Afghanistan + 2 more

Afghanistan: Strategic Situation Report: COVID-19, No. 86 (3 December 2020)

Situation Report
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Situation Overview:

Global Update: According to John Hopkins University, the number of people worldwide who have died with COVID-19 is close to 1.5 million, with many regions still reporting surging numbers of new infections as part of a second and sometimes potentially a third wave of the pandemic. The pandemic has spread to 191 countries with more than 64 million confirmed cases, as of 3 December.

MOPH Figures: As of 3 December, MoPH data showed that 47,258 people across all 34 provinces in Afghanistan are now confirmed to have had COVID-19. Some 37,302 people have recovered, and 1,841 people have died – at least 79 of whom are healthcare workers. Only 154,603 people out of a population of 36.7 million have been tested. Afghanistan now has a testpositivity-rate – positive tests as a percentage of total tests – of more than 30 per cent, suggesting overall under-testing of potential cases.

The majority of recorded deaths were men between the ages of 50 and 79. Men account for close to 69 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. Due to limited public health resources and testing capacity, lack of people coming forward for testing, as well as the absence of a national death register, confirmed cases of and deaths from COVID-19 are likely to be under-reported overall in Afghanistan. WHO notes that the official numbers reported by MoPH are unlikely to be capturing the full scale of the situation since testing remains limited to only the most severe cases. This assumption is supported by the results of an early seropositivity study by MoPH, Johns Hopkins and WHO that estimated 30 per cent of the population had been exposed to COVID-19 by July 2020. Stigma is considered a major factor in people choosing not to get tests and risk communications work is critical to turning this around. 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 or mask wearing protocols.

Second Wave: On 19 November, the MoPH confirmed that Afghanistan is in a second wave of the COVID-19 pandemic. Following two months of consistently lower confirmed COVID-19 cases, MoPH tracking data is starting to reflect anecdotal reports of a recent uptick in cases, with 1,768 new COVID-19 cases recorded over the past week. Furthermore, suspected and confirmed cases of COVID-19 are again rising in Hirat province. According to WHO, the Hirat Regional Hospital is currently operating at full capacity, prompting local authorities to ask NGO health partners to expand bed capacity for COVID-19 patients. Other COVID-19 hospitals in Kandahar and Nangarhar are also operating at full capacity.

While the official numbers across the country are not yet at the same level as the May/June peak, when taken together with reports of increased hospitalisations for COVID-19-like symptoms, the need for vigilance should be reinforced. The rollout of the annual influenza vaccination across Afghanistan will be more important than ever to help the health system manage the rise in COVID-19 cases. Increasing influenza vaccine coverage can reduce the strain on the health care system and free-up limited health resources to focus on treating more severe cases of COVID-19. Public health experts strongly urge the public to follow health advice on physical distancing, mask wearing, good hygiene, hand washing and other proven strategies that mitigate the risk of COVID-19 transmission amid this second wave.

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, especially in areas of active conflict. 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.

Almost 9 per cent of the total confirmed COVID-19 cases are among healthcare staff as of 26 November. Health facilities across the country continue to report 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 hundreds of thousands of pieces of PPE and several thousand items of life-saving medical equipment to MoPH. In total, since the start of the pandemic, almost 1.3 million PPE items have been delivered by humanitarian partners to both MoPH and directly to frontline NGO workers in Afghanistan. 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 14 laboratories are now operating in Afghanistan, the capacity of these facilities remains limited and stocks of supplies have periodically run out. National capacity for COVID-19 testing has topped 5,500 a day, but according to WHO, lack of demand means that fewer than 1,500 tests are actually being conducted daily. Humanitarian partners urge the Government to ensure laboratories are appropriately equipped, staff receive timely renumeration 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.

UN Office for the Coordination of Humanitarian Affairs
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