FACTS OVER FEAR: Coronavirus In Kurdistan
THE CURRENT SITUATION:
Last Tuesday, the Prime Minister and Deputy Prime Minister of the Kurdistan Regional Government chaired a cabinet meeting with governors from throughout the region to discuss recent developments, and potential next steps, in regard to the appearance of the coronavirus in Iraq. Following this meeting the KRG issued several responses, including; the promise to deliver up-to-date information via news media outlets, the screening of domestic and international tourists entering the region, the assurance that Kurdish shops would continue to stock all essential items and prevent price manipulation of essential goods and, most dramatically, the announcement that today the entire region would commence with a month long public holiday. Resulting in the closure of all schools, kindergartens, and universities, governmental offices until after spring break (24th of March). Since then gyms, shisha bars, and a variety of public spaces have also closed. Land borders between Iraq, Iran, Kuwait, and Turkey have all been closed and several international flights grounded
This was the day after Iraq announced a single case of the coronavirus south of Baghdad. The main concerns regarding coronavirus in the Middle-East surround Iran, which has experienced the largest number of fatalities outside of China (there have been 66 fatalities and 291 cases have been discharged from hospital after returning to full health). As of today, there are 17 confirmed cases of coronavirus in Iraq and 56 new cases in Kuwait, all of these cases can be traced back to visits to Iran. As the epicentre of Iran’s outbreak is situated in Qom, one of the two holiest cities in Shi’a Islam (the second being Najaf, Iraq, where the first Iraqi case of coronavirus, an Iranian student, was diagnosed), it is feared that the movement of pilgrims is aiding the spread of the virus across the Middle-East.
There are now cases of coronavirus on all 6 habitable continents, across 47 countries. Of the confirmed cases of coronavirus in Iraq, 4 are located in Sulaimani, Kurdistan. Those four people remain in quarantine and in good health. Kurdish and Iraqi authorities closed borders with Iran at the beginning of last week and are enforcing methods to tackle human smuggling across the border. Citizens are not allowed to travel to Iran and any returnee will have to undergo 14 days quarantine to determine their health and prevent the further spread of the virus. Almost 2,000 people who have recently entered or returned to the Kurdistan region from neighbouring countries are currently in quarantine. This quarantine process in becoming common globally for those travelling to and from areas where cases of the virus and rates of viral transmission are high.
PREVENTION AND MYTH-BUSTING:
Firstly, it is important to address that the mortality rate for the coronavirus is LOW, in fact the majority of people who contract the virus will either be asymptomatic (not experience any symptoms), or will experience a flu or cold-like virus. The majority of cases will not require any medical attention as the virus is “self-limiting” meaning the symptoms will disappear on their own. If you contract even a mild case of coronavirus you will not become infected again as your body will have produced antibodies against it. That is, unless the virus evolves in the future, of which there is no current evidence. More than 80% of coronavirus cases are mild and one of the main concerns of public health professionals is the harm caused by unnecessary panic. As we have consistently seen with international epidemics, the contagion of fear can be far more infectious and dangerous than the disease itself.
On Monday evening the racing streets of Dohuk were practically stationary. Cars lined the streets as hundreds of people queued for petrol stations. Aiming to stock up on fuel as rumours spread that as the border to Iran closed, fuel shortages would hit Kurdistan. This idea was immediately proven false and the KRG released a statement saying that only 10% of Kurdistan’s fuel was sourced from Iran and that there were contingency plans in place. In Kurdistan’s capital city, Erbil, 19 pharmacies were shut down by the KRG in retaliation to owners exploiting the mounting fear surrounding the coronavirus by hiking up the price of facemasks. There is little to no evidence of benefits from the use of facemasks, especially not the paper ones provided by pharmacies in Kurdistan. These masks are mostly used in hospitals to block larger particles and liquids but have little to no effect on viral transmissions. The Centre for Disease Control and the WHO recommend their use only by people who are already displaying symptoms (to prevent their infection of others through respiratory transmission methods e.g. coughing and sneezing), and by people who are directly caring for symptomatic people. If you are otherwise healthy there is no need and no evidence of benefits from wearing a face mask. In fact the most prominent effect of mask-use is panic incitement, the visual effect of many people wearing masks provokes ‘apocalypse’ imagery.
The best steps to prevent contraction of the coronavirus (and any virus), are good hand hygiene and good respiratory hygiene. Wash your hands regularly with soap and water for atleast 20 seconds (front, back, in-between the fingers, and up above your wrists), especially after using the toilet, coughing or sneezing, and before eating. When coughing or sneezing, cover your mouth with a bent elbow or a tissue which then should then be immediately disposed of. It is also recommended to not touch your own face, eyes, mouth, or nose, without washing your hands first. The main forms of transmission for coronavirus and influenza are “droplet transmission”, the inhalation of droplets produced by someone coughing of sneezing in your vicinity. And “smear infections”, when pathogens located on the hands enter the mucus membranes of the nose or eyes. As the virus may appear as something as simple as a sore throat in the majority of people it is important that everyone practice good prevention hygiene, so that those who are not displaying symptoms but are carrying the virus do not unintentionally infect others. General household disinfectants can efficiently deactivate the coronavirus within a single minute.
As well as recommending good practices to prevent the potential spread of coronavirus, it is also important to address false rumours. There is a rumour circulating suggesting that smoking and breathing in smoke is good for coronavirus prevention, this is false. Smoking can make you immune system even more vulnerable to viruses, lung disease experts warn that smokers could be at a higher risk of developing complications if they catch coronavirus. This is because the virus directly attacks people’s respiratory systems. Whilst on a run to the corner shop, a friend was warned against buying eggs. They were “dangerous” he was told. They were from Iran, where Middle-Eastern outbreak of the coronavirus had begun. It is scientifically proven that the coronavirus does not survive for long periods of time in an open environment. There is no evidence that food and items procured from Iran are of any danger to the population of Kurdistan. Viruses are also highly susceptible to heat, cooking foods (meat and eggs) well would also drastically reduce the risk of infections.
It is highly recommended that, if you live with someone displaying flu-like symptoms, you disinfect the surfaces that you touch regularly, this is to prevent the spread of a virus already in your vicinity.
Although the virus poses low health threats to individuals, as with many illnesses, including the flu, older people and people with pre-existing medical conditions (such as asthma, diabetes, and heart disease) are most at risk. It is thought that ageing immune systems are unable to fight and recover from a new virus as effectively. Ironically, one of the best protections for older people, as well as persistent good hygiene and making sure their essential medications are stocked, is the vaccination and continued health of young people. People living in refugee and IDP camps are particularly susceptible to rapid viral transmissions as everyone lives in close quarters with often poor ventilation. Camp managements also have to contend with poor sanitation and large numbers of both the elderly and people living with existing chronic conditions. As such, camp environments are of high concern to health professionals. Doctors Without Borders have recently put out a call for the production of cheap coronavirus diagnostic kits and there are currently only two sites in Iraq and Kurdistan (Baghdad and Erbil) that provide laboratory testing for coronavirus. It is difficult to determine whether the sanctions put in place by the KRG are an overreaction to the threat of coronavirus due to the sheer number of vulnerable people residing in Iraq. If the outbreak in Iraq were to spread it would be difficult to contain due to the reduced capacity of the national health system following decades of war, crisis, and corruption. Although the current sanctions may have a severe impact on Iraq’s, already unstable, economy, the severity of the restrictions may prevent Iraq from experiencing an outbreak as severe as the one in Iran.
It is incredibly important that ‘pandemic’ media framing and unchecked rumours do not exacerbate sectarian discrimination within Iraq and Kurdistan. Since the outbreak of the virus, increased international discrimination against people of Asian descent has shown how fear can promote division, cause unfounded racist attacks, and obstruct logical social responses. Viruses are indiscriminate, they effect everyone regardless of religion, ethnicity, or nationality. Although it is consistently important to practice good hygiene and voluntarily isolate oneself when experiencing flu-like symptoms (coronavirus or otherwise), it is equally important to not let fear cloud logic and further divide Iraq’s population. Years of sectarian conflict have already segregated the Iraqi population and it is important to note that religion, ethnicity, and nationality have absolutely no bearing on a person’s likelihood of contracting the coronavirus.
This may be especially important due to the links between coronavirus transmission in the Middle-East and travel through pilgrimage. At the beginning of the outbreak in China, a Tunisian cleric suggested that the virus was sent to them as a “soldier in Allah’s army”, a punishment for China’s detainment of Uighur Muslims. Other individuals online suggest that Iran’s suffering through coronavirus is a ‘punishment from Allah’. This kind of thought process is incredibly dangerous and it is important for us to engage with stigmatised people and speak out against negative behaviours, including the exclusion of groups of people who pose no risk to regular activities (CDC). It is also important to maintain the privacy and confidentiality of those seeking healthcare.
STEP-IN is currently working to adapt pamphlets and hygiene campaign materials provided by the WHO. We aim to make them available in Kurmanji and in purely visual forms for those unable to read. These campaign materials will be distributed throughout STEP-IN’s work locations.
We are also implementing an education and awareness campaign on influenza and the coronavirus in Dawoodia IDP camp through locally employed community health workers and within the next week our doctors will undergo specific training in the detection of coronavirus.
Ultimately these campaigns are aimed to reduce panic, address the distribution of false information, and give well-rounded practical advice not only on the prevention of coronavirus transmission, but the transmission of all viruses.