COVID World Status Report: 4 – The Middle East and North Africa

Deaths per case (darker is higher)

This is the fourth in a series of status reports on the COVID situation as at May 23^rd, 2022. This report covers the Middle East and North Africa. In essence, the Arab and Muslim world stretching from Morocco to Mali to Sudan to Pakistan, plus Israel and Armenia.

Vaccinations

Here’s the list of percentages of the populations fully vaccinated:

That’s a very large spread! And the UAE has vaccinated over 95% of its people. How many were vaccinated against their wills?

But it’s interesting that Israel, which at one point had vaccinated more of its population than anywhere else in the world, has now dropped off into seventh place in this group. And their vaccination rates are lower than any of the countries in my European “core 14.”

Lockdowns

Here are the graphs of lockdown stringencies over the course of the epidemic, and the current lockdown status, in each of the three groups of countries which make up this region:

There is much less coherence among different countries’ lockdown stringencies here than in either Europe or the Americas. Pakistan has chosen a particularly high-stringency strategy, and Iran, having started out trying to keep lockdowns minimal, has since gone the same way. At the other end, Afghanistan has kept lockdowns relatively low. And Armenia is not providing stringency data.

Saudi Arabia has generally kept lockdowns high, while Yemen has gone the other way – understandable, given their political situation. Israel has tried just about everything; but when they have unlocked, they haven’t always been able to make it last. Palestine is notable for changing their strategy from high lockdowns to low late in 2021, going from the top of the stringency table to the bottom in just a few months.

Another mass of spaghetti, with little cohesion to it. It’s notable that the countries in the south of the region have tended to lock down less hard than those in the north. Morocco, in particular, has kept stringencies high, only just recently falling below 60%. Note also the big drop in stringency in Niger in the second half of 2021.

Here is the ordered list of stringencies re-cast in the form of my “harshness” metric:

Kuwait is now completely unlocked, and Sudan has only International: Screening. The only mandate in Israel and Bahrain is Face covering: Required in some places. Jordan has Gatherings: Up to 101-1000, Face covering: Required in some places.

At the other end of the scale, here are the lockdown mandates for the top four:

Country	Measures
Pakistan	Schools: Mandatory closed, Workplaces: Some closed, Events: Mandatory cancelled, Gatherings: Up to 101-1000, Travel: Mandatory restrictions, International: Ban some arrivals, Face covering: Required outside the home
Saudi Arabia	Schools: Some closed, Workplaces: Some closed, Gatherings: Up to 11-100, Public transport: Mandatory closed, Travel: Mandatory restrictions, Face covering: Required in some places
Morocco	Workplaces: Some closed, Events: Mandatory cancelled, Gatherings: Up to <=10, Public transport: Mandatory closed, International: Screening, Face covering: Required when with others
Oman	Workplaces: Some closed, Events: Mandatory cancelled, Gatherings: Up to <=10, International: Ban all arrivals/border closure, Face covering: Required in some places

Cases

Here is the ordered list of cases per million in the region:

Almost half of these countries have less than 5% of the population having been diagnosed as cases. Israel and Bahrain are way ahead of the rest, roughly up to European penetration levels. Again, the countries in the far south of the region cluster together near the bottom, together with Syria (whose data is probably not reliable) and Afghanistan.

Could it be, that the virus doesn’t spread as easily in extreme heat as it does in temperate climes? Or could it just be that the data collection gets worse as the country gets hotter? Having worked in Indonesia, I can understand why that might be a problem!

Here is the same data, on a map:

Cases per million (darker is higher)

(Unfortunately, some of the countries, notably Bahrain and Palestine, are too small to show up on the map).

Here are the daily cases per million spaghetti graphs:

After the big omicron peak, all the countries’ daily case counts in this region are now low, albeit with a bump or two in Iran and Turkey.

Here, the recent cases per million peaks are orders of magnitude higher than in the northern Middle East, with Israel and Bahrain leading the way.

Current daily new case counts seem low everywhere in North Africa. Tunisia and Libya have been well ahead of most of the other countries throughout the epidemic.

Hospital and ICU Occupancy

In this entire region, only Israel is providing hospital and ICU occupancy data. Its hospitals are only about 1% full with COVID patients, and there are just under 6 COVID patients per million population in ICU beds.

Deaths

Here is the ordered list of deaths per million:

Here is the same data, shown on a map:

Deaths per million (darker is higher)

This shows quite a different picture from the cases per million. Armenia, Tunisia and Iran have moderate cases per million, but are at the top in deaths per million. Only eight countries in the region have deaths per million above 1,000; the remainder are well below even the lowest levels from major countries in Europe and the Americas.

Next, deaths per case:

Yemen beats the rest in deaths per case by an order of magnitude. Not really surprising, given their situation. But Sudan has a higher deaths per case than Peru, the worst hit country in South America. The Sudanese, too, are in a war situation; in effect, a civil war. And Syria, Egypt and Afghanistan are all comparable in deaths per case with the hardest hit countries in South America.

Meanwhile, the bottom 9 countries in the list above all have cumulative deaths per case under 1%, a class into which two-thirds of European countries fall. Apart from Turkey, these are geographically divided into two groups, one in the Gulf and one centred on Israel.

Here is the same data (normalized relative to Sudan, rather than Yemen) in map form:

Deaths per case (darker is higher)

War zones (Yemen, Sudan, Syria) do not do well in deaths per case. The two zones of low deaths per case, in the Gulf and around Israel, can be seen clearly. Otherwise, the deaths per case seem to spread across the region fairly evenly.

On to average excess mortality over the course of the epidemic. Here’s the ordered list:

Twelve of these countries have reported excess mortality figures. But only five of these (Armenia, Iran, Oman, Israel, Qatar) have continued to report into 2022. Lebanon, Egypt and Tunisia all stopped reporting late in 2021, and the rest stopped reporting at the end of 2020. This being said, these figures are generally better than in the Americas, but worse than in Europe. Only Israel breaches the threshold of under 10% average excess mortality over the course of the whole epidemic.

Let’s try putting these on a map:

Average excess mortality (darker is higher)

That suggests that the Kuwaitis, in particular, have seriously undercounted their COVID deaths. And that the Armenians and Tunisians have been more conscientious in their COVID deaths reporting than the rest.

To sum up

Data quality is patchy in this region. But one thing that stands out strongly is that war zones – Yemen, Syria, Sudan – are not good places in which to fight against pandemics. Another is that the further south you go in the region, the lower are the cases per million and deaths per million so far; but the data also becomes less trustworthy.

In Israel, Bahrain and Kuwait, barring a new variant, the epidemic now appears to be dying down. Jordan and Palestine have also reduced lockdowns, signifying that they too think they’re on the home stretch. Elsewhere, new cases are consistently low, in comparison to earlier in the epidemic. But it’s hard to work out just how far the epidemic has really spread in each country.

A number of countries continue to implement high lockdown strategies – Pakistan, Saudi Arabia, Morocco, Oman. Also: Lebanon, Iran, Algeria, Tunisia. They should be seriously contemplating some major unlocks, as Palestine and Niger did, with apparent success, late last year.