In Yemen, aid groups fear COVID-19 cases are going undetected

MANILA — There are a total of 197 confirmed novel coronavirus cases and 33 deaths in Yemen as of May 22, as reported to the World Health Organization. But aid groups working in the country highly suspect there are more, but aren’t able to confirm because of lack of testing capacity.

“We’re seeing a lot of respiratory distress [in patients and] suspect [it being] COVID, but it’s difficult to get a clear view of the magnitude of the outbreak because of lack of testing capacity,” Marc Schakal, Médecins Sans Frontières deputy operations manager for Yemen, told Devex.

But he fears the cases MSF is seeing in its facility is only part of the full picture.

“The patients we’re seeing in our center are the ones who are able to come, but we have reasons to think that the number of people affected and dead in the community is higher,” he said.

At the MSF-run COVID-19 treatment center in Aden, the medical humanitarian charity has reported 68 deaths from 173 patients it has admitted in the past two weeks. Outside the hospital, they are witnessing increased burials in communities.

“We cannot draw a clear conclusion, but it’s an indicator,” Schakal said.

Aid groups have been warning of the dire situation in countries like Yemen, where health systems have suffered from years of conflict and are therefore largely unprepared to tackle a COVID-19 outbreak.

On top of the pandemic, Yemen is also endemic to diseases such as malaria, dengue, and chikungunya. In addition, ongoing political tensions mean challenges in implementing a unified approach across the country. Large parts of Yemen, including the capital Sanaa, remain under rebel control.

Lack of data

New data published by the International Rescue Committee reveals Yemen has one of the lowest testing numbers, even compared with other conflict-affected countries, at 31 tests per million. In comparison, Chad has 105 tests per million, and Mali 173 tests per million. In northeast Syria, testing numbers are at 59 tests per million, according to IRC.

“These startling figures speak to the dangerous prospect of undetected and potentially  uncontrolled outbreaks in crisis and conflict-affected states. Rapid detection is essential for rapid response, and rapid response saves lives,” said David Miliband, IRC president and CEO, in a news release.

Altaf Musani, WHO country representative in Yemen, told Devex by email that the aid agency has distributed 6,700 testing kits to date, and is securing an additional 32,400 more, scheduled to arrive in the coming weeks. But he also underscored the challenges in securing test kits given global shortages and getting those supplies to the country.

Musani said only laboratory-confirmed cases can be officially counted as confirmed COVID-19 cases, but uncertainty over the caseload in Yemen “does not change in any way our response or our level of commitment in doing what we can with the limited resources we have,” he said.

“WHO encourages all countries to be fully transparent in this regard — only when we have all the data and numbers can we be able to, with the closest degree of accuracy, respond accordingly, and prioritize gaps and needs,” Musani said.

WHO and the wider U.N. system has been working to advise and inform authorities on case declaration and reporting, he said, but noted that the decision to declare or announce cases “rests with a country's leaders according to International Health Regulations.”

“There are many factors at play here, and we are ramping up our community engagement and awareness activities — in the absence of resources one of our top public health measures for mitigating this is PREVENTION — our existing resources are not enough to clinically respond to the impact this virus will have on the population,” he said.

Data issues amid the pandemic are not limited to Yemen and have been reported in many countries. This means the focus is now on helping the country tackle the crisis, MSF’s Schakal said.

“The lack of data is a general concern in many countries where there are outbreaks, and it is difficult to have reliable data because it depends on the incentive and the motivation they have to collect the data,” he said.

“So for the moment we don’t fight for data, we ... fight to make sure that the country has enough capacity to tackle and properly respond to the disease,” he said.

Funding cuts impact response

Apart from testing, aid groups said there is also limited personal protective equipment for health workers. This is putting off some health workers from coming to the hospitals, out of fear of being infected while treating suspected COVID-19 patients, impacting case management capacity.

They are also calling for increased supply of essential medical supplies. At MSF’s treatment center, a major concern is the limited supply of oxygen.

“Oxygen therapy is working and is saving lives, [but] some patients arrive late and … it’s a medical and technical challenge to have a proper oxygen,” said Schakal, warning that a slight drop in oxygen supply could “really affect the life of patients.”

There are other hospitals available that can admit patients, but Schakal said: “It’s a question of capacity.”

“There are hospitals in Aden that are big enough, with staff trained. But they need resources, technical support, supplies. If we can scale up the resources available, we have a chance [to set up another] center that could help us and ease the burden on us,” he said, adding that financial support could help incentivize health workers to come and maintain other essential health services in hospitals.

MSF pays the salaries of its staff at the center, the majority of whom are local health workers. But Schakal explained that if the ministry of health would like to open another similar facility, it will need additional financial support from the international community.

And that is a crucial point.

For years, WHO and other international organizations have stepped in to provide financial incentives to health workers, as Yemeni authorities have been unable to pay health workers on a regular basis. Now, that resource is expected to decline, with WHO itself facing funding constraints, phasing out the payments in the coming months. Earlier this month, U.S. funding cuts led WHO to eliminate its incentivization program for 10,000 health care workers in the country.