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How to deal with Covid-19 in rural Syria?

Publication date: 2020/03/19 19:14

Chamsy Sarkis,

CEO of Smart News Agency

Former scientist in Molecular Biology at the CNRS in France

This analysis does not reflect official views, but is intended to open debate over health policy in rural Syria to fight against the coronavirus epidemic.

Specialists can send their own views and replies to this article here.

The health policies in rural Syria need to be revisited according to the expected outbreak of Covid-19 in Syria. The war imbroglio will be further complicated by an epidemic that is expected to dramatically affect all populations in Syria. Tight coordination between local NGOs and UN agencies will be necessary to fight the expected epidemic. Moreover, Syrians will need to self-organize in this fight to avoid the announced catastrophe.

To combat the virus, there are currently two strategies. The first one relies on social distancing. It involves extraordinary restrictions on free movement and assembly, as well as aggressive testing, to interrupt its transmission entirely. Such a solution will certainly not be applicable in densely populated areas and those experiencing hostilities, where sample collection may be more challenging, as well as where mass gatherings typically occur. To the other hand, in the absence of social distancing, the outbreak will be uncontrollable, rapidly overwhelming all remaining health infrastructures and staff.

The second strategy is commonly called “herd immunity” and involves letting intentionally the virus spread among populations. Eventually if a majority of people are infected and, if they get immunity, the epidemic will drop down on its own as the germ finds it harder and harder to find a susceptible host. This implies that population is rather young and healthy, and that the health infrastructures are able to absorb the patients in serious and critical conditions. This is clearly not possible in the case of rural Syria in 2020, as health infrastructure is almost completely destroyed. However, if nothing is done to prevent the epidemic in Syria, it will be de facto the chosen strategy, resulting in huge number of deaths.

Very few solutions are left for Syrians to avoid more suffering. Any solution will need high levels of organizations and civism from the Syrians themselves. They have already shown their capacity to organize simply but efficiently in 2011, with hundreds of local committees and youth groups ensuring local security and relief and organizing medical emergencies to protesters and civilians throughout the country.

The first thing to do is to set up cheap, rapid and efficient ways of testing for the presence of SARS-CoV-2. This could be done by implementing few makeshift testing trucks or facilities in each governorate or area. Such makeshift facility or truck would contain a clean space, few PCR machines and biological reagents necessary for performing makeshift PCR testing. Using reagents very easily accessible to any molecular biology laboratory in the world, their supply could be guaranteed from neighboring countries in amounts much higher than commercial kits, as the ones distributed by the WHO. Roughly, equipping a makeshift testing facility or truck would cost few thousand dollars. Reagents would have a very low cost per test, and two laboratory technicians could perform about 400 tests per day.

Who should be tested? Strategically, only two populations should be tested. 

The first group to be tested are the people who are more vulnerable to the virus: the elderly (over 50 years) and people with existing health status enhancing the morbidity of Covid-19 (e.g. diabetes, cardiovascular disease, and hypertension). Each negative person should be immediately confined in a dedicated facility or camp, specially prepared or build to receive these coronavirus-vulnerable persons not yet infected, to protect them from future infection. Virus-free vulnerable people should be confined safely, and taken care by virus-free people (NGO staff), representing the second group of persons that need to be tested regularly before entering in contact with confined virus-free people.
Such efforts are feasible only with the help and will of local communities, their direct involvement, and their high awareness of the gravity of the situation. They should be educated about the disease and trained to procedures and adequately equipped to avoid transmission of disease to virus-free confined populations.
The strategy of massively and rapidly testing and confining vulnerable virus-free people will have several advantages for the war on SARS-CoV-2:

  • Vulnerable population will be affected in much lower numbers. 
  • This group represent the largest group that is at risk of serious and critical complications requiring heavy medical care. About 15% of persons from such groups are currently dying in countries where medical infrastructure is much more ready than in Syria. Preventing them from getting infected and ill will leave remaining medical infrastructure for younger and healthier people to be taken care of in case of serious or critical condition.
  • A relative few number of people will need to be tested. The age pyramid in Syria is such that there are much more young people than elderly people, the 65+ representing less than 5% of the population.
  • For the rest of the population, herd immunity will be feasible with minimized consequences, as many vulnerable people will be excluded from such an aggressive strategy.

In conclusion, the proposed policy for rural Syria, if applicable, would combine “reverse confinement” (confinement of virus-free vulnerable people) with “herd immunity”, the default strategy in rural Syria.