Saudi Arabia’s successful experience of managing a deadly coronavirus, Middle East respiratory syndrome, 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 health care strategy.
This was further highlighted in the Kingdom’s response to the ongoing coronavirus disease (COVID-19) pandemic, particularly as the nation prepares to host the G20 Riyadh Summit, with King Salman announcing in the wake of the extraordinary virtual meeting of the G20 in March that “a global response” is crucial to addressing the “COVID-19 pandemic and the challenges to the health care 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.
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 populous nation in the Arabian Gulf, Saudi Arabia also hosts a large population of expatriates from across the world. 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 pilgrims too.
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 Feb. 26, long before many nations had even considered locking down, and prior to the World Health Organization assessing that COVID-19 could be characterized as a pandemic. As of March 23, almost a month later, 174 countries, territories or areas had introduced or updated travel restrictions.
The impact of early travel restrictions has been significant in achieving better outcomes in managing the spread of the virus. An April study on the impact of mobility versus the spread of the pandemic indicated 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 those 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. The Ministry of Health took the lead on managing the response to the pandemic through reliance on the advanced digital health care structure already 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 an exponential growth of cases that could overburden the health care system. Measures were also taken to increase capacities, as well as the production of personal protective equipment and other medical supplies.
Food security was ensured with well-stocked supermarkets, even as reports of hoarding were making headlines in other nations.
Underpinned by decisive policymaking, strong governance and its robust health care 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 reopening of the economy.
At the outset of the pandemic, on March 30, King Salman decreed that coronavirus treatment must be available and at no cost to anyone in need of medical care, including for those who reside in the Kingdom illegally and with no legal ramifications.
Reporting to Crown Prince Mohammed bin Salman, a high-level multi-sectoral committee headed by the minister of health was immediately established. The committee continues to meet daily to evaluate the situation and 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, but this has increased to 95,000, with the daily average number of performed tests reaching 65,000. As of July 21, authorities had conducted more than 3.5 million laboratory tests for COVID-19.
The Kingdom also ramped up testing in multiple phases once restrictions on movement were eased. This included opening free drive-through mass testing centers in the Kingdom’s largest cities, including Makkah, Madinah, Riyadh, Jeddah, Dammam and Aseer, as well as activating Tetamman clinics — functioning as fever clinics — in more than 230 locations in primary health care centers and hospitals across the Kingdom for patients with symptoms.
In parallel, the national laboratory at the Saudi Center for Disease Prevention and Control was the initial reference center for advanced clinical laboratory tests. The Kingdom has since expanded its laboratories that provide COVID-19 PCR testing from one to 51 labs covering all regions.
From a capacity perspective, Saudi Arabia has significantly expanded its ability to admit patients, both critical and non-critical, by adding to its intensive care capacity more than 2,500 fully equipped beds in a period of three months, which is more than 30 percent 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 utilized to care for the critically ill, such as oxygen helmets and high-flow nasal cannulas, which have produced encouraging results, allowing for many patients to avoid intubation and mechanical ventilation.
Saudi Arabia has also started its phase one clinical trial on a vaccine candidate for MERS, as well as the MIRACLE trial that has been ongoing to evaluate antiviral therapeutics in severely infected MERS patients. This is now to be expanded to include COVID-19 patients.
The Kingdom implemented drastic containment measures, notably the closure of schools, universities and commercial outlets, the prohibition of public gatherings and suspension of operations in many government agencies. Complete lockdowns were imposed on major cities and smaller cities were subjected to part-time curfews, with all the decisions made after public health assessments. Flexible working hours and work-from-home routines, as well as the mandatory use of face masks in public, continue to support the Kingdom’s focus on pandemic management — all with successful results.
Currently, the COVID-19 mortality rate within the Kingdom is approximately 0.9 percent, which is considerably lower than the global rate. At this stage of the pandemic, the observed death rate globally is 4 to 5 percent. Variations in the rate of COVID-19-related deaths between countries and regions are not fully understood. However, quick access to health care, early intervention and supportive care seem crucial in reducing the number of 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 percent 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.
Saudi Arabia 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 health care system and performance effectiveness.
The successful response of Saudi Arabia in managing the crisis today serves as a road map in health care crisis management for the world.
• Dr. Mohammed Khalid Alabdulaali is Assistant Minister of Saudi Arabia’s Ministry of Health.