We read with interest the Correspondence by Ashleigh Tuite and colleagues. 1 The rapid spread of COVID-19, which started in China, led to its characterisation as a pandemic by WHO on March 11. 2 On Feb 14, Egypt announced its first COVID-19 case. 3 Thereafter, Egypt scaled up preventive measures, with a partial lockdown starting on March 25. RT-PCR was done in nasopharyngeal swabs from symptomatic patients and contacts of confirmed cases traced in the preceding 2 weeks. In patients with a high rate of suspicion, the test was repeated after 48 h. Screening at airports included body temperature and clinical assessment and the use of a rapid diagnostic test for antisevere acute respiratory syndrome coronavirus 2 IgM and IgG. Deaths from influenza-like illness were also reviewed.
As of March 31, Egypt announced 710 COVID-19 cases and 46 related deaths (fatality rate 6·48%, 95% CI 4·78-8·55). 4 We acknowledge that, in the absence of open screening, this could be an underestimation of the total number of patients and an overestimation of the fatality rate. To estimate the expected disease burden in Egypt, we used fatality rates in the USA and Germany, because they applied open screening, and in regional countries with conditions similar to those of Egypt (Algeria, Bahrain, Iran, Israel, Jordan, Saudi Arabia, Lebanon, Morocco, Palestine, Qatar, Tunisia, Turkey, and United Arab Emirates). On the basis of WHO's report on March 31, 4 the fatality rate of all reported countries ranged from 0·7% to 11·8%. We deduced a factor by dividing our fatality rate by the global rate and those of the listed countries. This factor was then multiplied by our number of identified cases to estimate the expected total number (table). In conclusion, the expected total number of patients with COVID-19 in Egypt, as of March 31, could be in the range of 710-5241 patients. Notably, the exclusion of patients who have not acquired the infection from the reporting country could have decreased these numbers. Additionally, the listed countries do not share the same curves of spread or deaths, stages of the epidemic, or steps of interventions. 