Coronavirus Disease 2019 (COVID-19) Situation Report 53

Issued 26 November 2020

Highlights

• The oPt is witnessing a concerning dynamic of community spread of SARS-CoV-2, with increasing numbers of COVID-19 cases
• While the health system at this stage can cope with the increasing number of people requiring treatment for COVID-19, there is a mounting risk that the health system may reach its capacity limits and get overwhelmed
• Decisive public health measures and strict adherence to hygiene protocols and physical distancing are needed to regain control and reduce the spread of the disease
• Oxygen supply generators have been identified as critical gap, in particular in the dedicated treatment facility for COVID-19 patients in Gaza, and the health cluster is working on mobilizing respective equipment through international suppliers
• WHO and partners have co-ordinated the delivery of 35 ventilators, to arrive over the coming days in Gaza to augment treatment capacities accordingly.

Thanks to the generous support of the Government of Kuwait, WHO delivered five ventilators to local health authorities in the Gaza Strip to support the management of critical patients with COVID-19.  
A further 30 ventilators are due to arrive in Gaza this week, 15 procure with funding from Kuwait, 15 are a donation from the Government of Germany. ​

WHO preparedness, readiness and response

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

 Coordination, planning and monitoring ​​

WHO conducted a monitoring visit to the European Gaza Hospital (EGH), the dedicated facility in the Gaza Strip to manage critical, severe and moderate COVID-19 cases. The WHO team observed the COVID-19 patients’ pathway and visited the Emergency Unit, Intensive Care Unit, Maternal and Child Unit as well as the wards where moderate and severe cases are hospitalized. 

• In the West Bank, a weekend and night-time closure and movement restrictions will be imposed from 27 November 2020 to mitigate a further increase in case numbers
• The Rafah Border Crossing, between the Gaza Strip and Egypt, has been open for three days (24-26 November). During the first two days, 595 Palestinians entered Gaza, and 1,849 people exited to Egypt. All returnees were requested to present a COVID-19 PCR certificate or tested upon entry.

Surveillance  

• The WHO risk assessment remains very high
• The oPt is witnessing a concerning increase in COVID-19 cases, with significant community transmission of SARS-CoV-2 over the reporting period, in the West Bank and in the Gaza Strip
• A 66% increase in confirmed cases (by 10,1716) and a 57% increase in deaths (by 83) was reported between 20-26 November, compared to the previous week (13-19 November). The overall Case Fatality Rate (CFR) remains at 0.8 % since the beginning of the outbreak. The CFR is the proportion of deaths among identified confirmed cases
• Gaza accounts for 42% of all active cases in oPt, followed by the West Bank governorates of Nablus (15%), Bethlehem (8%), Hebron (6%), Ramallah and Jenin (5%) Jerusalem (3%)
• On 21 November, 891 new confirmed cases were reported in Gaza, the highest number over a 24-hour period
• WHO is strongly recommending and advocating stricter adherence to public health measures. At this stage it is critical that communities implement effective prevention protocols to help curb the current increasing transmission trends, to save lives and to ease the pressure on the health system. Essential protective measures include wearing a mask; following good respiratory hygiene; regularly washing hands; social distancing of at least 1 metre including avoiding crowds and gatherings; staying  home and self-isolating if people develop Corona related symptoms.
• Meanwhile health system strengthening efforts with a focus on enhanced surveillance, further contact tracing capacity, and improved case management are needed.

Laboratory diagnostics  ​

WHO delivered 200 testing kits to local health authorities in the Gaza Strip on November 17 and 19 to conduct more than 19,000 COVID-19 tests. The delivery arrived at a critical time, with laboratory supplies and tests in demand due to the higher numbers of COVID-19 cases detected in Gaza. In addition, 70,000 swabs were delivered to help maintain Gaza’s testing capacity and support the detection of new COVID-19 cases.​

• The number of tests conducted has increased significantly in the reporting period (20—26 November), with 47,408 more tests conducted compared the previous week
• In Gaza, while the continued supply of lab testing kits and consumables remains a challenge, testing has been sustained. WHO delivered 200 testing kits on 17 and 19 November, to conduct almost 2,500 tests per day. Additionally, on November 25, WHO delivered 70,000 swabs to help maintain Gaza’s testing capacity and support the detection of new COVID-19 cases.

Infection Prevention and Control (IPC), Isolation and Case Management, Operations Support and Logistics 

“I found the training useful, especially during the spread of COVID-19 because it refreshed our knowledge and skills in infection prevention and control” – Eman, Midwife, Primary Healthcare Center, Khan Younis.  A comment from one of the 137 health workers being trained in the Gaza Strip on Infection Protection and Control during the COVID-19 pandemic. The latest course, conducted on November 17-18 by PNIPH and WHO, included role playing demonstrations, discussions, and practical sessions. 

• In the Gaza Strip, the overall occupancy rate of dedicated COVID-19 beds in health facilities is 61% (307 beds). Local health authorities expanded the capacity to manage critical and severe cases at European Gaza Hospital (EGH) by 30% to 150 beds, including 70 intensive care units (equipped with ventilators) and 80 high-dependency beds. The Gaza health authorities have identified the provision of oxygen for treatment of COVID-19 patients through the central supply system in the EGH as critical bottleneck. The Health Cluster has been working with partners to mobilize essential oxygen generation equipment through international suppliers, but complex international logistics will likely allow delivery only by early 2021.
• Local authorities introduced ‘home isolation’ for mild COVID-19 cases on November 14, while patients who require medical care will remain isolated at the two designated treatment facilities:
  • moderate, severe, and critical cases to be hospitalized at EGH
  • mild cases with co-morbidities to be hospitalized at the Turkish Hospital
• WHO delivered 25 adjustable beds to support the screening of people for COVID-19 in respiratory triage centres outside Gaza’s five main hospitals on November 9. With more medical equipment for case management due to arrive in Gaza to further scale-up hospital capacity, WHO is recommending health authorities consider increasing human resources capacity, particularly for ICU nurses
• WHO has supported the provision of fuel to Palestine Red Crescent Society (PRCS) ambulances, through UNRWA, in response to an increased demand for its services. Since COVID-19 community transmission was detected in Gaza in August, PRCS has increased their services by more than 300%. The fuel will cover the needs of ambulances in Gaza and Rafah governorates for approximately two weeks.

East Jerusalem

• Since November 20, 44 cases and 10 deaths were reported in East Jerusalem (EJ)
• 31 COVID-19 patients are currently hospitalized in EJ hospitals, 16 are at St. Joseph Hospital, 11 at Makassed hospital and 4 at Augusta Victoria Hospital. Since March 2020, St. Joseph hospital treated 368 COVID-19 patients.

COVID-19 vaccination: ​

• The Prime Minister’s Office organised two meetings of the National Immunisation Technical Advisory Group (NITAG) for introduction of the COVID-19 vaccine. The Minister of Health, Dr Mai Al-Kaila, chaired the meetings which were attended by the MoH, other line ministries, WHO, UNRWA and UNICEF. The meetings reviewed the status of implementation of the mandatory tasks ahead, including the completion of the GAVI AMC-92 application, cold chain assessment, WHO-UNICEF Vaccine Introduction Readiness Assessment Tool (VIRAT) and the World Bank’s VRAF tool.

Sustaining Essential Health Services 

WHO thanked the Norwegian Government for its generous funding of 8.5 million Norwegian Krone (USD $958,000) to support the strengthening of the Gaza’s Strip’s public health laboratory to respond to the public health threats caused by infectious disease outbreaks on November 25. Pictured is WHO’s Head of Office Dr Gerald Rockenschaub and the Norwegian Representative to Palestine, Ms Torunn Viste, signing an agreement which will support a scale up Gaza’s laboratory capacity and capability, by enhancing infrastructure and increasing skill and knowledge among the laboratory’s workforce. ​

• The delivery of essential health services continues to be impacted by the pandemic. Local health authorities in Gaza announced closure of all public outpatient clinics and temporary suspension of elective surgeries for two weeks on November 24, while maintaining urgent and life-saving surgeries only
• As of 23 November, the Palestinian Authority’s Ministry of Health Liaison Office resumed patient and companion permits coordination to support Palestinian patients and companions required by Israel to apply for permits to access essential health services outside the Gaza Strip, following the Palestinian Authority’s decision to resume coordination with Israeli authorities. WHO had initiated a temporary coordination mechanism to support patients and companions requiring exit from Gaza on 6 September when coordination was suspended.

More local information

WHO COVID-19 Dashboard for oPt

​UN’s COVID-19 Emergency Situation Reports and information via OCHA