As the world fights the coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the World Health Organization (WHO) reports that over 17 million people globally were infected with SARS-CoV-2 as of 1 August 2020. Although infections are asymptomatic in 80% of cases, severe respiratory illness occurs in 20% of cases, requiring hospitalization and highly specialized intensive care. The WHO, under the International Health Regulations, declared this pandemic a public health emergency of international concern; it has affected nearly all health systems worldwide. The health system in Egypt, similar to many others, was severely challenged when confronted with the need for urgent and major expansion required to manage such a significant pandemic. This review uses publicly available data to provide an epidemiological summary of the COVID-19 pandemic behavior during the first wave of the outbreak in Egypt. The article covers mathematical modeling predictions, Egypt’s healthcare system, economic and social impacts of COVID-19, as well as national responses that were crucial to the initial containment of the pandemic. We observed how the government managed the outbreak by enhancing testing capacity, contact tracing, announcing public health and social measures (PHSMs), as well as allocating extra funds and human resources to contain SARS-COV-2. Prospectively, economic losses from major sources of revenues—tourism, travel, and trade—may be reflected in future timelines, as Egypt continues to control cases and loss of life from COVID-19. Overall, trends indicate that the spread of COVID-19 in Egypt was initially contained. Revalidation of prediction models and follow-up studies may reveal the aftermath of the pandemic and how well it was managed in Egypt.

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Received: 23 October 2024 Accepted: 23 October 2024 Article published online: 10 December 2024 © 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/) Thieme Medical and Scientific Publishers Pvt. Ltd. A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

Exodus of medical graduates from low - and middle-income countries to high-income countries also known as “Brain Drain” is a growing global dilemma that has plagued the health industry particularly in poor countries for decades. The observed numbers of graduates migrating from Sub-Saharan African (SSA) origin to the United State alone during the years 2002, 2010, 2013, and 2016 were 7,830, 9,938, 11,787, and 12,846, respectively.[1] The total number of physicians resident in the same 34 SSA countries in 2013, as reported by the World Health Organization (WHO),[1] [2] was 11,519. Comparing the number of doctors who migrated to those who were resident in the same year shows that the health systems in those countries have lost more than 50% of its workforce, and that must represent a very serious dilemma to those fragile health systems.[1] [2] Similar challenges are encountered in retaining other skilled healthcare workers (HCWs) including nursing staff and health technologists in most low- and middle-income countries. Although the current efforts by accrediting bodies in most countries to acquire recognition by World Federation of Medical Education is a welcome step and will raise the standards of medical education all over the world, however, there are concerns regarding how will it impact the rates of migration of healthcare workforce over the coming decades.[3] The root causes of this insidious “brain drain” could be summarized as follows: Furthermore, it is customary that graduates seek higher training in developed countries with a promise to gain new skills and experience that they can apply in treating patients in their home countries as they return. However, most of these healthcare professionals choose to stay in the host countries rather than return home. Mullan et al found that a significant proportion of medical graduates from low-income countries who were trained in the United States chose to stay even after completing their higher training.[7] It is rather unfortunate that many of those who fail to progress up the career ladder in the hosting countries abandon their career rather than return home, a process that has been described as “Brain Waste” as the graduates often prefer to change their career path to jobs in order to stay in the host country for a potentially better quality of life and future prospects for their families in terms of social services, better education, healthcare, and probable better economic stability in the long run. The number of these “wasted” graduates is difficult to estimate due to lack of data on either side of the immigration borders! To address the so called “Brain-Drain” in the healthcare sector, several potential solutions are considered; however, the main solution is to invest in healthcare systems and improve working conditions in poorer countries to create more opportunities and incentives for healthcare professionals to stay home. Recently, Bhargava and Docquier have reported that improvements in working conditions and salaries can help to reduce the likelihood of medical graduates emigrating from low-income countries.[8] Another solution is to promote collaboration and knowledge-sharing between countries, to help build capacity and support the training and retention of healthcare professionals in donor countries. The United Nations and its organizations continue to emphasize the need for international cooperation to address this phenomenon in the healthcare sector; the World Health Organization Global Code on International Recruitment of Health Personnel, 2015, article 3.6, stipulates that member nations “...should strive, to the extent possible, to create a sustainable health work-force and work towards establishing effective health work-force planning, education and training, and retention strategies that will reduce their need to recruit migrant health personnel….”[9] This voluntary Global Code of Practice (GCOP) on International Recruitment of Health Personnel seeks to promote fair and ethical recruitment practices through exchange of information, cooperative arrangements, and joint efforts by source and destination countries to ensure health workforce sustainability and observe the rights and interests of individual health workers. Since its inception in 2010, GCOP has increased awareness between member states regarding the challenges ahead and improved global data and information on international health worker mobility, yet the actual figures on immigration continue to increase at a rate of around 5% per year from SSA to the United States alone.[10] Fewer WHO member states took meaningful actions beyond diplomatic acceptance of GCOP recommendations. The United States Global Health Initiative (USAID, 2021) has attempted to increase investment in healthcare education and training, improve working conditions at home, and promote collaboration between countries to address the health workforce crisis. However, by 2034, the United States is expected to face a shortfall of as many as 124,000 physicians and therefore the recruitment of the International Medical Graduates (IMGs) will continue for a long time.[11] Furthermore, in the United States there are now advocates calling for legislative changes to allow more non-US IMGs to come and stay. The AAMC and other groups have recently asked the Congress to expand the number of IMGs.[12] As alluded to earlier, escalation of this dilemma is likely for the inability of National and International Measures and Agreements to curb the exodus of medical graduates from low- and middle-income countries. The prospects of better jobs, career, and economic prospects in developed countries is not all unwelcome, as it is one of the strong incentives for students to seek high-quality university qualifications to allow access to such an inviting job market. Donnelly et al reported on the concept of “higher training for...

Background: Injuries are a major cause of death and disability worldwide and impose a substantial burden on countries of the Eastern Mediterranean Region (EMR), particularly those affected by conflict, political instability, and fragile health systems. We assessed trends and patterns in injury-related mortality and disability in the EMR using estimates from the Global Burden of Disease (GBD) 2023 study·MethodsWe conducted a secondary analysis of GBD 2023 estimates for the 22 EMR countries from 1990 to 2023. Injury mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs) were examined by gender, age group, country, and injury cause. Estimates were reported as numbers and age-standardized rates per 100,000 population with 95% uncertainty intervals (UIs)·Findings: In 2023, injuries accounted for an estimated 379,711 deaths in the EMR, representing 7·8% of global injury deaths, with an age-standardized mortality rate of 49·38 deaths per 100,000 population (95% UI 42·89–54·79). Mortality rates were higher among males than females (76·77 vs 34·83 per 100,000). Palestine, Libya, and Somalia had the highest mortality rates, whereas Kuwait, Qatar, and Bahrain had the lowest. Unintentional injuries were the leading cause of injury deaths, followed by transport injuries and self-harm and interpersonal violence. The injury burden totalled 27·6 million DALYs in 2023, with substantial variation across countries and marked increases in conflict-affected settings·InterpretationAlthough injury mortality and DALY rates declined overall between 1990 and 2023, progress was uneven and frequently disrupted by conflict and political instability. Strengthening injury prevention strategies, health-system resilience, and regional cooperation is essential to reduce the persistent burden of injuries in the EMR·FundingNo specific funding was received for this study.

Background: Previous grading and severity scores of MR were based on a mix of objective echocardiographic data and subjective findings such as the presence or absence of symptoms. There is a need for a grade - and a severity -score for Mitral Valve Regurgitation (MR) that is based purely on objective findings and avoids the ambiguity of labelling the same degree of MR differently according to symptoms severity and/or the underlying etiology. Methods: We reviewed published reports regarding MR severity and grades and provided a method for the assessment of MR severity and grades based purely on objective data regardless of the symptom(s) and/or underlying cause(s) of MR. Objective Echocardiographic and/or Cardiac Magnetic Resonance (CMR) findings of Vena Contracta (VC) size in cm², Effective Regurgitant Orifice area (ERO) in cm², Effective Regurgitant Volume (ERV) in mls/beat, and Regurgitation Fraction (RF) as a percentage of the left ventricular stroke volume, were given a score value of A, B, C or D with increasing severity, thus ranging from the mildest degree“A” to most severe “D”. Results: As summarized in Table 4, MR severity ranged between 4 “As” to 4 “Ds”. Further elaboration regarding the parameter(s) most severely affected may be added to the score value, e.g., scoring MR with a VC = 0.60 cm² associated with EROA = 0.4cm², ERV = 60mls and RF = 45% will be 2D (EROA and ERV) MR, thereby avoiding overlap between various degrees of MR and/or further data manipulation to make other parameters fit one grade of MR or another. Conclusion: Applying this scoring/grading system to Echocardiographic and/or CMR studies of patients with mitral valve regurgitation will enhance our endeavors to use a clear and unified language regarding MR severity without compromising the quality of Echocardiographic or CMR findings and/or reporting.