www.jogh.org • *Equal authorship. 6 5 4 3 2 1 Attaullah Ahmadi Kenesh Dzushupov Navigating awayout COVID-19 inKyrgyzstan: JoGH ©2021ISGH © 2021TheAuthor(s) The onlineversionofthisarticlecontainssupplementarymaterial. Electronic material: supplementary Global HealthFocusAsia,Kabul,Afghanistan Medical ResearchCenter, KatebUniversity,Kabul,Afghanistan Department ofThoracicSurgery, TheFirstAffiliatedHospital,SchoolofMedicine,ZhejiangUniversity,Hangzhou,Zhejiang,PRChina Faculty ofManagementandDevelopmentStudies,UniversitythePhilippines (OpenUniversity),LosBaños,Laguna,Philippines Department ofGlobalHealthandDevelopment,LondonSchoolHygiene andTropical Medicine,London,UnitedKingdom Department ofPublicHealth,InternationalSchoolMedicine,Bishkek, Kyrgyzstan teleworking. tions andstatebodiestoreturnback government toorderallprivateorganiza rupted otherhealthservices,forcingthe whelmed thehealthcaresystemanddis ed, and,finally,thepandemicover every day after the restrictions were lift dent cases showedasteady increase precautionary measures,however,inci pandemic toalargeextentbyinitiating care system,cushionedtheimpactof Kyrgyzstan witharelativelystronghealth doi: 10.7189/jogh.11.03020 in CentralAsia,wasdetectedonMarch18,2020[ deaths byNovember4,2020[ diately after the first cases, Kyrgyzstan enforced containment measures to curb the virus spread by establishing Three citizens returning from a pilgrimage inSaudi Arabia were tested positive on March 18, 2020 [ FIRST CASESANDRESPONSES the wave with total 60 and wentthroughalockdown,declarationofstateemergency, steady caseincreaseanddevastatingpeakof T [ in China,December2019,thediseasehasbeencreepingintoalmosteverycountryacrossglobe he COVID-19pandemicisthegreatestglobalhealthcrisisofourtime[ 2 5,6 , 3 1 ]. Thepandemichasledtoaglobalcumulativeincidentof47 * *, DonEliseoLucero-Prisno III
279 confirmed cases, 1159 deaths and 51 4 ------]. ThefirstcaseofCOVID-19inKyrgyzstan, amountainousland-lockcountry above theaveragecomparedto neighbouringcountries[ cy preparednessofKyrgyzstan forthepandemicwasexpectedtobe 64 nursesandmidwivesper10 the healthcare capacity showshaving 45 hospital beds, 18.8 physicians, el [ health outcomescomparedtoothercountrieswithasimilar income lev care systemofKyrgyzstan makingitrelativelystrong andwithbetter undertaken weresomewhatsuccessful,mainlyimprovingon thehealth ion, andtheIslamicDevelopmentBank.Thesewide-ranging reforms Development Bank,theWorldHealthOrganization, theEuropeanUn of largest bilateral donors and partners such as the World Bank, the Asian andsupport forms forthelastcoupleofdecadesundersupervision The healthcaresystemofKyrgyzstan hasbeengoingthroughvariousre country’s effortstoaddressthethreat. ry andcurrentstateoftheCOVID-19pandemicinKyrgyzstan andthe ber 4, 2020 [ 6 , 7 ]. The healthcare expenditure of the country is 6.6% of GDP and ]. Thehealthcareexpenditureofthecountryis6.6%GDP and 1
5 4 ]. Thereafter the country was plagued with the pandemic ]. Thereafterthecountrywasplaguedwithpandemic ]. This paper aims to provide a commentary on the histo 2,3 *, Dmitry Vishnyakov*, Dmitry COVID-19 inKyrgyzstan: Navitatingawayout.JGlobHealth2021;11:03020. Cite as: 288 recoveries across the country by Novem DzushupovK,Lucero-PrisnoIIIDE,VishnyakovD,LinX,AhmadiA. 000 people[ 901 761 confirmedcases,and1 1 ]. Since the pandemic started ]. Sincethepandemicstarted 6 ]. Thussaid,theemergen 2021 •Vol. 11 • 03020 1 *, XuLin 7 ]. 5 ]. Imme 221 4 *, 479 479 ------
VIEWPOINTS VIEWPOINTS 2021 •Vol. 11 • 03020 co-authors, usedwith permission). town, Kyrgyzstan,saying“We stayatworkforyou, youstayhomeforus”.(Ownedbyoneofthe Photo: Healthworkersonthefrontline ofthe fightagainsttheCOVID-19pandemicinKant that causeeconomicdownturn. with thenegativeimpactofrestrictions den increaseofcasesandtobalanceit or liftingrestrictionpoliciestoavoidsud needs toemploycautionwhenapplying are unavoidable.Thus,thegovernment tive long-termeffectsofthepandemic der control,asofthiswriting,thenega Though thepandemicissomewhatun number of incident cases of COVID 19 began increasing dramatically and by the end of the June 2020, the number of incident casesof COVID 19 beganincreasingdramatically andbytheendof the June 2020, the tourismandrecreationalactivitieswereresumed [ as production and sales, consumer services, The Kyrgyz governmentliftedmajority ofquarantinerestrictionsafterJune1,2020.Allbusinessactivitiessuch WAVE ONTHERISE ID-19 incidentcasesdidnotexceed100untilthemiddleofJune2020[ ble timetopreparehealthcaresystemforpossibleincreaseofcases.Thus,theaveragenumberdailyCOV of emergency allowedtodelaydramaticuncontrolledspreadofthevirus aroundthecountryandgavevalua biggest citiesofBishkekandOsh,somehighlyaffecteddistrictsKyrgyzstan [ The stateofemergency wasterminatedonMay10,2020.Yet,quarantine measureswerestillinplacethe port ofmedicinesandmedicalequipmentaswellsomefoodproductsotheressentialgoods[ encouraged thewearingoffacemasks.Thegovernmentclosedcountryborderstoforeignersandbarredex mended to maintain a one-meter physical distance, refrain from physical contacts such as hand-shaking, and 2020 [ such as grocery stores, food markets, pharmacies and medical centers on March 22, only essential services checkpoints ineachcity,temporarilyclosingcafes,shoppingmalls,andotherentertainmentplaces,permitting prompting theMinistryofHealthtodevelopanactionalgorithm,whichincludedguidelineswhereinindivid all preparednessmeasureshealthcarefacilitiesstartedtoexperiencedifficultieswiththeincreaseofnewcases number of daily incident cases was almost 3 times higher compared to the start of the month [ 5
]. Thelarge gatheringsalongwithprayersatmosquesandchurcheswerebanned.Peoplerecom - - - ue operatingusingvirtualmeans[ and administrationsoftheseinstitutionswererecommendedtocontin employees ofemergency Schoolsanduniversitieswereclosed services. hadtowork remotely fromhomeexcept ees andgovernmentservants gency exceptforcitizenswithlocalresidencepermits.Allstateemploy government prohibited entering theregions with declared state of emer food, medicines and visiting a medical facility during the day time. The hours andwereonlyallowedoutforessentialbusinessessuchasbuying The locals were forbidden to get outside of their homes during curfew March 25, 2020 in the three major cities of Bishkek, Osh and Jalal-Abad. stantly increasing. The government declared a state of emergency on Despite thestrictmeasures,numbersofCOVID-19caseswerecon STATE OFEMERGENCY 2
pneumonia and COVID-19 were classified sepa Previously, thestatistics on deathresulting from all cases of acute pneumonia as COVID-19 cases. pandemic. Healthauthoritiesstarted tocategorize beds andequipment,became the epicenterof est number of cases, lack of medical staff, hospital to exacerbatedramatically.Bishkekwiththehigh In themiddleofJune2020,situationstarted places andcitymarkets[ tions onworkinghoursofpublictransport, of Bishkek,the biggest city,imposed more restric state bodiestoreturnteleworking.Authorities government orderedallprivateorganizations and As dailynewcasescontinuedtoincrease[ PEAK OFTHEWAVE home andnothospitalized[ not higher than 38 degrees Celsius be treated at uals withoutsymptomsandwiththetemperature 9 4 ]. ]. www.jogh.org • 5 ]. The declaration of state ]. Thedeclarationofstate 9 ]. 5 doi: 10.7189/jogh.11.03020 ]. 5 ]. At once, the ]. At once, the 4 ]. Despite of ]. Despiteof 8 ]. 4 ], the ], the ------www.jogh.org • Kyrgyzstan. 1. Figure Novel coronavirus 19 (COVID-19) daily new cases in Novel coronavirus19(COVID-19)dailynewcasesin doi: 10.7189/jogh.11.03020 22,4% of the population live below poverty line [ al currencyvalueheavilydependsonexportsofrawmaterials,goldandincomemigrantsworkingabroad. tating notonlyonhealthbutalsoinsocio-economicareas.Kyrgyzstan isadevelopingcountryandthenation The COVID 19 pandemic is the greatest challenge for Kyrgyzstan and the impact of the pandemic was devas general population[ and someKyrgyz regionsmayaccountto be 62%in Narin and 50%in Bishkek ofseropositivityamongthe ological on-goingstudyshowedabout30%seroprevalenceofCOVID-19antibodiesamongKyrgyz population strengthen itshealthcaresystem becausenooneremainssafe,ifallisnotsafe. cause economicdownturn.Majordonorsandregionalpowers needtogivefullsupportKyrgyzstan to tion policiestoavoidsuddenincreaseofcasesandbalance itwiththenegativeimpactofrestrictionsthat The government needs to employ caution when applying or lifting restric between different health services. mobilized forapossiblesecondwaveinsomeregionsandthe maintenanceofbalanceinresourceallocation needs urgent measures which should include assessment of available resources in healthcare that might be immunity insomeregions,thenegativelong-termeffectsof the pandemicareunavoidable.Thus,country under control,asofthiswriting,andthepopulationmight haveaformofindirectprotectionthroughherd Thoughthepandemicissomewhat thehealthcaresystemanddisruptedotherhealthservices. ic overwhelmed precautionary measures,however, incident casesshowedasteadyincreaseeverydayand,finally,thepandem with arelativelystronghealthcaresystem,cushionedtheimpact ofthepandemictoalarge extentbyinitiating The devastatingeffectoftheCOVID-19pandemicmayhardly beoverestimatedinKyrgyzstan. Thecountry CONCLUSION the disastrouseconomicimpactinlongterm[ al institutionslined-uptoprovideaid,butthescaleandscopeofassistancewillnotsufficecompensate acerbated by plummeting business activities in production textile and tourism [ flows toKyrgyzstan might sink by 25% constituting 33.23% of the country’s GDP in 2018[ Kyrgyzstan and neighboring countries expect to lead to 4% drop in GDP by the end of 2020. Remittance in covered bysocialprotectionthatofficialemployeeshave[ coveries acrossthecountrybyNovember4,2020[ The lateststatisticsonCOVID19accountedtoatotalof60 per day[ the incidence started to decrease considerably. By the end of the month, it went down to 119 incident cases oratories [ 4 9 ]. ]. All the country efforts in the fight against COVID paid off in the middle of August 2020 when ]. Allthe country effortsinthefightagainstCOVID paid off in themiddle of August2020when
10 ]. homecare andconductPCRtestonCOVID-19usingmobilelab over, 253 mobile teamswereorganized toprovidesupport dents were mobilized to fill the gap of healthcare workers. More Kyrgyz physiciansreturnedfromMoscowandmanymedicalstu health workerswererecalledtothecityfromotherregions,30 and someoutpatientfacilitiesinvariousdistrictsofBishkek.100 opened departmentsforCOVID-19patientsinseveralhospitals In order to cope with the emergency situation, the government care ofpatientssufferingfromotherdiseases[ combatting thepandemicthusresultinginlimitedaccesstohealth healthcaresystemforcedproviderstofocusmorein overwhelmed of COVID-19 were among health workers [ the ventilators were not functional and one in four recorded cases care systembythatperiodcanbedescribedtwofacts:halfof reached onJuly19,2020( tion [ tions frompneumonia,itwasnotfeasibletomakesuchadistinc rately, butduetothesharpincreaseinnumberofhospitaliza 3
7 9 11 ] and large number of people are self-employed and are not ]. The peak of the wave with 1926 cases on a single day was ]. Thepeakofthewavewith1926casesonasingledaywas 4 ]. ]. Preliminaryresultsofpopulation-basedsero-epidemi 11 279 confirmedcases,1159deathsand51 ]. The quarantine restrictions implemented by ]. Thequarantinerestrictionsimplementedby Figure 1 ) [ 5 ]. Many financial internation 4 ]. Thestruggleofthehealth 2021 •Vol. 11 • 03020 9 5 ]. Furthermore, an ]. 7 , 12 ]. This is ex 288 re ------
VIEWPOINTS VIEWPOINTS 2021 •Vol. 11 • 03020 REFERENCES 12 11 10 9 8 7 6 5 4 3 2 1 public-socioeconomic-and-vulnerability-impact-assessment-and UN officefortheCoordinationofHumanitarianAffairs.Available: nections. TheQuarterlyJournal.2020;19:101-14. Gleason G,KuralayBaizakovaK.COVID-19intheCentralAsianRegion:NationalResponsesandRegionalImplications.Con ovie&place=translate ovie.akipress.org/news:1659164?from=portal&place=last&b=6 Serology testing for COVID-19 in Kyrgyzstan found over 2 million contracted coronavirus by August. Available: http://zdor ws/corona-virus-situation-kyrgyzstan Trade F. CORONAVIRUS–ThesituationinKyrgyzstan. Available: kyrgyzstan/livinghit.aspx?Section=6.%20Measures%20in%20other%20sectors&Type=Chapter COVID-19 Healthsystemresponsemonitor. PolicyresponseforKyrgyzstan. mains-vulnerable-d.html kg.undp.org/content/kyrgyzstan/en/home/presscenter/pressreleases/2020/04/kyrgyzstan-is-well-prepared-to-covid-19-but-re UNDP. Kyrgyzstan iswell-preparedtoCOVID-19butremainsvulnerable duetoeconomicchallenges.Available: 5 November2020. https://www.worldbank.org/en/news/press-release/2019/06/07/kyrgyz-republic-to-gain-better-primary-health-care. Accessed: The Kyrgyz Republic to Gain Better Primary Health Care, with World Bank Support. Press release # 2019/ECA/132 Available: cessed: 3November2020. OCHA. Kyrgyzstan COVID-19Response. Available: Worldometer. CoronavirusUpdates.Available:https://www.worldometers.info/coronavirus/. Accessed:4November2020. healthcare system.ConflHealth.2020;14:65. Lucero-Prisno DEIII,EssarMY,AhmadiA,LinX,AdebisiYA.ConflictandCOVID-19:adoubleburdenforAfghanistan’s Res Policy.2020;5:21. Lucero-Prisno DEIII,AdebisiYA,LinX.Currenteffortsandchallengesfacingresponsesto2019-nCoVinAfrica.GlobHealth challenges? JGlobHealth.2020;10:020341. Lucero-Prisno DEIII,AhmadiA,EssarMY,XuL,AdebisiYA.AddressingCOVID-19inAfghanistan:Whataretheeffortsand from thecorrespondingauthor),anddeclarenoconflictsofinterest. Competing interpretation andlanguageedit.Alltheauthorsreadapprovedfinalmanuscript. collect dataandliteraturewithanimportantcontributionbyDEL-P. DEL-PandLXassistedwithdatacollection,article Authorship Funding
: No fundingfromanyinstitutionordepartment. interests: The authors have completed the ICMJE Unified Competing Interest form (available upon request interests: TheauthorshavecompletedtheICMJEUnifiedCompetingInterestform(availableuponrequest contributions: DK, DEL-P and AA conceived the idea. AA, DK and VD wrote the draft of the manuscript, contributions: DK,DEL-PandAAconceivedtheidea.AA,DKVDwrotedraftofmanuscript, . Accessed:5November2020.
Medline:32391440 . Accessed:5November2020. . Accessed:7November2020.
doi:10.1186/s41256-020-00148-1
Medline:33110541
Medline:32973920 doi:10.11610/Connections.19.2.08 4 https://www.humanitarianresponse.info/en/operations/Kyrgyzstan
. Accessed:7November2020.
doi:10.7189/jogh.10.020341
doi:10.1186/s13031-020-00312-x https://www.flandersinvestmentandtrade.com/export/nieu https://reliefweb.int/report/kyrgyzstan/covid-19-kyrgyz-re https://akipress.com/news:650621/?from=zdor https://www.covid19healthsystem.org/countries/ [email protected] Postal Code:1004 Afghanistan Kabul Kateb University Medical ResearchCenter Attaullah Ahmadi,MD Correspondence to: www.jogh.org •
. Accessed:5November2020.
doi: 10.7189/jogh.11.03020
https://www. . Ac ------