100 days of COVID-19: Why UAE death rate is low compared to other countries

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Abu Dhabi: Ever since the coronavirus outbreak became a pandemic, the COVID-19 fatality rate has been one of its most closely watched details.

Figures on the World O Meter COVID-19 tracker suggest that the death rate currently stands at 5.7 per cent of infected patients, with more than 82,400 people having succumbed to the disease till date. In contrast, the UAE’s death toll of 12 is much lower, representing less than 0.5 per cent of the 2,659 infected.

Speaking to Gulf News, doctors have said that this is a result of a robust health and screening system colliding with demographics and early preparatory measures. In addition, it remains difficult to correctly estimate the worldwide fatality rate as the situation evolves.

“The UAE has outstanding infrastructure but it has also implemented careful and timely planning to avoid a sharp rise in the contagion’s curve. This may have [enhanced] the ability of the healthcare system to respond efficiently. It is when a healthcare system becomes overwhelmed by a large proportion of ill patients that the ability to treat complex patients at the same standards falls sharply,” said Dr Massimo Cristaldi, general consultant and colorectal surgeon at Harley Street Medical Centre in Abu Dhabi.

Dr Madhu Sasidhar, chief medical officer at Cleveland Clinic Abu Dhabi, added that the UAE is well-prepared.

Dr Madhu Sasidhar

“The UAE is well-prepared for outbreaks of this type, and has decisive leadership that engages with local providers to ensure that the measures taken are evidence-based and in the best interests of the community. The level of care available to patients here leads the region,” he said.

Age factor

The demographics also play an important role. UAE health officials announced last month that the country has a higher incidence of people between the ages of 20 and 44 years testing positive.

“In the UAE, the disease has been affecting the younger, robust work force which has a stronger immune system. Many of them belong to the Indian subcontinent,” said Dr Raza Siddiqui, executive director of RAK Hospitals and group chief executive officer of Arabian Healthcare Group.

“It is a misconception that COVID-19 only severely affects the elderly and those with comorbidities. But indeed, the younger population tents to have more asymptomatic infected patients. The elderly population in the UAE, composed of predominantly Emiratis, has [also] been well protected and retired at the right time from social life,” added Dr Cristaldi.

What the UAE is doing right

The UAE has also prepared its health and quarantine systems in advance to deal with an outbreak.

Dr Cristaldi, who studied the Chinese model during the Wuhan outbreak, said it is of paramount importance to test and trace all contacts of affected patients, and organise a centralised quarantine system where asymptomatic or minimally symptomatic patients are housed in hotels and those with more severe symptoms are cared for at dedicated COVID facilities.

“It is easier when all COVID patients are admitted into a dedicated hospital to follow therapeutic protocols that are subject to continuous changes as the medical community makes continuous breakthroughs. The UAE has created an amazing model where all these boxes are checked and it has done this rapidly, learning the good lesson from other countries’ errors,” he explained.

Dr Rasha Alain, family medicine specialist at Medcare Medical Centre, Al Khawaneej, said the country has also quickly implemented WHO guidelines, including training for healthcare providers and public awareness through social media channels.

Dr Rasha Alain

Global death rate will lower

As more information emerges about the coronavirus, experts anticipate that there may be a drop in the calculation of worldwide fatality rates.

“It is very difficult to determine the real death rate on any disease when the exact number of people affected is not known, [especially] as this virus tends to affect a large proportion of people who display minimal or no symptoms. Italy, for example, has so far had a higher death rate than any other country because it is calculated with the number of people who test positive. But three different epidemiological studies have estimated that the actual number of infected people may be around 6 to 7 million, [and not just around 135,000]. If we consider this, then the death rate in Italy would fall to 0.25 per cent,” Dr Cristaldi said.

Dr Vikas Bhagat, head of critical care medicine at Aster Hospital, Mankhool said the role of climate is also unclear, and additional studies about the impact of temperature on the coronavirus could also show why fatality rates have differed in various parts of the world.

Dr Vikas Bhagat
Image Credit: Supplied

So what makes COVID-19 severe?

Of course, certain factors are already suspected to increase the severity of COVID-19.

“The most important of these is the viral load. Additionally, people of advanced age with multiple comorbidities like hypertension, ischemic heart disease, diabetes and on immunosuppressants are more likely to have [severe forms of the disease],” Dr Bhagat said.

Dr Cristaldi said infection outcomes depend on the attacking agent, and on the response of the host or patient.

“Any impairment of the host response may cause the external attacking agent, the coronavirus in this case, to prevail. This can happen in subjects with compromised immune systems, for example. The load of the attacking agent can also affect the outcome; a very high load of virus or bacteria entering the body may find an inadequate response from the immune system, and therefore overcome the body’s defenses,” he said.

There have, however, been unpredictable cases in which some patients developed exaggerated immune system responses, which can occur in the case of all infections.

“The exaggerated response created a metabolic domino cascade, potentially damaging different organs and leading to a condition called multi-organ failure. This has been identified mainly in young and healthy individuals, and imunosuppressants have been used to successfully treat them,” Dr Cristaldi said.

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