The Impact of Implementing the Egypt Pandemic Preparedness Plan for Acute Respiratory Infections in Combating the Early Stage of the COVID-19 Pandemic, February-July 2020: Viewpoint (Preprint)

Abstract

BACKGROUND Egypt is a transcontinental country in the Middle East. Most of the country is situated in northeastern Africa with the Sinai Peninsula located in Western Asia. The country covers an area of 1 million km² and has a coastline at the Mediterranean Sea in north, and the Red Sea in east. Most of its population are concentrated along the banks of the Nile, and on the river's delta, with only about 3% of the territory is inhabited. Egypt population are more than 100 million inhabitants, GDP per capita in 2017 was $10,799. Life expectancy was 74.4 in females and 68.0 in males and under 5 mortality rate was 19.2. The main causes of death in Egypt are Ischemic heart diseases, stroke and cirrhosis, healthcare access and quality index are 58.0 and the governmental health spending per person was $39 in 2018. (IHME 2020) The beginning of COVID-19 epidemic in Egypt On December 1st, 2019 cluster of pneumonia cases of unknown cause was noticed in Wuhan, China. On the 31st of December 2019 China announced an epidemic of acute respiratory disease of unknown cause (She 2020). As soon as the epidemic was announced and before WHO announce a pandemic, Egypt Ministry of Health and Population (MoHP) started to adapt its ARI pandemic preparedness plan to apply to the anticipated pandemic. Egypt is considered one of the oldest countries to monitor infectious diseases through a national surveillance system for reporting infectious diseases that was established in Egypt back in 1946. Egypt national surveillance was assessed, enhanced, and expanded to include all governmental healthcare facilities in 1999. The National Egyptian surveillance (NEDSS) targeting 40 communicable diseases including Acute Respiratory Infections (ARIs) has electronic reporting element (Madiha 2017). A comprehensive network of epidemiological and laboratory vertical system for reporting ARIs was developed in 2009 with an alert system for early detection of novel respiratory viruses. The network covers all the country and composes of surveillance systems targeting severe acute respiratory infections (SARI), influenza like illness (ILI), pneumonia, avian influenza and MERS-CoV. Event-based surveillance was introduced in Egypt in 2009 in response to the 2009 H1N1 pandemic to help timely detection and response to possible epidemics. This viewpoint aims at review and discuss the preventive and control measures that have been implemented by MoHP Egypt in response to the COVID-19 pandemic to share Egypt experience with the public health practitioners and authorities for better response to such events in the future. The specific objective of the preparedness plan for response to COVID-19 is to reduce morbidity and mortality in the event of a COVID-19 epidemic in Egypt. OBJECTIVE To briefly describe Egypt acute respiratory infections (ARIs) epidemic preparedness and containment plan. In addition to find out the effect of plan implementation in combating the early stage of COVID-19 epidemic in Egypt. METHODS Egypt preparedness 5 pillars ARI preparedness plan was briefly described. Pillars are: Crisis management, enhancing surveillance systems and contact tracing, case, and hospital management, raise community awareness, quarantine, and entry points. To identify the impact of plan implementation, all COVID-19 patients data February-July 2020 was obtained from Egypt national disease surveillance. Descriptive analysis was conducted to describe the epidemic situation in the early stage of the epidemic in Egypt. RESULTS Overall, 102,789 COVID-19 cases were reported to NEDSS in the study period including 78,048 (43.2%) confirmed COVID-19 cases giving an attack rate of 77.0 case/1,000,000 population, and 3,457 (4.4%) deaths due to COVID-19. Of all cases 44,969 (57.6%) had mild symptoms, 71.5% were > 53 years. Growth rate and R0 declines 1.18 to 0.13 and 6.5 to 1.6, respectively, while doubling time increased from 1.8 to 15.6 days by the end of July 2020. CONCLUSIONS Egypt was successful in mitigating the early stage of COVID-19 epidemic. Commitment of all partners to implementation of the ARI epidemic preparedness plan helped in flattening the curve and containing the epidemic. Post-epidemic evaluation is needed to better assess Egypt national response against COVID-19 epidemic.