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Explainer

COVID-19 cure: ‘Just a breath away’

How Gulf countries are managing contagion, leading search for cure



Members of the research team at the Abu Dhabi Stem Cell Centre.
Image Credit: WAM/Gulf News

Highlights

  • Prior to the pandemic, Gulf cities were global hubs 
  • Dubai confirmed the first coronavirus case on January 29, 2020 (a 73-year-old Chinese tourist from Wuhan), the first confirmed case in the Gulf, and wider Middle East region
  • GCC countries have demonstrated resolve in containing the pandemic, keeping fatality rates low
  • Recent discovery of stem cell therapy for COVID-19 patients by a research team in Abu Dhabi is dubbed a 'game changer' in the fight against coronavirus
  • On May 9, Sheikh Mohammed Bin Zayed made a generous initiative to give free stem cell therapy treatment to critical patients

Dubai: The Gulf is a trading, tourism and aviation hub, pre-COVID-19. This openness has been a key factor in the relatively early spread of coronavirus in the region.

On Monday (May 11, 2020), the total coronavirus cases in the six Gulf Cooperation Council (GCC) states crossed the 100,000 mark, a Reuters tally showed.

Pre-COVID-19, Gulf cities were vibrant, busy. For one, each year, Saudi Arabia welcomes millions of pilgrims to Mecca and Madinah from around the world — a mass movement of the faithful on a journey of a lifetime unbroken over the centuries, until the virus came.

Abu Dhabi has emerged as the centre of innovation, high-tech manufacturing, arts and culture, mega events like F1 races and tolerance (last year, it welcomed Pope Francis, the first pontiff to set foot in the Arabian peninsula).

Pre-COVID, Dubai International, the world’s busiest airport in terms of international passengers, was clocking in more than 1,000 aircraft movements daily.

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Every major city in the GCC hosts millions of expat workers. There's also the constant flow of tourists.

There are clear signs such quarantine measures are working. The case fatality rate in the GCC, overall, has been relatively low, with most Gulf countries at under 1%, given preliminary data.

- Gulf News Report

This openness came at a cost.

On January 31, 2020, Dubai confirmed the first coronavirus case, a 73-year-old woman, who flew from Wuhan, China.

On Monday (May 11, 2020), the total cases in the six Gulf Cooperation Council (GCC) states crossed the 100,000 mark, a Reuters tally showed. However, with 557 COVID-19-related deaths (out of 54 million inhabitants), the average GCC case fatality rate (at 0.55%) has been relatively low.

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And, as millions remain hunkered down at home for weeks now, with social-distancing measures being implemented all over the world, it's not all bad news.

Not all bad news

There are clear signs such strict measures are working. With proven COVID-19 therapies available now — and tests being ramped up — the death rate is expected to go down even further.

The Gulf, the UAE in particular, has gone out of its way in helping other countries, airlifting tonnes of goods and equipment to help dozens of countries also hit by the virus.

Notably, researchers in Abu Dhabi have developed a stem cell therapy technique, with a "game-changing" potential in the fight against COVID-19.

Here’s an outline of what happened since then in the region:

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Gulf News (May 11) World population review [https://bit.ly/2Wk9v1o] • gcc stat [https://bit.ly/2Li8n8h] • Johns Hopkins CSSE [https://coronavirus.jhu.edu/map.html] • https://bit.ly/2SRQPnw 11/05/2020
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CASE FATALITY RATE
In epidemiology, a case fatality rate (CFR) — sometimes called case fatality risk — is the proportion of deaths from a certain disease, compared to the total number of people diagnosed with the disease over a certain period of time.

CFR is a notoriously difficult value to pinpoint during an active outbreak, especially when the majority of cases are asymptomatic or undiagnosed — and unaccounted for. So, even the best CFR estimates based on known cases tend to be skewed higher, though the real rate is actually lower.

Responses

In general, there's been a coordinated national strategy to deliver an efficient and effective COVID-19 response. It's a draconian task, especially for the frontliners: Massive COVID-19 testing has been rolled out, drive-through test centres have been set up across the UAE and other Gulf countries.

It has also seen heightened public-private sector partnerships. Remote work schemes were devised. People have come to understood it a "new normal".

Among the containment measures implemented in the GCC are:

  • Border closures
  • Curfews, stay-in-place orders
  • Work-from-home measures
  • Travel restrictions/grounding of passenger flights
  • Area-specific quarantine (UAE)
  • Suspension of Umrah pilgrimages (Saudi Arabia)
  • Stopping prayers at mosques, churches and other places of worship
  • Closure of most public venues
  • Shutdown of public transport
  • Mass testing, with drive-through tests (started in the UAE)
  • Ramped-up tests in high population-density districts (Al Ras in Dubai, Mussafa in Abu Dhabi)
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Here's how the region has responded so far:

Saudi Arabia

Saudi Arabia, with 34.76 million inhabitants, has a population bigger than the rest of the GCC states put together. In terms of land area (2.15 million square kilometres), it is also the largest among the Gulf nations. As of May 11, 2020, the Kingdom had 41,014 confirmed cases and 255 deaths.

The Saudis moved swiftly: They shut down domestic and international travel, closed businesses and imposed 24-hour curfews on all major cities.

A general view of empty Kaaba at the Grand Mosque during the holy month of Ramadan, in the holy city of Mecca, Saudi Arabia.
Image Credit: REUTERS

The daily rate of increase in positive cases in Saudi Arabia has been steady: Between 10-12 per cent since April 9, and not rising above 12 per cent since March 31.

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Saudi Arabia’s Health Minister Dr Tawfig al-Rabiah warned that the number of cases could hit up to 200,000 within weeks, citing four different studies conducted by Saudi and foreign experts.

When taking the population into account – the Kingdom has 1,068 cases per million people.

UAE

The UAE, with a population of 9.89 million, is the second-most populous state among the GCC nations. In terms of land area (83,600 square kilometres), it is the third-largest country among the GCC states. As of May 9, the UAE had 17,417 confirmed cases and 185 deaths.

A 73-year-old Chinese woman was the first case recorded in the UAE, and the wider Middle East, on January 29, 2020. This was followed by more cases, most of whom were also Chinese tourists. The UAE shut its schools, malls, gyms, restaurants and other places where people gather. A night-time curfew was imposed in Dubai on March 26, coinciding with a national disinfection drive. On April 4, Dubai extended the curfew to 24 hours, with movement permits made mandatory. Dubai also quarantined the high-density and commercial district of Al Ras.

The UAE was the first to introduce a drive-through COVID-19 test centre, as part of a nationwide drive to boost testing capabilities. After the first centre was set up in Abu Dhabi, the same facilities were rolled out across the country, including Fujairah. The country has also set up an industrial-scale testing laboratory with genomics company BGI and Abu Dhabi tech company Group 42 (G42), alongside a home-testing service for people of determination.

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When taking population into account – the UAE has 1,761 cases per million people.

Image Credit: Gulf News

Qatar

With the second-highest number of total infections in the GCC (21,331), Qatar has the GCC's largest number of cases per million — at 8,202. However, it also has the lowest CFR at 0.059%, with 14 deaths recorded as of May 11, 2020.

Qatar confirmed its first coronavirus case on February 27. From mid-March, the numbers kept rising with extensive tests across the peninsula.

Qatar’s 2.75 million people have seen a relatively high number of cases with 23,623 testing positive.

A health worker, wearing personal protective equipment, collects a swab sample from a man at a drive-thru testing service for COVID-19 coronavirus in the Qatari capital Doha, on May 7, 2020. Qatar's Ministry of Public Health (MoPH) has announced that it will operate drive through swabbing hubs at three health centres for two days, for a community based survey on COVID-19. The ministry has also clarified that participants of the test will be randomly selected based on age, gender and ethnicity and participation is entirely voluntary.
Image Credit: AFP

However, its death rate, with 13 fatalities, is one of the world's lowest. Experts say it’s due to the country's young population and mandatory health checks for its vast foreign workforce.

A two-day pilot project launched last Wednesday was aimed at checking asymptomatic residents. Citizens were contacted and invited to participate in voluntary tests at several clinics across the country. Migrant labourers in the industrial district and Qataris returning from virus hotspots, such as Iran, have been the focus of vigorous testing, along with those found to have been in contact with them.

Bahrain

The island nation confirmed its first case, a Bahraini citizen, on February 24, followed by a number of cases who came from Iran. The large number of cases from Iran prompted Bahraini officials to accuse the Iranian government of “biological aggression”.

Doctors and nurses are seen doing their final check on the equipment in a makeshift ICU "Field Intensive Care Unit 1" set up by Bahrian authorities to treat the coronavirus disease (COVID-19) critical patients, at a car-park of Bahrain Defence Force Hospital in Riffa, Bahrain
Image Credit: REUTERS

On March 16, Bahrain reported its first death, and the first death in the Gulf, due to COVID-19. The first case of fatality involved a 65-year-old woman who had died from COVID-19 while suffering from a pre-existing chronic health issue.

Bahrain now has the fifth-highest number of total cases in the GCC, at 4,911 (as of May 11, 2020), at a rate of 2,888 cases per million — the second highest in the Gulf.

Bahrain shuttered non-essential shops and businesses in late March and barred entry of foreign visitors, but did not impose a curfew. On May 6, the country was among the first to announce easing of restrictions, reopening several malls.

Kuwait

The first three cases in Kuwait were announced on February 24, all of which had arrived from Iran that was witnessing a massive increase in the number of cases at the time. Subsequent cases confirmed in Kuwait also involved people arriving from Iran. Kuwait has recorded 8,688 infections as of May 11, 2020, or 2,026 cases per million population. The first death due to COVID-19 was announced on April 4.

Police and civil aviation personnel wearing protective face masks work at the Kuwait Airport as the repatriation process of Kuwait citizens continues, following the outbreak of the coronavirus disease (COVID-19), in Kuwait City, Kuwait April 21, 2020. REUTERS/Stephanie McGehee
Image Credit: REUTERS

On March 22, Kuwait imposed a nationwide 11-hour curfew, from 5pm to 4am. Heavy fines were slapped on those who flouted the rules, with violators facing up to three years in jail. Kuwait has also shut schools and closed businesses, like its GCC neighbours. Kuwait has recorded 8,688 infections as of May 11, 2020, or 2,026 cases per million population.

On May 10, after a spike in cases, Kuwait imposed a total curfew until May 30.

Oman

On February 24, Oman announced its first two cases — two Omani women who had come from Iran. Among the GCC states, Oman has recorded the lowest number of coronavirus cases, with 3,399 and 17 deaths as of May 11. The 175 new cases comprise 52 Omanis and 123 expats. The Sultanate has so far recorded 738 cases per million people.

The Omani government has put some measures in place, including a complete lockdown of Muscat, where most cases have surfcent aced. However, the rest of the country is not under a complete curfew or lockdown. The overall number of recoveries in the country has risen to 1,117, with a fatality rate of 0.50 per cent based on current data.

While Oman has the lowest number of cases so far, the rate of new cases has been on the rise from April to early May. The Omani minister of health warned that the country was about to see a spike in cases.

Omani Health Minister Ahmad Al Saidi said the virus is still swiftly spreading and that related critical cases as well as fatalities are on the rise. "It has been noticed in the month of Ramadan in many governorates unjustified gatherings and moving out," the minister told the official news agency. He also cited many cases of flouting social-distancing rules.

Click here to visualise latest Gulf covid-19 data

UAE's response: Stem cell therapy

In the midst of the pandemic, it's not all bad news, though. The GCC has kept a relatively low case fatality rate from COVID-19. UAE has been sending aid flights to dozens of countries.

In what's been described as a breakthrough, scientists in Abu Dhabi have also found game-changing stem cell therapy to fight the virus.

On May 1, the UAE announced an effective treatment for COVID-19 patients. Stem cell therapy involves taking (aspirating) blood from the patient, then using a patented technique to activate these cells so that they can turn into an aerosolised agent that can then be inhaled by the patient.

By breathing the patient's own cultivated stem cells, it is hypothesised to have its therapeutic effect by regenerating lung cells and modulating the immune response to keep it from overreacting to the COVID-19 infection and causing further damage to healthy cells. The treatment, which has cured 73 patients so far in Abu Dhabi, has been given to patients along with the conventional medical intervention and will continue to be applied as an adjunct to established treatment protocols rather than as a replacement.

On May 9, 2020), His Highness Sheikh Mohammed Bin Zayed Al Nahyan, Crown Prince of Abu Dhabi and Deputy Supreme Commander of the UAE Armed Forces, ordered stem cell treatment for critical patients in the country.

STEM CELL THERAPY
By breathing the patient's own cultivated stem cells, it is hypothesised to have its therapeutic effect by regenerating lung cells and modulating the immune response to keep it from overreacting to the COVID-19 infection and causing further damage to healthy cells.

The treatment, which has cured 73 patients so far in Abu Dhabi, has been given to patients, along with conventional medical intervention, and will continue to be applied as an adjunct to established treatment protocols rather than as a replacement.

Along with repurposed drugs that show promise of working against COVID-19, many now see light at the end of the tunnel.

Image Credit: Gulf News

TAKEAWAYS

  1. Until recently, this virus believed to have jumped from bats to humans — and continues to threaten all of humanity’s lungs — seemed like an agent from the gates of hell.
  2. Even in the time of social distancing, collaboration is key: Man's ability to create and adapt to a given situation is not the exclusive domain of any country or community.
  3. Amidst the odds faced by frontliners, a pioneering spirit is alive in the Gulf, to find a cure, while giving aid to other countries..
  4. The outcome of the UAE research team's work on stem cell therapy to cure coronavirus patients has been dubbed as a "game-changer".
  5. Though described as “therapeutic, not curative”, 73 clinical cases of COVID-19 patients had reportedly been discharged after being cured.
  6. Could the therapy then be "open-sourced" by the patent holders, so its benefits can be more rapidly dispersed around the world? It's up to the patent holders to decide. But there's no doubt the team that developed it deserve recognition for the work they've done.
  7. If recent data show that the case fatality rate (CFR) from COVID-19 is rather low, and UAE scientists have found game-changing therapy for it, the next likely scenario is limited only by one's imagination.
  8. The Gulf has been defined by a "can-do" spirit, enshrined in the Expo 2020 Dubai theme: 'Connecting minds, creating the future'.
  9. Despite the one-year delay of this global party (Expo 20202 Dubai), the Gulf remains a region that wants to get things done, where the word "impossible" has become void.
  10. The GCC, together, has abundant "soft power" and the right attitude for the world in trying to find ways to start afresh.

Timeline of COVID-19 in the GCC

November 17, 2019: Earliest confirmed report of a case of "pneumonia of unknown cause", a 55-year-old man from Hubei, China, according to an SCMP report, citing official records.

December 1, 2019: Clinicians in Wuhan see a series of "pneumonia cases of unknown cause" emerging, reported The Lancet.

December 29, 2019, and Jan 4, 2020: Six members of a family travel to Wuhan from Shenzhen and all get infected with “unexplained pneumonia” after returning to Shenzhen, Guangdong province, China. The researchers, who analysed genetic sequences from these patients, also saw evidence of a person-to-person transmission of the virus. In The Lancet, the researchers wrote: "One of the family members had contacts with Wuhan markets or animals, although two had visited a Wuhan hospital. Five family members (aged 36-66 years) presented with...(symptoms) 3-6 days after exposure.” An additional family member who did not travel to Wuhan also fell ill.

January 1, 2020: Chinese authorities shut down Huanan Seafood Wholesale Market.

The Huanan Seafood Wholesale Market in Wuhan, Hubei Province.
Image Credit: Noel Celis/AFP via Getty Images

January 24, 2020: Chinese researchers publish a study showing the SARS-CoV-2 virus (then called nCov-2019) did not jump from animals to humans in the Huanan seafood market in Wuhan. The research did not identify the place where the other patients (66 per cent of positive patients were traced to the market) got their infection from.

January 24: Researchers in Hong Kong, led by Chan JF, Yuan SKok KHet, also publish separate clinical study in The Lancet confirming “person-to-person transmission of this novel coronavirus in hospital and family settings, and the reports of infected traveller in other geographical regions”.

January 28: The New England Journal of Medicine (NEJM) publishes an article further confirming evidence of person-to-person transmission. Vietnamese researchers Phan LT, Nguyen TV, Luong QC wrote the report titled, 'Importation and human-to-human transmission of a novel coronavirus in Vietnam'.

January 28: Dubai port operator DP World suspends staff travel to China.

January 29: UAE confirms a case of coronavirus, a 73-year-old Chinese woman. It was the first case in the wider Middle East. The announcement was followed shortly by several other cases, most of whom were also Chinese tourists.

A tourist wearing a surgical mask in Dubai. The United Arab Emirates announced the first confirmed cases of the new coronavirus in the Middle East, with a four-member Chinese family from Wuhan found to be infected.
Image Credit: AFP

January 31, 2020: World Health Organisation (WHO) director-general, Dr Tedros Adhanom Ghebreyesus, declares the novel coronavirus (2019-nCoV) outbreak a "Public Health Emergency of International Concern".

January 31: Etihad Airways suspends flights between Nagoya and Beijing in the wake of coronavirus outbreak

February 3: UAE announces suspension of all China flights, except Beijing, from February 5.

February 3, 2020: Oman’s Public Authority for Civil Aviation (PACA) announces suspension of all Oman Air flights to and from Guangzhou, China.

February 21: Bahrain announces its first case of novel coronavirus, following by a number of cases who had come directly or indirectly from Iran.

Doctors and nurses are seen doing their final check on the equipment in a makeshift ICU "Field Intensive Care Unit 1" set up by Bahrian authorities to treat the coronavirus disease (COVID-19) critical patients, at a car-park of Bahrain Defence Force Hospital in Riffa, Bahrain
Image Credit: REUTERS

February 24: Oman announces its first two cases of COVID-19; Bahrain and Kuwait announce first cases of coronavirus infection.

February 25: Bahrain suspends flights from Dubai, Sharjah for 48 hours over coronavirus.

February 27: First coronavirus case in Qatar confirmed.

February 27: Saudi nationals and GCC citizens temporarily suspended from using national identity cards to travel to and from the Kingdom.

March 12: WHO declares COVID-19 outbreak a pandemic. Rapid escalation of COVID-19 in Europe, with more than 20,000 confirmed cases and 1,000 deaths in the zone.

March 15: Dubai disinfects its streets, public seats, doors, elevators against coronavirus spread.

March 16: Bahrain reports first death from coronavirus, also marks the first death in the Gulf due to COVID-19.

March 19: Emirati businessman Khalaf Al Habtoor donates 50 ambulances and quarantine building unit.

March 20: Dubai starts massive coronavirus sterilisation drive of city streets. Residents advised to keep off the streets during disinfection drive.

Sterilisation teams pose beside a drone in Al Khawaneej
Image Credit: Supplied

March 20: Qatar places its largest labour camp for migrant workers in total lockdown after hundreds of construction workers became infected with COVID-19.

March 22: Emirates suspends more flights across the globe; flights to destinations in Asia, Australia, Europe and Americas affected.

March 24: Saudi Arabia reports its first death; 205 new cases of COVID-19 also reported.

March 28: UAE opens first mobile drive-thru COVID-19 test centre. Checks done in five minutes at new test facility.

Drive-through COVID-19 screening centre in Abu Dhabi.
Image Credit: Seha

March 28: Qatar reports first death from novel coronavirus, 28 new infections.

March 29: Dubai-based Indian businessman donates entire property for quarantine.

March 30: Dubai announces two weeks of restrictions for Al Ras area to intensify sterilisation.

March 30: UAE helps set up a 4,000-bed 'NHS Nightingale Hospital' for COVID-19 patients in the UK.

March 31: RTA announces closure of three Dubai Metro stations on the Green Line (Al Ras, Palm Deira and Baniyas Square) for two-weeks.

March 31: Oman reports first COVID-19 death.

March 31: Saudis urge more than one million Muslims intending to perform Haj to put plans for 2020 on hold.

JOURNEY OF A LIFETIME
Each year, up to two million Muslims perform the Haj, which all able-bodied Muslims with the means are required to perform once in their lifetime. For many, the Haj takes years of planning and savings, and among the faithful, it is seen as a journey of faith, a journey of a lifetime.

April 1: Saudi Arabia places Makkah and Madinah on 24-hour curfew. The same was imposed on the capital Riyadh, as well as Tabuk, Dammam, Dhahran, Hofuf, Jeddah, Taif and Khobar, and the region of Qatif. Residents are allowed to leave their homes only for medical reasons or to purchase food from within their neighbourhoods, between 6am and 3pm.

April 4: Kuwait announces the first death from the COVID-19 in the country, with 62 new cases of the disease recorded, taking the total in the country to 479.

April 5: Two aid planes carrying medical supplies fly from UAE to Pakistan.

April 6: Abu Dhabi announces sterilisation drive hours, from 8pm and 6am; Kuwait places Mahboula and Jleeb Al Shuyoukh districts — two hubs for expatriate workers — under total lockdown for two weeks.

April 15: Bahrain converts car park into COVID-19 hospital. At the makeshift ICU of the hospital in Riffa, each bed is equipped with a ventilator 

April 15: Field hospital at Dubai World Trade Centre opens with a capacity to treat 3,000 COVID-19 patients. Dubai Police use 3D printing, provides 1,000 3D-printed face shields to frontline personnel.

April 17: Dubai extends its sterilisation programme.

April 18: UAE gets 5.5 million hydroxychloroquine pills from India.

April 20: Kuwait expands nationwide curfew to 16 hours a day, from 4pm to 8am, and extends a suspension of work in the public sector, including ministries, until May 31.

April 21: UAE’s aid planes carry approximately 260 tonnes of medical and food aid to 24 countries in the region and beyond since the outbreak of pandemic COVID-19.

April 26: Dubai eases movement restrictions in Al Ras, Naif. Decision comes as both areas record zero COVID-19 cases in last two days

April 28: Dubai’s Naif residents celebrate after easing of movement restrictions.

April 29: Roads and Transport Authority reopens Al Ras, Palm Deira and Baniyas Metro stations in Dubai.

April 29: UAE sends medical aid to the Philippines and Pakistan to help in the fight against COVID-19.

May 1: UAE announces breakthrough treatment for COVID-19 patients, using stem cell therapy.

May 2: The UAE sends an aid plane containing seven metric tonnes of medical supplies to India to bolster the country's efforts to curb the coronavirus crisis.

May 4: Saudis use ozone technology to sterilise Grand Mosque and Kaabah in Makkah.

May 7: Qatar launches a drive-through coronavirus testing programme to test a wider population beyond the worst-affected groups where tests had initially been targeted.

May 8: The number of coronavirus cases in Saudi Arabia cross 35,000.

May 8: Kuwait announces "total curfew" from 4pm on May 10 through to May 30.

May 8: Robot doctor named 'Dr B2' unveiled in Saudi Arabia's King Salman hospital in Riyadh. it allows the hospital to limit the amount of direct contact that doctors and nurses have with patients, thus reducing the risk of infection.

May 9: Etihad Airways starts operating limited one-way flights to Abu Dhabi to enable residents to return to the UAE from different parts of the world, according to the latest update provided by the airline.

May 10: The UAE sends aid planes to Sierra Leone, Niger and Mali to bolster their efforts in curbing the spread of coronavirus. A total of 19 metric tonnes of aid carried to help 19,000 health-care workers.

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