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WHO EMRO Weekly Epidemiological Monitor: Volume 13, Issue no 32; 9 August 2020

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Situation Report
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Six months since the first COVD-19 cases in the Eastern Mediterranean Region

The first confirmed cases of COVID-19 in the Eastern Mediterranean Region were reported on 29 January 2020 and soon after the outbreak spread to all 22 countries. The COVID-19 pandemic that began in China in late 2019 has spread rapidly around the world, leading to 15 785 641 confirmed cases and 640 016 related deaths as of 26 July 2020. Within WHO Eastern Mediterranean Region (EMR), 1 482 315 cases and 37 932 deaths have been reported.

Editorial note

Initial response in the EMR was led by an informal taskforce that was convened within the WHO Regional Office for the Eastern Mediterranean to support preparedness. Escalation of the pandemic led to the activation of the regional incident management support team (IMST) on 22 January 2020. Consisting of eight pillars as well as cross-cutting support functions for external and internal communication, and resource mobilization. Since then, the IMST has played a crucial role in coordinating the regional COVID-19 response, and in bringing together different departments within the Regional Office and regional partners.

Beside improving the coordination mechanism and mainstreaming communication, the IMST put extra effort to address key challenges in relation to the pandemic response. The initial challenge was tackled through the establishment of PCR laboratory testing capacities through the procurement and distribution of COVID-19 testing kits, equipment and reagents. Regional capacity building efforts also took place by all pillars which was crucial to support the operational response, with over 80 sessions reaching more than 7700 participants with trainings on infection prevention and control (IPC) programmes and rapid response teams (RRT). Various technical guidance were also developed across pillars, including regularly updated documents on clinical management and for longer term health system strengthening. This has been complemented by strong technical assistance to countries with feedback on clinical management and IPC protocols, surveillance strategies, development of tools for epidemiological analysis and modelling, and risk communication and community engagement (RCCE) materials.

The communications team has produced 153 daily updates for the Regional Director to share with ministers of health, and conducted over 200 media interviews. Weekly coordination calls brought together over 35 regional partners, with working groups set up to boost specific areas of the response on community based surveillance and RCCE. Efforts were also made to detect new cases, monitor and forecast the evolution of the epidemic, understand the disease and its determinants, and communicate the results of their analysis through the Health Information Management and Surveillance pillar. The Health Operations and Technical Expertise pillar provided countries with continuous technical assistance for different aspects of the response. The IMST supported preparedness through investment in International Health Regulations (2005) measures by providing guidance on managing points of entry. The Operational Support and Logistics pillar conducted rapid procurement and dispatched critical COVID-19 medical supplies.

Even in the face of severe travel restrictions, 8 country support missions were undertaken and 7 deep-dive calls were held with individual ministers and senior staff. Twenty three videos were produced on technical issues for the public. Technical support was also provided for the maintenance of essential services, in the form of a rapid assessment of the impact of the pandemic on non-communicable diseases such as mental health, with the production of guidance on how to integrate these services into the COVID-19 response. This has opened the door to potential innovation, and has become an integral part of IMST activities along with research.

IMST experienced several challenges, with the need for its coordination role often exposing the lack of regional structures for collaboration. Limited human resources, medical supplies and especially funding were consistently raised as areas of concern. The incompleteness or unavailability of data often lead to challenges in analysis and modelling. Gaps also existed in identifying priorities for vulnerable groups such as refugees and displaced people. Finally, the lack of country capacity for activities such as IPC and RRT limited their COVID-19 response, and resulted in a focus on immediate issues at the expense of the long-term continuation of essential services.

Learning from the last six months, the IMST will continue to foster coordination and cooperation at the regional level, while identifying gaps and potential areas for further collaboration.