In the emergency department of a private hospital in the Cairo district of Heliopolis, Mustafa, a resident cardiologist, is running from one case to another trying to make sure that admitted patients are not suffering from signs of infection with Covid-19. He then attends to cases that have no symptoms of the new coronavirus. Unless someone is clearly suffering symptoms of a heart attack, they will not get priority over possible cases of Covid-19. Like other duty medical doctors, Mustafa has to make sure that any potential positive cases are immediately isolated to make sure that the infection is not passed on to other patients, mostly admitted for emergency health conditions, or to the medical team that could in turn pass the virus on to other wards of the hospital. For Mustafa, it has been a tough year since March 2020 when Egypt started its battle with the pandemic. However, this year Mustafa is "a lot more worried". "Things are worse. People are a lot less cautious, and the opening of the economy was mixed up with an inexplicable laxity reflected in more and more cases of Covid-19. The numbers could have been lower if people had stuck to the same level of caution they observed last year," he said. Officially recorded daily cases of Covid-19 in Egypt exceeded 800 earlier this week, bringing the country's confirmed cases to a total of 209,677. The country's total death toll has been 12,405 fatalities. According to a physician like Mustafa, who serves five shifts in the emergency department of his hospital, and other medical doctors including pathologists and radiologists, the figures are much higher. Some said they could be 10 times higher, while others suggested 20 times. However, these same doctors, who spoke during the past few days, agreed that in general the numbers were better than they had been over the past two months. "I think we have passed the worse part of the second wave, to judge by the turnover of people coming in with possible Covid-19 symptoms. But we are really worried about Ramadan, when people start to go to Iftars and other gatherings. It will pick up again, I am afraid," said Mohamed, a radiologist in Dokki. The holy month began on Tuesday 13 April. Both Mustafa and Mohamed are also worried that the government is not planning serious restrictions during Ramadan. They said they had hoped for a dusk-to-dawn curfew to prohibit large gatherings as much as possible and consequently to avoid a second rise in numbers. "At any given hour of the day, we have all the beds in the emergency department busy, with at least two or three people waiting to be transferred for check in. If we get another spike in Ramadan, and I think it is inevitable, I don't know how we will cope," Mustafa said. Both Mustafa and Mohamed said they hoped that the vaccination scheme that has been introduced would help to reduce the number of severe cases of Covid-19, but they both knew that this scheme is still in its early stages. According to figures released by the Ministry of Health last week, around 150,000 people have received their first dose of the Covid-19 vaccine. The vaccination scheme is set to continue uninterrupted throughout the holy month of Ramadan. The vaccination scheme has had its ups and downs, with accounts shared on social media indicating an easy process in some places and in others a tougher one. Problems have related mostly to crowded vaccination centres that at times did not allow all individuals summoned for their first dose to get the vaccine as scheduled. The Ministry of Health has so far allocated around 200 vaccination centres around the country. According to official statements, more centres are to be allocated to avoid complaints. Moreover, the ministry has promised that it will secure a bigger stock of the three vaccines it has approved — the Sinopharm, Oxford-AstraZeneca, and Sputnik V vaccines — in the coming weeks to allow larger scale vaccination. WILLINGNESS According to a source at the Ministry of Health, beyond the "mix up" in the execution of the vaccination scheme "in some centres", the trouble now is with the willingness of people to get the vaccine. He said that according to the official website put up by the ministry for registration for the vaccine, the numbers are not big. "People are still apprehensive. I think many are still waiting to see how things go with the people who got the first dose," he said. According to the source, it is unlikely that Egypt will secure a high vaccination rate before the last few weeks of this year. "I think by June we could see a marked increase in the numbers of people who get the first dose, and also in the numbers who get the first and second doses. But if the question is about securing a vaccination rate of around 10 to 15 per cent, then we are talking about late this year or early next year as a best-case scenario. This is why we keep calling on people to stick to restrictive measures as much as possible," he added. Neither the level of observation of precautionary measures nor the speed or timeline of vaccination is compatible with the Ramadan crisis that many medical doctors are worried about. Unlike last year, this Ramadan is curfew-free. Also unlike last year, evening prayers in mosques will be allowed. The Ministry of Religious Endowments, in charge of running mosques, said it would allow a 30-minute evening Ramadan prayer (taraweeh) if the number of those allowed into mosques was restricted and on the condition that all those admitted for prayers should wear masks, observe social-distancing, and bring their own prayer mat. According to Hassan, a retired civil servant in Manial in Cairo, "this all sounds good, but in practice it might not happen." Hassan himself decided to drop Friday prayers over the past few months due to concerns over the level of adherence to the restrictive measures at his local mosque. "When Friday prayers were first allowed last summer, people were careful, but it did not take long for things to change — not everyone who comes to pray is wearing a mask; some keep the mask on while stepping in and then take it off; and social-distancing has not always been observed over the past few months," Hassan said. "This is too much of a risk for someone like myself who is nearing his 70s and is still waiting to get the first dose of the vaccine," he added. Hassan has decided he will have to miss taraweeh this year. In recent statements, Ahmed Al-Monzeri, director of the World Health Organisation (WHO) office for the Eastern Mediterranean, warned of the increasing level of infections in most of the countries of the region due to laxity in observing restrictive measures and the slow process of vaccination. The WHO had previously warned of inequalities in the distribution of vaccines between rich countries and developing ones. For medical doctors, who had lost around 450 physicians since the beginning of the pandemic in Egypt in the spring of last year, the answer to this situation could have been secured by more restrictive measures. "People tend to think that they are immune, and then when they get sick and come to the hospital and don't find a place or a doctor available to attend to them, they become angry. I am afraid we are going to be seeing a lot of this in Ramadan," said Hatem, a doctor at a leading Cairo public hospital. Despite the debate in medical quarters over the expected rise in the number of Covid-19 cases with the advent of Ramadan, and the parallel run up to Christian Holy Week masses ahead of Coptic Easter on 2 May, Cairo seems to be in a mood for socialising and shopping. "This year is certainly a lot busier than last year. There is no comparison," said Ibrahim at a Nasr City branch of a big supermarket. "Last year, there were not just fewer people, but also people used to come in with masks and gloves on. They used to spray their shopping trolleys with detergent and every time they got something off the shelf. Many had shopping lists to reduce the time they spent in the store," he added. This year, however, "we often have to remind people to put on their masks before they step into the store and to try not to stand too close to one another in the queues. I think because of the big scare last year this year people have decided they just want to enjoy themselves come what may," Ibrahim said. *A version of this article appears in print in the 15 April, 2021 edition of Al-Ahram Weekly
