In Egypt, the first person to die of the novel coronavirus was a 60-year-old German man who visited tourist hotspots during a Nile cruise trip. While traveling from the historic city of Luxor to the Red Sea resort town of Hurghada, he started running a fever.

He went to a nearby hospital on March 6, where he tested positive for COVID-19 and, within days, succumbed to respiratory failure caused by acute pneumonia. His case was one of many linked to Nile cruises in Upper Egypt.

Egyptian authorities eventually tested dozens of people aboard cruise ships operating in the area and discovered 45 positive cases of coronavirus, including 12 staff members. None of them had purportedly shown symptoms of the deadly pathogen.

Yet, weeks before Egyptian authorities started waking up to the magnitude of the epidemic in early March, public health officials as far as the US, Taiwan and Canada were piecing together a severe albeit unreported outbreak deep in the Egyptian heartland.

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Coronavirus in the Middle East: Lock down or play down? Iran: Bearing the brunt With a high number of deaths and cases, Iran has been a regional epicenter of the outbreak. Several top officials have been infected and there are concerns the number of cases are higher than reported. The government has canceled Friday prayers but health workers have complained they are under-equipped. Iran has asked the International Monetary Fund for emergency funding.

Coronavirus in the Middle East: Lock down or play down? Saudi Arabia: strict measures Saudi authorities banned international religious pilgrims early on, leaving the Grand Mosque's Kaaba in Mecca virtually empty. Other measures have involved sanitizing streets and mosques, closing schools and universities, an extensive travel ban and fines of up to 500,000 riyals (€120,000/$133,000) for people hiding health details. It has also locked down the Shiite-minority area of Qatif.

Coronavirus in the Middle East: Lock down or play down? Egypt: Travel restrictions In Cairo, hundreds of Egyptians tried to get certificates showing they have a clean bill of health after Saudi Arabia announced new travel regulations. Although Egypt has only detected a low number of cases, more than 100 tourists returning from the country tested positive for the virus. Officials have limited sermons to 15 minutes and cancelled large public gatherings.

Coronavirus in the Middle East: Lock down or play down? Israel, West Bank: Shielding themselves from the world Gatherings of less than 100 are still allowed, leaving visits to the Wailing Wall open. But Israeli authorities have virtually halted air traffic in and out of its territory and tourists are required to self quarantine. The city of Bethlehem has declared a state of emergency, emptying streets usually teeming ahead of Easter. Israeli researchers have said they are close to finding a COVID-19 cure.

Coronavirus in the Middle East: Lock down or play down? Kuwait: Virtual lockdown As Kuwaitis kept their distance at this makeshift testing center, the country entered a virtual lockdown, with the entire workforce given a two-week holiday from March 12. All commercial flights have been suspended from Friday on, schools have been closed and gatherings at restaurants, malls and commercial centers have been banned.

Coronavirus in the Middle East: Lock down or play down? Iraq: Coronavirus fails to dampen protests Iraq's protest movement has set up its own makeshift disinfection stations to counter the spread of COVID-19. Although Iraq is highly prone to the outbreak due to its proximity and close relations with Iran, protesters have been defiant, saying the government is the virus. Elsewhere authorities have closed major public spaces and religious institutions have cancelled gatherings. Author: Tom Allinson



Exporting an outbreak

It was the end of February. A Canadian man in his 70s had returned to Ontario and started running a fever. In a moment of clarity, the man took measures to isolate himself.

Having just returned from Egypt, he figured it best to head to the hospital and let the experts determine his illness. But the tests returned positive for the novel coronavirus. At that point, the Egyptian government had only acknowledged three cases, and the chain of transmission was pointing in their direction.

"We chose Egypt because we had an import case of COVID-19 to Canada from Egypt. At the time, Egypt was not really on anyone's list of being a location with a high burden of COVID-19 infections," Isaac Bogoch, associate professor and infectious diseases physician at the University of Toronto's Department of Medicine, told DW.

Bogoch said that if a country is exporting cases of the novel coronavirus via air travel, that suggests the likelihood of many more cases on the ground. Data he collected shows that Egypt has exported more than 95 cases, including tourists, and that the latest death occurred far from the initial cluster in Upper Egypt.

In a peer-reviewed article accepted by the Lancet Infectious Diseases academic journal, Bogoch demonstrated that the outbreak could be as high as 19,000 cases. Officially, the Egyptian government has reported less than 200.

"This all points to there likely being a greater number of cases in Egypt than is being reported," Bogoch said. "Based on our data, I believe that there are likely closer to 6,000 cases, not the larger number, as many were clustered around Luxor in tours."

Here you can see the worldwide spread.

Johns Hopkins University interactive map

Read more: Coronavirus: Are less-developed EU countries more susceptible?

The curse of truth

But circulating such claims — that is, of larger-than-officially-reported figures — has already landed some people in jail.

At least seven people have been arrested by Egyptian police for "circulating rumors" about the outbreak concerning the number of positive cases. Interior Ministry officials said those arrested would be punished to the full extent of the law.

Last week, Egyptian authorities launched a campaign urging citizens to "not circulate any data or information not issued by the official authorities concerned, in order to avoid being subject to legal accountability," according to independent advocacy platform Egypt Watch. Authorities even published WhatsApp numbers to encourage reporting violators.

The situation in Egypt is further exacerbated by ineffectual tips published by the the country's Health Ministry to confront the outbreak, such as "drink more orange juice" or "eat honey" in order to "strengthen your immune system," recommendations that healthcare practitioners say undermine the WHO's carefully-designed guidelines.

Read more: Coronavirus and the plague: The disease of viral conspiracy theories

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