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The battle against Covid-19
Published in Ahram Online on 24 - 03 - 2020

It has been well over two weeks since Nader (not his real name) was removed from his hometown of Luxor to a seclusion hospital where he has been quarantined since he tested positive for the Covid-19.
Nader was working on one of the cruise ships on the nile that experienced the first infections with the new coronavirus in Egypt last month. He had heard a little about the new virus in the media but never thought it would be something for him to worry about.
However, a few days down the road from the day he heard some of his colleagues murmuring concerns over their safety when 12 foreign tourists tested positive for Covid-19 upon their return home to Europe after a cruise on the boat he works on, Nader got worried. The virus was closer to home than he had expected.
The following day, he said, speaking from his hospital room by phone, medical teams were heading to Luxor to test workers on the boat and to take samples from other people, both tourists and Egyptians, in Luxor hotels and boats.
Nader was confident he had nothing to worry about. “No symptoms whatsoever,” he recalled.
However, he tested positive. The medical team then went to his house to test his family and to ask all family members to self-isolate while Nader was taken along with other workers to the airport where they boarded a plane that took them to the hospital where they have been quarantined.
“This is the most horrible experience of my life – a total state of isolation. I have very little here to remind me that I live in this world, except perhaps when I talk to the doctors and nurses,” Nader said.
He is not allowed to walk out of his room except to go to the bathroom. He can use the phone to call his family to a certain extent, but “the network is horrible and there is no Internet.”
Almost a week after being treated in isolation, another test showed that Nader's recovery was incomplete. He has to test negative for the virus before he is allowed to leave. He had been hoping that the day he would test negative he would be able to leave. However, even testing negative is not enough. He has to fully recover.
Despite his impatience, Nader has no choice but to wait for full recovery. He is not sure when this will happen, and the medical team that is treating him is being reserved in offering estimates.
“They just say that they are doing the best they can and that every case is different. Some people have recovered and left, and others have come in since I have been here, a period of over three weeks now,” he said.
According to figures from the Ministry of Health on Sunday night, the total number of recorded cases of Covid-19 in Egypt has reached 366 as Al-Ahram Weekly went to print. Of these, 14 have passed away due to complications of the infection, 56 have recovered and left hospital and 74 have tested negative after having tested positive.
The vast majority of those numbers are for Egyptians from about 13 governorates that either have a high rate of people working in European countries or are associated with the tourism industry like in Luxor and Hurghada. There have also been foreigners, mostly tourists, who have fallen ill while in Egypt.
Meanwhile, the Covid-19 pandemic has paralysed the tourism industry in Egypt and across the world. Before the decision of the Egyptian authorities to suspend international flights starting last Thursday noon, Egyptian tourist companies were already seeing cancellations from several countries.
According to sources in the industry, the first wave of cancellations seemed to be prompted by uncertainty about the state of infections in Egypt.
“With so many newspapers reporting on tourists that were tested positive for the coronavirus upon their return home from Egypt, people were getting sceptical about what was really happening here. We were getting questions about the reliability of government announcements that had not recorded any cases until the end of the second week of February,” Maged, a tour operator, said.
For Maged, the tone of the questions he was receiving was indicative of a sense of doubt that Egypt was being transparent enough in reporting on the virus.
“I did not know if anyone was hiding anything, but I knew that some of those who had tested positive when they went back to their countries had been in other places before coming to Egypt and had not necessarily gone home on direct flights but had had stop-overs in several airports,” he said.
“I am not saying that they did not get the infection in Egypt or that it was they who brought the infection to Egypt. I am just saying that factually speaking it is impossible to say what happened when,” Maged said.
FOLLOWING WEEKS: A couple of weeks down the road, leading markets for tourism to Egypt began to experience high levels of infections with the new coronavirus.
Maged, who works on the Italian market, said he cannot believe what is happening in Italy, statistically the second-worst infected country after China, the original epicentre of the Covid-19 virus.
After Italy, there was France and then several other European countries.
“When this whole thing started, I was thinking it was just going to be in China and maybe few other neighbouring countries, but in no time the nightmare has been spreading all over the world and countries have been closing their airports one after the other. It is a real nightmare and worse than anything we have seen in the industry,” Maged said.
Maged has been in the business since the late 1980s. He recalls some hard moments, including a terrorist attack on a group of Japanese tourists in Luxor in the late 1990s, attacks on hotels in the Red Sea resorts in the early 2000s, the impact of the 25 January Revolution and subsequent political changes in Egypt and the crash of a Russian plane carrying tourists home from a Red Sea resort in the autumn of 2015.
“But there has never been anything worse than the present situation. It is so sad because tourism was just starting to pick up, and we were hoping that by the end of 2020 we would be able to record the same level of tourists that we recorded in 2009 and 2010, two of the best years for the industry. But now we have been hit very hard,” Maged said.
Cancellations have gone way beyond the Easter holidays.
“Uncertainty prevails. People cannot make plans the world over: it is not just about the situation in Egypt,” Maged said. However, he added that it would be “a nightmare worse than all nightmares if the situation started to stabilise in Europe and the US, which are now struggling very hard, but got worse in Egypt. This would mean that even if people could travel from Europe, they would not be coming here and we would be doomed for the rest of this year and maybe more,” he commented.
Like other workers in the tourism industry, Maged is critical of the reaction of the government to the challenge.
“We know that for us tourism is a big deal, and we know that we would never want to take any decisions that would negatively influence the flow of tourists,” said Mina, a tour guide.
“I think the authorities were hoping that the thing would not be as bad for Egypt as elsewhere, as was the case with previous epidemics like SARS and Ebola,” he added.
Government officials working on the Covid-19 situation say they are racing against time. In press statements over the weekend, Minister of Health Hala Zayed said that the target for Egypt was to make sure that it kept the number of patients in the hundreds. This was not just about reducing the level of infections, but also about keeping track of the path of the infections, she said.
“Once we go beyond the line of patient 1,000, it will be very difficult for us to trace the path of the infections and thus be harder for us to keep containing the situation,” Zayed said in a telephone interview with an evening talk-show aired on MBC Masr.
Government and independent medical sources say that the authorities are reporting all cases that have been tested. The question, however, according to one independent medical source, is how much testing is being done and how many individuals get infected and recover without having to access medical services.
Covid-19 is a new virus for which there is no clear profile. However, it has so far been established that in around seven cases out of 10, a patient who is in good health and has a good immune system can recover from the virus without being admitted to hospital.
The Ministry of Health can only report cases that get tested through its facilities, which are the only testing services available.
FIGHTING THE VIRUS: At first, testing for Covid-19 was only administered in Cairo. However, in following weeks, the Ministry of Health started to provide facilities in other government labs across the country.
In theory this means that anyone who gets tested will be recorded if the test is positive. In press statements this week, Zayed said that Egypt had already bought over 30,000 testing kits and that it was waiting to receive triple that number.
Financial allocations for the combat against Covid-19 have already been made, with Prime Minister Mostafa Madbouli saying that President Abdel-Fattah Al-Sisi has allocated LE100 million for the fight against the coronavirus.
In televised remarks made on Sunday while marking Egyptian Women's Day, Al-Sisi said that the state stood ready with any necessary allocations for the combat against the Covid-19 virus. However, he also appealed to the public to help the state in the fight by “staying at home”.
Al-Sisi is not the first official to emphasise the need for social distancing. Prime Minister Madbouli and Minister Zayed have also appealed to the public to stay at home if they do not need to go out to work or for some other compelling reason.
On Tuesday, the state imposed a dusk to dawn curfew along with more restrictive measures in yet another attempt to contain the infection rate.
The authorities have during the past ten days adopted a series of measures that are aimed to reduce large gatherings. In addition to the suspension of schools and universities, which extended for 14 more days, the authorities have ordered the reduction of the workforce and the suspension of international flights and ordered a curfew at 7pm.
On Saturday, after much debate, the authorities also ordered the closure of mosques and churches, thus suspending all communal prayers.
Before the curfew was announced on Tuesday, some people have opted to stay at home, but not all. In Imbaba, south of Giza, Hassan, a waiter at a café, said that for him it was business as usual. Speaking 24 hours after the introduction of the decree to close cafes at 7pm, Hassan said that his “really small café” worked quite a bit later.
On Sunday, in Nasr City, Mahmoud said he had performed noon prayers at the small mosque on the ground floor of the apartment building opposite his house. Speaking around 24 hours after the official decree to close all mosques and churches, Mahmoud said that he had gone to see if the mosque was still open, and it was.
“I joined about five people who were there, and we prayed. If it is just a few people in a small mosque, more like a prayer room really, there is no harm. The problem is with big crowds,” he argued.
On Saturday and Sunday, the Ministry of the Interior was rounding up the owners and waiters of cafes that had not observed the new regulations. On Sunday, the Ministry of Endowments, awqaf, suspended the imams of two mosques for overlooking the closure decree.
But beyond the violations, the country is still faced with the problems of people who have to stay at home. This applies to the clients of five-star cafes by gated residential communities who think that they are safe to socialise within the confinement of their upscale socio-economic areas and to the small vendors and daily workers who have no way of making an income if they stay at home.
The choices of the state are no less complicated than those of individuals.
Government sources who spoke on condition of anonymity said that the state was hesitant to rock the boat of the tourism industry and it was even more hesitant to prompt public fury, especially in rural areas, by closing mosques and churches.
According to the source, the official assessment is that the level of social distancing that has been observed during the past week falls short of what is necessary to help stop the spread of Covid-19.
“The government did not want to move too fast in a way that would be too disturbing to the lives of people, but it looks increasingly unlikely that this situation can be sustained for long,” the source said.
He added that there was “no final date” set for a total lockdown, which would include not just a full curfew on movement but also closing off the governorates if need be, but it might come next Saturday. He spoke before the announcement of the curfew on Tuesday afternoon.
“The date is being considered, but we are in a process of escalated restrictive decisions,” he said.
RESTRICTIONS: Dalia Samhouri, manager for emergency preparedness and international health regulations in the World Health Organisation (WHO) Regional Office for the Eastern Mediterranean, said that “any decision related to travel restrictions and the closure of borders, as well as the closure of schools and cancelling of mass gatherings, is purely a country decision and should be evidence-based following a thorough risk assessment.”
But she added that restrictive measures “are not enough by themselves and must be accompanied by intensive efforts to scale up the health system to detect, diagnose, isolate and treat cases, as well as conduct extensive contact tracing to ensure suspected cases are also diagnosed before there is opportunity for further spread.”
In written answers to questions put by the Weekly, Samhouri said that a two-week lockdown “is not a definitive answer when a country decides to go into lockdown.” She added that “this is based on their own risk assessment. The length of the lockdown may be modified or extended depending on the required measures that need to be taken to meet their objectives.”
These measures, she said, were generally taken “with the goal to reduce the spread and transmission of the virus and give the government time to enhance its health system.” But “again, these lockdown measures cannot happen in isolation without additional scaling up of measures to find, isolate and treat patients before the virus spreads.”
According to Samhouri, “countries that have limited health capacities need to think of priority strategies to implement prevention and response measures based on their existing capacities and situation in order to limit the transmission of the virus.”
Last week, the WHO said Africa needed to do more in terms of testing and quarantine to avoid a disaster in the making. This was how Ahmed, a doctor in a leading hospital in Cairo, expressed his worry over the situation.
“I guess that people confuse some of the things that have been said about Covid-19,” Ahmed said. The statements of some officials that the new coronavirus could be like any other winter viral infection and that most cases could recover with mild medication had prompted a sense of recklessness on the part of some people, he said.
“I think the message has to be clear to people that while a Covid-19 infection can be treated without serious complications, it can also have some very serious complications. If we want people to change their attitudes, we need to put out the message in clearer terms,” he said.
Ahmed argued that government officials need to be a lot more direct in reminding people of the limitations of the health system in Egypt given the volume of the population.
“When people hear that there is a budget of LE100 million allocated for the problem, they may say everybody who gets ill will be treated, but this is not the case. We need this money to buy testing kits and other necessary equipment for hospitals and medical teams,” he said.
He added that “the real question” in a situation of high rates of infection related to the capacity of hospitals and the capacity of intensive care units in hospitals, bearing in mind that coronavirus patients are only treated in public hospitals that do not have large numbers of ventilators.
“We have all seen on TV that big industrial countries with generous health budgets like the US, France and Italy are having a hard time facing up to a challenging situation. We should all understand what this means for us,” Ahmed said.
He added in an unequivocal tone that “we should be doing more testing and enforcing more quarantines, but we should also be opting for a serious awareness campaign on TV and radio. I guess that for at least two to three weeks we will also have to have a lockdown.”
This week, the message on radio and TV has been that people should stay at home if they don't need to go out.
Popular TV hosts have been offering their followers detailed accounts of the drama in China and Italy in order to argue for the need for people to stay at home. They have also spoken of the inevitability of a lockdown as the only way to prevent a high rate of infection in some countries.
*A version of this article appears in print in the 26 March, 2020 edition of Al-Ahram Weekly


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