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Syrian Arab Republic: COVID-19 Response Update No. 08 - 4 August 2020

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This report is produced by the World Health Organization (WHO) and the Office for the Coordination of Humanitarian Affairs (OCHA), in collaboration with humanitarian partners. The next report will be issued on or around 15 August 2020.

HIGHLIGHTS

• As of 4 August, the Syrian Ministry of Health (MoH) confirmed 847 people tested positive with COVID-19, including 46 people who died and 268 who recovered.

• In north-west Syria (NWS), 36 people with COVID-19 have been identified as of 3 August, including 19 cases in Idleb and 17 in Aleppo governorates. No deaths have been reported.

• As of 4 August, 34 people with COVID-19 were reported in north-east Syria (NES), including one death and five people who recovered.

• Areas of concern: Densely populated areas, notably Damascus/Rural Damascus, Aleppo and Homs, and those living in camps and informal settlements in NWS and NES, collective shelters throughout the country, as well as other areas, including Deir-Ez-Zor, and where hostilities may be ongoing making sample collection more challenging.

• As of 24 June, 12,416 COVID-19 tests have been performed in laboratories in Damascus, Aleppo, Homs and Lattakia governorates. In addition, 3,543 COVID-19 tests have been performed in Idleb National lab for samples from Idleb and northwest Aleppo countryside as 3 August 2020.

SITUATION OVERVIEW

To date, the Syrian MoH has reported 847 people with COVID-19. Of these, Damascus reported the highest number of cases (463), followed by Rural Damascus (181); Aleppo Governorate (41); Quneitra Governorate (40); Lattakia (36); AsSweida Governorate (28); Homs Governorate (25); Dar’a Governorate (12); Tartous Governorate (11); as well as Hama Governorate (10).

Of the total cases, 104 cases were reportedly imported as of 24 July, with 203 reported as secondary cases (exposure/contact with a known case). According to available MoH data, nearly 28 per cent of cases required hospitalization, including, in some cases, oxygenation or mechanical ventilation in ICU units.

Of particular concern is the number of cases involving health workers. On 3 August, three health workers reportedly tested positive for COVID-19 at the Al-Hol IDP camp in Al Hasakah Governorate. The contact tracing process is ongoing. As a precautionary measure, only critical staff, with personal protective equipment (PPE), are allowed to operate inside the camp.

As of 24 July, 44 health care workers (eight per cent of reported cases) tested positive for COVID-19, according to the Syrian MoH, an increase of 26 since the previous report. Of these, 34 were in Damascus, six in Rural Damascus Governorate, two in Aleppo Governorate, and one each in Quneitra and As-Sweida governorates.

In NWS, the per centage of healthcare workers affected is significant, as the case index was a doctor. Of all cases, 17 (47 per cent) are health care workers.

This highlights the particular risks faced by healthcare workers; and underscores – given Syria’s fragile healthcare system with already insufficient numbers of qualified healthcare personnel – the potential for its overstretched healthcare capacity to be further compromised.

Of the 46 fatalities in Government of Syria (GoS)-controlled areas, 37 were in Damascus; three was in Rural Damascus; two were in As-Sweid’a; two were in Homs; one was in Aleppo; and one was in Qunietra;
As of 24 July, the Syrian MoH reported 12,416 tests had been conducted by the Central Public Health Laboratory (CPHL) in Damascus and the public health laboratories in Aleppo, Lattakia and Homs. The enhancement of laboratory and case investigation capacity across Syria, including in NES, remains a priority, as does the timely communication of all information relevant to the safeguarding of public health.

Since mid-April, there have been 34 confirmed cases of COVID-19 in NES, resulting in one death and five recoveries as of 4 August. To date, there has been one confirmed cluster of COVID-19 cases, centered on the Al Amran neighborhood of Al-Hasakeh. There has been no confirmed community-level transmission reported.

But despite the limited number of reported cases, the risk of large-scale transmission in NES remains high. Following the announcement of four new cases on 23 July, local authorities in NES reinstated a partial curfew. Included in this was the banning of all mass gatherings, including weddings and funerals, while restaurants are now limited to take-away service only. Authorities also emphasized the importance of personal preventive measures, such as physical distancing.

Additionally, effective immediately, no corpses are permitted to be transported into NES. While the border has been closed from 24 July, it’s understood that weekly humanitarian exemptions will be maintained.
The preventive measures came into force with immediate effect for an initial period of initial 15 days. Further clarification is being sought from NES authorities on a number of issues, including humanitarian exemptions, movement between administrative areas, as well as the possible adoption of more stringent measures, including localized lockdowns in areas most affected.
Of the four NES cases reported on 23 July, all reportedly suffered from underlying health conditions, and none had had contact with each other (i.e. the possibility of multiple separate clusters). Three of the cases (all in Qamishli city) had no travel history, while the confirmed case in Hassakeh city had reported recently travelled from Damascus. Each of the cases is reportedly self-isolating in their homes, with immediate contacts/family members also under quarantine. Contact tracing is continuing for all these cases, with all close contacts to be asked to undergo a polymerase chain reaction (PCR) test and self-quarantine for 14 days.

There is particular concern that medical personnel may have had sustained/unprotected exposure to at least one of these cases, with efforts underway to alert and isolate workers who may have been exposed. To this effect, an emergency meeting of the NES Forum COVID-19 TF technical committee was convened on 23 July. A series of priority actions were identified focusing on the activation/reactivation of capacities (e.g. isolation facilities, community messaging, rapid response teams (RRTs), sample collection/transportation), aggressive isolation of cases and transmission prevention, implementation of rigorous controls/ restrictions at points of entries (PoEs) and enhanced diagnostic capacity. Recommended actions were shared with local authorities and humanitarian partners, with further discussions to be convened in the coming days to support local implementation.
Meanwhile, the ongoing impacts of displacement, military operations, security hazards and nine years of conflict in both NES and NWS are increasingly being compounded by the rapid devaluation of the Syrian Pound (SYP) and the COVID-19 pandemic.

As of 3 August, 36 people with COVID-19 have been identified in NWS, with the first positive result recorded in Bab AlHawa on 9 July. Of these, 19 were from Idleb and 17 were from Aleppo. Since 9 July, 20 patients have recovered while 16 cases remain active. To date, 32 cases developed mild symptoms and 4 cases were asymptomatic. Out of total 36 cases, 23 (64 per cent) have recovered, with 3 cases having recovered in the past 24 hours.

As of 3 August, a total of 1,551 samples have been tested since reporting of the first case from NWS, with a test positivity rate of 2.3 per cent. Contact tracing is continuing for all positive cases and health partners are focusing on interrupting virus transmissions and reducing secondary infections.

NWS COVID-19 taskforce members have expressed their concerns over violations of coronavirus preventive measures during the Eid al-Adha holiday. The NWS might face a growing number of clusters of COVID-19 cases in two weeks time, given an incubation period of up to 14 days for the disease after exposure. Precautions against a potential spread of the virus have been scaled up in response to identified cases, including restrictions on movements, gatherings, commercial activities, and in-person education services. These measures are crucial to contain transmission, though they may intensify humanitarian need by complicating humanitarian response and through their impacts on local markets, income-generating opportunities and vital services. A total of 159 hospitals and primary health centres (PHC) have been equipped with COVID19 triage systems, and four community-based treatment centres (CCTC) have been operationalized to treat patients with mild-to-moderate cases of COVID-19. Humanitarian actors continue to adapt how they work in order to assist people in need while minimizing transmission risks for themselves and local communities, suspending services only when no safe solution is available.

UN Office for the Coordination of Humanitarian Affairs
To learn more about OCHA's activities, please visit https://www.unocha.org/.