Authors: Hayder M. Al-kuraishy  ( Department of Clinical Pharmacology, Medicine and Therapeutic, Al- Mustansiriya University, Baghdad, Iraq )
Ali I. Al-Gareeb  ( Department of Clinical Pharmacology, Medicine and Therapeutic, Al- Mustansiriya University, Baghdad, Iraq )

The early months of the year 2020 witnessed the entry of COVID-19 in Iraq spreading terror among the public causing an exaggerated use of preventive measures by isolating patients in specialized centres, emphasizing social distancing, and imposing a comprehensive roaming ban to prevent and limit the spread of this pandemic.1 The social and economic impact was severe enough to cause a crisis.

In the beginning, the number of infected cases were low and did not exceed 100, but the social media somehow caused a tremendous hype by exaggerating the dangers of the disease, projecting fabricated cases and advising infected people to use herbs and alternative medicines. This led to a dramatic rise in the number and spread of infected cases.2

Medical and health personell began to take matters seriously and international protocols for treating patients were adopted. In the beginning, chloroquine and azithromycin were largely used,3 according to international research and protocols, which relied on these drugs based on previous experiences of SARS epidemic in 2003, which is very similar to Covid-19.4 Within a few months, the side effects of these drugs began to appear on Covid-19 patients, such as arrhythmias and sudden cardiac arrest due to prolongation of QT interval.5 For these reasons the mortality rate of in-hospital Covid-19 patients increased which could be attributed to chloroquine use rather than Covid-19 itself.5 In addition a dramatic use of chloroquine by private clinics without knowing the precise drug-drug interactions could have been the potential reason for high mortality of Covid-19 patients outside hospitals. Covid-19 patients should ideally be treated by senior and specialist physicians, though in Iraq even junior doctors were involved in the management of hospitalized Covid-19 patients.

In due course, a specialists team of scientists was nominated by the Ministry of Health and Higher Education Department to decide on the drugs to be used for the treatment of COVID-19 patients and to identify the drugs which did not qualify for use according to the updated scientific research. In the meantime, antiviral drugs such as remdesivir and favipiravir were prescribed along with ivermectin, which have been proved to have a beneficial effect on the corona virus. Use of these drugs showed a remarkable reduction in the mortality rate of Covid-19.6

These medicines proved to be successful and the new cases decreased with recovery of the infected patients. Early months of 2021 witnessed a second wave of the pandemic with the number of infected patients reaching thousands. Complications as acute respiratory distress syndrome (ARDS) and liver damage were witnessed which responded to corticosteroid therapy.7

By mid-2021, the third wave entered. This could be scientifically and medically controlled. Although the infected cases rose to more than a million, however, the number of recovered cases exceeded the new infected ones.

 As a result of global scientific research, effective vaccines for Covid-19 were developed.8 They were widely used in the United States and United Kingdom. These vaccines were approved by the Iraqi Ministry of Health for Covid-19 patients. Before they could be put to use, a series of global accusations emerged against these vaccines, which adversely influenced the Iraqi society, and Iraqi people developed a fear against taking the vaccine. The Iraqi Ministry of Health, along with the Iraqi government, promulgated a law obligating the vaccination for all state employees, especially the teaching staff in the universities and public schools. The vaccination drive, led to a significant decrease in the rate of infections and deaths in the second half of 2021.9

Despite all adversities, the Covid-19 pandemic is under control in Iraq because of the integrated cooperation between health agencies and the people. It is anticipated, that soon the pandemic would end and no more variants of the virus will emerge.

 

References

 

1.       Al-Kuraishy HM, Al-Naimi MS, Lungnier CM, Al-Gareeb AI. Macrolides and COVID-19: An optimum premise. Biomed Biotechnol Res J 2020;4:189-92. DOI: 10.4103/bbrj.bbrj_103_20

2.       Al-Kuraishy HM. Witchcraft and Myths about Covid-19 in Iraq. J Convent Knowl Holist Health 2021;5:211.

3.       Brondani M, Cua D, Maragha T, Shayanfar M, Mathu-Muju K, von Bergmann H, et al. A Pan-Canadian narrative review on the protocols for reopening dental services during the COVID-19 pandemic. BMC Oral Health 2020;20:352. doi: 10.1186/s12903-020-01340-y.

4.       Al-Kuraishy HM, Al-Gareeb AI, Alzahrani KJ, Alexiou A, Batiha GE. Niclosamide for Covid-19: bridging the gap. Mol Biol Rep 2021;48:8195-202. doi: 10.1007/s11033-021-06770-7.

5.       Bernardini A, Ciconte G, Negro G, Rondine R, Mecarocci V, Viva T, et al. Assessing QT interval in COVID-19 patients:safety of hydroxychloroquine-azithromycin combination regimen. Int J Cardiol 2021;324:242-8. doi: 10.1016/j.ijcard.2020.09.038.

6.       Al-Kuraishy HM, Hussien NR, Al-Naimi MS, Al-Buhadily AK, Al-Gareeb AI, Lungnier C. Is ivermectin-Azithromycin combination the next step for COVID-19? Biomed Biotechnol Res J 2020;4(Suppl 1):s101-3. DOI: 10.4103/bbrj.bbrj_109_20

7.       Liu Z, Li X, Fan G, Zhou F, Wang Y, Huang L, et al. Low-to-moderate dose corticosteroids treatment in hospitalized adults with COVID-19. Clin Microbiol Infect 2021;27:112-7. doi: 10.1016/j.cmi.2020.09.045.

8.       Williams L, Gallant AJ, Rasmussen S, Brown Nicholls LA, Cogan N, Deakin K, et al. Towards intervention development to increase the uptake of COVID-19 vaccination among those at high risk: Outlining evidence-based and theoretically informed future intervention content. Br J Health Psychol 2020;25:1039-54. doi: 10.1111/bjhp.12468.

9.       Almufty HB, Mohammed SA, Abdullah AM, Merza MA. Potential adverse effects of COVID19 vaccines among Iraqi population; a comparison between the three available vaccines in Iraq; a retrospective cross-sectional study. Diabetes Metab Syndr 2021;15:e102207. doi: 10.1016/j.dsx.2021.102207.