Libya COVID-19 Surveillance Weekly Bulletin: Epidemiological Week 42 (18 – 24 Oct)

Situation Report
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• At the national level, Libya reported a declining trend in cases and lab testing in Week 42 with a rising trend in the number of deaths since the last five weeks, with a high incidence of community transmission and moderate lab testing capacity.

• 29 COVID-19 labs (out of 39) reported 23,500 (22,416 PCR and 1,084 Ag-RDT) new lab tests done in Epi-week 42.
Thus, out of the 1,785,155 tests in Libya since the beginning of the response, 354,215 (19.8%) were confirmed positive for SARS-CoV-2 (COVID-19).

• Compared to Epi-week 41, there was a 13% decrease in overall national testing: by regions, West (15% decrease), South (55% decrease) and East (16% increase). Thus, 87.1% (20,465) of national testing was performed in the West as compared to both East (only 2915 tests) and South (only 120 tests) Regions. (-see fig. 1). The decrease in West and South is attributable to low reporting of cases by RRTs and constraints in lab supplies. In the South, testing was only done in Sabha in week 42.

• The national positivity rate for Epi-week has a decreasing trend since week 28. It increased from 14.1% in week 41 to 15.3 in week 42, in the West, with a positivity rate of 12.7%. It cannot be generalized based on the positivity rate in the East (32.8%) and South (25.8%), which differ markedly from the national-level positivity rate. It is recommended that positivity rates should be kept below 5% in all districts. National numbers of cases, deaths and lab tests are skewed to West.

• Case incidence per 100,000 decreased from 56.01 in week 41 to 52.67 in week 42. The overall number of new cases reported in EPID week 42 shows a 6% decrease (3,587 cases) from 3,815 cases last week, with West reporting a 12% decrease in new patients. East reported a 22% increase, and South had a 64% decrease in cases.

• Libya has not reported an official confirmation of the Delta variant. However, Delta circulation has been detected in neighboring Egypt, Tunisia, and Algeria. In addition, neighbouring Sudan has reported a Gamma variant. Therefore, Libya stays classified under community transmission (high incidence) with Alpha and Beta Variants of Concern (VOC) circulation.

• In Epi-week 42, the number of new deaths (124) showed an 11% increase compared to last week (112). As a result, the mortality rate increased from 1.6 to 1.8 deaths per 100,000 cases, with a case fatality rate of 3.5%. The CFR remained high in the East (7.7) and South (16.1), showing increased disease severity. Compared to last week, West reported no change in deaths for the reporting week, East (14% increase) and 150% increase reported in South (- see table 1).

• In the last four weeks, a decoupling of mortality and incidence trends (i.e., mortality higher than expected for a given incidence) shows an increase in disease severity and increased transmission in particular age or high-risk group and cases to deaths lag period. (Fig 3).