to 503 of 8,476 total cases. The mortality rate had reached its peak on 23 April, at 7.4%.
Khaled Mujahid, spokesman for the Ministry of Health, attributed this to the expansion of the use of more efficient treatments such as the Japanese flu drug Avigan and a treatment protocol approved by Egypt that includes the drug Tamiflu with a number of immunity-boosting medicines.
Onus laid on citizen responsibility
Despite the promising figures concerning infection, recovery and mortality rates, fears grew that the Egyptian health system would not be able to deal with spikes in the number of new infections.
On 8 May, Hala Zayed, the Minister of Health, announced that infected persons placed in isolation hospitals had nearly occupied all the available capacity.
Zayed therefore announced, on the same day, arrangements for 33 new fever and chest hospitals to work as isolation wards from the beginning of Eid al-Fitr, which marks the end of Ramadan on 23 May.
Also, there is a worry that a great deal of precautionary measures depend on citizens being aware of risks and applying appropriate safety measures. The government has been reluctant to resort to punitive or heavy-handed measures on violators given the fact that the holy month of Ramadan is traditionally a time for people to visit each other.
The Egyptian State Information Service had announced that Egypt had conducted about one million tests to detect those infected with the coronavirus, including the use of 105,000 PCR diagnoses, 105,000 respiratory virus swabs and 790,000 rapid tests.
Those million tests have been conducted for 900,000 suspected of being infected, either from being in contact with infected persons or being returnees from abroad as part of the government’s campaign to bring all stranded citizens back. Egypt banned flights to and from the country on 19 March, as a part of the precautionary measures.
So far, the rapid and flexible approaches taken by the authorities have succeeded in severely reducing the spread of the disease without causing the populace undue hassle or mass losses of livelihood.
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