http:// ijp.mums.ac.ir Review Article (Pages: 11429-11434)

Coronavirus Disease 2019 (Covid-19) in Middle East: Data, Facts and Doubts *Majid Rajabian1, Maham Doagooyan2 1

1Department of Biochemistry, Payame Noor University, , . 2MSc, Medical Biotechnology, Medical Faculty, University of Medical Sciences, Mashhad, Iran.

Abstract Coronavirus disease 2019 (COVID-19) is an infectious disease caused by a newly discovered coronavirus. A pneumonia of unknown cause detected in Wuhan, China was first reported to the WHO Country Office in China on 31 December 2019. The outbreak was declared a Public Health Emergency of International Concern on 30 January 2020. On 11 February 2020, WHO announced a name for the new coronavirus disease: COVID-19. The Middle East is one of the areas where the virus has become widespread and has caused many deaths. The severity of the COVID-19 disease varies from country to country, with the highest rates of infection in Iran, Turkey and Egypt. Compared to other countries involved, Iran has the most recovery, too. It is worth noting that these countries have been the target of unfair US sanctions for many years, and the import of drugs and medical equipment is associated with many problems. By maintaining personal hygiene and keeping a distance from anyone who is coughing or sneezing, also stopping the civil and foreign wars, lifting the sanctions and paying special attention to the health of all people, especially the weak and sensitive, there is hope that the disease may be defeated. Key Words: Coronavirus disease 2019, Covid-19, Middle East.

*Please, cite this article as Rajabian M, Doagooyan M. Coronavirus Disease 2019 (Covid-19) in Middle East: Data, Facts and Doubts. Int J Pediatr 2020; 8(6): 11429-11434. DOI: 10.22038/ijp.2020.48778.3914

*Corresponding Author: Dr. Majid Rajabian, Assistant Professor, Department of Biochemistry, Payame Noor University, Tehran, Iran. Email: [email protected] Received date: Mar.30, 2020; Accepted date: Apr.12, 2020

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1- INTRODUCTION from Wuhan, a city in the Hubei Province Coronaviruses are a large family of of China, at the end of 2019, more than viruses. Some coronaviruses cause illness 80,000 COVID-19 cases have been in humans and others cause illness in reported in China, with the majority of animals, such as bats, camels, and civets. those from Hubei and surrounding Human coronaviruses generally cause mild provinces. A joint World Health illness, such as the common cold. Rarely Organization (WHO)-China fact-finding do animal coronaviruses evolve to infect mission estimated that the epidemic in and spread among humans, causing severe China peaked between late January and diseases such as Severe Acute Respiratory early February 2020 (13), and the rate of Syndrome (SARS), which emerged in new cases decreased substantially by early 2003, and Middle East Respiratory March. However, cases have been reported Syndrome (MERS), which emerged in in all continents, except for Antarctica, and 2012. The most recently discovered have been steadily rising around the world coronavirus causes coronavirus disease (4). The Middle East is one of the areas COVID-19. The Coronavirus disease 2019 where the virus has become widespread is an infection caused by a virus called and has caused many deaths. In this SARS-CoV-2 (1-3). review, we aimed to have a brief review of Middle Eastern countries in terms of The virus first appeared in late 2019 in the conflict with the virus. city of Wuhan, Hubei province, China in December 2019, where it caused a large 2- MATERIALS AND METHODS and ongoing outbreak and has since spread 2-1. Method more widely in China. Regrettably, since then it has spread quickly and there are In this review, the following now cases around the world. The outbreak databases were searched for relevant was declared a Public Health Emergency papers and reports: Scopus, EMBASE, of International Concern on 30 January, Cochrane, Web of Science and Medline 2020 (4). On 11 February, 2020, WHO (via PubMed) with no language or time announced a name for the new coronavirus restrictions (until Apr 17, 2020) using the disease: COVID-19. The COVID-19 virus related keywords. Table.1 presents the is closely related to a bat coronavirus. search query for Medline database. In Outbreaks of new coronavirus infections addition, a manual search was also among people are always a public health performed in the Google and Google concern. The situation is evolving rapidly. Scholar search engines and the bibliographies of related articles. Two Until the source of this virus is identified reviewers, who initially examined the and controlled, there is a risk of abstracts of searched articles and then reintroduction of the virus in the human downloaded their full text to review population and the risk of new outbreaks carefully, chose the relevant studies like the ones we are currently experiencing independently. Finally, the articles that (4-10). Globally, more than a million met the inclusion criteria were enrolled in confirmed cases of COVID-19 have been the systematic review, and their used reported. Updated case counts in English relevant references were reviewed to find can be found on the World Health further studies. The review also involved Organization, and European Centre for articles acquired through hand searching. Disease Prevention and Control websites The third reviewer judged any (11, 12). Since the first reports of cases disagreement.

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Table-1: Search query in PubMed. Database Query Medline (via ("middle east"[MeSH Terms] OR middle east[Text Word]) AND ("coronavirus"[MeSH Terms] PuBMed) OR Coronavirus[Text Word]) OR ("COVID-19"[All Fields] OR "severe acute respiratory syndrome coronavirus 2"[All Fields] OR "severe acute respiratory syndrome coronavirus 2"[All Fields] OR "2019-nCoV"[All Fields] OR "SARS-CoV-2"[All Fields] OR (("Wuhan"[All Fields] AND ("coronavirus"[MeSH Terms] OR "coronavirus"[All Fields])) AND 2020[All Fields])).

3- RESULTS smallest country (14-17). In general, the The Middle East is a region of the Middle East has a climate that leans world that is in between Europe and Asia. towards being dry and relatively humid in This detail about the Middle East is what nature. The Middle East comprises makes the region transcontinental. The seventeen countries in total. These Middle East is a region that spans the countries include Bahrain, Cyprus, Egypt, easternmost part of Europe and the Iran, Iraq, Israel, Jordan, Kuwait, Lebanon, westernmost part of Asia, and since the Oman, Palestine, Qatar, Saudi Arabia, countries fall on two different continents, , Turkey, United Arab Emirates, and the Middle East is considered a Yemen. Globally, until 17 April 2020, transcontinental region, not a continent, there were 2,034,802 confirmed cases of country, or anything of the like. Most COVID-19, including 135,163 deaths, Middle Eastern countries (13 out of 18) are reported to WHO. Authoritative global part of the Arab world. Several major statistics show that all countries in the religions have their origins in the Middle Middle East are somehow involved in East, including Judaism, Christianity, coronavirus (Table.2). The severity of the and Islam. Arabs constitute the majority disease varies from country to country, ethnic group in the region followed with the highest rates of infection in Iran, by Turks, Persians, Kurds, Azeris, Copts, J Turkey and Egypt. Compared to other ews, Assyrians, Iraqi,Turkmen, and Greek countries involved, Iran has the most Cypriots. The most populous countries in recovery; and this is while the country has the region are Egypt, Iran, and Turkey, been the target of unfair sanctions by the while Saudi Arabia is the largest Middle US government for many years and it is Eastern country by area, and Bahrain is the not even possible for the people of this country to import drugs and health items.

Source: WHO.

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4- DISCUSSION facilities (Yemen, Syria, Iraq, Palestine, For the first time, in December 2019 and Lebanon). in Wuhan, China, a new type of 2. Some countries whose economies are coronavirus was first identified as 2019- based on tourists and pilgrims are more nCoV (18) after people became infected likely not to provide real statistics. without a specific cause and the existing 3. Some countries also try not to provide vaccines and treatments were not effective. real statistics due to political However, as the number of victims of the considerations. Coronavirus virus crossed the 1,000 individuals mark, the World Health 4. Some countries are unable to perform Organization chose the official name of testing for all people due to lack of COVID-19 for the disease. On January 30, facilities and health personnel, and 2020, the World Health Organization therefore the statistics provided are flawed. issued a statement declaring the outbreak 5. In some countries, due to civil and of the new coronavirus an emergency foreign wars, COVID-19 disease is not public health emergency that posed a their first priority. threat to the entire world, not just China (19). People can catch COVID-19 from 6. Some countries have many specialists others who have the virus. The disease can for prevention and treatment, but due to spread from person to person through unfair US sanctions, it is not possible for small droplets from the nose or mouth medical equipment to enter their country, which are spread when a person with etc. COVID-19 coughs or exhales. The prevalence of COVID-19 disease has These droplets land on objects and severe consequences in Iran. The available surfaces around the person. Other people evidence shows that the cowardly then catch COVID-19 by touching these sanctions that were unilaterally imposed objects or surfaces, then touching their by the United States of America on this eyes, nose or mouth. People can also catch country in May 2019 have also negatively COVID-19 if they breathe in droplets from affected the health system. In many a person with COVID-19 who coughs out countries around the world, COVID-19 has or exhales droplets. This is why it is created a significant economic burden that important to stay more than 1 meter (3 may have been unprecedented in recent feet) away from a person who is sick (7- decades. Despite the efforts of health 12). In this review, we aimed to have a officials, especially at the forefront of brief review of Middle Eastern countries in medical centers, it has been very effective terms of conflict with the virus. Results in controlling and reducing the effects of showed that Iran, Turkey and Egypt have the coronavirus epidemic, but Iran has the highest incidence of the disease. Also, borne a double burden due to cowardly the least affected countries are Syria, sanctions; and to this day, many health Yemen and Palestine. The results also care workers and innocent children and showed that most of the recovery cases are adults have lost their lives due to lack of related to Iran (4, 7, 8, 11-13). Regarding medicine and medical equipment and the results obtained, the following points many staff in treatment and care, along are important: with the people in this difficult and exhausting path, have lost their lives. In 1. The Middle East region has 17 the Middle East, some countries are countries, most of which have weak involved in civil and foreign wars in economies and very poor health care addition to the prevalence of COVID-19

Int J Pediatr, Vol.8, N.6, Serial No.78, June.2020 11432 Rajabian and Doagooyan disease, which has exacerbated the coronavirus disease (COVID-19). All situation and affected sensitive and countries in the Middle East are vulnerable groups (such as children, somehow affected by COVID-19 women and the elderly). In places like disease. Iran, Turkey and Egypt have Syria and Yemen, where healthcare the highest rates of infection. On the infrastructure has been significantly other hand, Iran has the most cases of damaged by ongoing conflict, mounting an recovery from the disease. With effective response against COVID-19 personal hygiene and self-care, poses an extremely difficult challenge. distance from sick people, attention to WHO has received reports of dozens of healthy eating, attention to the weak confirmed cases and two deaths in Syria and susceptible people to disease, as due to COVID-19. A further spread of the well as the end of civil and foreign virus could create a disaster for a country wars and the lifting of unilateral wracked by 10 years of war, particularly sanctions against countries involved in for internally displaced persons the fight against COVID-19, recovery (IDP). Dangerously cramped conditions in and treatment can be improved and the multiple IDP camps, settlements, and defeat of COVID-19, is promising. places of detention increase the risk of infection. Five years into the conflict in 6- CONFLICT OF INTEREST: None. Yemen, the country’s healthcare system is 7- REFERENCES on the brink of collapse and millions of Yemenis lack access to healthcare 1. Zhu N, Zhang D, Wang W, Li X, Yang B, services. Song J, Zhao X,, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. Yemen has become home to diseases such N Engl J Med. 2020;382(8):727. Epub 2020 as diphtheria and dengue, which can turn Jan 24. into serious health threats for a population 2. Lu R, Zhao X, Li J, Niu P, Yang B, Wu H, that has been chronically malnourished for et al. Genomic characterisation and years. The results of the present study epidemiology of 2019 novel coronavirus: showed that most cases of recovery from implications for virus origins and receptor COVID-19 disease are related to Iran. This binding. Lancet. 2020;395(10224):565. Epub may indicate that despite years of unfair 2020 Jan 30. sanctions by the United States and other 3. Perlman S. Another Decade, Another countries, with the help of hardworking Coronavirus. N Engl J Med. 2020;382(8):760. people as well as its experts and innovative Epub 2020 Jan 24. youth, Iran has not given in to unilateral 4. Coronavirus disease (COVID-19) sanctions against Iran by the United States Pandemic. World Health Organization. and its allies, and serving the people Available at: continues, even with the least facilities. https://www.who.int/emergencies/diseases/nov el-coronavirus-2019 5- CONCLUSION 5. National Coronavirus Health Information A pneumonia of unknown cause Line. Available at: detected in Wuhan, China was first https://www.health.gov.au/contacts/national- reported to the WHO Country Office coronavirus-helpline in China on 31 December 2019. The 6. NSW Health - Novel coronavirus. Available outbreak was declared a Public Health at: Emergency of International Concern https://www.health.nsw.gov.au/Infectious/covi on 30 January 2020. There is no d-19/Pages/frequently-asked-questions.aspx. specific medicine to prevent or treat

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