key: cord-0795347-zayg2lid
authors: Khassawneh, Adi H.; Alrabadi, Nasr; Al-Mistarehi, Abdel-Hameed; Obeidat, Nail; Kheirallah, Khalid A.
title: The role of Non-State Actors in Combating COVID-19 spread in northern Jordan
date: 2020-11-09
journal: Ann Med Surg (Lond)
DOI: 10.1016/j.amsu.2020.11.005
sha: 04313866b5bf53edcbb30c0c6152441dd292cc76
doc_id: 795347
cord_uid: zayg2lid

nan

The coronavirus disease 2019 (COVID-19) pandemic is a global problem where all countries should react properly and participate effectively to deal with it. In Jordan, a small country with a population of 12.2 million in the Middle East, after the first case with COVID-19 infection was reported on March 2 nd , 2020, the government initiated a two-week quarantine for arrivals from high-risk countries. On March 15, as a response to the increased number of reported new cases, the government further adopted a series of strict Non-Pharmaceutical Intervention (NPI) measures to mitigate the spread of COVID-19. These included extensive contact tracing and quarantining of contacts within their households for two weeks if tested negative. Besides, all laboratory-confirmed COVID-19 cases, even if asymptomatic, were forced to mandatory quarantine within designated hospitals (1, 2) .

On March 17th, 2020, the number of reported confirmed COVID-19 cases reached 40.

This called on the Jordanian government to take several additional NPI measures including activating the National Defence Law. Accordingly, a countrywide strict lockdown and nationwide curfew were imposed. This curfew prohibited the movement of people, implemented a stay-athome policy, stopped public, social, and religious events, closed all shops, and suspended both governmental and non-governmental institutions except for vital sectors (1, 3) . During the early couple of days of the curfew, the residents were prevented from leaving their homes except for the health emergencies only (3) . Then, they were allowed five specific days per week to move around and walk in their geographic boundaries between 10 AM and 6 PM (3) . People who were found in violation of the curfew order would be immediately imprisoned for up to a year.

Although these strict state NPI measures including lockdown and curfew were successful in combating the spread of the infection (1, 3) (Figure 1) , they had major impacts on the population including difficulty in reaching their daily needs, the inability of individuals with chronic medical illnesses to reach their medications' supplies, and obstacle dealing with health emergencies as well as the psychological impact of the COVID-19 outbreak and its related lockdown measures and the home quarantine of unknown duration on the general population.

During the lockdown, the residents were going through a range of psychological and emotional reactions, loss of income, fear, and uncertainty being one of the infected cases. A recent study from Italy assessed the mental health effects of three to 4 weeks lockdown measures in the Italian general population and reported high rates of post-traumatic stress symptoms, depression, and anxiety symptoms, insomnia, perceived stress, and adjustment disorder symptoms (5) .

The hardest-hit part of the country was the northern part of Jordan, particularly Irbid city which is Jordan's second-most populous. Therefore, in response to the localized spread of the COVID-19 epidemic in Northern Jordan and in order to relieve some of the workloads on healthcare workers, and to mitigate the curfew effects on people; a medical Initiative was launched to provide supportive healthcare services and medical consultations, and to deliver medications to patients with chronic medical conditions. This Initiative, called "Himmat Wattan Throughout the Initiative, the number of participants increased from around 30 JMA members to more than 500 members. Volunteers were directly participating in almost all activities of the Initiative but mainly field investigation and contact tracing. As part of the continuous efforts in dealing with the COVID-19 pandemic, the medical teams focused more on community awareness and efforts towards controlling the pandemic. On April 19 th , A huge safety campaign "Salamatuna Fe Tba'adouna" (our safety in our distancing) was established, where a big group of volunteers launched a community awareness campaign that included many trained and professional teams of medical students and physicians. They held awareness lectures within public places such as shopping malls and grocery stores, raised awareness about the importance of social distancing, and distributed flyers, posters, and sterilizers in addition to installing safety belts in crowded places. This was even improved on July 10 th , when J o u r n a l P r e -p r o o f an agreement has been signed with the Forum of Artists to allocate a huge educational wallmurals to be implemented starting from the beginning of August. This aimed at consolidating the concepts of social distancing and awareness of COVID-19 and honor everyone who had a role in the fight against the pandemic.

However, we faced several challenges during the conduction of this initiative. First, the relatively small number of JMA members to participate, and we solved this issue by inviting members from outside JMA (mainly dentists, nurses, and medical students) to be part of our project. Second, the financial resources were limited and there was a shortage in PPE in the markets, we overcame this by collecting monetary donations and going to the industries in order to purchase the required PPE. Third, overcame the need for vehicles to transport the medications and PPE to the target populations by depending on the volunteers' private cars.

Forth, the lack of emergency management specialists to run the initiative was evident as decisions for proper implementation of activities were not efficient, sometimes, and corrective action was necessary in times where a limitation presented itself. Finally, the need to implement mental health counseling and services to the general population at times of the lockdown was not met as such services are considered a taboo during normal circumstances. Lack of professionals to implement such services also played a role in designing such interventions.

Without proper guidance, this service may not work and fire back at the activities of the initiative.

Overall, volunteers and non-state actors play an important role in mitigating the effects of the COVID-19 outbreak and its related lockdown measures on the general population as well as helping the hospitals, civil defense emergency services, and contact tracing teams run smoothly and relieving workloads on healthcare workers. This Initiative successfully reduced the number of hospital transfers from 911-calls by more than 85% and ensured medications for chronic 

COVID-19 outbreak in Jordan: Epidemiological features, clinical characteristics, and laboratory findings

Depression and Coping Among COVID-19-Infected Individuals After 10 Days of Mandatory in-Hospital Quarantine

The Effect of Strict State Measures on the Epidemiologic Curve of COVID-19 Infection in the Context of a Developing Country: A Simulation from Jordan

COVID-19 pandemic in Jordan

COVID-19 Pandemic and Lockdown Measures Impact on Mental Health Among the General Population in Italy. Front Psychiatry

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