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Syrian Arab Republic: COVID-19 Response Update No. 10 - 23 September 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 9 October 2020.

HIGHLIGHTS

  • As of 19 September, the Syrian Ministry of Health (MoH) reported 3,765 laboratory-confirmed cases,932 recoveries and 170 deaths.

  • In northeast Syria (NES), the number of confirmed cases continues to rise, with 1,121 cases confirmed as of 18 September, including 328 recoveries and 52 deaths. The actual number of COVID-19 cases in NES is likely significantly higher due to significant gaps in detection and testing capacity.

  • As of 19 September, the MoH reported approximately 34,033 tests performed in laboratories in Damascus, Aleppo,
    Homs and Lattakia governorates. A new laboratory in Rural Damascus has been established. Of the cases announced by the MoH, 143 are reported to be healthcare workers, mainly working in Damascus.

  • In northwest Syria (NWS), a major focus has been on curbing transmission among health care workers (HCWs), as over 35 per cent (25) of cases are among HCWs. To mitigate outbreaks among the medical community, a number of actions are being undertaken. One of the most significant challenges remains the isolation of people living in crowded conditions and camp settings.

SITUATION OVERVIEW

In Government of Syria (GoS)-controlled areas of the country, 3,765 laboratory-confirmed cases have been reported by the MoH as of 19 September: three in Ar-Raqqa; 13 in Deir-ez-Zor; 26 in Al-Hasakeh; 76 in Dar’a; 76 in Quneitra; 104 in Tartous; 130 in As-Sweida; 139 in Hama; 270 in Homs; 317 in Rural Damascus; 410 in Lattakia; 873 in Aleppo; and 1,328 in Damascus. In total, 1,892 new cases have been announced since the last report. The Syrian MoH has announced 170 fatalities, representing an increase of 58 cases since 1 September, or one-third of all reported deaths. In addition, 932 recoveries were reported.
Highlighting the particular risks faced by healthcare workers, 143 healthcare workers have tested positive for COVID-19, according to the Syrian MoH; an increase of 53 since the last report. This includes 59 in Damascus, 30 in Lattakia, 14 in Rural Damascus, nine in Aleppo, six in Quneitra, six in Tartous, seven in Hama, six in Dar’a, three in Al-Hasakeh, two in As-Sweida and one in Homs. Eleven HCWs are reported to have died, most recently on 3 September.
The steady increase in affected healthcare workers reported since July 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. Humanitarian actors continue to receive reports that healthcare workers in some areas do not have sufficient personal protective equipment (PPE). The WHO continues to lead efforts to support increased distribution of PPE where needed to ensure the protection of healthcare workers already operating under very challenging circumstances.
While official numbers remain relatively low, it is clear that in past weeks the epidemiological situation in Syria has rapidly evolved and all factors – including that some 91 per cent of announced cases to date have not been linked to exposure/contact with a known case – point to community transmission now being widespread. Since July, official numbers have risen sharply and outpaced the rate of expansion in reported numbers of tests performed. In the past four weeks alone, confirmed cases reported by the MoH have increased by around 94 per cent.
As of 18 September, there are 1,121 confirmed cases of COVID-19 in NES. Of these, there were 741 active cases, 328 recovered cases and 52 deaths. More information on the epidemiological situation in NES by area is provided under the next section. Of the 1,121 cases, the highest number of cases (358) were reported from Qamishli and Al Hasakeh District (264) in Al Hasakeh Government.
As of 12 September, new confirmed cases continue to be concentrated in Al-Hasakeh Governorate, with the highest weekly increase recorded in Derik (Malakiyeh) District with 50 new confirmed cases (a 53 per cent increase in confirmed cases week-on-week). The number of new confirmed cases recorded outside Al-Hasakeh remains limited. Overall, the number of confirmed cases in NES does not provide an accurate reflection of infection prevalence.
Under-testing resulting from a combination of factors, including low reporting, the widespread use of rapid diagnostic tests (RDTs), and the misapplication of clinical screening protocols, presents a high likelihood of significant undetected transmission, particularly for cases with more mild symptoms. In addition, there are concerns around the laboratory’s capacity to process a significant increase in samples.
The high risk of undetected transmission in NES is compounded by the limited lockdown measures imposed in many areas, local coordination challenges (including around the deployment of rapid response and contact tracing teams, as well as the referral of patients with severe symptoms to designated COVID-19 facilities), sub-optimal case management capacity, as well as concerning levels of transmission being reported among healthcare workers and at key health facilities.
As of 18 September, 165 of the 1,121 confirmed cases of COVID-19 in NES were recorded amongst health workers. Of these, 66 (40 per cent of cases among health workers) were recorded in Hassakeh District. As previously reported, transmission has been recorded at the three main hospitals in the city- Hassakeh National Hospital (HNH), Hassakeh Military Hospital (HMH) and Al Hikma Hospital. As of the week beginning 6 September, there were reportedly two active COVID-19 cases amongst health workers at both HNH and HMH.
The number of confirmed cases among healthcare workers is likely considerably higher with reports that some health workers displaying symptoms have not been tested and a lack of visibility on transmission in some hospitals. This has had a significant impact on health service continuity. The high level of exposure among health workers is due to a combination of factors, including low levels of compliance with personal preventative measures – including proper use of PPE and lack of social distancing among staff, inadequate screening/triage at the entrance to health facilities, suspect cases visiting health facilities rather than reporting symptoms remotely, movement of health workers between multiple health facilities and, in some cases, reported shortages of PPE. Over the last week, in consultation with the NES COVID19 Technical Committee, local authorities’ central Directorate of Health (DoH) circulated a formal directive to all local health committees mandating additional measures/safeguards to limit transmission among health workers.
To date, there have been seven confirmed cases among camp residents in NES, including a 19-year-old woman at the Al Hol camp on 14 September who is currently in isolation, as well as four cases confirmed at camps in Menbij on 19 September. It’s not been possible to impose local lockdowns in camps or movement restrictions, and screening of close contacts is only occurring at the Al Hol IDP camp, not Menbij.
There remains a significant risk and high likelihood of transmission in camps. Since the previous update, several confirmed cases of COVID-19 have been recorded among non-resident staff (including health workers) at multiple camps.
Although community-level testing is not possible, active surveillance inside camps in NES is being stepped up, including through a dedicated camp-wide campaign in Al Hol. This aims to enhance detection of suspect cases with a view to containing any outbreaks as effectively as possible. Key challenges in relation to COVID-19 risk mitigation and response capacity include the total lack of screening procedures at the entrance to some camps, poor adherence to lockdown/preventative measures, underreporting of symptoms (especially when mild) among the camp population, low contact tracing capacity, the lack of dedicated quarantine capacity in camps, as well as limited readiness of isolation areas in all camps (gaps including partitions for suspect cases, medical waste disposal capacity i.e. incinerator, laundry area and WASH infrastructure), with many people refusing to relocate to the isolation area.
In NWS, as of 12 September, 213 confirmed cases of COVID-19 were reported (69 from Idleb and 144 from Aleppo governorate), including three deaths (Case Fatality Rate: 1.4 per cent). Until that date, 193 cases developed mild symptoms, 10 developed moderate/severe symptoms, and 10 cases were asymptomatic. 87 (41 per cent) of the cases have already recovered. Among the cases, 110 were males and 103 females. The mean age of the cases is 34 years, five cases are under five years of age, and 15 cases are over 60 years old. Of all cases, 67 (31 per cent) are health care workers.
As part of capacity building activities, the early warning alert and response system (EWARN) District Level Officers have conducted 40 training sessions for 40 Health Facilities in Ariha, Idleb, Harim, Afrin, Jarablus and Jisr as Shagur district from Idleb and Aleppo governorates to train 505 NGO health care providers on the basics of COVID disease surveillance and diagnosis. Also during this period, under the collaborative initiative between the EWARN partner and the MoH Turkey for Laboratory Quality Assurance program for COVID-19, the second batch of samples were dispatched from Ankara reference laboratory to be tested in Idleb laboratory.

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