Exploiting epidemiological data to understand the epidemiology and factors that influence COVID-19 pandemic in Libya

'COVID-19 is just another way to die…': a qualitative longitudinal study of frontline COVID-19 response governance across Syria

INTRODUCTION

Governance of COVID-19 responses has been challenging for all countries. Syria has been particularly challenged due to protracted multiparty conflict and debilitated health systems fragmented across different areas of control. To improve response governance, better understanding of frontline response policy implementation across the country is needed. This study thus explored perspectives of COVID-19 response governance among frontline healthcare providers over time and across major areas of control.

METHODS

We used a qualitative longitudinal study design, conducting five rounds of remote semistructured interviews in Arabic (ie, approximately eight interviews each in March 2020, July 2020, September 2020, December 2020 and September 2021) with 14 purposively sampled public and private healthcare providers in the three main areas of control (ie, opposition-controlled area, Autonomous Administration-controlled area and al-Assad government-controlled area (GCA)). We conducted integrative thematic analysis in Arabic within and across geography and time.

RESULTS

Almost all participants across all areas and rounds expressed distrust of local health authorities and dissatisfaction with COVID-19 response governance. This was most apparent in initial rounds and in GCA. Response planning was identified as insufficient, non-participatory and non-transparent. Limited infrastructure and resources were the main challenges across time, though anticipated rapid virus spread and health systems' collapse did not occur and participant optimism increased over time. Public adherence to prevention measures varied-initially weak due to general scepticism, increasing after first cases were confirmed and then fluctuating with case numbers and challenges of insecurity and misinformation. Perceptions of COVID-19 vaccination varied, with low uptake and hesitancy attributed to misinformation, disinformation and disinterest. Suggested improvements to COVID-19 response governance focused on strengthening health systems' capacity and coordination.

CONCLUSION

This is a unique longitudinal study of COVID-19 responses. Addressing transparency and misinformation should be a first step to improving public engagement and trust and thus response governance for health emergencies in Syria.

Hospitalization among vaccines for SARS-CoV-2 breakthrough infection after dose sparing strategies in Libya: A cohort study

SARS-CoV-2 infection is widely spread over people, from youth to the elderly. Vaccination against SARS-CoV-2 is an essential preventive measure to help end the SARS-CoV-2 pandemic. A multi-center retrospective cohort study was conducted on patients in Libya who had received single-dose licensed three different types of vaccines (Oxford/AstraZeneca, CoronaVac, or Sputnik-V) and were admitted to healthcare centers with SARS-CoV-2 infection from 30^th April to 15^th July 2021. In this study, the number of people infected with SARS-COV-2 and the mortality rate from daily reports issued by the National Centers for Disease Control of Libya (NCDC) were collected. Approximately 445000 single doses of the SARS-COV-2 vaccine were administered in Libya from April to July 2021. In corresponding, 39996 people were infected during this period. It has been found that among the people who did not receive any vaccine, the number of patients infected by SARS-COV-2 and admitted to the healthcare centers, and died was (N = 3176 patients (7.94%), and 266 (7.10%) respectively). Compared to 43 (0.10%) of those admitted to healthcare centers who had taken a single dose from one of the licensed vaccines, of which 8 patients (0.02%) died during this period. The documented 23 patients were those who admitted to healthcare centers and got vaccinated with the CoronaVac (Sinovac) vaccine. Fourteen patients received Oxford/AstraZeneca. Only 2 patients received the Sputnik V vaccine. Of the breakthrough infection cases reviewed, 8 patients died. No deaths due to breakthrough infection among Sputnik V vaccinated patients were reported. In conclusion, a single dose of the three different types of the vaccine has significantly reduced virus interpersonal transmission and also showed a decrease in the mortality rate until the tenth week in Libya. The present study demonstrates the extent of the remarkable success of the early rollout of the coronavirus national vaccination campaign.