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Coronavirus in a war zone: Afghanistan braces for outbreak after first case

26 Feb 2020 The Guardian

Preparations for an outbreak of coronavirus were underway in Afghanistan as the country confirmed its first case in the western province of Herat, which borders Iran.

Seven more suspected cases have been identified in Herat, and three cases in the nearby provinces of Farah and Ghor.

The affected Herat residents had recently returned from Qom in Iran, where the coronavirus outbreak has already killed at least 16 people and infected dozens of others, according to Iranian officials.

Quick guide What is the coronavirus and should we be worried? Show Hide What is Covid-19 - the illness that started in Wuhan?

It is caused by a member of the coronavirus family that has never been encountered before. Like other coronaviruses, it has come from animals. Many of those initially infected either worked or frequently shopped in the Huanan seafood wholesale market in the centre of the Chinese city.

Have there been other coronaviruses?

Severe acute respiratory syndrome (Sars) and Middle Eastern respiratory syndrome (Mers) are both caused by coronaviruses that came from animals. In 2002, Sars spread virtually unchecked to 37 countries, causing global panic, infecting more than 8,000 people and killing more than 750. Mers appears to be less easily passed from human to human, but has greater lethality, killing 35% of about 2,500 people who have been infected.

What are the symptoms caused by the new coronavirus?

The virus can cause pneumonia. Those who have fallen ill are reported to suffer coughs, fever and breathing difficulties. In severe cases there can be organ failure. As this is viral pneumonia, antibiotics are of no use. The antiviral drugs we have against flu will not work. Recovery depends on the strength of the immune system. Many of those who have died were already in poor health.

Should I go to the doctor if I have a cough?

UK Chief Medical Officers are advising anyone who has travelled to the UK from mainland China, Thailand, Japan, Republic of Korea, Hong Kong, Taiwan, Singapore, Malaysia or Macau in the last 14 days and who is experiencing a cough or fever or shortness of breath to stay indoors and call NHS 111, even if symptoms are mild.

Is the virus being transmitted from one person to another?

China’s national health commission has confirmed human-to-human transmission, and there have been such transmissions elsewhere.

How many people have been affected?

As of 20 Februrary, China has recorded 2,118 deaths from the Covid-19 outbreak. Health officials have confirmed 74,576 cases in mainland China in total. More than 12,000 have recovered.

The coronavirus has spread to at least 28 other countries. Japan has 607 cases, including 542 from a cruise ship docked in Yokohama, and has recorded one death. There have also been deaths in Hong Kong, Taiwan, France and the Philippines.

There have been nine recorded cases and no fatalities to date in the UK. As of 17 February, a total of 4,501 people have been tested in the UK, of which 4,492 were confirmed negative.

Why is this worse than normal influenza, and how worried are the experts?

We don’t yet know how dangerous the new coronavirus is, and we won’t know until more data comes in. The mortality rate is around 2% at the centre of the outbreak, Hubei province, and less than that elsewhere. For comparison, seasonal flu typically has a mortality rate below 1% and is thought to cause about 400,000 deaths each year globally. Sars had a death rate of more than 10%.

Another key unknown is how contagious the coronavirus is. A crucial difference is that unlike flu, there is no vaccine for the new coronavirus, which means it is more difficult for vulnerable members of the population – elderly people or those with existing respiratory or immune problems – to protect themselves. Hand-washing and avoiding other people if you feel unwell are important. One sensible step is to get the flu vaccine, which will reduce the burden on health services if the outbreak turns into a wider epidemic.

Is the outbreak a pandemic?

A pandemic, in WHO terms, is “the worldwide spread of a disease”. Coronavirus cases have been confirmed outside China, but by no means in all 195 countries on the WHO’s list. It is also not spreading within those countries at the moment, except in a very few cases. By far the majority of cases are travellers who picked up the virus in China.

Should we panic?

No. The spread of the virus outside China is worrying but not an unexpected development. The WHO has declared the outbreak to be a public health emergency of international concern. The key issues are how transmissible this new coronavirus is between people, and what proportion become severely ill and end up in hospital. Often viruses that spread easily tend to have a milder impact. Generally, the coronavirus appears to be hitting older people hardest, with few cases in children.

Sarah BoseleyHannah Devlin and Martin Belam

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Afghanistan’s national security council announced on Monday that all air travel to and from Iran had been suspended and borders had been closed.

However, an estimated 3,000 people cross between Iran and Afghanistan illegally every day.

Coronavirus fears grip Middle East as Iran denies cover-up Read more

Oral swabs have been sent from Herat to Kabul’s central public health laboratory for testing. The laboratory in Kabul is the only one in the country of 35 million people able to test for the virus. It has just three machines.

Alimi Sahib, a project manager at the lab, said more testing equipment was needed. “We need to decentralise to regional level, especially since test results take between four to six hours.

Staff at Afghan-Japan Communicable Disease Hospital in Kabul are gearing up for potential cases. Photograph: Stefanie Glinski

“If there are more cases in the provinces in the future, we cannot continue to send all of them to Kabul,” he said.

The World Health Organization (WHO) in Afghanistan said work to prepare for an outbreak had been underway since January, but the country needed at least $3.5m (£2.7m) to implement the measures needed.

“More than 700 surveillance-reporting health facilities have already been allocated in the provinces, but more funding is needed to equip isolated areas, as well as more staff, protective equipment and mechanical ventilation machines,” said Dr Elnoor Muntasir El Hassan from WHO.

The Afghan-Japan Communicable Disease Hospital in Kabul was gearing up to treat the virus in the city, where so far no cases have been reported. Munir Shah, a nurse at the hospital, said: “I’m very scared. The situation is tense. I walk through the empty halls and I worry that they might fill up.”

Dr Mohammed Khan said ‘people are afraid’, but he’s confident his hospital in Kabul is prepared to deal with the virus. Photograph: Stefanie Glinski

The hospital in the west of Kabul, which normally treats HIV and tuberculosis patients, has increased its bed count from 60 to 100, and has constructed separate male and female isolation wards.

Though it is empty and eerie, new equipment is arriving daily. Coronavirus awareness brochures and posters have been put up around the building.

“People are afraid,” said Dr Mohammed Khan, one of the hospital’s heads, but he added he felt confident. “We are ready to take on patients. We’ve dealt with other highly contagious viruses in the past, and we will be able to handle this one too – if it comes to Kabul.”

But amid political turmoil, the threat of a wider coronavirus outbreak has added to an already tense environment throughout Afghanistan.

Last week’s election results, in which President Ashraf Ghani was reelected for another five-year term, have been disputed by his main rival Abdullah Abdullah, who also declared himself the winner and said he would form a separate government.

The country is in the midst of a seven-day violence reduction period, preceded by the signing of a peace deal between the US and the Taliban, that could end America’s longest war in history and lead to its troops leaving the country.

“Everything is happening at once,” Khan said, standing outside the clinic on the outskirts of the city. “I hope we can at least fend off the coronavirus.”


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