Brigadier Gen (ret) Tarek Mohamed Galal, NESA Alumnus and Senior Researcher, Crisis & Disaster Management Dept., Information and Decision Support Center (IDSC), Egyptian Cabinet
The coronavirus pandemic has resulted not only in widespread health crises and human suffering, but also dire global economic consequences. While many countries were able to reopen their economies after a series of strict preventive measures, others saw a resurgence of the pandemic as citizens failed to comply with recommended precautionary practices. Due to the progress made by the Egyptian Ministry of Health and Population in reducing death rates and the leveling off of the numbers of new infections, a reopening of the economy was possible. The Information Center in the Egyptian Cabinet conducted polls to measure the economic impact of stay-at-home restrictions, as well as citizens’ awareness of preventive measures with the following results:
- About 1% of the sample surveyed were negatively impacted financially. Of those, 53.7% saw the coronavirus significantly affecting the Egyptian economy, while 34% supported reopening of the economy as long as necessary precautions were taken. Of those surveyed, 90.1% of the citizens supported a fine for those refusing to wear a protective mask in mass transportation, government departments, banks, and markets. Those surveyed also believed that restrictions could be gradually phased out based on citizens’ continued willingness to comply with prevention requirements.
- The survey also reflected a high level of awareness among citizens (4%) to the causes and danger of spreading the virus. Confidence in the government that measures to reduce the spread of the virus were successful was at a high of 61.7%. Also, 57.6% of those surveyed had confidence in the government’s statements and its official reported numbers of infections/deaths.
The Egyptian government began implementing gradual opening of the economy with the so-called “Coexistence Plan“on 25 May 2020, which was still heavily geared towards continuing prevention measures. The first stages of reopening started with government offices that provided needed services to citizens, after which came the opening of cafes and restaurants with a restricted occupancy rate of 25%. Also tracked during the gradual reopening was citizens’ continued compliance with preventive measures. Further progress and steps to reopen were tied to reported cases in the various governorates using modeling to determine compliance and links to new cases of infection. The modeling included:
- Use of the differential Susceptible-Infected-Exposed-Recovered-Dead (SEIRD) model, which captures data on death rates.
- The construction of a model started in May 2020 to project future cases, especially after the early stages of economic reopening in the period started on 21 July.
- The results of Egypt’s “interactive testing” to diagnose and record new cases. The process limits polymerase chain reaction (PCR) tests only for cases with symptoms and some contact cases. The disadvantage of this strategy of course is the loss of capturing correct number of actual cases which therefore limits the government’s ability to devise a comprehensive health policy for managing future epidemic cases.
- Use of “Google Maps” to track the movement of Egyptian citizens in the streets and show their movement from their homes and places of gatherings, specifically tailored to governorates. This tracking was used for movements of people during the period from 25 March to 27 June when curfews were in place allowing a baseline comparison to January 2020 prior to Covid-19 and the ban on movements. This provided visibility of governorates that were more successful and committed to implementing movement bans.
- Mobility studies were done weekly and compared to new cases after 10 days and deaths after 21 days. Data reflected a direct relationship between increased citizen movement and rates of infection and death.
- The model relied on a number of variables:
- Steady movement of citizens in the streets.
- Infection rates and acquired immunity ratio were related when a specific infection rate was reached, in this case when 40-60% of the population infected was reached, then the infection rates decreased.
- The number of beds in hospitals was fixed for the country and the infection rate was steady.
- The number of social contractions was equal to the number exposed to infection, with no new mutation in virus transmission.
- Includes a number of other PPE-related variables: the percentage of the population wearing protective masks, as well as the quality of the masks; the extent of the commitment of citizens to follow preventive protocols such as staying at home, reducing movement, and maintaining social distancing; infection rates and acquired immunity; the number of beds; use of good medical protocols; development of an effective vaccine; effectiveness of media awareness campaigns; state institutions’ efforts; and the level of state control to include fines and penalties for non-compliance.
- The stability of daily testing results where the ratio of diagnosed and undiagnosed cases and deaths remains constant.
- As testing numbers change, the model and proportion between diagnosed and undiagnosed injuries, as well as mortality ratios, will be adjusted accordingly.
Analyzing the movement of citizens in the various governorates of Egypt, a number of findings were observed:
- By comparing the movement of citizens through the application of the “Google” engine during the baseline period from January 2020 until the end of the first week of the reopening on 3 July 2020, the level that resulted was less than at the pre-reopening levels. Therefore, despite the increased mobility, citizens were more cautious and observing prevention measures laid out.
- In spite of the closure and stay at home orders, on the first day after the closure, citizens had a slight increase in movement.
- The progression of the number of cases at the local level indicated that Egypt reached the peak of the curve at the end of the first half of July. That said, the first wave is expected to end at the end of August and depends on the continued observation by citizens of preventive measures – wearing masks, good hygiene, and social distancing. The curve demonstrated the effectiveness of curfew and stay-at-home orders since 24 March.
- The period from 9 to 14 July, when reopening started, could result in a second wave mostly in governorates other than the capital and major cities that were not immediately impacted during the early days of the pandemic and whose residents do not have similar levels of immunity.
- Post-reopening results were envisioned to include:
- The first case: 80% of citizens wear a protective masks (optimistic scenario)
- Its potential impact: This case allows the first wave to end on the first of August, reducing the death rate by up to 45% within two months and lower state spending on medical examinations, treatment, and the pressure on the health system (hospitals and intensive care rooms). This also results in decreasing the economic loss by the state by up to 125 billion Egyptian pounds.
- The second case: 50% of citizens wear protective masks with a degree of effectiveness of only 50% (weighted scenario)
- Its potential impact: This case delays and pushes the end of the first wave to 1 September, with a reduction in deaths of 17% – 45%. In this scenario, the death rate begins to increase to reach its peak during the period from 14 to 21 July; only then can economic reopening continue.
- The third case: Only 20% of citizens wear protective masks (the worst scenario)
- Its potential impact: The virus spreads in many governorates of the Republic, the health system is so severely stressed that a number of field hospitals established by the armed forces to absorb the numbers of acute infections must be established; and the country prepares for a second wave of infections with higher death rates.
- The first case: 80% of citizens wear a protective masks (optimistic scenario)
There is a direct relationship between the movement of citizens in the streets and the high incidence of infection:
- Based on movement data from various governorates collected by the search engine “Google” since the end of January 2020 until the end of the first week of reopening the economy on 3 July 2020, results indicate a strong correlation between increased movement of citizens in the streets and the rise in the number of infection cases and deaths. In these cases, infection occurs after 10 days and death after 21 days. These high rates of infection reflect the increase in movement early in the month of Ramadan (with the extension of curfew to 9:00 p.m.), as well as during the Eid al-Fitr period (even though curfew was reduced to 3:00 p.m.). This increase in movement of peoples resulted in an increase in infections from an average of 600 cases per day to 1300 cases per day, as well as an increase in the number of deaths from 40 to 90 cases per day.
- By continuing to analyze citizens’ movement a week after the decision to gradually reopen the economy on 27 June, the government was able to track rates of infection and deaths associated with increased movement in the governorates since 3 July 2020. Results indicated a slight increase due to reopening of public transportation, restaurants, cafes, shopping centers, parks, museums, libraries and cinemas.
- Citizens gathered in large numbers in public spaces such as parks and public beaches, but in far fewer numbers than before the advent of COVID-19.
Much credit is owed to the health system and dedicated workers who, through their efforts, succeeded in effectively combating the pandemic and containing its impact on the Egyptian community. Provided that the citizens continue their commitment to following appropriate preventive measures, support surveillance in public areas, and allow expanded testing, the state will be able to avoid further financial and economic setbacks. To that end, it may be useful to continue to impose for the time being fines for non-compliance for preventive measures such as wearing protective mask while taking public transportation and in government offices. It also is prudent, in parallel to these efforts, to intensify awareness/education campaigns through the media to encourage continued compliance by citizens and the importance of wearing protective masks and social distancing until which time we can return to normal.
The views presented in this article are those of the speaker or author and do not necessarily represent the views of DoD or its components.