The pandemic, take three

Dina Ezzat , Tuesday 18 Jan 2022

The fast-spreading Omicron variant of Covid-19 is adding to the burdens that the pandemic has been placing on people’s lives.

photo: AP
photo: AP

The Ministry of health announced this week that the Omicron variant of Covid-19 has become the predominant strain in Egypt. The announcement, made last Friday, came fewer than four weeks after the health authorities announced on 17 December that three cases of Omicron had been detected among over 25 travelLers who had tested positive for Covid-19 upon arriving in Egypt.

This week, the registered number of positive cases of the virus in Egypt soared from 800 to over 1,000. Doctors treating Covid-19 patients in public and private hospitals say that there is no doubt about the increase in the number of patients seeking medical help or needing hospitalisation after contracting Covid-19.

But this is less, they add, among healthy individuals who have had two shots of the vaccine and who then contract the Omicron variant than among those who catch the Delta variant, which, they say, is still present in Egypt.

According to figures from the ministry of health this week, the highest number of infections has been occurring among unvaccinated individuals, less so among those who have received two shots of the vaccine and even less among those who have received a booster.

By the beginning of this year, close to 40 million people had received one shot of the vaccine against the new coronavirus, according to figures released by the Ministry of Health. Approximately half of those have received two shots.

There are no official figures about the number of people who have received the booster. However, according to a source at the ministry, the numbers are still not very high “despite the ambitious campaign that aims to reach out to as many people as possible among those who received their second shot over six months ago, especially the elderly and individuals with low immunity and chronic health issues.

“But people are not being very enthusiastic about the third shot of the vaccine. I am not sure why, but we have noted that some people received their first shot over eight months ago and never came back for their second,” the same source said.  

The Egyptian authorities have not made vaccination mandatory, and according to the same source at the Ministry of Health, “making vaccination mandatory does not seem to be the plan, at least for now.”

He added that the focus of the ministry was to expand the outreach campaign “to encourage awareness of the need for vaccination and how it makes a difference in saving people’s lives, to dispel misconceptions about the side-effects of the vaccines, and to make the vaccines more easily available for as many people as possible.”

The government has already made it mandatory for all civil servants to be fully vaccinated to attend work or to provide a negative Covid-19 test on regular basis. On the spread of the highly infectious Omicron variant, the government announced stricter rules on wearing masks in all closed places and stricter observation of social distancing.

“But this is simply not happening, and the situation could take a very negative twist if we continue with this high level of recklessness. People are not always wearing masks, and in some cases they are forging vaccination cards to go to work and not even thinking about social distancing,” said one medical doctor who works in one of Cairo’s leading public hospitals.

According to this doctor, who declined to be identified, “the pressure is already increasing on hospitals and intensive care units [ICUs]” in most public and university associated hospitals in Egypt.

“It is true that the symptoms of Omicron are not as harsh as those of previous variants, but we have lost cases who were diagnosed with Omicron,” the doctor said. “The trouble is that sometimes people have undiagnosed health problems, so when they contract Omicron they could well end up in the ICU or face worse scenarios.”

According to figures announced by the Ministry of Health this week, while registered cases were over 1,000 per day, the number of mortalities was in the thirties, far fewer than the higher mortality of around the seventies in the previous three waves of Covid-19 that have been hitting the country since February 2020.

The health authorities and doctors treating Covid-19 cases have been unequivocal in stressing that the actual numbers of infections and possibly of mortalities are much higher than those that are officially registered. This is because a large percentage of patients get treated at home as a result of blood tests and X-rays without having to do a PCR test or register in the official system.

Speaking over the past two weeks, doctors in the public and private healthcare systems in Cairo have said that the decline in the number of mortalities, fortunate as it is, does not lift the pressure on the health system or on the volume of required medication.

Pharmacists speaking in Cairo said that while there was no long-term shortage of the drugs required for Covid-19 patients, there was certainly pressure.

IMPACTS

The tough impacts on the healthcare system during the first and second waves of the Covid-19 pandemic in 2020 have been one of its key consequences, according to research conducted at the American University in Cairo (AUC) to examine the socio-economic effects of the pandemic.

The research reported a high level of complaints over access to hospitals and ICUs at the peak of the first and second waves of Covid-19. Fever hospitals, usually never under pressure, came under enormous pressure as a result.

According to Dina Makram Ebeid, lead researcher and assistant professor of sociology at the AUC, the research showed that people living in less central parts of the country had a harder time in accessing adequate healthcare or even healthcare at all.

While the research acknowledged additional government allocations to support the healthcare system in the face of the pandemic, it also noted that the pressure put on it did not come without a cost to the comprehensive health insurance system initiated in Port Said and supposed to cover the entire nation by 2030.

The cost of treating Covid-19 was not only covered by the government, especially in cases where patients did not turn to the public healthcare system or received treatment at home either due to personal preference or to a lack of access to public or even private hospitals.

Nada, a Cairo resident who caught Covid-19 in the second wave along with both parents and husband, said that her family had had to spend over LE400,000 for treatment. While Nada and her husband, both in their mid-30s, managed to get over the infection after four weeks at home, her parents had to be admitted to hospital where they spent over two weeks, with her mother spending a full week in ICU.

According to Nada, it was only through the help of a family doctor that she managed to get her parents admitted into this private and costly hospital at all. “It was not easy, and we had to produce LE100,000 as a down-payment for each of my parents,” she said.

Nadia, also a Cairo resident in her 30s, could not pay the bills of a private hospital. Unlike Nada, who works at a well-paying multinational, Nadia is a house-help who lost most of her income upon the first wave of Covid-19 as most of her clients declined to continue to employ her out of fears of infection.

Nadia “had to go through it all” at her house as a result. She isolated herself in the bedroom that she shares with her husband who moved to the living room. Nadia’s husband had had to “reach out for financial help from a charity to be able to buy medicine,” she said. She added that her husband, who works in the cleaning service of a factory, had requested a loan that could be paid in instalments from his salary but that he was turned down by the administration.

Today, Nadia is fearful of another wave that could lead her clients to suspend her weekly visits that provide a significant portion of the household income. Nadia herself is fully vaccinated, and so are her clients. However, she said that she is “scared by the level of infections. Every day, I hear of people who have got Covid-19. This means that people could get scared again and I could be without work again for a few months.

“We don’t have savings to lean on. We live from hand to mouth, and during the past two years we have had to turn to charities more than once,” Nadia said. She added that the pressure on charities has also increased significantly and that they are not as forthcoming in accommodating requests as they used to be. “So many people are now without work or with less work than it takes to buy the basics,” she lamented.

According to Amr Adli, a researcher in the AUC project that examined the socio-economic impact of the pandemic in Egypt during the first two waves, a lack of employment security was one of the main effects of the pandemic.

“Vulnerability in this respect is not only about those working in the informal sector, but also about those working in the formal sector,” he said.

Adli, an assistant professor in the political science department at the AUC, argued that this vulnerability is not only the result of the pandemic. “It has been there since the 1990s, as a result of neo-liberal economic policies for sure, but aggravated by the pandemic,” he explained.

According to Hania Sholkami, an associate professor at the Social Research Centre of the AUC, the fact that the government has established a database on the neediest families in the country to help them access the social-protection programmes that have been launched over the past five years has helped with outreach mechanisms.

But she argued that there is still room for improvement, as the pandemic has demonstrated. “We certainly could use more effective programmes with wider outreach possibilities to reach more beneficiaries,” she said.  

Sholkami said that one of the things the pandemic did was put existing programmes to the test. This, she said, had showed “that yes, we do have a certain readiness for sure, but it also showed that we could work on improving this.”

Improving the quality of this readiness, she argued, would mean better financial allocations, better targeting of segments of the population that need help, and more prompt and efficient outreach mechanisms.

One of the things revealed by the pandemic’s first and second waves was that a good segment of the middle class in Egypt is illegible for government support during a crisis, contrary to traditional wisdom.

HITS TO INCOMES

Saher, a 28-year-old part-time Arabic teacher at a primary school in Giza, said that over the past two years he has had to cut down on all expenses as his income has suffered.

He is one of over 120,000 teachers who are on uncontracted teaching schemes that pay LE20 per class. On average, Saher teaches 20 classes a week, or a little more. However, the bulk of his income, “which still falls far short of allowing me to get a life started because it is hard to make enough money to have an apartment and get married,” comes from private lessons.

However, in 2020 many parents suspended private lessons for fear of infection or due to pressure on their own finances. In 2021, things picked up a bit. Saher was hoping that things would get back to normal this year. However, with the spread of Omicron he is starting to worry.

“Luckily, I work with young children whose parents are also young. This obviously reduces the fear of a tough illness, but we will see how things go,” Saher said.

According to Amira Othman, a researcher with the AUC, it was not untypical for families, including those in the middle classes, to cut down on food items as a result of the pandemic.

Meanwhile, Hind Zaki and Diana Magdi, two researchers with the same project, found that while the Covid-19 pandemic relied on deeply-seated social and national policy interventions, it also provided an opportunity for a comprehensive reassessment of national structures for gender-based violence reporting, socio-legal interventions, and risk-mitigation.

A source at the Ministry of Social Solidarity agreed that the volume of complaints that have been received during the past two years of family violence, particularly the type that targets wives, has increased significantly.

Women have been complaining about physical abuse that in some cases has been quite harmful, the source said. The trouble is that it is impossible to share accurate figures about the volume of wife-battering and other forms of physical abuse because “everyone knows that the complaints are only a small segment of the cases that actually occur on a daily basis in many households across the socio-economic spectrum,” he added.

The Ministry of Social Solidarity has set up a hotline to report cases of physical household abuse. It has also allocated safe havens for women who cannot tolerate consistent and increasing physical abuse by their husbands. However, it is not typical for women to wish to turn to these safe houses.

“Women feel they cannot abandon their children or embarrass their families by running to these houses. In most cases, women feel that outbursts of anger that are due to economic pressures should be tolerated for the sake of the family, and we cannot advise them against this way of thinking. We just provide them with ways of improving communication as much as possible with their husbands or of seeking the intervention of an older family member or relative,” the source said.

According to the AUC research, one of the main things that needs to be addressed in the post-pandemic phase is how to deal with the issue of violence against women better, since while this might have been amplified by the pandemic, it will not go away when the pandemic comes to an end, especially if the economic pressures that came with the pandemic take longer than expected to subside.

*A version of this article appears in print in the 20 January, 2022 edition of Al-Ahram Weekly.

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