Libya EWARN & Diseases Surveillance Bulletin Week 41 (11 - 17 October 2021)

Situation Report
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• At the national level, Libya reported a declining trend in cases and COVID-19 testing with increased deaths in Week 41 compared with Week 40, with a high incidence of community transmission and moderate lab testing capacity.

• 30 COVID-19 labs (out of 39) reported 26,963 (26268 PCR and 695 Ag-RDT) new lab tests done in Epi-week 41. Thus, out of the 1,761,655 tests in Libya since the beginning of the response, 350,628 (20%) were confirmed positive for SARS-CoV-2 (COVID-19).

• Compared to Epi-week 40, there was an 8% decrease in overall national testing: by regions, West (9% decrease), South (26% increase) and East (5% decrease). Thus, 89.7% (24,176) of national testing was performed in the West as compared to both East (only 2522 tests) and South (only 265 tests) Regions. (-see fig. 1). The decrease in East and West is attributable to low reporting of cases by RRTs and constraints in lab supplies.

• The national positivity rate for Epi-week has a decreasing trend since week 28. It slightly decreased from 14.4% in week 40 to 14.1 in week 41, mainly in the West, with a positivity rate of 12.2%. It cannot be generalized based on the positivity rate in the East (31.2%) and South (32.8%), 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 62 in week 40 to 56 in week 41. The overall number of new cases reported in EPID week 41 shows a 10% decrease (3,815 cases) from 4,255 cases last week, with West reporting an 11% decrease in new patients. East reported an 8% decrease, and South had a 6% 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 41, the number of new deaths (112) showed a 24% increase compared to last week (90). As a result, the mortality rate increased from 1.3 to 1.6 deaths per 100,000 cases, with a case fatality rate of 2.9%. The CFR remained high in East (8.3) and South (2.3), showing increased disease severity. Compared to last week, West reported a 45% increase in deaths for the reporting week, East (20% increase) and 60% decrease 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 a particular age or high-risk group. (Fig 3).