Tunisia buying time in a bid to avert coronavirus catastrophe

The country has brought in strict measures to stem the flow knowing its underprepared health system cannot cope with a steep influx of patients

Abir Mdini, a physician of SAMU Tunisia, wears protective equipment before visiting the coronavirus patients in Tunis, Tunisia. EPA

Members of Tunisian Red Crescent prepare food packages for the elderly and low-income families in the coastal town of Ezzahra near Tunis during the coronavirus pandemic. AFP

Saida Zelfani, a physician of SAMU Tunisia, dressed in personal protective equipment (PPE) puts on latex glove before attempting to get a swab sample of suspected Covid-19 patients in the capital Tunis. AFP

President Kais Saied taking part in the distribution of aid packages amid the coronavirus pandemic, in Gammarth town on the outskirts of Tunis. AFP

Members of Tunisian Red Crescent prepare food packages for the elderly and low-income families in the coastal town of Ezzahra near Tunis. AFP

A member of Tunisian Red Crescent prepares food packages for the elderly and low-income families in the coastal town of Ezzahra near Tunis. AFP

An employee of the Tunisian Social Solidarity Union prepares food packages for the elderly and low-income families in Tunis. AFP

Medical and paramedical staff of SAMU Tunisia dressed in personal protective equipment (PPE) head out to visit a coronavirus patient in the capital Tunis. AFP

A paramedic rescuer of SAMU Tunisia looks out from the back of an ambulance in the capital Tunis. AFP

In Tunisia, disregarding medical instructions and fatally infecting another person with coronavirus now carries a manslaughter charge. Although cases are still relatively low – only 624 confirmed infections and 24 deaths in a population of 11.5 million – the country is not taking any chances. It has and put in place strict measures to stop its fragile public healthcare system being overwhelmed.

Tunis enforced a 12-hour curfew on March 17 when only 29 cases had been detected. Three days later that became a nationwide lockdown limiting all but essential travel throughout the day.

The swift measures, at least for now, appear to be keeping new infections to a minimum although detection remains an issue as testing is not carried out widely.

The swift action has earned praise from some Tunisians.

"Other countries have been putting much more effort to fight against the virus, but I think our government is doing its best,” Ezzeddine Hazel, a security guard with the national water company said. “It's a humble effort, but I think it's the best it can do,”  Mr Hazel, a resident of rural Medenine in Tunisia’s south, said.

But the slow spread may itself be undermining the government’s efforts. Police had detained 1,973 people for breaking curfew as of Wednesday and a further 600 for breaking movement restrictions at other times.

“There’s a problem with people… they are not helping the government by staying at home,” he said. But one factor, Ezzeddine, who has a special pass to continue his duties during the curfew, said, was money.

"The whole situation is complicated. Some of these people need to leave their houses on a daily basis to work, or else they would not have anything to eat," he told The National.

While Tunisian doctors are respected and professional, its public medical system is aging and fragile in contrast to many of the exclusive private medical hospitals who have historically provided a lucrative source of revenue for the country from medical tourism.

As of 2016, Tunisia was spending about 7 per cent of its GDP on health care but the public system is in dire need of modernisation.

The death of 15 newborn babies at a public hospital in Tunis in March of last year highlighted the shortfalls in care that remains, with images of crumbling buildings and unsanitary conditions flooding Tunisian social media.

Tunisia's healthcare system has not been tested with a major virus emergencies since a cholera outbreak in 1850 – avoiding the outbreaks of Mers that hit other Middle Eastern countries in 2012 and the Ebola outbreak that ravaged large parts of West Africa after 2013 remained a remote threat.

Between the public and private sector, there are about 500 ICU beds but almost all are in hospitals on the northern coast.

A statistical model published to the online platform Medium on Wednesday by a team of Tunisian Doctors and statisticians suggested Tunisia's healthcare system risked being overwhelmed by June, well in advance of a projected peak in August 2020, when 2,500 people could be in need of ICU beds.

"The government acted swiftly, and that gained time, but it's how you use that time which is critical," Dr Amine Ghrabi, one of the authors of the Medium report, told The National. "We need to build capacity, to reach out to the private sector and build partnerships ahead of the peak."

Another model, published by independent Tunisian investigative website Inkyfada, put the saturation point much closer. Their prediction, based on the increase in infections during the early stages of the outbreak, suggested the country’s intensive care units risked becoming overrun by the middle of April.

The scale of the threat is lost on few people.

But many of those now in isolation at home say they’re doing what they can within their rapidly shrinking world.

“I’ve never really been busier,” Jihen Nabi, a 28 year old pricing specialist with a multinational company, said. “I quickly adapted to homeworking. I just do all my usual work during the day, before switching to online classes for my Masters in the evening.

“I’m an introvert. Tunisians are a loving people, they’re always standing way too close and wanting to touch you. I like this. This is how life should be.”