Coronavirus disease (COVID-19) in Morocco: situation update and proposed remedial measures

Coronavirus disease (COVID-19) is an emerging infectious contagious disease caused by a strain of coronavirus called SARS-CoV-2. The symptoms are fever, cough and difficulty in breathing and, more rarely, acute respiratory distress syndrome that can lead to death especially in people made fragile by age or who present comorbidities. The disease appeared in December 2019 in Wuhan city, in central China with unusual cases of pneumonia justifying containment measures in January 2020.¹ In March 2020 COVID-19 was announced to be a pandemic by the World Health Organization (WHO). The COVID-19 pandemic spread rapidly to many countries of the world.

Until May 2, 2020, there were 4729 confirmed cases of COVID-19 in Morocco and 173 deaths.² A total of 78 cases are being taken care of in the past 24 hours by intensive care and resuscitation services, reporting a drop to around 3% in the number of cases in serious or critical condition, while cases with little or no symptoms represent around 92%.³ In the lead is Casablanca-Settat region with 1203 infected people. The Marrakech-Safi region is in second position, totaling 1059 cases, followed by that of Tangier-Tetouan-Al Hoceima, which has had 657 cases. The region Meknes-Fez is in fourth position with 584 cases and 546 cases in the Daraa-Tafilalet in fifth place and the Rabat-Sale-Kenitra region comes in sixth position with 329 cases and the Orientale region in seventh position with 175 cases. The regions with less than 100 infected people are Beni Mellal-Khenifra (83), Souss-Massa (51), Laayoune-Sakia Al Hamra (4), Dakhla Oued Deheb (2) and Guelmin-Oued-Noun (36).² Morocco announced its first positive case for the new coronavirus on March 2, in a Moroccan returning from Italy. The 39-year-old man was declared cured on Friday March 14. So far, Morocco has 1256 cases that have recovered.²

According to the World Health Organization (WHO) as of May 2, 2020, the number of COVID-19 cases in the United States is increasing, with 1,156,313 infected cases and 67,206 deaths. In Spain, there were 245,567 cases with 25,100 deaths due to COVID-19, Italy has 209,328 confirmed cases with 28,710 deaths, United Kingdom has 182,260 cases with 28,131 deaths and France has 168,396 cases with 24,760 deaths.⁴

What remedial steps can be undertaken

1. During the week of March 9 to March 15 2020, Morocco implemented measures to contain the spread of the epidemic. Thus, flights to several countries are suspended, but return flights are however authorized. At the same time, maritime links with Spain and France are suspended.

2. On March 13, the Ministry of National Education, Vocational Training Higher Education and Scientific Research announced the closure of nurseries, schools, colleges, high schools and universities starting March 16 and until further notice.⁵

3. On March 16, the Ministry of Internal Affairs ordered the closure of many public spaces and public domain facilities. This decision concerns cafes, restaurants, cinemas and theaters, party rooms, clubs and sport halls, hammams, games rooms, mosques and nearby grounds.⁶

4. On March 19, the Ministry of Internal Affairs declared a state of health emergency and restricted traffic in Morocco from Friday at 6 p.m. until further notice and declared this as the only inevitable way to keep the coronavirus under control.⁷

5. On April 18, the draft decree law to establish a state of health emergency in the kingdom was adopted by the Moroccan government. The state of health emergency is in effect from April 20, 2020 at 6 p.m. local time to May 20, 2020 at 6 p.m. local time. This legislative decree allows the public authorities concerned to take the necessary and adequate measures to ensure compliance with the sanitary confinement which must be respected in order to fight against the pandemic.⁸

6. In conjunction with Ministries of the Internal Affairs, Health, Economy and Finance, Administrative Reform, Industry and Investment, Trade and the Digital Economy, the obligation to wear a mask outside was decided since Tuesday, April 7.⁹

7. Increase beds resuscitation and create new hospitals. In Casablanca, Benslimane and Nouaceur, thousands of hospital beds are being installed in emergency to receive patients of the new coronavirus (COVID-19) in the Kingdom.

8. Therapies. Various drugs have used, including antimalarials (e.g., chloroquine), in a first step, the prescription of chloroquine sulfate at the rate of 500 mg in two doses per day for ten days or of hydroxychloroquine sulfate, at the rate of 200 mg in three doses per day for ten days. The treatment also includes azithromycin (500 mg the first day then 250 mg/day from the second to the 7^th day). This treatment is intended for patients who have not followed any other therapy for the coronavirus. If it turns out ineffective, the second option consists of a combination lopinavir/ritonavir 400 mg twice a day, for ten days. Treatment also includes antibiotics in the event of bacterial superinfection (amoxicillin, moxifloxacin or levofloxacin).¹⁰