Coronavirus in Middle East: What you need to know

The new coronavirus is spreading rapidly in the Middle East, with cases recorded in at least nine countries in the region – six of them reported their first infections in the past week.

Officially known as COVID-19, the disease has spread to 34 countries and killed more than 2,600 people globally, the vast majority in China where the virus first emerged in late December. 

Outside China, Iran has the largest number of deaths, with at least 15 dying from the virus within a week – a development the World Health Organization (WHO) has called “deeply concerning”.

The virus – for which there is no vaccine yet – causes mild disease in four out of five infected people. However, it can be fatal for the elderly and those with underlying health conditions such as heart disease and diabetes.

As governments in the Middle East and North Africa (MENA) scramble to contain the spread of the infection, experts are expressing concern over the region’s capability to handle the outbreak because of war, conflict and weak health systems in some countries. 

Here is what you need to know about the spread of the virus in the MENA.  

Which countries have confirmed cases in MENA?

The United Arab Emirates (UAE) was the first country in the Middle East to register a case of COVID-19. On January 29, the UAE’s health ministry said four members of a Chinese family who arrived from Wuhan, the Chinese city at the epicentre of the outbreak, had tested positive for the virus. Another nine cases have since been confirmed. 

Egypt reported its first case – a foreigner who did not show serious symptoms – on February 14, according to the health ministry in Cairo. 

On February 19, Iran said two elderly people had died in the city of Qom after testing positive for the virus. Authorities have since reported 95 infections and 15 deaths.

Lebanon confirmed its first case on February 21 – a 45-year-old Lebanese woman who returned from Iran. Israel also reported its first case on the same day. An Israeli woman who was evacuated from a cruise liner that was quarantined off the coast of Japan tested positive after arriving home.

On February 24, Kuwait, Bahrain, Iraq and Oman reported their first cases – all patients had been in Iran before being infected.

Which countries are most at risk and why?

Five of the nine Middle Eastern countries that reported infections said their first cases were all linked to travellers from Iran. These countries are Lebanon, Kuwait, Bahrain, Iraq and Oman. Meanwhile, the UAE also said the latest infections in the country were an Iranian tourist and his wife.

In this context, the countries at immediate risk are those with close links with Iran, according to Dr Abdinasir Abubakar from the WHO’s Regional Office for the Eastern Mediterranean.

“Countries that have flights to or communities that have contact with people in countries affected by the outbreak are most at risk,” he said.

“In the Middle East, countries bordering Iran – like Turkey, Iraq – and countries that have large Shia communities are most at risk of importing the coronavirus.”

In Iran, the most number of infections were recorded in Qom, a city that is home to important Shia shrines and seminaries. The city attracts millions of pilgrims from countries with significant Shia populations, including Lebanon, Iraq, Bahrain, Yemen and Kuwait.

Separately, Djibouti also has a high risk of importing the virus because it has a large number of Chinese workers, he said. 

Abubakar, an epidemiologist, said the second class of countries most at risk were those whose health systems that have been severely weakened by conflicts, such as Iraq, Syria, Yemen and Libya.

“These countries with complex emergencies, they have weak health systems, weak infrastructures, and weak capacity to respond in comparison to the countries in the Gulf,” he said.

“In the case of Syria, Yemen, Libya … They do have some laboratory capacity, but if the coronavirus is introduced to these countries, we should probably worry.”

How should MENA governments respond?

In hard-hit Iran, authorities have designated 230 hospitals to treat infected patients nationwide, and closed schools and universities in Qom to contain the virus. Film screenings, art events and football matches were cancelled, and in the capital, workers have begun sanitising the Tehran Metro rail every night.

Meanwhile, several neighbouring states have closed their borders with Iran – including Turkey, Afghanistan, Armenia and Pakistan. Kuwait has cut all air travel links with Iran, while the UAE has cancelled flights to most Iranian cities – a measure the WHO has called unnecessary.

“It’s not about shutting borders,” said WHO’s Michael Ryan in Geneva on Monday. “This is about good communication between states … What we need to focus on is risk management, reducing the risks of disease importation, reducing the risk of disease transmission, increasing the survival of patients who gets sick.”

Fadi El-Jardali, director of the Knowledge to Policy Center in Lebanon, echoed that sentiment, adding that the most important measure to combat the outbreak in MENA was transparency.

“Countries should declare what is happening and not hide any information. This is a public health issue … People should be provided updated information, not to make them panic, but to give them good guidance for assessment and treatment.”

In Iran, some have accused the government of withholding information on the number of deaths and infections and of failing to act fast enough, a claim authorities have denied.

Rana Sidani Cassou, head of communication at International Federation of the Red Cross (IFRC) for MENA region, added efforts to tackle false claims about the virus must be stepped up. “Misinformation in the region is spreading more quickly than the virus … time is crucial, we need to prepare to avoid panic.”

El-Jardali also said effective isolation of infected people, especially in healthcare settings, was key to contain the virus. “My worry is that poor infections control practices in healthcare facilities might lead to a disaster,” he said.

But Abubakr of WHO said the outbreak of the Middle East respiratory syndrome (MERS), that originated in Saudi Arabia in 2012, had helped health facilities in the region boost infection control in hospitals.

A large number of health workers had contracted the virus, causing it to spread, he said. 

“The region has learned a lesson from that and now countries have a very effective infection control practices. There probably won’t be any outbreak in health facilities now,” he said, adding that the region was “also more prepared in the rapid recognition, confirmation and communication about infected people” because of the MERS outbreak.

The virus spread to 27 countries and killed more than 800 people, most of them in Saudi Arabia. MERS is much less contagious than COVID-19, however.