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Table 1.  Demographics of the Tested Persons
Demographics of the Tested Persons
Table 2.  Clinical Details of the Persons With a Positive or Reactive SARS-CoV-2 Polymerase Chain Reaction
Clinical Details of the Persons With a Positive or Reactive SARS-CoV-2 Polymerase Chain Reaction
1.
Bagcchi  S.  Infectious diseases in Afghanistan: a dismal scenario.   Lancet Infect Dis. 2021;21(10):1357. doi:10.1016/S1473-3099(21)00573-9PubMedGoogle ScholarCrossref
2.
Essar  MY, Hasan  MM, Islam  Z, Riaz  MMA, Aborode  AT, Ahmad  S.  COVID-19 and multiple crises in Afghanistan: an urgent battle.   Confl Health. 2021;15(1):70. doi:10.1186/s13031-021-00406-0PubMedGoogle ScholarCrossref
3.
Al-Mandhari  A.  Adapting to the events in Afghanistan: call for maintaining essential public health services and supporting critical medical supplies distribution.   East Mediterr Health J. 2021;27(9):855-856. doi:10.26719/2021.27.9.85PubMedGoogle Scholar
4.
Butt  AA, Al-Halabi  AM, Ghazouani  H,  et al.  SARS-CoV-2 infection rates in air passengers arriving in Qatar.   J Travel Med. 2021;28(8):taab163. doi:10.1093/jtm/taab163PubMedGoogle ScholarCrossref
5.
Butt  AA, Dargham  SR, Chemaitelly  H,  et al.  Severity of illness in persons infected with the SARS-CoV-2 Delta variant vs Beta variant in Qatar.   JAMA Intern Med. 2022;182(2):197-205. doi:10.1001/jamainternmed.2021.7949PubMedGoogle ScholarCrossref
6.
Worldometer. Coronavirus updates. Accessed March 19, 2022. https://www.worldometers.info/coronavirus/?utm_campaign=homeAdTOA
Research Letter
Global Health
May 23, 2022

SARS-CoV-2 Polymerase Chain Reaction Positivity Rates Among Evacuees From Afghanistan After Withdrawal of the Coalition Forces

Author Affiliations
  • 1Hamad Medical Corporation, Doha, Qatar
  • 2Departments of Medicine and Population Health Sciences, Weil Cornell Medical College, New York, New York
  • 3Departments of Medicine and Population Health Sciences, Weil Cornell Medical College, Doha, Qatar
  • 4Ministry of Public Health, Qatar
JAMA Netw Open. 2022;5(5):e2213467. doi:10.1001/jamanetworkopen.2022.13467
Introduction

Afghanistan has been a major armed conflict zone for over 2 decades. Consequently, the response to multiple infectious disease threats, including the SARS-CoV-2 pandemic, has been poor because of a lack of resources and inadequate infrastructure.1,2 In August 2021, the Western coalition forces completely withdrew from Afghanistan, which further exacerbated the shortage of critical medicines and supplies.3 Qatar was the first stop for a large proportion of evacuees en route to their final destination. We conducted a cross-sectional study to determine the rate of active SARS-CoV-2 infection among evacuees arriving in Qatar from Afghanistan.

Methods

All evacuees from Afghanistan arrived in Qatar on charter flights through a separate noncommercial airport. Most were quickly transported to their next destination without entering Qatar. Those who entered Qatar between August 20 and December 15, 2021, were subject to Qatar’s routine testing policies and were included in this study.4 Each evacuee who entered Qatar was tested for SARS-CoV-2 within 12 hours of entering Qatar at a single reference laboratory using TaqPath COVID-19 Combo Kits (Thermo Fisher Scientific).4,5 Age, sex, and nationality were determined by the individual’s passport used for entry. This report complied with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline. The study was approved by the institutional review board at Hamad Medical Corporation with a waiver of informed consent requirement because data were collected as a part of the national public health response. Data were analyzed using Excel for Microsoft 365 (Microsoft Corp).

Results

Between August 20, 2021, and December 15, 2021, 7834 evacuees (median [IQR] age, 23 [11-35] years; 4772 male individuals [54.5%]) entered Qatar and were tested for SARS-CoV-2 infection (7576 individuals [96.7%] were tested within 24 hours). Their demographic characteristics are provided in Table 1. At presentation, 122 individuals (1.6%) reported having upper respiratory infection–like symptoms. Sixteen individuals (0.2%) had a positive or reactive test, with 7 of 16 persons (43.8%) having a cycle threshold value of less than 30. Clinical details of the 16 positive cases are provided in Table 2. Information on the presence of symptoms was available for 13 of 16 persons, with 3 of 13 being symptomatic. Two of those persons had a cycle threshold value of greater than 30.

Discussion

As of March 19, 2022, Afghanistan had reported a total of 177 093 SARS-CoV-2 infections and 7654 deaths.6 With a population of approximately 40 million, Afghanistan had conducted 911 530 tests.6 With a strained and inadequate public health infrastructure, a high rate of infection transmission and a high incidence of infection would be expected. Whether the rugged mountainous geography of Afghanistan, which makes travel and intermingling difficult, its relative isolation from the rest of the world during the conflict years, or other unknown factors are reasons for these findings is unknown.

The low rate of infection among the evacuee population may be expected if a robust pretravel testing and screening program prevented infected persons from traveling. However, the evacuees in this cross-sectional study mostly left in a chaotic emergency situation with no known testing occurring prior to their leaving Afghanistan. A biased selection of those tested may also explain such findings. However, every person who entered Qatar from among the evacuees was tested. Limitations of this study include lack of accurate information on pretravel testing, and testing of only those who entered Qatar after evacuation. Information on the vaccination status was also not available for most evacuees.

The low rate of SARS-CoV-2 infection among evacuees from a major global armed conflict zone is reassuring to the concerned population, as well as countries receiving those evacuees. Whether these dynamics have changed in more recent weeks because of the global spread of the more infectious Omicron variant needs further investigation.

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Article Information

Accepted for Publication: March 22, 2022.

Published: May 23, 2022. doi:10.1001/jamanetworkopen.2022.13467

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Butt AA et al. JAMA Network Open.

Corresponding Author: Adeel A. Butt, MBBS, MS, Hamad Medical Corporation, PO Box 3050, Doha, Qatar (aabutt@hamad.qa).

Author Contributions: Drs Butt and Masoodi had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Butt and Masoodi contributed equally to the study and are joint first authors.

Concept and design: Butt, Masoodi, Haidar, Al Rauili, Abou-Samra.

Acquisition, analysis, or interpretation of data: Butt, Jawad, Al Rauili, Al-Marri.

Drafting of the manuscript: Butt, Masoodi, Jawad, Al Rauili.

Critical revision of the manuscript for important intellectual content: Butt, Haidar, Al Rauili, Al-Marri, Abou-Samra.

Statistical analysis: Jawad.

Administrative, technical, or material support: Butt, Masoodi, Haidar, Al Rauili, Al-Marri.

Supervision: Butt, Al Rauili, Abou-Samra.

Conflict of Interest Disclosures: None reported.

Disclaimer: The views expressed in this article are those of the authors and do not necessarily represent official government views or policy of the State of Qatar or Hamad Medical Corporation.

Additional Contributions: The authors are grateful for the leadership and assistance provided by the Ministry of Public Health in Qatar, the System-Wide Incident Command and Control Center and the Business Intelligence Unit at Hamad Medical Corporation, and all the dedicated frontline health care workers who have selflessly served and provided care and comfort to all patients in Qatar.

References
1.
Bagcchi  S.  Infectious diseases in Afghanistan: a dismal scenario.   Lancet Infect Dis. 2021;21(10):1357. doi:10.1016/S1473-3099(21)00573-9PubMedGoogle ScholarCrossref
2.
Essar  MY, Hasan  MM, Islam  Z, Riaz  MMA, Aborode  AT, Ahmad  S.  COVID-19 and multiple crises in Afghanistan: an urgent battle.   Confl Health. 2021;15(1):70. doi:10.1186/s13031-021-00406-0PubMedGoogle ScholarCrossref
3.
Al-Mandhari  A.  Adapting to the events in Afghanistan: call for maintaining essential public health services and supporting critical medical supplies distribution.   East Mediterr Health J. 2021;27(9):855-856. doi:10.26719/2021.27.9.85PubMedGoogle Scholar
4.
Butt  AA, Al-Halabi  AM, Ghazouani  H,  et al.  SARS-CoV-2 infection rates in air passengers arriving in Qatar.   J Travel Med. 2021;28(8):taab163. doi:10.1093/jtm/taab163PubMedGoogle ScholarCrossref
5.
Butt  AA, Dargham  SR, Chemaitelly  H,  et al.  Severity of illness in persons infected with the SARS-CoV-2 Delta variant vs Beta variant in Qatar.   JAMA Intern Med. 2022;182(2):197-205. doi:10.1001/jamainternmed.2021.7949PubMedGoogle ScholarCrossref
6.
Worldometer. Coronavirus updates. Accessed March 19, 2022. https://www.worldometers.info/coronavirus/?utm_campaign=homeAdTOA
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