Coronavirus Disease 2019 (COVID-19) WHO Update 41

occupied Palestinian territory, issued 27 August 2020
Information for period: 5 March – 27 August 2020

• First cases of COVID-19 confirmed outside of quarantine centres
• Gaza is in lockdown until 29 August
• WHO delivered 10 ventilators to Gaza to treat critical COVID-19 patients

WHO is continuing to work with partners to support Ministry of Health’s (MoH) efforts to respond to the COVID-19 situation.

This feature follows the first cases of COVID-19 confirmed outside of quarantine centres

Overall COVID-19 Situation: 

• Total confirmed cases in Gaza: 135
• Total number of active cases: 60
• Public Quarantine: 2,239 in 15 quarantine centres
• Total deaths: 3
• Total recovered: 72
• Total samples: more than 18,273 tested (135 tested positive).

Detail on latest cases: 

Twenty-five cases and 2 deaths were confirmed in the past two days (25 and 26 August). On August 26 21 cases including confirmed including 2 deaths:

• 1 death of 61-year-old male while being transferred from Indonesian hospital to European Gaza Hospital
• 1 death of 60-year-old male oncology patient at Al-Rantisi hospital
• 7 cases at the Indonesian hospital
• 3 cases tested positive at AL-Shifa medical complex including 1 health worker
• 2 cases tested positive at Rantisi hospital
• 1 case (Al-hayah hospital)
• 8 cases from different areas (6 Al-Maghazi camp; 1 Tofah and 1 North Gaza)

On August 25: 4 cases from Al-Maghazi camp.

Local authorities’ response 

• The source of infection (the index case) remains unknown, according to MoH
• Contact tracing is ongoing and anyone who has been in contact with the confirmed cases has been asked to self-quarantine for 21 days and contact authorities
• All medical staff and patients in hospitals are being tested
• Confirmed cases will move from the Turkish Hospital to the European Gaza Hospital in coming days
• On 26 August at 23:30 local authorities in Gaza (MoH and MoI) announced that the 48hr curfew started on 25 August would be extended for another 72 hours.  Those moving for necessity must adhere to the precaution measures (wearing mask, keeping physical distancing).

Capacity for COVID-19 case management in Gaza  

• Current bed capacity in Gaza is 350 beds:
  • The Turkish Hospital: 250 beds
  • Rafah Field Hospital: 100 beds
• Surge capacity being prepared by authorities:
  • 400 beds to be prepared at Gaza European Hospital
  • Facilities for up to 2,000 cases can be made available when authorities convert existing quarantine facilities into isolation centres for mild and asymptomatic cases

Respiratory Triage centres (RTC) are to be established at the key Gaza hospitals:

• North Gaza: Indonesian hospital
• Gaza: Al-Shifa hospital
• Middle Area: Al-Aqsa hospital
• Khan Younis: Nasser hospital
• Rafah: Al-Najar hospital.

It remains critical to focus on containment of the outbreak and to prevent widespread human-to-human transmission and to ensure adequate treatment capacity, protocols and procedures are put in place.

Since March, in Gaza, WHO has:

• Scaled up lab testing capacity (from 0 to 4 PCR machines), by helping co-ordinate and procure PCR machines
• Has procured more than US $2 million of essential medical equipment and supplies for Gaza including:
  • 72 case management items including 10 Intensive Care Unit (ICU) ventilators, 2 defibrillators, 9 ECG machines, 17 ICU monitors, 2,300 oxygen masks. 12 medicine items
  • 1 PCR machine, 196 testing kits (18,816 tests)
  • 115,500 gloves, 140,000 masks and other 15 PPE items (68,000 Personal Protective Equipment supplies)
  • A further 20 ventilators, 20 ICU beds 20 ICU monitors and 40 beds are in the pipeline to be procured with the support of UNICEF
• Supported establishment and training of MoH and frontline staff for Respiratory Triage Centres with MoH and PRCS
• This week, WHO delivered 10 ventilators and 2 defibrillators (see image) and facilitated the delivery of 10 pallets of essential drugs to support the management of non-communicable disease (such as heart disease, diabetes and cancer) to local health authorities in the Gaza Strip (see image).

Concerns, Priority needs 

There is continued concern about the ability of Gaza’s health system to manage the surge in COVID-19 cases. According to recent assessments conducted in February and March 2020, health authorities in Gaza reported:

• Gaza health authorities need to significantly scale-up testing of suspect cases per WHO case definition, contacts of confirmed cases; test patients identified through respiratory disease surveillance; strengthen the infrastructure of the designated laboratories. There is a critical shortage of the testing kits, essential lab supplies and equipment to support screening of COVID-19. Currently there are four PCR machines in Gaza and capacity to test up to 1,000 people per day. The MoH plans to scale up testing to 30,000 tests per month and requests 100,000 tests to conduct COVID-19 tests in addition to swabs and other reagents for the next three months.
•  Shortages of personal protective equipment (PPE) kits for frontline staff, both health and non-health, who deal with infected or suspected cases also need to be trained on the proper use of PPE to avoid being infected or infect others. The immediate need is to provide up to 150,000 full PPE kits, 1 million surgical masks and 2 million gloves for the next three months for the hospital health workers dealing with COVID-19 patients
• Health facilities designated to receive COVID-19 patients, especially in Gaza, lack essential medical equipment, supplies, drugs for case management and disposables for treatment of respiratory distress and other COVID-19 associated complications. In Gaza, the recent report from the Central Drug Store indicates that 48% of all essential drugs were at less than a month stock.  The MoH in Gaza has requested 38 drug items to address these critical shortages to treat COVID-19 and other critically ill patients.  Additionally, Gaza has only 4 hours of electricity a day which makes response to the outbreak more challenging
• According to the latest global reviews, an estimated 5% of all clinical COVID-19 cases would be in critical condition and would require intensive care. Currently, according to the MoH and the Health Cluster, there are 97 adult ICU beds with ventilators in Gaza (August 2020) in government with two-thirds already in use. Ventilators, cardio-monitors, fully equipped emergency carts and portable X-Ray machines are in short supply and at least 50 additional ICU sets need to be procured for at least three designated hospitals as all MoH hospitals already suffer from gaps in such vital equipment
• Risk communication and Community Engagement is a priority. With no community transmission detected in Gaza prior to August 25 2020, it’s clear the population needs to be re-engaged with tailored messaging, campaigns and activity to encourage compliance with preventative measures for COVID-19 as well as to address uncertainty and misinformation and mobilise support and consolidate efforts within the community.

Isolation and Case Management, Operations Support and Logistics 

• WHO teams are conducting an assessment of the five respiratory triage centers (RTCs) to assess their preparedness to manage suspected COVID-19 cases. So far, the assessment has targeted the RTCs in Rafah, Khan-Younes, Gaza and the North governorate.

Surveillance 

• The WHO risk assessment remains very high for the West Bank and occupied Palestinian territory (oPt)
• The number of people testing positive for SARS-CoV-2 continues to rise
• The total number of cases in West Bank is 27,251 cases and 155 deaths
• Most cases recorded are from Hebron (11,954), East Jerusalem (6,709), Jerusalem (2,088), Ramallah (1,882), Bethlehem (1,315), Nablus (1,131), Qalqilya (656), Jenin (234) and Tulkarm (330). Only two governorates (Salfit and Tubas) continue to record low case numbers
• 30 patients are in a serious condition (ICU), with four requiring mechanical ventilation (as of 26 August, 14:00
• To-date, the Ministry of Health (MoH) reported 18,747 cases have recovered in the West Bank (including 4,625 in East Jerusalem). The case fatality rate (CFR) is estimated at 0.57%.

East Jerusalem 

​As of August 25, there is a total of 32 patients treated at the COVID-19 designated hospitals in East Jerusalem (two cases from Gaza treated at Augusta Victoria, 25 cases from East Jerusalem treated at St. Joseph and 5 cases from West Bank and Gaza treated at Al-Makassed hospital).