Saudi Arabia’s successful experience in managing a deadlier coronavirus, MERS-CoV, marks its exceptional agility in responding to public health emergencies. Ensuring the well-being of residents and pilgrims is a primary pillar of Saudi Arabia’s healthcare strategy.
This was further highlighted in the Kingdom’s response to the recent COVID-19 pandemic, more so as the nation prepares to host the G20 Riyadh Summit, with HRH King Salman bin Abdulaziz, the Custodian of the Two Holy Mosques, announcing in the wake of the extraordinary virtual meeting of the G20 in March that “a global response” is crucial to address the “COVID-19 pandemic and the challenges to the healthcare systems and the global economy.”
Saudi Arabia walked the talk in this regard: Despite also facing oil price volatility, alongside the challenges of the pandemic, the Kingdom took concerted efforts to overcome the crises from all fronts. The country responded to the pandemic head-on, scoring across all four phases of the preparedness and response framework - prevent, detect, contain and treat.
Overcoming challenges through concerted efforts
Saudi Arabia had one of the most challenging environments in managing the crisis, with some unique circumstances to navigate. In addition to being the most populated nation in the Arabian Gulf, Saudi Arabia also has a large population of expatriates from across the world who live and work in the Kingdom. Any crisis preparedness and response framework, therefore, had to address not just Saudi nationals but this diverse demography.
Second, as the birthplace of Islam, Saudi Arabia welcomes pilgrims from across the world to the two Holy Cities of Makkah and Madinah, which required taking bold and swift measures to ensure the safety of not just residents but also of pilgrims.
Even before a single case of COVID-19 was reported in the Kingdom, Saudi Arabia suspended pilgrimages. Access to the two Holy Cities was barred as early as February 26, 2020 – long before many nations had even considered lock down, and prior to the World Health Organisation assessing that COVID-19 could be characterised as a pandemic. As of March 23, almost a month later, 174 countries, territories or areas introduced or updated travel restrictions.
The impact of early-on travel restrictions has been significant in achieving better outcomes in managing the spread of the virus. A study undertaken on the impact of mobility versus the spread of the pandemic indicate that “the Wuhan travel ban came too late” while in “Europe, travel restrictions were implemented a week after every country reported cases of COVID-19… and as a consequence, no European country was protected from the outbreak.” The foresight of the Kingdom enabled it to be among countries that did not report an uncontrollable outbreak.
Responding to the COVID-19 crisis with a clear plan of action, Saudi Arabia implemented extensive measures, with the Ministry of Health taking the lead on managing the response to the pandemic through reliance on the advanced digital healthcare structure in place, as well as the fast-paced mobilization of more than 25 hospitals and care resources in the early phases of the pandemic, in order to contain the outbreak and to prevent exponential growth of cases that could burden the healthcare system. Measures were also taken to increase capacities as well as the production of PPE and medical supplies.
Food security was ensured with well-stocked supermarkets, even as reports of hoarding were making headlines in other nations.
Underpinned by decisive policy making, strong governance and its robust healthcare system serving as the backbone of care, the Kingdom successfully navigated the crisis, and is today on the road to the ‘new normal’ with the phased opening of the economy.
Nation-wide detection programme
At the outset of the pandemic, on March 30, 2020, HRH King Salman bin Abdulaziz decreed that coronavirus treatment must be available and at no cost to anyone in need of medical care, including those who reside in the Kingdom illegally with no legal ramifications.
Reporting to HRH Prince Mohammad bin Salman bin Abdulaziz, Crown Prince, Deputy Prime Minister and Minister of Defense, a high-level multisectoral committee, headed by the Minister of Health, was established, immediately. The committee continues to meet daily to evaluate the situation and to take timely action, underpinned by the leadership’s hands-on guidance.
Updates were communicated to the public, with the cooperation of other entities, to promote transparency and build trust. The messages were carefully calibrated to reach every segment of the audience – young and old, and all the various nationalities living in the Kingdom.
Initially, the polymerase chain reaction (PCR) testing capacity in the Kingdom was about 1,000 tests per day and has increased to 95,000, with the daily average performed tests reaching 65,000. As of July 21, 2020, authorities have conducted over 3.5 million laboratory tests for COVID-19.
The Kingdom also ramped up testing in multiple phases once restrictions on movement were eased by opening free mass testing drive-through test centres in the Kingdom’s largest cities, including Mecca, Medina, Riyadh, Jeddah, Dammam and Aseer, as well as activating (Tetamman) Clinics – functioning as fever clinics - in over 230 locations in Primary Healthcare Centres and hospitals across the Kingdom for patients with symptoms.
In parallel, the National Laboratory at the Saudi Centre for Disease Prevention and Control (SaudiCDC) was the initial reference centre for the advanced clinical laboratory tests. The Kingdom has since expanded its laboratories that provide COVID-19 PCR testing, from 1 to 51 labs covering all regions.
From a capacity perspective, the kingdom has significantly expanded its ability to admit patients, both critical and non-critical, adding to its intensive care capacity more than 2,500 fully equipped beds in a period of three months, which is more than 30% of the ICU capacity that has been built over the years.
In parallel, skilled health care workers are being recruited and thousands of health care workers and volunteers are being trained or retrained to assist with the care of patients if need be. Additionally, clinical and therapeutic protocols are being monitored by dedicated specialized teams to ensure swift and timely updates.
New technologies have also been utilised to care for the critically ill, such as the oxygen helmet and the high flow nasal cannula, which have produced encouraging results, allowing for many patients to avoid intubation and mechanical ventilation.
Saudi Arabia has also started its phase I clinical trial on a vaccine candidate for MERS-CoV as well as the MIRACLE trial which has been ongoing to evaluate antiviral therapeutics in severely infected MERS patients - now to be expanded to include COVID-19 patients.
The road to the new normal
The Kingdom implemented drastic containment measures, notably the closure of schools, universities and commercial outlets, prohibited public gatherings and suspended operations in many government agencies. Complete lockdowns were imposed on major cities, and, smaller cities were subject to part-time curfews – all the decisions made after public health assessments. Flexible working hours and work-from-home routines, as well as mandating the use of face masks in public continue to support the Kingdom’s focus on the pandemic management – all to successful results.
Currently, COVID-19 mortality rates within the kingdom is approximately 0.9%, which is considerably lower than the global rate. At this stage of the pandemic, the observed death rate globally is 4-5%. Variations in the rate of COVID related deaths between countries and regions are not fully understood. However, quick access to healthcare, early intervention, and supportive care seems crucial in reducing COVID-19 related deaths.
Furthermore, the mortality rate, while low, should also be viewed in the context of population risk factors related to lifestyle diseases such as diabetes, obesity and cardiovascular diseases. The diabetes prevalence rate of 18.3% in the Kingdom constitutes a major risk factor for COVID-19 patients. Comorbidity is an additional complexity the Kingdom faced while still managing to sustain low mortality rates.
The success of the approach is highlighted by the Kingdom returning to normalcy in just 73 days. Commercial activities have returned to normal, with all safety protocols in place, and the Ministry of Health assessing the situation, especially in relation to pilgrimage to the Holy Cities, which is being reviewed periodically.
The Kingdom has also lifted the ban on domestic flights. Mosques, malls, recreational facilities and restaurants have opened. This followed the systematic approach of tracking indicators such as readiness of the health system to tackle the pandemic, managing community spread, the efficiency of the healthcare system and performance effectiveness.
The successful response of Saudi Arabia in managing the crisis today serves as a roadmap in healthcare crisis management for the world.