No abstract

No abstract

This article briefly describes Egypt’s acute respiratory infection (ARI) epidemic preparedness and containment plan and illustrates the impact of implementation of the plan on combating the early stage of the COVID-19 epidemic in Egypt. Pillars of the plan include crisis management, enhancing surveillance systems and contact tracing, case and hospital management, raising community awareness, and quarantine and entry points. To identify the impact of the implementation of the plan on epidemic mitigation, a literature review was performed of studies published from Egypt in the early stage of the pandemic. In addition, data for patients with COVID-19 from February to July 2020 were obtained from the National Egyptian Surveillance system and studied to describe the situation in the early stage of the epidemic in Egypt. The lessons learned indicated that the single most important key to success in early-stage epidemic containment is the commitment of all partners to a predeveloped and agreed-upon preparedness plan. This information could be useful for other countries in the region and worldwide in mitigating future anticipated ARI epidemics and pandemics. Postepidemic evaluation is needed to better assess Egypt’s national response to the COVID-19 epidemic.

Background. Cocirculation of influenza (Flu) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (SARS-CoV-2/Flu) represent a public health concern as it may worsen the severity and increase fatality from coronavirus disease 2019. An increase in the number of patients with coinfection was recently reported. We studied epidemiology, severity, and outcome of patients with SARS-CoV-2/Flu coinfection seen at Egypt’s integrated acute respiratory infections surveillance to better describe disease impact and guide effective preventive measures. Methods. The first two outpatients were seen daily, and every fifth patient admitted to 19 sentinel hospitals with respiratory symptoms was enrolled. Patients were interviewed using a standardized questionnaire and provided nasopharyngeal swabs to be tested for SARS-CoV-2 and influenza by real-time polymerase chain reaction at the central laboratory. Data from all patients with coinfection were obtained, and descriptive data analysis was performed for patients’ demographics, clinical course, and outcome. Results. The total number of patients enrolled between January 2020 and April 2022 was 18,160 and 6,453 (35.5%) tested positive for viruses, including 52 (0.8%) coinfection. Of them, 36 (69.2%) were coinfected with Flu A/H3, 9 (17.3%) Flu-B, and 7 (13.5%) Flu A/H1. Patients’ mean age was 33.2 ± 21, 55.8% were males, and 20 (38.5%) were hospitalized, with mean hospital days 6.7 ± 6. At the hospital, 14 (70.0%) developed pneumonia, 6 (30.0%) ICU admitted, and 4 (20.0%) died. The hospitalization rate among patients coinfected with Flu-B and Flu A/H3 was 55.6 and 41.7%, with mean hospital days (8.0 ± 6 and 6.4 ± 6), pneumonia infection (40.0 and 80.0%), ICU admission (40.0 and 26.7%), and death (20.0% for both), while no patients hospitalized with A/H1. Conclusions. The recent increase in the number of SARS-CoV-2/Flu coinfections was identified in Egypt. The disease could have a severe course and high fatality, especially in those coinfected with Flu-B and Flu A/H3. Monitoring disease severity and impact is required to guide preventive strategy.

Introduction: An integrated surveillance for acute respiratory infections (ARIs) was established 2016 at network of 19 governmental hospitals to identify causes of ARIs in Egypt. In response to COVID-19 pandemic, WHO requested surveillance adaptation to address the emerging challenges. This report aims at describing Egypt experience in adapting ARI surveillance to COVID-19 pandemic. Surveillance methods: WHO case definitions are used to identify ARI patients. NP/OP swabs collected for influenza testing by RT-PCR at central laboratories. Data collected by interviewing patients for demographic and clinical information and entered at sites. During COVID-19 pandemic, the first two outpatients daily and every fifth admitted patient were enrolled. Patients COVID-19 clinical data and testing for SARS-CoV-2 by RT-PCR were added. Results: Between January 2020-April 2022, 18,160 patients were enrolled including 7,923(43.6%) outpatients and 10,237(56.4%) admitted. Of them 6,453(35.5%) tested positive including 5,620(87.1%) SARS-CoV-2, 781(12.1%) influenza and 52(0.8%) SARS-CoV-2/influenza coinfection. SARS CoV-2 caused 95.3% of admitted cases and 65.4% of outpatients. Influenza subtypes included A/H3 (55.7%), Flu-B (29.1%), H1/pdm09 (14.2%). Compared to influenza, SARS-CoV-2 infections prevail in elderly, warm weather, and urban governorates. SARS-CoV-2 caused more hospitalization, longer hospital stay, more severe course and higher case fatality than influenza (16.3 vs 6.6%, p<0.001). Conclusion: Egypt ARI surveillance was successfully adapted to COVID-19 pandemic and effectively describe clinical characteristics and severity of circulating viruses. Surveillance reported re-emergence of influenza viruses with severe course and high fatality. Maintaining ARI surveillance is essential to monitor respiratory viruses activity for guiding clinical management and preventive and control measures.

Rapid and accurate diagnosis and treatment are crucial and problematic for patients admitted to an intensive care unit. The incorrect physical examination was extensively reported when the intensive care unit was admitted. Various methods of diagnostic imaging were developed, but most lacked sensitivity, availability and portability. When a short echocardiographic study is added to extend the physical examination, the diagnostic accuracy can be increased. Ultrasound (US) has grown rapidly and has been widely accepted. In a recent study up to 36 per cent of patients admitted to a non-cardiac intensive care unit had one or more occult heart defects. Intensive patients with thoracic and abdominal pathologies often require the ultrasound examination for prompt diagnosis and treatment, and prevent deterioration or death of the patient's disease. In this review article, we discussed the role of the United States in the intensive care unit and we concluded that the critical care community has a number of application points for ultrasound in the intensive care unit. The literature advances rapidly every year. Thoracic applications, such as lung, cardiac and diaphragm ultrasound, and brain ultrasound and procedural direction are the main topics of focus. The trend of the new studies is to demonstrate the diagnostic exactness of new ultrasound treatment methods and their impact on the daily practise of critical care.

WHO informed Egypt health authorities of individuals of different nationalities who proved positive for COVID-19 after returning from Egypt. Patients were among touristic group who visited Cairo and spent 1-week onboard Nile cruise ship. Investigation performed to confirm outbreak, detect source, and implement containment measures. Active case finding and contact tracing performed among contacts of the index cases and their contacts. Contacts defined as anyone within 6 feet from confirmed or suspected COVID-19 case for ≥15 min. Overall, 331 contacts, including 201 ship boarders and 130 hotel guests, were listed and interviewed using semistructured questionnaire and tested for COVID-19 by PCR. Among them, 136 (41.1%) were close contacts of index cases and 195 (58.9%) contacted secondary cases. Their mean age was 34.6±11.5 years, 251 (75.8%) were males and 126 (38.1%) non-Egyptians. Of them, 67 (20.2%) tested positive for COVID-19, including 57 (28.4%) ship boarders and 10 (7.7%) hotel guests. Per cent positive was significantly higher in: contacts of index cases, Egyptians, ship boarders and in males than corresponding categories (35.3% vs 9.7%, 22.9% vs 15.9%, 27.4% vs 7.7%, 24.7% vs 6.3%), respectively. Of all positive cases, 40 (59.7%) were asymptomatic where ship boarders, non-Egyptians, >50 years old and females were more likely to be asymptomatic than corresponding categories (85.0 vs 48.9%, 72.7 vs 54.5%, 100.0 vs 56.5%), respectively. COVID-19 patients among group of tourists triggered an outbreak onboard Nile ship and hotel in Egypt. Outbreak quickly contained through lab testing, case isolation, strict infection control measures and contact tracing which proved effective in reducing COVID-19 transmission early in pandemic.

No abstract