With the appearance of first cases of Coronavirus disease (COVID-19), strict control measures were implemented in the Kurdistan Region of Iraq to combat the infection. These measures included the closure of schools and universities, the closure of borders and airports, cancellation of public and religious gatherings, and mandatory quarantine for persons returning from traveling abroad. Such measures have played a major role in the control of COVID-19 spread. However, due to social and economic pressures, the government relaxed the lockdown. After relaxing the measures, a sharp increase in the number of patients was noticed. Besides, there was a significant increase in the number of symptomatic patients and the case fatality rate was doubled. In addition, the outbreak and outbreak response led to the loss of trust and a breakdown in relations between the society and local authority. To minimize the consequences for population health, local authority should have a plan that balances between health imperatives and socioeconomic imperatives. Finally, to be successful in controlling the infection, the government must rebuild public trust in the handling of COVID-19 outbreak and compensate people for lost earnings.

Abstract On March 1, 2020, the first case of severe acute respiratory syndrome coronavirus 2 infection (SARS-CoV-2) infection was diagnosed in the Kurdistan Region of Northern Iraq. The highest number of infections was recorded in Erbil city (233 cases) and Sulaymaniyah (178 cases). Among diagnosed patients, 20% had symptoms. The most common symptoms were fever (9.5%), dry cough (12%), and shortness of breath (6.5%). There was a sharp marked increase in the number of cases after relaxing of the control measures on May 1. The case fatality rate was 1.1% (5/452). Case fatality was significantly associated with advanced age (p=0.001) but not sex (p=0.68). Overall, 385/452 patients (85.2%) recovered without complications. Most patients were asymptomatic. The case fatality rate was low but increased with age. Further research is needed to determine the high recovery and low case fatality rates relative to those reported in other countries.

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Social distancing is important to decrease the interactions between people in the society. As a set of measures, social distancing is taken to reduce infections transmitted by droplets. To achieve its aim, social distancing should include the cancellation of funerals and weddings, the closure of schools and universities, and the cancellation of mass gatherings (1). In a study conducted in China during the epidemic outbreak of coronavirus disease 2019 (COVID-19), the death rate was about 10% in the epicenter of the epidemic whereas the death rate was 1% in other areas. It was concluded that the high death rate was due to the breakdown of the healthcare system owing to the large number of patients. It was then recommended that social distancing may help in preventing the breakdown of healthcare system (2). In another study in China, it was concluded that social distancing can reduce the number of infections by 98% and the number of deaths by 99% (3). The first case of COVID-19 in Kurdistan region was diagnosed in beginning of March 2020, and from that time 324 confirmed cases have been recorded onwards. The region is divided into four cities: Duhok (15 COVID-19 cases), Erbil (168 cases), Sulaimani (120 cases), and Halabja (21 cases). The age range of COVID-19 patients was from 10 months to 70 years old. Amongst the 324 patients, 52% were female, 80% were asymptomatic and diagnosed while in the quarantine, and 0.9% passed away (4). The regional government in Kurdistan, northern Iraq imposed strict measures to stop the spread of the infection. These measures included the closure of educational institutions, workplaces, roads, and the cancellation of public gatherings including Friday prayers, church gatherings, funerals, and weddings. Besides, measures included mandatory quarantine of uninfected subjects with a history of travel We would like to thank all the doctors and medical staff working in COVID-19 hospital for their continuous support during the study. As a part of COVID-19 national program, all the COVID-19 data are

Background and aims The coronavirus disease-2019 (COVID-19) pandemic impacted healthcare services for kidney disease patients. Lockdown and social distancing were mandated in Kurdistan, Iraq to combat the transmission of the infection. The report analyzed the impact of the COVID-19 pandemic on kidney disease patient care in Duhok City, Kurdistan Region of Iraq. Methods This study took place in the Duhok Kidney Disease and Transplant Center and compared data from February–April 2019 and 2020. Results The average number of patients visiting the consultation unit per week was reduced from 68.67 ± 13.6, to 33.42 ± 29.36 (P = 0.001) during the pandemic. In the dialysis unit, weekly hemodialysis sessions were reduced from 341.5 to 306.42 sessions (P = 0.002). The number of patients visiting the kidney transplant consultation unit was significantly reduced (135.7 ± 37.7 versus 102.5 ± 26.3; P = 0.005). The number of kidney transplant operations per week was reduced from 1.167 to 0.5 (P = 0.025). Conclusions The COVID-19 pandemic interrupted healthcare services and may continue to impart long-term negative consequences for kidney disease patients.

BackgroundEstimates of the incidence of glomerulonephritis (GN) and end-stage renal disease (ESRD) in an Iraqi population are compared with the United States (US) and Jordan.MethodsThe study set consist of renal biopsies performed in 2012 and 2013 in the Kurdish provinces of Northern Iraq. The age specific and age standardized incidence of GN was calculated from the 2011 population. ESRD incidence was estimated from Sulaimaniyah dialysis center records of patient’s inititating hemodialysis in 2017.ResultsAt an annual biopsy rate of 7.8 per 100,000 persons in the Kurdish region, the number of diagnoses (2 years), the average age of diagnosis, and annual age standardized incidence (ASI)/100,000 for focal segmental glomerulosclerosis (FSGS) was n = 135, 27.3 ± 17.6 years, ASI = 1.6; and for all glomerulonephritis (GN) was n = 384, 30.4 ± 17.0 years, ASI = 5.1. FSGS represented 35% of GN biopsies, membranous glomerulonephritis 18%, systemic lupus erythematosus 13%, and immunoglobulin A nephropathy 7%. For FSGS and all GN, the peak age of diagnoses was 35–44 years of age with age specific rates declining after age 45. The unadjusted annual ESRD rate was 60 per million with an age specific peak at 55–64 years and a decline after age 65. The assigned cause of ESRD was 23% diabetes, 18% hypertension, and 12% GN with FSGS comprising 41% of biopsy-diagnosed, non-diabetic ESRD.ConclusionsThe regional incidence of ESRD in Northern Iraq is much lower than the crude incidences of 100 and 390 per million for Jordan and the US respectively. This is associated with low renal disease rates in the Iraqi elderly and an apparent major contribution of FSGS to ESRD.

Background: Hepatitis C virus (HCV) infection is a public health problem. Such an infection is prevalent and aggressive in patients with end-stage kidney disease (ESKD). The efficacy and the safety of direct acting antivirus (DAA) in patients with acute HCV and ESKD is under investigation. The aim of this study was to assess the safety and efficacy of sofosbuvir containing regimens in this difficult-to-treat population. Methods: A prospective and observational study was conducted to evaluate the efficacy and the safety of sofosbuvir containing regimen in patient with ESKD who were undergoing haemodialysis and were acutely infected with HCV. Subjects either received sofosbuvir 200 mg and daclatasvir 60 mg daily or sofosbuvir 400mg/ledipasvir 60mg daily for 12 weeks.   Results: 19 Patients were recruited in this study who were infected with HCV genotype 1a. All subjects achieved sustained virologic response (SVR) twelve weeks after finishing the treatment course. No major adverse effects were reported and the treatment course was well tolerated. Conclusions: sofosbuvir containing regimens were effective and safe for the treatment of acute HCV in patients with ESKD who were on haemodialysis.

Background: The incidence of kidney diseases among bodybuilders is unknown. Methods: Between January 2011 and December 2019, the Iraqi Kurdistan 15 to 39 year old male population averaged 1,100,000 with approximately 56,000 total participants and 25,000 regular participants (those training more than 1 year). Annual age specific incidence rates (ASIR) with (95% confidence intervals) per 100,000 bodybuilders were compared with the general age-matched male population. Results: Fifteen male participants had kidney biopsies. Among regular participants, diagnoses were: focal segmental glomerulosclerosis (FSGS), 2; membranous glomerulonephritis (MGN), 2; post-infectious glomeruonephritis (PIGN), 1; tubulointerstitial nephritis (TIN), 1; and nephrocalcinosis, 2. Acute tubular necrosis (ATN) was diagnosed in 5 regular participants and 2 participants training less than 1 year. Among regular participants, anabolic steroid use was selfreported in 26% and veterinary grade vitamin D injections in 2.6%. ASIR for FSGS, MGN, PIGN, and TIN among regular participants was not statistically different than the general population. ASIR of FSGS adjusted for anabolic steroid use was 3.4 (− 1.3 to 8.1), a rate overlapping with FSGS in the general population at 2.0 (1.2 to 2.8). ATN presented as exertional muscle injury with myoglobinuria among new participants. Nevertheless, ASIR for ATN among total participants at 1.4 (0.4 to 2.4) was not significantly different than for the general population at 0.3 (0.1 to 0.5). Nephrocalcinosis was only diagnosed among bodybuilders at a 9-year cumulative rate of one per 314 vitamin D injectors. Conclusions: Kidney disease rates among bodybuilders were not significantly different than for the general population, except for nephrocalcinosis that was caused by injections of veterinary grade vitamin D compounds.