Greece is a European-Union country, of around 10 million people, located in the southeast part of Europe. The economy is recovering from a long period of deep recession, due to the economic crisis that started in 2008. The economic problems greatly influenced the structure and resources of the healthcare system of the country. In addition to the economic challenges, the country has been facing a refugee crisis, characterized by many overcrowded hotspots and tensions with neighboring Turkey. The COVID-19 outbreak arrived in Greece on 26 February 2020, at the time that Athens had declared a state of emergency at the Greek/Turkish border. From this point in time the government enforced a series of measurements, aiming to contain the epidemic and avoid the collapse of the healthcare system. The vast majority of the general population complied to the measures and consequently Greece’s death toll was low. The impacts of the outbreak are expected to be, as everywhere worldwide, multifaceted and to affect many parts of the economic, social and political life of the country.
The coronavirus disease 2019 (COVID-19) pandemic has affected millions of people worldwide. It brought about the implementation of various measures and restrictions at a global level. Iran has been one of the countries with the highest rates of COVID-19 cases. This study reviews the initial outbreak of COVID-19 in Iran and examines the mitigation strategies adopted by the country. Moreover, it reports the socioeconomic challenges faced by the authorities during the efforts to contain the virus. A transdisciplinary literature review was carried out and a political measures timeline was constructed. A broad overview of the initial phase of the COVID-19 outbreak in Iran is presented, starting from the first confirmed case on 19 February 2020 until April 2020. The results of this epidemiological and socioeconomic case review of Iran suggests that the political measures undertaken by the Republic of Iran contributed to the decrease of the prevalence of COVID-19. However, due to the existing financial bottleneck, Iran has faced limited health system resources. Therefore, the response was not sufficient to restrict the spread and the efficient handling of the virus in the long-term.
Objective: To quantify the initial spread of COVID-19 in the WHO African region, and to investigate the possible drivers responsible for variation in the epidemic among member states. Design: A cross-sectional study. Setting: COVID-19 daily case and death data from the initial case through 29 November 2020. Participants: 46 countries comprising the WHO African region. Main outcome measures: We used five pandemic response indicators for each country: speed at which the pandemic reached the country, speed at which the first 50 cases accumulated, maximum monthly attack rate, cumulative attack rate, and crude case fatality ratio (CFR). We studied the effect of 13 predictor variables on the country-level variation in them using a principal component analysis, followed by regression. Results: Countries with higher tourism activities, GDP per capita, and proportion of older people had higher monthly (p < 0.001) and cumulative attack rates (p < 0.001) and lower CFRs (p = 0.052). Countries having more stringent early COVID-19 response policies experienced greater delay in arrival of the first case (p < 0.001). The speed at which the first 50 cases occurred was slower in countries whose neighbors had higher cumulative attack rates (p = 0.06). Conclusions: While global connectivity and tourism could facilitate the spread of airborne infectious agents, the observed differences in attack rates between African countries might also be due to differences in testing capacities or age distribution. Wealthy countries managed to minimize adverse outcomes. Further, careful and early implementation of strict government policies, such as restricting tourism, could be pivotal to controlling the COVID-19 pandemic. Evidently, good quality data and sufficient testing capacities are essential to unravel the epidemiology of an outbreak. We thus urge decision-makers to reduce these barriers to ensure rapid responses to future threats to public health and economic stability.
During the first wave of the COVID-19 pandemic, sub-Saharan African countries experienced comparatively lower rates of SARS-CoV-2 infections and related deaths than in other parts of the world, the reasons for which remain unclear. Yet, there was also considerable variation between countries. Here, we explored potential drivers of this variation among 46 of the 47 WHO African region Member States in a cross-sectional study. We described five indicators of early COVID-19 spread and severity for each country as of 29 November 2020: delay in detection of the first case, length of the early epidemic growth period, cumulative and peak attack rates and crude case fatality ratio (CFR). We tested the influence of 13 pre-pandemic and pandemic response predictor variables on the country-level variation in the spread and severity indicators using multivariate statistics and regression analysis. We found that wealthier African countries, with larger tourism industries and older populations, had higher peak (p<0.001) and cumulative (p<0.001) attack rates, and lower CFRs (p=0.021). More urbanised countries also had higher attack rates (p<0.001 for both indicators). Countries applying more stringent early control policies experienced greater delay in detection of the first case (p<0.001), but the initial propagation of the virus was slower in relatively wealthy, touristic African countries (p=0.023). Careful and early implementation of strict government policies were likely pivotal to delaying the initial phase of the pandemic, but did not have much impact on other indicators of spread and severity. An over-reliance on disruptive containment measures in more resource-limited contexts is neither effective nor sustainable. We thus urge decision-makers to prioritise the reduction of resource-based health disparities, and surveillance and response capacities in particular, to ensure global resilience against future threats to public health and economic stability.
The geographic and economic characteristics unique to island nations create a different set of conditions for, and responses to, the spread of a pandemic compared with those of mainland countries. Here, we aimed to describe the initial period of the COVID-19 pandemic, along with the potential conditions and responses affecting variation in the burden of infections and severe disease burden, across the six island nations of the WHO’s Africa region: Cabo Verde, Comoros, Madagascar, Mauritius, São Tomé e Príncipe and Seychelles. We analysed the publicly available COVID-19 data on confirmed cases and deaths from the beginning of the pandemic through 29 November 2020. To understand variation in the course of the pandemic in these nations, we explored differences in their economic statuses, healthcare expenditures and facilities, age and sex distributions, leading health risk factors, densities of the overall and urban populations and the main industries in these countries. We also reviewed the non-pharmaceutical response measures implemented nationally. We found that the burden of SARS-CoV-2 infection was reduced by strict early limitations on movement and biased towards nations where detection capacity was higher, while the burden of severe COVID-19 was skewed towards countries that invested less in healthcare and those that had older populations and greater prevalence of key underlying health risk factors. These findings highlight the need for Africa’s island nations to invest more in healthcare and in local testing capacity to reduce the need for reliance on border closures that have dire consequences for their economies.
Introduction: The main objective is to present an overview of the evolution of the COVID-19pandemic in the six African island nations: Cabo Verde, Comoros, Madagascar, Mauritius, SãoTomé e Príncipe and Seychelles, up until 29 November 2020. The relevance of studying theoutbreak in these countries is their distinct geography, which may facilitate rapid closure andcontrol of their international borders. Here, we investigate whether this geography may haveled to an effective response and management of their respective COVID-19 epidemics.Methods: A literature review and analysis of national public health reports, officialcoronavirus websites and previously published research in each of the studied countries fromthe start of the pandemic through 29 November 2020 was performed. Data on metrics on thecountry-specific progression of COVID-19, the level of strictness of the governmental policies,the testing practices, as well the national healthcare systems, the description and the state ofhealth of the populations in the African island nations were reported.Results: Five out of six countries controlled their respective COVID-19 epidemics at an earlystage in the context of the total number of confirmed cases and deaths. In Cabo Verde, therewas an increasing number of cases as of 29 November 2020, when 10,526 total cases and 104total deaths were reported nationally. All six nations maintained a case fatality rate (CFR)lower than the global average, estimated between 2 - 3% in previously published research.Among the island nations, Mauritius had the highest CFR of 2%.Discussion: African island nations have different demographic, socioeconomic, and healthcareprofiles. However, their shared geographic characteristics likely played a role in limiting thespread of the infection. Furthermore, data from these nations support the idea that theimplementation of strict restrictions at an early stage, such as border closure and lockdowns,was crucial for the epidemic response.
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