New COVID-19 resurgence in the WHO Eastern Mediterranean region.

After 7 weeks of falling numbers of COVID-19 cases, a global upsurge was reported during the week of Feb 22, 2021. This case resurgence was observed earlier in the WHO Eastern Mediterranean region, where, between Jan 30 and Feb 26, 2021, the number of weekly cases increased from 158 004 to 207 424 (31%; appendix).

Multiple factors might have contributed to the increase. These factors include changes in testing capacity or strategy, increased transmission associated with mass gatherings, easing of, or decreased adherence to, public health and social measures, and increased viral transmissibility.

In the Eastern Mediterranean region, the weekly number of tests increased by 4% during the same period, but no major changes were observed in testing strategies, no major mass gatherings were organised, and the number of public health and social measures actually increased. Therefore, the increased case numbers could have resulted from decreased adherence to public health and social measures and SARS-CoV-2 variants of concern, which are more transmissible than the originally identified virus.

Adherence to public health and social measures is reflected in mobility data. According to Google Community Mobility Reports, since mid-January, 2021, visits to retail and recreational places have reduced by only 3–15% on average compared with the pre-pandemic period.

SARS-CoV-2 variants of concern have been reported in 13 countries in the Eastern Mediterranean region (B.1.1.7 in all; B.1.351 and B.1.1.28 in the United Arab Emirates). The WHO COVID-19 dashboard shows that, by the end of February, 2021, the effective reproduction number was 1 or more in these countries. Mathematical models taking into account the circulation of variants of concern forecast a continuing increase in cases, with a new peak in April to May, 2021 (unpublished).

As of March 2, 2021, 14 countries in the Eastern Mediterranean region have started COVID-19 vaccine roll-outs. However, vaccination coverage is still low, with only three countries (ie, Bahrain, Morocco, and the United Arab Emirates) reporting more than ten doses per 100 inhabitants.

The increase in COVID-19 cases is worrying. In most countries in the Eastern Mediterranean region, the effect of vaccination will not be observed for several months. The spread of SARS-CoV-2 will not be contained without effective coordination among WHO, its member states, and its partners, stronger community engagement, enforcement of, and adherence to, public health and social measures, rapid detection and isolation of patients with COVID-19 (particularly those infected with variants of concern), and systematic tracing and quarantine of case contacts. Special attention must be paid to the many countries affected by fragility, conflict, and violence.

Moreover, the COVID-19 response, including public health and socioeconomic decisions, needs to be evidence-based and informed by robust, disaggregated data. Improvements in COVID-19 data collection and analysis, including data sharing with WHO and relevant stakeholders, remains a major priority of the pandemic response in the Eastern Mediterranean region and globally.

We declare no competing interests.