09 – 15 August, 2020 | Press Review Morocco

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August 15, 2020: Rapid Serological Tests-Physician associations criticize the Health Minister’s strategy

Following the publication of a circular calling on health centres to use serological tests to identify patients suffering from new coronavirus or in remission, two doctors’ associations criticised this measure for being “irrational in relation to scientific data and the socio-cultural reality of Moroccans”.

In a letter addressed to the Minister of Health, the Moroccan Society of Emergency Medicine (SMMU) and the Moroccan Society of Anaesthesia, Analgesia and intensive care (SMAAR) noted that, contrary to their recommendations published in early August, the department had recommended the use of rapid IgM/IgG tests for the diagnosis of suspected cases. However, this protocol should be dedicated “exclusively for epidemiological surveillance and as a complement to PCR or virological tests”, according to the doctors.

“Referring patients at home on the basis of serological tests, which are negative in the viral phase of the disease, without taking into account the clinical condition, will expose them to delays in treatment and consequently to excess mortality”, the authors of the correspondence believe. The authors warn in particular that “rapid serological tests are not validated for positive diagnosis on a global scale, given the high percentage of false negatives on the one hand, and the delay in the appearance of antibodies beyond the tenth day of infection on the other”.

As a result, “a negative rapid test in the early phase ignores the carriers of the virus, which is the source of transmission of the disease, an epidemiological explosion and the appearance of serious forms with a poor prognosis, requiring hospitalisation in intensive care units”, according to the two associations.

For doctors, “priority must be given to the early initiation of treatment according to the national protocol”, which implies early diagnosis, urgent care and close monitoring of active patients and contact cases.

Thus, the two structures consider it “necessary” to mobilise local health centres, but express their concern that this integration in the management of COVID-19 according to the model proposed in the circular becomes “the origin of the emergence of clusters by multiplying the routes and meeting places”.

For more information, please consult (in French) the following link.

August 15, 2020: Russia announces the start of production of the first vaccine

The production of the first coronavirus vaccine, developed by the National Research Center for Epidemiology and Microbiology “Gamaleya” began Saturday, the Russian Ministry of Health said.

The vaccine, registered under the name “Sputnik V”, is expected to be on the market on January 1, 2021, and production has begun at three sites to meet production targets for the Russian market as a priority, said the director of the Gamaleya center, Alexander Gunzberg.

In this sense, he recalled that the vaccine will be an intramuscular injection solution, which will have to be injected in two phases separated by a period of three weeks, in order to form long-term immunity that can last up to two years.

Sputnik V” will initially be administered to those working directly with coronavirus patients and then to at-risk groups, before being generalised, but with respect for a voluntary vaccination process, as the Russian President Vladimir Putin stressed on 11 August when announcing the registration of the world’s first COVID-19 vaccine.

Russia has also received orders from 20 countries for the supply of 1 billion doses of the vaccine, Kirill Dmitriev, director of the Russian Direct Investment Fund, announced.

About 917,000 people have been infected with the coronavirus in Russia, including 15,600 deaths and 729,000 recoveries, placing the country fourth in the world in terms of infections and 11th in terms of deaths due to the pandemic.

For more information, please consult (in French) the following link.

August 14, 2020: Rabat-Hay Rachad put under lockdown due to its epidemiological situation

El Youssoufia, one of the five districts of the “city” Rabat is located east of the capital, has seen one of these “Hays” or neighbourhoods, Hay Rachad, sealed by the authorities. Yesterday, Thursday, he was under a general shakedown.

Alleys, markets and other public spaces have seen an increase in police officers and metal barriers have been placed to prohibit or at least limit the entry and exit of some places in the neighbourhood which contains an important population density.

This local containment was decided by the authority after the district had been declared a cluster, epidemic hotspot that could dangerously spread the coronavirus (COVID-19). In fact, in 24 hours, more than 21 cases were detected in Hay Rachad and many more are expected based on the results of numerous tests carried out in the emergency. Nevertheless, the inhabitants of this working-class district have wisely welcomed these restrictive measures, considering them to be entirely appropriate to the situation.

Hay Rachad returned to localized and even partial confinement and home confinement for some. Decided, following the evolution of the epidemiological situation in the district where several outbreaks have been discovered, this closure will imply a decrease or even a total stop of a set of activities (commercial, economic and social) strict control of public transport and car traffic, even a ban from certain hours and a night curfew defined by the authorities concerned.

The young people of the Hay Rachad neighbourhood in the El Youssoufia district, made up of a network of associations, said they were ready to collaborate with the authorities, with whom they held a few meetings as briefings. They say they are ready to participate in the success of this operation and to raise awareness among the inhabitants of their neighbourhood about the dangerousness of the situation of the COVID-19 that is affecting their neighbourhood. This participation is welcome at a time when the pandemic is becoming more and more pressing in the Kingdom and when a decrease in following the protective measures has been noted.

For more information, please consult (in French) the following link.

August 14, 2020: Casablanca – Restrictive measures after the multiplication of Anfa contaminations

The measures taken include a ban on the broadcasting of matches on screens in cafés and the sealing off of certain neighbourhoods and districts and the establishment of roadblocks.

Local authorities in Casablanca on Friday undertook a series of restrictive measures in the Anfa district of Casablanca, following the multiplication of cases of Covid-19 contamination.

The measures taken include the ban on broadcasting matches on screens in cafes and the closure of certain arteries and neighbourhoods, namely Boulevard Taher El Alaoui, Rue Abderrahmane El Mkhanet, Rue Mouha Ou Said, Bab Marrakech, Bab Jdid, Sour Jdid and Tnaker, local sources said.

Joint patrols were also set up on checkpoints at the accesses to the central, Benjdia and Chaouia markets.

For more information, please consult (in French) the following link.

August 13, 2020: Inauguration of a new medical unit in Tangiers

A new medical unit for the management of moderate and severe cases of COVID-19 was inaugurated on Thursday 13 August at the Mohammed VI Hospital in Tangier.

This unit, which was erected and equipped in less than a week, includes 48 beds in individual rooms equipped with respiratory assistance devices and vital signs monitors and will thus be dedicated to patients whose state of health requires the immediate administration of oxygen.

The capacity of this unit will enable the health authorities to handle recent cases of COVID-19 contamination that come to hospitals in Tangier, said the Regional Director of Health in Tangier-Tetouan-Al Hoceima, Dr. Ouafae Ajnaou, adding that this unit is dedicated to the management of patients suffering from chronic diseases and the elderly whose state of health requires intensive care.

This unit will ease the pressure on the ICU units, which have a capacity of 73 beds, Dr. Ajnaou added, noting that the inauguration of this unit aims to free up the beds in the ICU units for patients whose state of health requires these services.

Cases requiring medical supervision will be handled at this unit, while serious and critical cases will be transferred to the three ICU in Tangier, explained the official.

For more information, please consult (in French) the following link.

August 13, 2020: Morocco Introduces Rapid Serological Tests in Health Clinics

This is a turning point in strategy. Morocco is introducing rapid serological tests in neighbourhood dispensaries (primary health care centres), so that people at risk or referred by doctors or pharmacists can be tested quickly. If the test is positive, a PCR test is carried out and while waiting for the result, the person concerned must be placed in isolation.

This is a major change as it will reduce delays and greatly reduce the time in which undiagnosed and contagious cases circulate in the population.

Until now, and under the pressure of the increase in confirmed cases and contact cases, the delays between the identification of a contact or suspect case and the start of treatment have varied on average between 7 and 9 days according to informed medical sources.

Now, a serological test (blood sample which gives a rapid result between 15 and 30 minutes) will allow a first opinion to be made and the suspect case to be isolated while awaiting PCR confirmation.

This decision had been briefly announced by the Minister of Health during a webinar organized Tuesday, August 11 by the Moroccan Society of Medical Sciences. Khalid Ait Taleb, the minister of health, quickly gave concrete form to his announcement.

This decision was the subject of circular 64 DHSA of August 13, 2020, addressed by the Minister to the regional directors of Health.

“The ESSP primary health care institutions are called upon to carry out rapid serological tests for the population at risk and the suspect cases referred by private (and labour) sector doctors, pharmacists and those detected at the level of the health centre,” the minister wrote in the circular.

People at risk are those aged 65 or over with chronic diseases such as diabetes and/or high blood pressure.

Patients with IGM positive (presence of antibodies showing recent coronavirus infection) are referred to hospital outpatient facilities for a PCR test and an additional check-up. Pending the result of the PCR test, those eligible for home care will be confined to their homes.

If the PCR result is negative, the health centre contacts the patient, informs him/her and recommends that he/she remains self-confined while respecting the barrier gestures.

If the PCR result is positive, the eligible asymptomatic patient will remain at home for follow-up. Otherwise, the patient will be hospitalized.

The regional health directorates are responsible for the availability of serological tests and treatments at the PHC level.

This decision breaks with the centralization strategy that had prevailed but which showed its limitations when the number of cases and tests increased. Now, serological tests will be done in the neighbourhoods and closer to the population. The process will become faster and, in any case, the population will be better protected since, while waiting for PCR results, people with positive serology will be isolated.

These measures will be carried out with the support of the territorial administration, announced the Minister of Health on Tuesday 11 August.

For more information, please consult (in French) the following link.

August 12, 2020: Travellers from Morocco banned from entering the Netherlands as of August 13

Travellers from Morocco will no longer be able to enter the Netherlands from midnight on 13 August, in accordance with a measure decided on Wednesday by the Dutch Ministry of Justice and Security.

The measure is justified, according to the ministry, by the increase in cases of contamination observed in recent weeks in the Kingdom.

“This decision was taken on the basis of a risk assessment with criteria as objective as possible on the health situation in Morocco and the measures applicable there,” the Dutch ministry said in a document published on its website.

It adds that “In this context, as in the case of Serbia, Montenegro and Algeria, the number of new infections was examined, among other things. This number must be lower than the European average of June 15 per 100,000 inhabitants over the last 14 days. It also examines the overall response to COVID-19 in the country concerned. This includes the number of corona tests performed, source and contact tracing and control measures”.

In this regard, the Dutch Minister of Justice and Security, Ferdinand Grapperhaus, noted that “unfortunately, the health situation in Morocco has deteriorated to such an extent that the Member States of the European Union decided on 7 August to remove the country from the list of countries for which the entry ban could be lifted”.

The list of travel restrictions does, however, include a few exceptions for health personnel, diplomats, military personnel, international civil servants, border workers, transport personnel, fishermen, people working in the energy sector, offshore companies, transit passengers and seafarers.

For more information, please consult (in French) the following link.

August 10, 2020: Slow detection of cases contributes to the explosion of the number of cases

The webinar organized on Tuesday, August 11 by Dr. My Said Afif, President of the Moroccan Society of Medical Sciences, was rich in information.
Snippets put together shed additional, different light on one of the major reasons for the worsening of the situation. It is in fact a dysfunction in early detection. Early detection, which has been central to any strategy to date, requires a rapid diagnosis of COVID-19 cases, including and especially contact cases. However, it has become clear in the debate that for a contact case, the time between the identification of the person, the sampling and the test result is greater than or equal to 7 days!

There was a consensus on the situation, which was described as “worrying, serious, disturbing”. The figures speak for themselves: in the last seven days there have been as many new cases as in April and May combined. On Tuesday evening, 11 August, there were 9,277 active cases, “one third of the bedding capacity of the public sector, which is 23,000 beds,” warned Dr. Abdelkrim Meziane Bellefquih, head of the division of communicable diseases at the Ministry of Public Health.

The speaker recalled that “Morocco has exceeded 35,000 cumulative cases, 500 deaths. The incidence of the disease is now 96 per 100,000 inhabitants”. At the time of the gradual lifting of containment, the RT (virus reproduction rate) was 0.70 at most in each region, and after the de-containment, “we were expecting a rise to 0.90, but we are currently between 1.2 and 1.4. »

Patients are arriving later and later, say several workers. My Hicham Afif, DG of the Casablanca University Hospitals, asserts: “one patient in five arrives (in the emergency room of the University Hospitals for critical cases), almost dying”. Professor Lahoucine Barrou, head of the intensive care unit at the Ibn Rochd University Hospital in Casablanca, said: “23% of patients [in a serious condition] die in the emergency room.”

Dr Tayeb Hamdi, vice-president of the National Health Federation, a doctor and researcher in health policies and systems, recalls that “one test in 20 is now positive”, which is enormous.

Call for volunteers

Saïd Ahmidouch, wali of the Casablanca-Settat region, not one to exaggerate, describes the situation as “difficult” in Morocco and in the region. He describes the rise in numbers, “the increasingly late arrival of patients, in a relatively serious state, sometimes desperate, sometimes directly in intensive care”. He is more than favourable and strongly advocates “the sentinel system”, starting with the work/occupation doctors, the pharmacist or the free-practice doctors.

“We are close to saturation of the technical platforms,” adds Ahmidouch, inviting private clinics to take more non-Covid cases. He suggests referring some of the injured from the public highway to the private sector, as an example, to relieve the public. Like other speakers, he appealed for voluntary work by doctors and paramedics to support their colleagues in the public sector.

So far, everyone agrees on the first three points: worsening of indicators; patients arriving later and later and in an increasingly advanced state in health institutions.

The minister announced a change in the course of the possible or suspect case with the establishment of diagnostic and referral referral centres for COVID-19, in city neighbourhoods.

Ahmidouch spoke of “the need to reorient the screening strategy so that contact cases are detected as quickly as possible and to focus more on at-risk groups. “We also need an increase in testing capacity and additional machines in the private sector. Of course, he is talking about his region, but that says it all: contact cases are not being detected quickly enough.

Dr Hamdi cites a study published in The Lancet on 16 July: “The time between the onset of symptoms and the release of results must be less than a day to contain the epidemic”

In Morocco, however, these delays have instead increased, perhaps due to the rise in the number of cases. “The increase in testing is the new war” (Dr. Meziane Bellefquih).

The number alone is not enough: “we must reduce the time required for sampling and obtaining results and establish greater homogeneity in the national distribution”. The same speaker was ruthless: “It is an aberration that contact cases are detected after 2, 3 or 4 days without being sampled since we wait 2, 3 or 4 days for the results. The result should not exceed a maximum of 36 to 48 days”.

In the end, there is a consensus on the need to change the diagnosis and care pathway. It is certain that there is a loosening of the barrier measures. The situation is worrying. But there is one thing that the Ministry of Health can and must do as a priority, and that is to shorten the time it takes to identify, collect samples and then diagnose contact cases; to expand testing; these are decisions that are the sole responsibility of the ministry.

For more information, please consult (in French) the following link.

August 10, 2020: 3 prefectures under high surveillance

Like Tangier and Fez, Casablanca has seen a worrying rise in numbers in recent weeks.

Today, the threshold at which restrictions are reinstated has not been reached, but the evolution of indicators in three prefectures is particularly worrying, namely Sidi Bernoussi, Anfa and Ain Sebaa Hay Mohammadi.
One need only compare the number of active cases on 6 June and 9 August (two months). Today Morocco has done so on the basis of official figures from the Ministry of Health. It thus emerges that in the prefecture of Sidi Bernoussi, the number of active cases on 6 June was 24, whereas it reached 604 on the 9th of August, i.e. 25 times more. In the prefecture of Ain Sebaa Hah Mohammadi, the same operation shows that the active cases on 6 June reached 21, whereas on 9 August they reached 296 cases, i.e. a 14-fold increase. Finally, in Anfa Prefecture, the number of active cases on 6 June was 15, whereas on 9 August it was no less than 252, i.e. 17.8 times higher.

For the other 5 prefectures, the number of active cases was multiplied by a factor of 2 to 7 between June 6 and August 9. The evolution of the epidemiological situation will thus be decisive for the future. Although for the moment the restrictions are not being tightened, this possibility cannot be ruled out if the epidemiological situation exceeds certain red lines.

As a reminder, the authorities had not hesitated to take the necessary measures in the cities of Tangier, Fez and Marrakech because of the resurgence of contaminations in these three major cities of the kingdom. One thing is certain in any case: Inhabitants have an important role to play in limiting the spread of the virus by adopting barrier gestures and safety instructions that are rather simple to apply.

For more information, please consult (in French) the following link.

10 August, 2020: Royal Air Maroc maintains exceptional flights until September 10

Royal Air Maroc (RAM) announced on Monday that its special flight program will continue until September 10, when the state of health emergency was extended due to the pandemic of the new coronavirus and given the epidemiological situation in Morocco.

“Launched since 15 July, these exceptional flights, scheduled in coordination with the Moroccan authorities concerned, are operated according to the conditions imposed by the governments of the various countries within the framework of this operation,” a said by the company statement that reached Yabiladi newspaper.

Thus, the regular flights initially planned are being replaced by these new special flights. In this sense, the RAM stressed that “passengers in possession of tickets on regular flights are invited to contact the call center of Royal Air Maroc to inquire about the modalities of change or cancellation of these tickets”.

For flights in the Morocco-France direction, they will be operated by Air France and Transavia until September 10, according to a source within the RAM, contacted by Yabiladi.

As a reminder, health measures to limit the spread of COVID-19 are still in place. “Passengers on flights to Morocco must have a negative PCR test within 48 hours and a serological test. Children under 11 years of age are exempt from the test,” the statement said. Those taking flights from Morocco will have to inform themselves about “the health provisions required by the countries of their final destination and comply with them”.

Also, the wearing of masks remains mandatory on all flights. Only handbags, children’s and computer bags are allowed as carry-on baggage.

For more information, please consult (in French) the following link.