Afghanistan: Strategic Situation Report: COVID-19, No. 79 (1 October 2020)

Situation Overview:

Global Update: According to John Hopkins University, the number of people worldwide who have died with COVID-19 has passed one million, with many regions still reporting surging numbers of new infections. In a video message released on 29 September, UN Secretary-General António Guterres called it a "mind-numbing" figure and "an agonising milestone" while urging the world to “never lose sight of each and every individual life”. The pandemic has now spread to 188 countries with close to 34 million confirmed cases, as of 8 October.

MOPH Figures: MoPH data shows that 39,285 people across all 34 provinces in Afghanistan are now confirmed to have COVID-19. Some 32,842 people have recovered, and 1,458 people have died - 76 of whom are healthcare workers. 111,310 people out of a population of 37.6 million have been tested. The majority of the recorded deaths were men between the ages of 50 and 79. Men account for more than 70 per cent of the total COVID-19 confirmed cases in the MOPH data, although this may be the result of over-representation of men in testing. Different gender trends are also emerging in the west of the country. Due to limited public health resources and testing capacity, as well as the absence of a national death register, confirmed cases of and deaths from COVID-19 are likely to be underreported overall in Afghanistan. Kabul remains the most affected part of the country in terms of confirmed cases, followed by Hirat, Balkh, Kandarhar and Nangarhar provinces. WHO warns that widespread complacency and failure to follow public health advice is creating grave risks in the community with people generally not observing physical distancing protocols.

Second Wave: With a fragile health system, a developing economy and underlying vulnerabilities, the people of Afghanistan are facing extreme consequences from the COVID-19 pandemic. While data suggests that the first wave seemed to peak in June, a new rise in cases is being closely monitored, especially in the west of the country. Doctors are warning that the second wave of COVID-19 may be deadlier than the first if people do not follow health advice. This dangerous second wave of the virus comes at a time of increased conflict and political uncertainty and with reduced community adherence to prevention measures. Limited access to water and sanitation, widespread food insecurity and high rates of malnutrition are all additional complicating factors for Afghanistan. Resourcing community engagement, surveillance, and contact tracing is critical to supporting the COVID-19 response and preventing unnecessary suffering. Effective awareness raising, rumour management, adoption of safety measures, and identification of people with COVID19 requires substantial investment in community-informed communication and engagement.

Health Services: Hospitals and clinics continue to report challenges maintaining or expanding their facilities’ capacity to treat patients with COVID-19 as well as maintaining essential health services. A WHO comparison of HMIS health data from Q2 2019 with Q2 2020 shows that the utilisation of health services has dramatically decreased during the pandemic. The drop in the utilisation of health services indicates that many of the severe medical cases that required hospital care have been unable to receive treatment during the COVID-19 pandemic as a result of a variety of factors including health staff falling ill with COVID-19, overwhelmed health facilities focused on COVID-19 response, patients’ unwillingness to attend health facilities, movement restrictions. These unaddressed medical conditions will likely to result in increased mortality and increased needs in the second half of the year and into 2021. WHO notes that when health systems are under stress, as is being seen in Afghanistan, both direct mortality from the outbreak and indirect mortality from vaccinepreventable and treatable conditions increase dramatically. WHO emphasises that infection prevention and control need to be improved in health facilities to encourage people to return to health services safely. Effective and accurate risk communication activities are needed to reassure people that it is safe to seek treatment at hospitals and health centres, and that health centres are carrying out proper infection prevention and control measures. WHO stresses the need to balance the demands of responding directly to COVID-19, with simultaneously engaging in strategic planning and coordinated action to maintain essential health service delivery, mitigating against the risk of system collapse.

Around 10 per cent of the total confirmed COVID-19 cases are among healthcare staff. Health facilities across the country are reporting shortfalls in PPE, medical supplies and equipment, further challenging their capacity to treat COVID-19 patients. In support of the Government, humanitarian partners have provided tens of thousands of pieces of PPE and several thousand items of life-saving medical equipment to the Ministry of Public Health. With a second wave of the gathering pace globally, there is an urgent need to ensure a rapid distribution of medical and protective equipment to all corners of the country.

While 13 laboratories are now operating in Afghanistan, laboratory capacity in Afghanistan remains limited. Humanitarian partners urge the Government of Afghanistan to ensure laboratories are appropriately equipped and that procured supplies go to under-resourced health centres in a transparent manner, so that life-saving support can be delivered to those most in need.