Egypt COVID-19 Response: Misinformation and Mixed Results

Hadeel Hamoud and Sama Elmahdy

Second only to South Africa, Egypt has one of the highest number of Covid-19 cases in Africa as of September 6, 2020. Officials believe the outbreak originated at the Nile Cruises in Luxor, a southern Egyptian city and a well-known tourist hotspot. In mid-February, Egypt registered its first confirmed positive case for the virus from a foreign national who recovered after careful monitoring. Dr. John Gabor, representative of the World Health Organization, praised Egypt for its rapid and transparent handling of the situation. Since then, the virus has spread throughout the country.

This map shows the governorates in Egypt with confirmed (red) or suspected (blue cases) of Covid-19 in Egypt, as of May 13, 2020. (https://simple.wikipedia.org/wiki/File:Latest_details_of_COVID-19_outbreak_in_Egypt.png)

As of September 6, 2020, there have been 99,712 confirmed coronavirus cases, 77,208 recovered cases, and a total of 5,511 deaths. Recent data from the Egyptian Ministry of Health illustrates a significant increase in new cases and deaths from August 11, raising suspicions of a second wave. While these are the official numbers, the Higher Education and Scientific Research minister, Khaled Atef Abdul Ghaffar, announced recently that the real tally of infections is likely to be five times higher, while the death rates are likely ten times higher.

Egypt’s government has implemented effective lockdown measures, economic reforms, and increased investment in the health sector to lower the curve of daily coronavirus cases. However, expanded state security, increased state repression, and a still weak public health sector have perpetuated the spread of the virus and exacerbated economic, health, and political consequences.

A graph showing the number of new cases in Egypt over the past couple of months. (https://www.bing.com/covid/local/egypt?vert=graph)

GOVERNMENT RESPONSE

Timeline

Purple: Public health measures; Orange: health system response; Blue: socio-economic measures

February 15: First COVID-19 confirmed case in a foreign national. Dr. John Gabor, representative of the world health organization (WHO), praised Egypt for the rapid and transparent handling of the situation.

March 1: Minister of Health, Dr. Hala Ziad made a trip to China to show “solidarity.” Egypt gave ten tons of medical supplies to China. Similar gestures made toward Italy, the U.K. and the U.S. sparked outrage in Egypt where supplies were already short.

March 5: Egypt registers first COVID-19 case in an Egyptian national who returned from Serbia via France.

March 9: Government bans community events and mass gatherings. First death due to COVID-19 of a German tourist who came down with the infection during a visit to Luxor

March 15: Officials insist that tourist sites in Luxor remain open. Egyptian military announced new measures including using chemical weapons department to help with testing and sanitizing some streets and public spaces. Schools and universities announced a two- week closures.

March 17: Minister of Trade and Industry issued two decrees banning for three months the export of infection prevention supplies including face masks and alcohol.

March 19: Flights to and from countries with high virus spread like China and Italy suspended at Egyptian airports until the end of month. Until March 31, all cafes, malls, sporting cubs, and nightclubs would be closed from 7pm to 6am.

March 21: Minister of Endowments announced that prayer in all mosques would be suspended for two weeks.

March 24: Curfew from 7pm to 6am for two weeks, beginning March 25. Flights suspended until April 15th. School, university, cafes, sports club, and gym shut downs extended to April 15. Public transportation to be halted and most public service and government offices to be closed to the public during the curfew. Government allocating one billion Egyptian pounds ($6.4 billion) to the health ministry. To support the economy, a 3% interest rate cut has been added.

March 29: Central Bank announced a series of limits on cash withdrawals and deposits to avoid overcrowding especially during payroll and pension disbursement.

March 30: Several hospitals close temporarily for sterilization.

March 31: Government requires Egyptian citizens to sign waiver agreeing to mandatory quarantine upon arrival to Egypt.

April 7: Government bans Ramadan gatherings.

April 8: Egypt expands the nighttime curfew until April 23.

April 23: Government extends nighttime curfew through Ramadan.

April 28: President Abdel Fatah al-Sisi ordered the renewal for another three months of the long-running state of emergency which gives broad powers of arrest and detention and curtails constitutional rights such as freedom of speech. Egypt has been in a state of emergency since April 2017 with the government arguing it’s necessary to combat terrorism.

May 3: Hotels to progressively begin operations.

May 5: Health ministry officials announced that the 17 public hospitals that had been designated to quarantine and isolate patients were full.

May: Egypt received $2.8 billion in financing under Rapid Financing Instrument from IMF approved to respond to virus.

May 8: President al-Sisi has ratified new amendments to Egypt’s emergency law giving himself and security additional powers¹.

May 17: World Bank approves $50 million for Egypt as an emergency response under World Bank Group’s Fast Track COVID-19 Facility. Face Masks mandatory in banks.

May 19: Officials announce a fine of 4000 Egyptian pounds on anyone not wearing a mask.

May 21: Minister of higher education presented a statistical model that predicted the pandemic would recede by May 28 after reaching 40,000 cases.

May 24-29: Authorities announced that coronavirus restrictions will be tightened during Eid Al-Fitr.

May 30: Nighttime curfew reverts to 8pm to 6 am. Facemasks now required for those using public/private transport, or entering public spaces.

May 31: Nighttime curfew reduced from 8pm to 5am.

June 1: International flights and tourist resorts to resume operations.

June 21: High schools reopen for final exam period.

June 23: Number of deaths among medical staff reached 92 doctors.

June 27: Most restrictions are lifted. Restaurants and cafes are allowed to open at 25% capacity, and close by 10pm. Shops have to close by 9pm. Cinemas, cultural centers, and sports clubs are also limited to 25% capacity. Places of worship not allowed to hold weekend services. Beaches, public parks, and shisha bars to remain closed. The nationwide curfew was reduced from 12am to 4 am.

July 9: Egypt received $5.2 billion from the IMF under a 12 month Stand-by Arrangement (SBA).

August 28: Friday prayers reopen at some mosques under strict measures such as restricting attendance and social distancing.

September 11: Coptic Orthodox Church to resume mass every day except Friday.

October 17: Academic year for public schools and universities will begin using a “hybrid” model.

Lockdown and Expanded Security State

President Abdel Fatah al-Sisi has used the pandemic as an opportunity to expand state powers under emergency law. Egypt has been in a state of emergency since April 2017 under claims that it is needed to combat terrorism and drug trafficking. However, many human rights groups see these measures as tools to strengthen al-Sisi’s control over the country. On May 8, al-Sisi ratified new amendments that gave him additional powers under emergency law to address what the government claims is a “legal vacuum” and to prevent the spread of coronavirus. Human Rights Watch reports that only 5 of the 18 amendments clearly involve public health issues such as shutting down schools, universities, courts, and businesses as well as placing those returning from overseas in quarantine. Other amendments give al-Sisi the power to postpone tax and utility payments, provide economic support to communities and businesses and allow him to restrict people from owning, transporting, selling, buying, or exporting goods or services including controlling their prices. al-Sisi also has the authority to ban or limit public and private gatherings, even in the absence of a public health emergency. Still, lockdown measures have been effective and Egypt is seeing an overall decline in cases with new infections dropping. Nevertheless, human rights groups are concerned the regime is using the pandemic to expand security, increase the state’s repressive powers, and crack down on the few remaining civil society groups in the country, opening the door for more human rights abuses.

Response in Education and Tourism: Effective Lockdowns and Early Reopenings

Schools

Egypt’s public health measures effectively lowered the rate of new coronavirus cases; however, early reopening threatens this progress. Due to lockdown policies, public and private schools, as well as higher education institutions were closed on March 15. Students began accessing materials online to continue their education. Final exams were cancelled for students in the K-8 grades, and they instead had to submit a research paper for each subject. On the other hand, high school students took their final exams on June 21 in person, despite parental concern over the virus. Over 798,000 high school students were due to sit for exams throughout the nation. To mitigate risk, students’ temperature was measured before they were seated for the exam. The health ministry also prepared 2,500 ambulances and provided a doctor to each school. Although schools have remained closed throughout the summer, the academic year for public schools and universities are set to begin on October 17 with a “hybrid” model. However, international schools are not required to adhere to the October 17th timeline, so they may open earlier or have a different operating status.

Tourism and Travel

With tourism accounting for about 12% of Egypt’s gross domestic product, the country was eager to start reopening travel again to foreigners. After a 3-month halt of tourist flow due to the virus, Egypt reopened its seaside resorts to international flights and foreign tourists on July 1st. The national airline, EgyptAir, also announced the resumption of international flights on July 1st, but that it would ensure testing before boarding. Egypt also re-opened Luxor and Aswan to international visitors on September 1. As the country has reopened, the number of COVID-19 cases has spiked. This may be partly due to Egypt’s reopening; as of August 26th, there have been over 126,000 tourists. Some precautions have been set in place to mitigate spikes in new cases. Foreigners arriving in Egypt are required to have their temperature taken, fill out a Public Health Card, and show proof of a valid health insurance policy. Additionally, government officials introduced a new policy on September 1st, in an effort to hinder the spread of COVID-19. Under the new restrictions, all travellers, including Egyptian nationals, must provide a negative PCR test upon entry into Egypt.

Economic policies/assistance

OECD developed a comprehensive overview of the policy reactions to the COVID’s economic impact as of April 20, 2020. Most measures that the government has implemented target economic reforms for big businesses. Egypt has granted a 3% interest rate cut and injected 20 billion Egyptian pounds into the stock market. Notably, the government allocated the equivalent of $6.4 billion towards the health sector. Egypt has also implemented several economic policies to assist individual citizens. Pension wages have been increased by 14%. A targeted support initiative for irregular workers in sectors most severely impacted by the virus has also been announced, which consists of 500 EGP monthly grants to over 1.6 million beneficiaries. Additionally, another initiative totalling 10 billion EGP grants citizens 2-year, low interest loans to pay for discounted consumer goods and provide ration card subsidies.

SHORTFALLS AND LIMITATIONS

Lack of Data and Misinformation

Lack of data, the spread of misinformation, and a lack of transparency have created an official information blackout, contributing to Egypt’s failure to implement effective COVID policies. The Supreme Media Regulatory Council, a government entity that censors and oversees media, warned of “legal action” against any media outlet or journalists whose reporting contradicts official statements on Egypt’s COVID-19 response. This exacerbates the spread of misinformation since 60% of 1,098 adults surveyed in Cairo say they completely or mostly trust information from the government about COVID-19.

Campaign against journalists, health workers and free speech

Media plays a vital role in raising public awareness about protective measures and spreading accurate, up-to-date scientific information about the virus. In response to the pandemic, human rights groups have suggested that President al-Sisi’s government has focused instead on spreading misinformation, propaganda, and repression to promote claims of low infection rates as well as conspiracy theories. Since March, security forces have detained healthcare professionals for speaking out about deaths of frontline healthcare workers, complaining about a lack of protective gear, criticizing the government’s response, or reporting coronavirus cases without authorization. The Arab Network of Human Rights head Gamal Eid estimates a total number of arrested at 500 people including 11 journalists.

March-June: More than 70 people including doctors, medical workers, journalists, and lawyers, were arrested between March and June 2020.

March 13: Three doctors arrested for spreading false news on Facebook about the number of infected people in Egypt.

March 16: Egyptian Ministry of Health rejected results of a Canadian medical study analyzing the likely spread of COVID-19 in Egypt.

March 17: Health Ministry launched a media campaign against The Guardian, revoked its accreditation, and closed its office.

May 25: Dr. Ala Eid, Head of the Preventative Medicine sector said the pandemic was “stable.

June 1: Minister of Health stated the superior strength of Egyptians’ immune systems had given the government “breathing space” to deal with the pandemic.

Lack of testing and PPE

Limited data on testing exists due to government censorship and lack of transparency. However, on July 15, Egypt had conducted 105,000 for its population of 100 million. By comparison, Germany had conducted close to 4 million tests for its population of 83 million. This lack of testing has contributed to the spread of the virus.

Moreover, in an effort to uphold claims of a low number of cases, Egypt gave ten tons of medical supplies including PPE to China, Italy, the U.S. and the U.K. despite running short at home. On April 19, with the shipment of supplies to the US was scheduled land three days later, Egypt registered a total of 3032 cases and 224 deaths with a 7.3% death rate. Some doctors have to buy their own PPE, raising the price and putting doctors and nurses at risk. To this end, by May 2020, 11% of those infected with the virus were healthcare workers. In early April, doctors at the National Cancer Institute began posting on social media that many colleagues were infected, but the hospital’s management had not taken appropriate measures to quarantine patients or staff. Hospital management threatened to fire doctors for speaking out about PPE shortages. In May, the doctors’ union said the deaths and infections among its members were the result of the health ministry “falling short” of doing its duty to protect them. Health Minister Hala Zayed responded by stating that there were “sufficient stocks” of PPE.

Medical brain drain

The Middle East and North Africa (MENA) scores second-lowest among all regions in the overall Global Health Security Index, while ranking last in both ‘epidemiology workforce’ and ‘emergency preparedness and response planning. Egypt in particular has one of the world’s lowest rates of doctors per capita, averaging 10 doctors per 10,000 citizens compared to a global average of 32. This physician shortage is exacerbated by doctors’ emigration. Between 2016 and 2019, the Egyptia Medical Syndicate estimates that half of the country’s doctors, 110,000 out of 220,000 registered doctors, have left the country. Public hospitals are understaffed by about 55,000 nurses. Low wages, high cost-of-living due to the devaluation of the Egyptian pound, poor working conditions, and a weak health sector are some of the reasons for the emigration of health workers.

The medical brain drain thus worsens Egypt’s already underinvested healthcare resources. In 2018/2019, only 31% of Egyptians said they were satisfied with the overall performance of their government’s health care service. Moreover, a shortage of healthcare workers increases the population’s vulnerability to coronavirus by weakening its capacity to address the influx of patients. On May 5, Egypt’s isolation hospitals for people infected with COVID-19 reached maximum capacity.

Poor Access to Water Sanitation and Hygiene (WASH)

Many rural areas and urban slums are deprived of access to clean, safe water. In 2014, 7.3 million people were deprived of access to safe water among which 5.8 million lived in rural areas and 1.5 million in urban areas. Moreover 8.4 million were deprived of access to improved sanitation, mostly in rural areas. Approximately 50 million people suffer from overflowing sewage from traditional septic tanks. Only 6% of Egyptian villages are provided with wastewater treatment services. Additionally, only 18% of households in rural Egypt are linked to public sewer, leaving millions of citizens to deal with overflowing sewage systems. Lack of access to safe water, proper sanitation, and wastewater facilities contribute to the spread of the virus. The absence of key measures to address these concerns has consequently exacerbated infection rates.

Weak, underfunded public health sector

Egypt’s weak healthcare system has also exacerbated infection rates. With 95% of the population living on just 4% of the land, wide geographical disparities exist between urban and rural areas of the country. Moreover, there are only 3,000-4,000 ventilators and 11,000 intensive care beds for the 100 million person population, and the health system accounts for just 5% of the country’s GDP exemplifying the government’s low investment in the health sector. Due to low public investment, many citizens rely on the private health care system, exacerbating inequities.

Weak health infrastructure makes refugees particularly vulnerable. More than half of Egypt’s refugees are from Syria with others from Sudan, Ethiopia, Eritrea, South Sudan, and Yemen. Prior to the pandemic, vulnerability assessments conducted by UNHCR showed that eight out of ten refugees in Egypt were unable to meet their basic needs. Since the beginning of the crisis, UNHCR continued to disburse its monthly multi-purpose cash assistance to 40,449 individuals. To help mitigate the consequences of a weak WASH sector, UNHCR supplemented the cash assistance for the month of May with an additional one-off special grant for hygiene items.

COVID outbreaks in prisons

It is essential also to highlight Egypt’s prisons and detention centers. According to the UN, as many as 114,000 inmates are held in overcrowded, unsanitary prisons and detention centers including thousands of democracy activists, political opponents, journalists, and bloggers. A May 2015 report from the National Council for Human Rights estimated that police stations and prisons were 300% and 160% over capacity respectively with inhumane and degraded conditions. Since March, the Egyptian Interior Ministry has kept detainees from the outside world, banning all prisoners from receiving visits (including from families and lawyers) and making or receiving phone calls or written communications, what critics say is an illustration of Al-Sisi expanding his security state.

The Human Rights Watch developed a report on apparent COVID-19 outbreaks in Egypt’s prisons based on witness accounts, leaked letters from two prisons as well as credible reports by local rights groups and media. As of July 15, 14 prisoners and detainees in 10 detention facilities have died likely from COVID-19 complications. Of the 14 deaths, only 9 were transferred to a hospital. Prisons have insufficient medical care and virtually no access to testing for the virus or symptom screening. Prison authorities have not administered any contract tracing measures and have failed to isolate prisoners who show symptoms, according to the HRW report. Authorities have released about 13,000 prisoners since late February, but this is still insufficient to alleviate overcrowding.

LOOKING FORWARD

Egypt has used the pandemic to increasingly crack down on civil society by censoring reporting and free speech. However, Egypt has implemented some effective policies and invested resources directed at stopping the spread of the virus. The country has increased investment in the public health sector and several lockdown procedures have been put in place. Beyond this, Egypt and human rights groups have also created several promising projects to improve access to water and sanitation.

In collaboration with USAID, the Egyptian Holding Company for Water and Wastewater (HCWW) has initiated the North Sinai Initiative, which aims to provide potable water and improve sanitation for North Sinai residents through the construction of deep wells desalination plants, water reservoirs, and potable water transmission and distribution lines. So far, this initiative has brought potable water access to all of the estimated 450,000 people living in the region, and has provided sanitation services to more than 110,000 people. Additionally, HCWW has selected a consortium to lead another project that aims to improve access to sanitation services through wastewater infrastructure in the Fayoum governorate. The Fayoum Wastewater Expansion program plans to increase access to sanitation from 32.6 percent to 86 percent in rural areas of the Fayoum governorate and, improving access for a total of 940,000 people in the rural areas of Fayoum. Beyond this, in an effort to protect healthcare workers, scientists from Egypt have used nanotechnology to develop a new and more effective design for a protective respirator mask. The design utilizes a reusable, recyclable, customizable, antimicrobial and antiviral respirator facial mask feasible for mass production, and demonstrates Egypt’s strides towards implementing innovative solutions to curb the spread of coronavirus throughout the nation. The international community should begin to hold Egypt accountable for its human rights violations and lack of transparency around data and information related to the coronavirus. Nevertheless, new technological improvements and projects show promise and effort in regards to keeping the virus contained.

Notes