Resurgence of the COVID-19 cases in Northern Afghanistan: Are we closer to fifth wave?

The first case of the Corona Virus Disease-2019 (COVID-19) detected in Afghanistan in late February 2020 in a person who had come from Qom city of Iran [1]. There have been a total of 185,272 confirmed cases, including 7743 deaths reported to the World Health Organization (WHO) as of July 29, 2022. The recovery rate reported to be around 89% and Case Fatality Rate to be 3.80% [2]. However, it is assumed that many cases would have been left out beyond reporting [3].

As of 23 July 2022, a total of 6,181,638 (48.7% female, 51.3% male) people were fully vaccinated and 1,390,312 were partially vaccinated in the country. Overall, 15.7% of the total population are fully vaccinated against the COVID-19 thus far [4]. Afghanistan is lowest among many nations in terms of the COVID-19 vaccine coverage. The types of vaccines administrated include Janson-Janson, CoviShield, Sino Pharm and COVAXIN. All vaccines are supplied by international donors, including USA, India and China.

The COVID-19 pandemic has spread in Afghanistan in four distinct waves thus far (Fig. 1). The first wave spread during April–June 2020; the second wave spread during October–December 2020; the 3rd wave began in April 2021 and lasted until mid-August 2021; and the fourth wave started in late January 2022 and lasted until March 2022. The third wave was the most deadly of all waves in terms of mortalities and morbidities [2].

Fig. 1

Weekly COVID-19 cases in Afghanistan since the beginning of the pandemic.

An analysis of the recent data uploaded to the District Health Information Software-2 (DHIS2) reveal that the COVID-19 cases are increasing throughout the country, with most cases being reported from Northern region, particularly Kunduz province. The resurgence begun by third week of July 2022 where the number of confirmed cases increased two times more than the previous week (Fig. 2). The cases continue to rise from then onwards. This might be indicative of a new wave, i.e. the fifth, and may soon hit the entire country.

Fig. 2

The trend of the COVID-19 confirmed cases during January–July 2022 in Kunduz province.

The COVID-19 pandemic resurges in Afghanistan at a time when the country is plagued with many humanitarian crises. More than half of the population are in dire need of urgent life-saving humanitarian assistance due to the adverse effects of decades of war, recurring natural disasters, lack of recovery from past disasters, added layers of challenges resulted from takeover of the government, suspension of international funds following the regime takeover, and the resulting economic shocks [5].

Currently, there are 22 fully functional COVID-19 hospitals in the country out of 40 COVID-19 dedicated hospitals established since the start of the pandemic. The funding mainly come from international donors. These hospitals provide outpatient, inpatient, risk communication and sample collection services. Moreover, there are 36 functioning COVID-19 laboratory facilities across 34 provinces. These facilities are mainly supported by WHO. The testing capacity of all laboratories is reported to be 9200 tests per 24 hours. A total of 14 GeneXpert PCR machines, with an average capacity of 1000 tests per day, also provided by WHO and distributed to 12 provinces to scale up the diagnostic capacity [4]. However, insufficient healthcare workers and lower capacity, lower quality of healthcare services, lack of healthcare personnel to collect the samples of suspected individuals and shortage of diagnostic kits are still the major challenges in most districts of Afghanistan.

Although the fourth wave passed without any grave consequence and this has led to a decreased interest of donors in supporting COVID-19 services, however, the recent trends show a higher incidence of the infection compared to the initial stage of the fourth wave, i.e. the number of confirmed cases reported in the first weeks of the resurgence from Kunduz is two times higher than the numbers reported during peak of the fourth wave in the same province. This might create the fear that the current wave may resemble the third wave which happened in the same period last year and was deadliest of all four waves. However, it is too early to postulate the length and magnitude of the current resurgence.

In order to reduce the burden of the COVID-19, it is vital to keep the hospitals active by providing technical and operational supports. Focus should also be placed on speeding up the vaccination efforts. Afghanistan is way behind the threshold to reach the herd immunity. While the COVID-19 designated hospitals and vaccination efforts play a significant role in containing the pandemic, the importance of non-pharmaceutical interventions cannot be underestimated. Social distancing, avoiding crowds and closed spaces, wearing masks and personal hygiene should be strictly followed to keep the most vulnerable population safeguarded. De facto government, civil societies, healthcare workers, social media users and the literate public at large should contribute together in curbing the infection.

Ethical approval

Since no patients were involved in this report, therefore, no ethical approval needed.

Sources of funding

This study has not received any financial support.

Author contribution

Abdullah Asady proposed the concept, reviewed the initial draft and proofread the manuscript; Mohammad Faiq Sediqi enriched the concept, contributed in data collection and the first draft; Haseebullah Shirzada contributed in data collection, analysis and proofreading; Sayed Samir Habibi collected, cleaned and analysed the data; Qudratullah Qurishi prepared the first draft of report and contributed in proofreading. All authors read and approved the final manuscript.

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Guarantor

Dr Abdullah Asady.

Consent

Since no patients were involved in this study, therefore, no consent obtained.

Declaration of competing interest

We have no conflict of interest.