The Battle Against COVID-19 in Jordan: From Extreme Victory to Extreme Burden

As of 25 th November 2020, worldwide, more than 60 million people are confirmed to have the novel COVID-19 infection with more than 1.42 million deaths (1). In Jordan, the first case of COVID-19 was discovered on 2 nd March 2020 when the government implemented immediate and large range of non-pharmaceutical interventions to combat the spread of the virus (2). Patients were immediately and completely isolated in specialized hospitals and quarantine was initiated as per official guidelines to the medical professionals and using all personal protective equipment (3). These interventions were empowered by the activation of the National Defense Law on 17 th March 2020. The activation of the law led to suspension of the studies at educational institutions, closure of borders, stopping prayers in places of worship, and banning all large gatherings.After three weeks of discovery of the 1 st case in Jordan, the total number of cases in the country was 98. This number of cases constituted a red flag sign and pushed the government towards implementing more strict interventions including complete nationwide lockdown for three days (22-24 March) (4). As of 2 nd July 2020 (after four months from the 1 st confirmed case), the total number of cases of COVID-19 in the country was 1,136 (4).During the 5 th month of the epidemic in Jordan (from 2 nd July to 2 nd August 2020), only 77 new cases were diagnosed heading the total number of cases to 1213 and 11 deaths, despite the available and convenient diagnostic testing (4). Simultaneously, Jordan had the lowest number of COVID-19 cases compared to other countries in the Middle East despite having the disease before some countries like Turkey and Bahrain (2).Early strict intervention measures showed evidence of containing and suppressing the disease and resulted in low incidence rate. Among all countries in the Middle East, Jordan was in principle better position in fighting against the disease (5,6).The well-controlled epidemiological situation formulated the feeling of a well-controlled and comfortable epidemiological situation among both public and decision makers which encouraged the local authorities to relieve lockdown measures to prevent further deterioration of the economy and maintain public mental health (7).In one month after relieving the lockdown measures (from 2 nd August to 2 nd September 2020), the number of cases has almost doubled heading the total to 2161. In the next month, (from 2 nd September to 2 nd October 2020), the situation became uncontrollable and the epidemiological investigation became impossible after reaching 13,650 cases (4).As of 26th November 2020, the total number of COVID-19 cases in Jordan reached more than 200,000 (4). The disquieting news is the daily testing trends in the last 14 days where the positivity rate reached 28.8% with a 7-day moving average of 20.46%. Furthermore, the number of deaths of COVID-19 cases in Jordan is distressing. The case fatality rate reached 1.23% which is higher than other countries in the Middle East such as Qatar; 0.17%, United Arab Emirates; 0.35%, and Bahrain; 0.40% (1).Alleviating lockdown measures, especially at Syrian borders as stated by the Minister of Health, led to this unfortunate situation, and aggravated by having high prevalence of chronic non-communicable diseases among the Jordanian population (8), which places these vulnerable groups at higher risk for catching COVID-19 virus. Table 1 are predictive of increasing the total number of cases and fatality rate in Jordan to an unmanageable situation led by lack of resources, poor economic status, and the high prevalence of chronic diseases among population. Furthermore, despite high, the 7-day moving average of positivity rate in the Jordanian population doesn't reflect the actual prevalence of COVID-19 in the country for many reasons. First, only those who are suspecting themselves as having the virus due to becoming symptomatic or contacting confirmed cases are taking the test. Second, this rate is not figured from screening procedure rather than testing the high risk groups. Third, not all high risk individuals are taking the test. Finally, in the era of COVID-19, test sensitivity and specificity issues remain a concern (9).In Jordan, as a tribal community, these figures are projected to increase in the next few weeks after the recent too many illegal public gatherings in the Election Day (10 th November, 2020) and the following days. During those days, adherence to protective measures was absent, and violating the laws and regulations of physical distancing was the predominant feature of those gatherings. Decision makers in Jordan had to think wisely before easing the lockdown measures and pay attention to the consequences of public gatherings. They should have learned from previous experiences when a wedding ceremony led to a large outbreak of COVID-19 in northern Jordan in the early days of the epidemic (10).Jordan experience in dealing with COVID-19 pandemic is an example that can be of great benefits to other countries with a well-controlled epidemiological situation to avoid any blunders. Moreover, from such scenario, great lessons can be learned and taught to best encounter similar threats in the future. Meanwhile, more strict regulations on social distancing, further educating public about the importance of protective measures, applying severe penalties on violators, and encouraging good nutrition, especially for older adults, are the sole path to decrease incidence rates.None declared.During COVID-19 pandemic, countries have responded in diverse ways to combat its spread. In the first four months of the epidemic, Jordan has implemented strict measures in fighting against the disease that proved to be effective in decreasing infection rate in the country. However, easing these combating measures has its price. Jordan has now immense number of cases proportionate to its population and these numbers are projected to increase in the next weeks. Jordan experience in dealing with COVID-19 pandemic is an example that can be of great benefits to other countries with a well-controlled epidemiological situation to avoid any blunders.The author confirms being the sole contributor of this work and has approved it for publication.The publication of this paper was supported by the Deanship of Scientific Research and Graduate Studies at Yarmouk University.