The COVID-19 pandemic of the
twenty-first century is changing the shape of the world. Not unlike this
infection, fear is going viral, with over half of the global population
currently under home quarantine. Jordan is no exception; the Kingdom has come
to a standstill, leaving people with many unanswered questions and concerns. With
new hotspots being identified, a daily fluctuating caseload, and occasional sudden
surges in numbers, people tend to get frustrated with these changes.
The daily case report should be construed
with caution, with no premature assumption of things getting out of hand or
under control. The daily number of confirmed cases is an excellent measure of the
performance in the last couple of weeks and for adjusting our future strategies
accordingly. Frequent, and thorough evaluation of the situation
based on data, albeit incomplete, is the hallmark of rapid, adaptive,
Everybody is waiting for the inclining
of the epidemiological curve. This will happen, but it takes time and effort
and will come at a cost. Moreover, neither people nor the government can claim
a victory after going through the curve. Data and prediction models forecast that
it is not unlikely that communities might experience other spikes: a rebound of
the epidemic, imported cases, or perhaps with the cycling of the seasons. In
the meantime, we should make use of the time we get from the mitigation strategy to prepare for the future.
Jordan has to anticipate all the possible scenarios, the good and the bad and
put forward realistic plans anticipating: a sudden spike of patients seeking
acute medical attention, and the serious adverse effects and mortality for the current
patients, which are not yet apparent.
Expanding the Testing Capacity
What are the advantages of the three
T’s model (Test, Treat, and Trace)? To identify as many cases as possible, have
them isolated and treated, and to identify their contacts and have them tested.
This will break the chain of transmission in the community and modify the shape
of the curve, but the question is: whom to test? There may be something boiling beneath the surface, such as
silent infected areas or missed chains of transmission. Expanding the testing
capacity will reveal these blind spots and buy more time to help in bringing
the curve under control.
capacity varies widely between countries and depends on resources, supplies,
and the availability of well-trained personnel. The methods of testing are of
great importance when considering such a strategy. RT-PCR test is the most
sensitive and specific practical test to diagnose the disease, but it is time-consuming
and requires a well-equipped laboratory. Newer, portable, faster machines do not
only hold promise in expanding the testing, but they also reduce the
uncertainty caused by fixing and transporting the samples.
One scientist in the U.K argued that
the lockdown-relax approach would exhaust the economy and risk the health care
system. Dr. Peto proposed a weekly testing of the whole population and
immediate quarantine of the infected along with their contacts, reducing the
infection rate of the entire community. Despite being less intrusive and
limiting to the public than the 3 T’s model, it is, indeed, not practical for
Only a few countries, like the U.K,
can bring such suggestions to the table, but Jordan can apply these strategies in
hotspot areas, which are presumably few. In addition, taking a random sample
from the public, as well as testing (and retesting) people running essential
institutions, may be inviting and reassuring. Small businesses might also
benefit from this strategy, and this may ease the economic consequences of the
crisis after considering quality control and full collaboration from academic
institutions, the private sector, and pharmaceutical companies. Retesting
should be considered for all contacts to overcome the false negatives due to
test inaccuracy, inferior quality kits, and very early testing when the viral
load is low.
Keeping Together by Staying Distant
Everyone is vulnerable, even the young
who have a sense of being immune or unlikelihood of getting a serious infection.
This misconception may come at a catastrophic cost and demands a change in the
way we think about the disease. There is, indeed, a considerable number of
asymptomatic people, who are most likely young and mobile, spreading the virus
and igniting the outbreak. What can be done to control the unwitting spreaders,
and shall we need to recommend the face mask in public?
At the beginning of the crisis, the
recommendations did not advocate wearing masks for the asymptomatic, but as
time passes, we are learning more about the disease. In the U.S, where there is an
apparent shortage of surgical facemasks, the CDC is recommending wearing cloth
face masks, because they appear to lower the rate of transmission. This
recommendation may also reduce the stigma that comes from wearing facemasks. People
should get familiar with this new lifestyle particularly concerning massive
entertainment venues and travel hubs.
Look before you leap
The question on everyone’s mind is
“When do we reopen the country and relax the mitigation measures?”. Although we
eventually have to restart the economy with some degree of safety and certainty
about the procedures, we do not want to push the country to its breaking point.
Incomplete data and predictive models show that: the longer and the more stringent
lockdown result in better control over the epidemiological curve. Currently, one
of the practical solutions after initial control is to relax the lockdown
partially and observe. Authorities can be flexible while adopting this
strategy, such as increasing measures in highly affected areas, while relaxing
them in clear ones.
Interestingly, it appears that
periodic lockdowns with short intervals of relaxation work effectively in local
control of the disease. Serologic antibody testing can also play a crucial role
in identifying people who are presumably immune to the disease and allowing an earlier
return to work. Some countries are considering the idea of immunity
certificates or color-based coding based on their tests to facilitate movement
However, this is applied to countries wherein the infection rate is relatively
Peculiar Aspects of Jordan
COVID-19 crisis, the
situation in Jordan has multiple faces. The country with a population of around
ten-million hosts more than 1.5 million refugees, sparking fears and real
concerns. The situation in refugee camps needs strict monitoring, with any
outbreak in refugee camps having drastic consequences on the health care sector
and the economy.
note, our attitude towards science and research have to change after this
pandemic. Several institutions are racing to find effective treatments or
vaccines. A new era of decision-making science, scientist appreciation, and raising
the culture of research are the pillars of future strategies in research. Jordan needs more regulatory flexibility and support
to launch randomized trials, and it is about time we consider adaptive clinical
trials with better utilization of resources and money. If this crisis has
taught the world anything, in terms of research, it is that we cannot wait
until evidence has become overripe. Researchers must use their experiences
and available knowledge to develop actionable solutions and implement them
after testing and quality control using the Rapid-Cycle Research methodology.
The views in this article are the
author's own beliefs and do not represent the views of any organizations with
which the author is affiliated.