COVID-19 in the Arab countries: Three-year study

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Nevertheless, governmental policies, healthcare systems, and resources differ from one Arab country to another. We have been following Coronavirus (COVID-19) from the beginning in each Arab country. In the present study, we aimed to assess the prevalence of COVID-19 in the Arab world and to compare these findings with other significantly affected countries. Methods Websites of the World Health Organization, World COVID-vaccinations tracker, Worldometer, and Ministries of Health were used to extract COVID-19 data in all Arab countries between the period January 2020 to December 2022. Results All Arab countries had 14,218,042 total confirmed COVID-19 cases, 13,384,924 total recovered cases and 173,544 total related deaths. The trend demonstrated that the third quarter of 2021 recorded the highest death toll and the first quarter of 2022 recorded the highest number of confirmed and recovered cases. Compared to the top 15 affected countries, the Arab world ranked last as it had the lowest overall incidence per million population (PMP) of 31,609. The data on total deaths PMP showed that India had the lowest number of deaths with only 377 cases followed by the Arab world with 386 cases. Conclusions Although the number of confirmed, death, and recovered cases of COVID-19 have greatly reduced in the last quarter of 2022 in most Arab countries, many Arab countries still need to re-campaign about COVID-19 vaccines and raise awareness programs about boosters. COVID-19 has had a relatively smaller impact on Arab countries than on other countries that have been significantly affected. 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F1000Research 2024, 12 :1448 ( https://doi.org/10.12688/f1000research.142541.3 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Review Revised COVID-19 in the Arab countries: Three-year study [version 3; peer review: 2 approved, 1 approved with reservations] Previous Title 'COVID-19 in the Arab countries: Three-year review' Nasar Alwahaibi https://orcid.org/0000-0002-9421-0951 1 , Muna Al Maskari 1 , Samiya Al-Jaaidi 2 , Buthaina Al Dhahli 1 , Halima Al Issaei 1 , Shadia Al Bahlani 1 Nasar Alwahaibi https://orcid.org/0000-0002-9421-0951 1 , Muna Al Maskari 1 , [...] Samiya Al-Jaaidi 2 , Buthaina Al Dhahli 1 , Halima Al Issaei 1 , Shadia Al Bahlani 1 PUBLISHED 29 May 2024 Author details Author details 1 Department of Biomedical Science, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Muscat Governorate, Oman 2 Department of Biology, College of Science, Sultan Qaboos University, Muscat, Muscat Governorate, Oman Nasar Alwahaibi Roles: Conceptualization, Formal Analysis, Methodology, Supervision, Writing – Original Draft Preparation, Writing – Review & Editing Muna Al Maskari Roles: Formal Analysis, Investigation, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing Samiya Al-Jaaidi Roles: Formal Analysis, Investigation, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing Buthaina Al Dhahli Roles: Formal Analysis, Investigation, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing Halima Al Issaei Roles: Formal Analysis, Investigation, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing Shadia Al Bahlani Roles: Formal Analysis, Investigation, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the Emerging Diseases and Outbreaks gateway. Abstract Background Twenty-two Arab countries share a common language, history, and culture. Nevertheless, governmental policies, healthcare systems, and resources differ from one Arab country to another. We have been following Coronavirus (COVID-19) from the beginning in each Arab country. In the present study, we aimed to assess the prevalence of COVID-19 in the Arab world and to compare these findings with other significantly affected countries. Methods Websites of the World Health Organization, World COVID-vaccinations tracker, Worldometer, and Ministries of Health were used to extract COVID-19 data in all Arab countries between the period January 2020 to December 2022. Results All Arab countries had 14,218,042 total confirmed COVID-19 cases, 13,384,924 total recovered cases and 173,544 total related deaths. The trend demonstrated that the third quarter of 2021 recorded the highest death toll and the first quarter of 2022 recorded the highest number of confirmed and recovered cases. Compared to the top 15 affected countries, the Arab world ranked last as it had the lowest overall incidence per million population (PMP) of 31,609. The data on total deaths PMP showed that India had the lowest number of deaths with only 377 cases followed by the Arab world with 386 cases. Conclusions Although the number of confirmed, death, and recovered cases of COVID-19 have greatly reduced in the last quarter of 2022 in most Arab countries, many Arab countries still need to re-campaign about COVID-19 vaccines and raise awareness programs about boosters. COVID-19 has had a relatively smaller impact on Arab countries than on other countries that have been significantly affected. READ ALL READ LESS Keywords Arab countries, confirmed, coronavirus, recovered, COVID-19, COVID-19 vaccines, death Corresponding Author(s) Nasar Alwahaibi ( [email protected] ) Close Corresponding author: Nasar Alwahaibi Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2024 Alwahaibi N et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Alwahaibi N, Al Maskari M, Al-Jaaidi S et al. COVID-19 in the Arab countries: Three-year study [version 3; peer review: 2 approved, 1 approved with reservations] . F1000Research 2024, 12 :1448 ( https://doi.org/10.12688/f1000research.142541.3 ) First published: 08 Nov 2023, 12 :1448 ( https://doi.org/10.12688/f1000research.142541.1 ) Latest published: 29 May 2024, 12 :1448 ( https://doi.org/10.12688/f1000research.142541.3 ) Revised Amendments from Version 2 The title has been slightly modified. The population of Mauritania has been modified and subsequently the countries in Table 1 have been reordered. Two additional paragraphs have been added to the discussion section. Few sentences have been rephrased. The title has been slightly modified. The population of Mauritania has been modified and subsequently the countries in Table 1 have been reordered. Two additional paragraphs have been added to the discussion section. Few sentences have been rephrased. See the authors' detailed response to the review by Muhammad Nauman Zahid See the authors' detailed response to the review by Ahmad A. Alrasheedi See the authors' detailed response to the review by Yasser Amer READ REVIEWER RESPONSES Introduction On March 11, 2020, the World Health Organization (WHO) declared coronavirus disease 2019 (COVID-19) as a pandemic. COVID-19, which is caused by severe acute respiratory syndrome-coronavirus (SARS-CoV-2), is a highly contagious virus. 1 In the last three years, COVID-19 has infected and killed millions of people around the world, including those in Arab countries. When COVID-19 started in the first period of 2020 and the polymerase chain reaction (PCR) tests were not available, fever, dry cough, sore throat, headache, fatigue, and breathlessness were the common symptoms for COVID-19 patients. However, many people with COVID-19 remain asymptomatic but can transmit SARS-CoV-2 to others. 2 , 3 In the past, vaccines have saved lives, avoided illness and infection, and been evaluated as effective health interventions. 4 In fact, WHO has shown that vaccines are safer than treatment. 5 COVID-19 vaccines reduce the risk of illness, hospitalization, and death from COVID-19. A study showed that the mean percentage of death with one dose was 11.55% compared to 4.31% after the second dose of any type of approved vaccine. 6 Globally, it has been estimated that about eight billion doses of the COVID-19 vaccine have been distributed to reduce the rate of COVID-19. 7 Comprehensively, the COVID-19 vaccination saved approximately 20 million lives during its first year of distribution. 8 As of January 1, 2023, more than 5.51 billion people worldwide have received a dose of a COVID-19 vaccine, which corresponds to approximately 71% of the world population, and fully vaccinated about 66%. 9 A recent study in Qatar concluded that deaths attributable to SARS-CoV-2 vaccination are extremely rare. 10 They reported that the death rate among the vaccinated persons with a high probability of relationship to SARS-CoV-2 vaccination was 0.34 per 100,000 vaccine recipients, while the death rate among the vaccinated persons with either high or intermediate probability of relationship to SARS-CoV-2 vaccination was 0.98 per 100,000. In line with this study, the United States Centers for Disease Control and Prevention identified only nine deaths from 14,980 reports of death among more than 589 million vaccine doses between December 14, 2020, and June 6, 2022. 11 On the other hand, WHO has identified many different variants of SARS-CoV-2 including Alpha, Beta, Omicron, Gamma, Delta, Eta, Iota, Kappa, Zeta, and Mu. On 26 November 2021, WHO declared the Omicron variant, known as lineage B.1.1.529, a variant of concern. 12 It was first identified in Botswana and South Africa. 13 Although the Omicron variant (B.1.1.529) causes less severe symptoms, it is more contagious and spreads faster than any previous variant. Many studies reported that this variant causes reinfection, and may escape the immune system’s defenses, and two doses of vaccination appeared to be less effective. 14 – 16 However, some studies show that boosters can provide protection against Omicron infection. 17 – 19 Unfortunately, these variants and probably others will continue to emerge as long as SARS-CoV-2 remains. The development of vaccines is usually a lengthy and complex process. However, in order to stop the transmission of COVID-19, vaccine development has been accelerated. 20 , 21 Despite unequal vaccine distribution, vaccine hesitancy, and waning immunity, billions of vaccine doses have been administered worldwide. One of the major causes of vaccine hesitancy and delay in vaccination is the concern about adverse effects. 22 As of December 29, 2022, WHO approved 11 COVID-19 vaccines including Sinopharm, Sinovac, Bharat Biotech, Moderna, Pfizer/BioNTech, Oxford/AstraZeneca, Serum Institute of India, Janssen/Johnson & Johnson, Novavax, Serum Institute of India, and CanSino. 23 The Arab world contains 22 countries, distributed 12 in Asia and 10 in Africa. Language, history, traditions, and culture are shared by Arab countries. 24 However, the healthcare systems and availability of resources differ from one Arab country to another. Previously, we published two review papers. The first was a 5-month COVID-19 data in all Arab countries from January 1, 2020, to May 31, 2020, and concluded that most Arab countries took some serious early steps to minimize the outbreak of COVID-19. 25 The second one was a one-year from February 2020 to February 2021, and we concluded that among the Arab countries, Qatar, Bahrain, and Lebanon showed the highest number of recovered, confirmed, and deaths per million population, respectively. The number of confirmed and death cases among Arab countries triggers significant worries about morbidity and mortality related to COVID-19, respectively. 26 We have been following COVID-19 from the beginning in each Arab country. In the present study, we aimed to assess further the prevalence of COVID-19 in the Arab world from January 2020 to December 2022 and to compare these findings with other significantly affected countries. Methods We used the WHO, World COVID-vaccinations tracker, Worldometer, and Ministries of Health official websites to search for COVID-19 data in Algeria, Bahrain, Comoros, Djibouti, Egypt, Iraq, Jordan, Kuwait, Lebanon, Libya, Mauritania, Morocco, Oman, Palestine, Qatar, Saudi Arabia (SA), Somalia, Sudan, Syria, Tunisia, United Arab Emirates (UAE), and Yemen. The period covered was from January 2020 to December 2022. The inclusion criterion was official information about clinically diagnosed COVID-19 in English or Arabic. The exclusion criterion was unspecified date and location of information, or suspicion of duplicate information. The data were collected monthly and verified with the data in the Worldometer. The following information was collected from each Arab country: total population, median age, number of monthly confirmed, death, and recovered cases, the total number of COVID-19 tests, and COVID-19 vaccine rates (first and second). The data for the topmost 15 affected countries were extracted from the Worldometer at the same time as the data for the Arab countries. Ethical approval and written informed consent were not required for this type of study. Data were analyzed using the IBM SPSS Statistics (RRID:SCR_016479) software version 25 (SPSS Inc., Chicago, IL, USA). Results are presented as numbers, percentages, and means. Results By January 01, 2023, the total Arab population who live in Arab countries was 449,809,846. Egypt recorded the highest population among all Arab countries, followed by Sudan, and Algeria with 106,156,692, 45,992,020, and 45,350,148, respectively. The highest median age was seen in the UAE, followed by Qatar, and Bahrain with 38.4, 33.7, and 32.3 years, respectively. Whereas the lowest median age was seen in Sudan at 18.3 years. The total number of COVID-19 tests in all Arab countries was 362,542,626. The UAE recorded the highest number of tests per million population (PMP) with 19,632,329, followed by Bahrain (5,960,320), and then Oman (4,695,724). The people in Qatar and the UAE have received two doses of the COVID-19 vaccine equally to about 99% whereas those in Yemen received only 3% for both doses ( Table 1 ). Table 1. Features of the Arab countries related to COVID-19 from January 2020 to December 2022. Countries Population Median age, years Total tests Tests PMP One dose of COVID-19 vaccine in % Two doses of COVID-19 vaccine in % Egypt 106,156,692 23.9 3,693,367 34,792 54 40 Sudan 45,992,020 18.3 562,941 12,240 25 19 Algeria 45,350,148 28.9 230,861 5,091 18 15 Iraq 42,164,945 20 19,448,292 461,243 29 20 Morocco 37,772,756 29.3 12,856,284 340,359 69 64 SA 35,844,909 30.8 44,940,564 1,253,750 79 74 Yemen 31,154,867 19.8 329,592 10,579 3 3 Syria 19,364,809 24.3 146,269 7,553 19 13 Somalia 16,841,795 18.5 400,466 23,778 49 41 Tunisia 12,046,656 31.6 4,983,949 413,721 62 55 Lebanon 10,300,869 30.5 4,795,578 717,380 40 35 UAE 10,081,785 38.4 197,928,922 19,632,329 99 99 Libya 7,040,745 28.9 2,483,446 352,725 34 18 Jordan 6,684,849 22.5 17,201,885 1,669,945 48 45 Palestine 5,345,541 21.1 3,078,533 575,907 43 38 Oman 5,323,993 25.6 25,000,000 4,695,724 65 61 Mauritania 4,736,139 20.5 1,009,957 206,030 46 34 Kuwait 4,380,326 29.3 8,447,300 1,928,464 82 79 Qatar 2,979,915 33.7 4,065,369 1,364,257 99 99 Bahrain 1,783,983 32.3 10,633,110 5,960,320 76 75 Djibouti 1,016,097 23.9 305,941 301,094 33 31 Comoros 907,419 19.9 NA NA 52 47 Total/Average 449,809,846 26 362,542,626 1,903,204 The total number of COVID-19 cases in all Arab countries was 14,218,042 and of those, 173,544 (1.2 %) were deceased and 13,384,924 (94%) were recovered. Jordan, Qatar, Kuwait, Palestine, and Lebanon recorded the highest number of reported cases PMP with 261,404, 164,032, 151,138, 131,568, and 118,957, respectively. Yemen recorded only 383 cases PMP. Based on the evaluation of three years from January 2020 to December 2022, the trend showed that the first quarter of 2022 had the highest number of confirmed COVID-19 cases in all Arab countries with 3,235,665 cases. In the same quarter period, 11 Arab countries scored their highest number of COVID-19 confirmed cases ( Table 2 ). Table 2. The trend of quarterly COVID-19 confirmed cases in all Arab countries from January 2020 to December 2022. Countries Q1-20 Q2-20 Q3-20 Q4-20 Q1-21 Q2-21 Q3-21 Q4-21 Q1-22 Q2-22 Q3-22 Q4-22 Total PMP Jordan 268 864 10,693 282,669 323,565 133,345 73,293 238,708 630,811 4,368 48,866 0 1,747,450 261,404 Qatar 781 95,307 29,672 18,074 36,130 42,107 14,572 13,885 110,444 20,962 69,138 37,730 488,802 164,032 Kuwait 289 45,906 58,989 45,404 81,619 124,474 54,539 5,455 213,137 15,012 12,985 4,227 662,036 151,138 Palestine 117 2,490 37,471 98,105 135,048 69,898 93,879 33,514 185,519 3,812 42,915 536 703,304 131,568 Lebanon 470 1,308 37,856 141,869 286,897 76,466 80,579 102,485 364,579 19,690 103,726 9,444 1,225,369 118,957 UAE 669 47,998 45,523 112,561 253,623 170,330 103,085 25,945 129,372 54,500 81,702 19,506 1,044,814 103,633 Tunisia 393 779 16,233 119,811 118,092 164,795 287,880 19,860 308,041 16,296 93,506 1,885 1,147,571 95,260 Oman 192 39,878 58,515 30,282 30,351 109,327 34,511 1,720 81,808 2,385 7,265 656 396,890 74,547 Libya 8 816 33,701 65,410 60,045 33,494 147,617 47,643 113,004 400 4,856 148 507,142 72,029 Iraq 630 48,479 313,872 232,310 255,633 494,980 665,730 82,106 226,168 28,754 111,320 6,627 2,466,609 58,499 Mauritania 6 4,143 3,325 6,168 4,205 2,961 15,306 5,753 16,802 1,145 3,009 602 63,425 49,755 Morocco 602 11,783 108,798 316,149 59,344 34,685 403,467 30,592 197,794 53,695 48,052 6,634 1,271,595 33,664 SA 1563 189,260 143,782 28,136 27,266 97,585 59,605 8,102 194,578 44,282 22,233 10,615 827,007 23,071 Djibouti 31 4,651 734 408 2,356 3,422 1,279 787 1,917 105 0 0 15,690 15,441 Comoros 0 303 171 291 2,939 239 204 2,541 1,398 14 371 511 8,982 9,898 Algeria 716 13,191 37,306 48,098 17,993 22,322 64,031 15,161 46,853 416 4,589 552 271,228 5,980 Egypt 711 67,600 34,768 33,565 66,199 78,439 24,748 80,328 118,906 10,381 0 0 515,645 4,857 Syria 10 269 3,921 7,234 7,605 6,476 9,405 15,358 5,428 221 1,380 169 57,476 2,968 Somalia 5 2,919 664 1,126 6,785 3,447 5,034 3,552 2,878 393 411 86 27,300 1,620 Sudan 7 9,251 4,382 11,860 4,611 6,547 1,670 8,190 15,437 669 661 401 63,686 1,384 Bahrain 567 25,980 44,106 21,811 51,770 121,382 9,230 7,005 269,111 70,383 54,916 17,811 694,072 389 Yemen 0 1,158 876 68 2,429 2,389 2,219 987 1,680 18 111 14 11,949 383 Total 8035 614,333 1025,358 1621,409 1834,505 1,799,110 2,151,883 749,677 323,5665 347,901 712,012 118,154 14,218,042 Deaths PMP were dominant in Tunisia, Jordan, Palestine, Lebanon, and Libya with 2,430, 2,116, 1,073, 1,052, and 914, respectively. The trend demonstrated that the third quarter of 2021 had the highest number of deaths in all Arab countries with 31,275 cases. In the same quarter period, five countries had the highest number of COVID-19-related deaths ( Table 3 ). Table 3. The trend of quarterly COVID-19 death cases in all Arab countries from January 2020 to December 2022. Countries Q1-20 Q2-20 Q3-20 Q4-20 Q1-21 Q2-21 Q3-21 Q4-21 Q1-22 Q2-22 Q3-22 Q4-22 Total PMP Tunisia 10 40 196 4,374 4,223 6,116 9,962 655 2,747 368 558 35 29,284 2,430 Jordan 5 4 68 3,773 3,090 2,810 977 1,926 1,395 20 69 12 14,149 2,116 Palestine 1 7 303 1,089 1,501 932 579 522 721 5 68 8 5,736 1,073 Lebanon 12 22 363 1,221 4,616 1,617 490 778 1,187 159 253 119 10,837 1,052 Libya 0 24 527 893 1,236 513 1,471 1,046 709 11 7 0 6,437 914 Bahrain 4 83 164 101 169 831 37 5 75 21 28 18 1,536 861 Oman 1 175 759 564 179 1,411 974 20 136 10 0 0 4,229 794 Mauritania 0 126 35 181 107 40 288 93 112 1 12 2 997 782 Iraq 46 1,897 7,238 3,632 1,510 2,863 5,206 1,766 1,009 74 133 27 25,401 602 Kuwait 0 354 256 324 379 645 477 19 87 1 5 7 2,554 583 Morocco 36 189 1,927 5,203 1,470 471 5,019 536 1,209 49 169 16 16,294 431 SA 10 1,639 3,119 1,455 446 1,150 897 161 170 164 146 163 9,520 265 UAE 6 309 104 250 828 314 286 67 138 14 29 3 2,348 233 Egypt 46 2,907 2,961 1,662 4,465 4,128 1,230 4,369 2,649 196 0 0 24,613 232 Qatar 2 111 101 31 46 299 16 13 57 2 3 3 684 229 Djibouti 0 54 7 0 10 84 14 20 0 0 0 0 189 186 Comoros 0 7 0 2 137 0 1 10 3 0 1 0 161 177 Syria 2 7 191 511 563 602 389 632 243 10 26 0 3,176 164 Algeria 58 854 807 1,032 345 620 2,103 465 590 1 4 2 6,881 152 Sudan 2 570 264 725 502 691 150 427 1,576 44 10 33 4,994 108 Somalia 0 90 9 31 407 238 336 222 17 0 2 9 1,361 81 Yemen 0 312 275 23 296 455 373 250 159 7 9 4 2,163 69 Total 241 9,781 19,674 27,077 26,525 26,830 31,275 14,002 14,989 1,157 1,532 461 173,544 Bahrain, Jordan, Kuwait, Qatar, and Palestine showed the highest number of recovered cases PMP with 307,175, 258,944, 147,542, 134,455, and 131,528, respectively. The trend showed that the first quarter of 2022 had the highest number of recovered cases in all Arab countries with 3,261,712 cases. In the same quarter period, 10 countries had the highest number of recovered cases ( Table 4 ). Table 4. The trend of quarterly COVID-19 recovered cases in all Arab countries from January 2020 to December 2022. Countries Q1-20 Q2-20 Q3-20 Q4-20 Q1-21 Q2-21 Q3-21 Q4-21 Q1-22 Q2-22 Q3-22 Q4-22 Total PMP Bahrain NA 14,685 NA NA 20,226 125,972 5,933 4,065 267,768 65,995 43,351 NA 547,995 307,175 Jordan 26 856 3,744 265,925 249,947 214,596 66,432 217,370 660,045 4,805 47,261 0 1,731,007 258,944 Kuwait 73 36,957 59,756 49,831 70,573 118,640 70,978 3,098 213,361 11,229 11,788 NA 646,284 147,542 Qatar 62 81,502 41,135 18,723 22,699 55,678 14,963 10,480 114,060 17,280 24,083 NA 400,665 134,455 Palestine 18 607 40,603 91,590 112,106 91,952 71,379 53,346 187,621 3,622 37,821 12,426 703,091 131,528 Lebanon 35 1,148 15,927 151,201 202,376 161,850 63,531 63,380 402,783 25,356 0 0 1,087,587 105,582 UAE 61 37,505 46,154 100,718 260,913 166,087 114,804 16,520 122,607 58,187 80,882 22,927 1,027,365 101,903 Tunisia 1 1,028 1,512 104,639 110,748 136,513 323,184 18,861 312,348 0 0 0 1,008,834 83,744 Oman 34 23,391 64,704 33,362 22,480 88,015 62,971 1,284 82,558 1,730 NA NA 380,529 71,474 Libya 0 209 19,152 52,746 75,757 30,523 82,498 115,393 113,774 921 9,537 151 500,661 71,109 Iraq 152 24,608 267,437 245,644 226,255 481,432 680,125 139,317 217,997 25,792 124,945 7,436 2,441,140 57,895 Mauritania 2 1,620 5,469 4,289 5,713 2,697 14,976 4,464 18,456 620 3,486 631 62,423 48,969 Morocco 24 8,815 91,414 307,251 76,207 33,865 391,322 32,110 206,249 28,105 73,192 6,294 1,254,848 33,221 SA 165 130,601 187,165 34,650 24,230 113,424 68,185 5,173 175,193 39,662 23,509 6,419 808,376 22,552 Djibouti 2 4,522 820 384 810 4,905 758 1,183 2,006 37 0 0 15,427 15,182 Comoros 0 200 253 363 2,720 229 201 832 3,121 14 372 514 8,819 9,718 Egypt 157 18,303 77,634 16,452 42,470 56,368 46,868 62,880 115,379 5,671 0 0 442,182 4,165 Algeria 46 9,851 26,065 31,165 14,505 15,457 42,435 10,784 28,050 179 3,776 335 182,648 4,027 Syria 0 105 998 4,193 7,559 8,970 2,202 8,487 14,816 5,428 1,341 249 54,348 2,806 Sudan 0 4,014 2,750 6,772 10,678 6,302 1,599 6,599 1,615 0 16,961 889 58,179 1,265 Somalia 0 932 2,014 666 1,249 2,385 2,277 3,425 234 0 0 0 13,182 782 Yemen 0 488 798 108 288 2,386 1,591 1,363 1,671 513 123 5 9,334 299 Total 858 401,947 955,504 1,520,672 1,560,509 1,918,246 2,129,212 780,414 3,261,712 295,146 502,428 58,276 13,384,924 In comparison to the topmost 15 affected countries, the Arab world ranked 16 as it had the lowest overall incidence PMP of 31,609. The data on total deaths PMP showed that India had the lowest number of deaths with only 377 cases followed by the Arab world with 386 cases. The United States recorded the highest number of deaths with 3,339 cases. In terms of the total number of tests for SARS-CoV-2, Arab countries ranked eleventh with 805,990 tests PMP. The highest number of tests PMP was conducted by Spain (10,082,298) and the lowest was by Brazil (296,146). Arab countries showed the youngest median age followed by India with 28.7 years as its median age. Conversely, Japan had the oldest median age of 48.6 years, however, it had fewer COVID-19 deaths per million populations with 456 cases. It is worth mentioning that six of the top 15 affected countries are from Europe. France was the worst country (after South Korea) as it recorded 599,471 cases PMP and ranked first. Other parameters, which include total tests and population, are also compared ( Table 5 ). Table 5. Comparison of COVID-19 prevalence between the Arab world and the top 15 affected countries from January 2020 to December 2022. Country Total Confirmed cases Total Death cases Total Cured cases Confirmed cases PMP Deaths PMP Total Tests Tests PMP Population Median Age, years 1. France 39,316,017 161,962 38,342,881 599,471 2,470 271,490,188 4,139,547 65,584,518 41.7 2. S. Korea 29,116,800 32,219 27,893,416 567,248 628 15,804,065 307,892 51,329,899 43.2 3. Germany 37,369,865 161,465 36,615,400 445,497 1,925 122,332,384 1,458,359 83,883,596 47.8 4. Australia 11,131,707 17,052 10,979,282 427,013 654 78,835,048 3,024,116 26,068,792 44.5 5. Italy 25,143,705 184,642 24,541,402 417,234 3,064 262,558,741 4,356,898 60,262,770 46.5 6. UK 24,135,084 198,937 23,844,243 352,348 2,904 522,526,476 7,628,357 68,497,907 40.6 7. USA 102,513,690 1,117,983 99,513,507 306,189 3,339 1,152,003,631 3,440,817 334,805,269 38.5 8. Spain 13,684,258 117,095 13,486,683 292,905 2,506 471,036,328 10,082,298 46,719,142 43.9 9. Japan 29,212,535 57,266 21,105,754 232,612 456 86,237,109 686,684 125,584,838 48.6 10. Argentina 9,891,139 130,124 9,609,732 214,977 2,828 35,716,069 776,264 46,010,234 32.4 11. Turkey 17,042,722 101,492 N/A 199,186 1,186 162,743,369 1,902,052 85,561,976 32.2 12. Brazil 36,354,255 693,941 34,938,186 168,812 3,222 63,776,166 296,146 215,353,593 33.2 13. Russia 21,798,509 393,712 21,207,802 149,504 2,700 273,400,000 1,875,095 145,805,947 40.3 14. Vietnam 11,525,231 43,186 10,611,275 116,471 436 85,826,548 867,342 98,953,541 31.9 15. India 44,679,564 530,702 44,144,029 31,764 377 910,365,101 647,195 1,406,631,776 28.7 16. Arab World 14,218,042 173,544 13,384,924 31,609 386 362,542,626 805,990 449,809,846 26.0 Discussion The present study aimed to assess the prevalence and the impact of the COVID-19 pandemic in 22 Arab countries and compare them with other significantly affected countries from January 2020 to December 2022. COVID-19 confirmed cases increased exponentially in the first quarter of 2021 due to the influenza season with Jordan demonstrating the highest number of cases followed by Lebanon. A dramatic increase in COVID-19 confirmed cases occurred in the third quarter of 2021 due to the emergence of the Delta variant, 27 which peaked in Iraq with a total number of 665,730. Another reason for the spike increase is the slow uptake of the vaccine in many countries of the world, including Arab countries. 28 For example, only 20% of the population in Iraq had received single/double doses of the COVID-19 vaccine. In addition, people in several countries, such as Iraq, refused to take the vaccine, which in turn, might have played a role in accelerating the number of COVID-19 confirmed cases. 29 Furthermore, the re-opening of schools and businesses, people returning from holidays and social mixing subsidized the escalation in the COVID-19 confirmed cases at the end of summer and the start of winter of 2021. 27 The situation was further aggravated by the economic disturbance in some of these countries hence, they had a compound crisis; COVID-19 and economic disruption. 30 Preventive measures taken by countries during the pandemic affected the spread of the COVID-19 virus. During the first, second, and third quarters of 2020, the pandemic was under control in most Arab countries mostly due to the implementation of extreme precautionary measures. The major measures include land, sea, and air route closure, nighttime or all-day curfew and lockdown, school and universities closure, worship places closure, prohibition of gatherings, closure of shops, malls, beaches, public parks, and gardens, cancellation of all cultural and sports events, festivals, seminars, and scientific meetings, and suspension of work in all government and private sectors. 31 – 33 A study conducted in Saudi Arabia showed that preventive measures had an enormous effect in reducing the number of expected confirmed cases of COVID-19 from 437,096 cases to an observed number of 28,656 at the beginning of the second quarter of 2020. 34 Because of the economic crisis in some countries like Jordan, some of these measures were diminished in the fourth quarter of 2020, leading to an increase in COVID-19 cases. 35 During the first quarter of 2022, which was a shockwave, the Arab countries recorded the highest number of confirmed COVID-19 cases ever reported between 2020 and 2022. The total number of cases was 3,235,665, with Jordan reporting the highest number of cases at 630,811. The potential reason for the spike is the occurrence of the Omicron variant that had affected the death rate and increased hospitalization. 36 On the other hand, the pandemic had intense consequences on the economy of many countries. Therefore, to revive the economy, different approaches were taken such as the period of isolation of the infected people was reduced and guidelines on PCR testing of suspected COVID-19 cases became more restrictive. 35 Subsequently, there was a dramatic decrease in the confirmed cases in the second quarter of 2022, which continued to decline until the end of the year. Both the third-fourth quarters of 2021 and 2022 demonstrated a similar wave but with a lesser rate of confirmed COVID-19 cases in 2022. This could be due to the higher vaccine coverage in that year emphasizing the importance and the impact of vaccination intake. 37 Despite the full vaccination coverage in Qatar (99%), among Arab countries, Qatar was reported with the highest number of confirmed cases of COVID-19 in the fourth quarter of 2022 with a total number of 37,730. The conceivable reason could be that Qatar was hosting the World Cup 2022 with no COVID-19 restrictive measures required to enter the country, which had strikingly increased the social gathering and thus, increased COVID-19 confirmed rates. 38 Among Arab countries, such as the Gulf Cooperation Council (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the UAE) and Morocco, with over 60% of their population fully vaccinated, showed a sharp decrease in the death rate PMP in the last quarter of 2021 ( Table 3 ). However, the first quarter of 2022 retained a death peak, which disappeared by the second quarter of the same year, probably because of the fast-spreading Omicron variant wave. Countries like Yemen, Syria, Iraq, and Sudan showed a low percentage of vaccination, a low number of tests, and surprisingly low deaths PMP ( Tables 1 and 3 ). Political instability and a weak healthcare system that depends on outside humanitarian aid could be attributed to a lack of regular testing and continued poor documentation of COVID-19 status. 25 Jordan, as an example of an Asian country, experienced the first wave of viral spread during the fourth quarter of 2020, lasted until January 2021, and resulted in a great increase in accumulative confirmed and death cases. Before the first wave started, epidemiological status was under control, but by early September 2020 some restrictions were removed, e.g. , land boundaries were opened for export/import goods from neighboring countries, universities opened doors for registration, and people started to take the crisis less seriously. 35 The second wave in Jordan was led by the fast-spreading UK variant that started in January 2021 continued until May 2021 and peaked in March 2021. The Indian Delta strain spread in Jordan during the second quarter and beginning of the third quarter of 2021, but the epidemiological data did not show any peak due to vaccination or naturally acquired immunity. 35 The third and fourth waves, from October 2021 until January 2022 and January 2022 to March 2022, respectively, started as the government halted many preventive measures due to economic stress. Both waves were led by the Omicron variant. 35 Tunisia, as an example of an African country, started to record positive cases in early March 2020, however by June 2020, the government could control the situation by applying preventive measures, which resulted in zero cases between 4 th and 12 th June. In July 2020, borders opened and clear slackening in sticking with preventive measures by people resulted in the second wave, which affected the country. March 2021 was the start of the third wave in Tunisia, which was highlighted by severe cases and a high transmission rate, caused by the Alpha variant after the fourth wave, which was led by the Delta variant that occurred in May 2021. During this period, Tunisia got a high rate of deaths PMP ( Table 3 ). The Omicron variant of concern was the cause of the fifth wave by the end of 2021, so the country experienced another peak of death during the first quarter of 2022. These waves attributed to a large number of deaths. Tunisia has the highest number of deaths PMP among Arab countries. The economic crisis in addition to political problems made it difficult for the government to control COVID-19 and this in turn, resulted in the delay of the introduction and dissemination of COVID-19 vaccines. 39 Studying the trend of recovered cases is a useful indication of the health status and the health system in these countries. It is also a good tool to be used in terms of applying certain restrictions such as the duration of lockdown. From January 2020 to December 2022, all Arab countries showed various numbers of recovered cases of COVID-19. Such variation depended initially on the number of infected cases and on a broader scope, the severity of infection, treatment, patient immunity, vaccination, and other political and health factors. 37 Although some data were missing on the number of recovered cases for some countries, Bahrain, followed by Jordan, Kuwait, and Qatar showed the highest among all Arab countries. Whereas, Syria, Sudan, Somalia, and Yemen showed the lowest number of recovered cases, which may be explained by the unstable political status and subsequently the weakness of the healthcare system. Over time and based on the registered cases, the trend of recovered cases started at a low, reached a high peak, and eventually declined. This trend is common in such pandemics and the mode of spreading such infection had been observed in the previous pandemic. 40 The bell-shaped trend in certain countries such as Palestine, given all collected data, are accurate, and helped tremendously in managing the pandemic crisis in terms of lockdown, financial and social impact, and predicting the coming waves of the mutant viruses. The effect of a complete vaccination regimen on the recovered cases was not consistent among Arab countries. As mentioned previously, Qatar had the highest percentage of the vaccinated population but was not the top-rated country in the recovered cases. Such observation does not exclude the importance of vaccination effect on these cases rather than additional factors that might have contributed to this outcome. A recent study showed the effectiveness of the vaccine in preventing SARS-CoV-2 infection and its symptoms. In addition to other mitigation strategies, vaccine campaigns could have a great impact on the number of confirmed and recovered cases. 41 Although quarantine was one of the most important measures in controlling the spread of the epidemic, 42 such a theory changed once the right vaccine was used. Quarantine controls the disease by the large fraction of pre-symptomatic and asymptomatic transmission, unlike the vaccine that eliminates the virus and reduces its symptoms in many cases. During the recent pandemic, vaccination campaigns have proven their effectiveness to control the disease and reduce the severity of its symptoms. Certain tactics were used to enhance public awareness and acceptance of vaccine during these campaigns. One of the most effective tactics was to address public opinions of vaccine safety and efficacy by disseminating accurate information through authorized channels. This information was in different languages to reach out all in the community. Community engagement and healthcare guidance were also helpful. During the vaccination process, the uptake of vaccine was enhanced by removing any obstacle that might delay such a process. For example, setting up vaccination centers in different locations with an easy access and quick appointment. These centers had big area to accommodate more people at each time. Community outreach existed for those who could not go to these centers. 43 Unfortunately, many countries had anti-vaccine groups that were affecting the vaccination campaigns badly. Those groups influenced the decision of several people on taking the vaccines and subsequently affecting the control of the disease. Changing the culture and the mentality of certain groups in societies will be the first and biggest challenges for vaccination campaigns in any pandemic in the future. Altogether, the authors hypothesized that vaccination campaigns influenced the number of confirmed and recovered cases in these Arab countries despite the impact of other related factors. It is very important to open new insights in the research of vaccine discovery and more time and effort should be spent in this area. Recently, Hoxha and coworkers analyzed COVID-19 data from 164 different countries and concluded that higher COVID-19 vaccination rates are associated with lower COVID-19 mortality rates and that there is a tendency for more vaccinations and fewer deaths per 1,000 cases with increasing country income levels. 44 Notably, Both Qatar and UAE represent as the highest income countries in the Arab world. The UAE recorded the same percentage of the vaccinated population as Qatar, and both demonstrated low number of deaths. Research conducted in the UAE regarding the inactivated BBIBP-CorV (Sinopharm) vaccine revealed that its efficacy against severe COVID-19 outcomes was 80% for hospitalization, 92% for critical care admission, and 97% for preventing death. 45 In addition, a study conducted in Morocco on the long-term efficacy of the inactivated BBIBP-CorV vaccine revealed a decrease in effectiveness, dropping from 88% to 64% six months after vaccination. 46 Furthermore, in Qatar, a different study demonstrated that the efficacy of BBIBP-CorV vaccine against SARS-CoV-2 infections decreased gradually, with a more rapid decline observed after the fourth month. This decline resulted in about 20% protection at five to seven months following vaccination. However, the vaccine’s efficacy remained nearly 96% effective in preventing hospitalization and death six months after vaccination. 47 Compared with the 15 topmost affected countries in the world, the Arab world experienced a lower number of cases and deaths PMP ( Table 5 ). It also performed fewer tests than its population. South Korea, Japan, Argentina, Brazil, Vietnam, and India also performed a lesser number of tests than their populations. Conversely, the six European countries (France, Germany, Italy, UK, Spain, and Russia), Australia, the United States of America, and Turkey have performed tests more than their populations. A similar result was observed for most European countries by November 2022, where the number of tests exceeded the number of residents. 37 The diagnostic testing strategy and mass screening including the screening of asymptomatic people is a major strategy in controlling the spread of the virus. 48 Hence, testing procedures such as PCR is a tool used to detect and record both confirmed and death cases. 49 It is possible that such countries that performed fewer tests than their populations could have resulted in recording fewer confirmed cases and deaths. Furthermore, it has been suspected that the smaller number of tests carried out could be a reason for the reduced spread of the virus and the slowing down of the spread of the infection. However, the analysis conducted by Hisaka et al. , (2020) concluded that extensive PCR testing might be effective in reducing the number of deaths and that further studies are required to verify this hypothesis. 50 A previous study reported that older age plays a vital role in influencing the severity of COVID-19 disease and negative clinical outcomes than the younger population. 51 With this, the lower deaths PMP as observed in both the Arab world (386 cases) and India (377 cases) could be attributed to the low median age of 26 and 28.7 years, respectively. By contrast, this claim contradicts why Japan with the highest median age of 48.6 years in the top 15 affected countries also recorded a low number of deaths PMP (456 cases). Studies have reported that in response to the COVID-19 pandemic, all 44 Muslim countries including the Arab world and Turkey, mainly implemented mitigation strategies to control the virus. 52 , 53 The main aim of implementing a mitigation strategy is to reduce the number of death tolls by focusing on the medical care of severe cases and relying on social distancing and quarantine to flatten the curve of epidemic impact and burden on hospitals. 54 Stringent measures included the suspension of all airline flights, cancellation of Umrah, and down-scaling of the pilgrimage to Mecca. 52 Other countries that mainly responded with mitigation strategies included the United States, and European countries. 54 , 55 Mitigation measures are adopted immediately once the containment strategies (strict lockdowns) fail to isolate the infected individuals due to the widespread infection in the community or until vaccines are developed. 56 Hence, there is a clear indication that countries vary widely in their response to the COVID-19 impact and that these differences could be partially explained by many factors such as the economic and cultural situation, governmental policies, medical capacities, the age and genetic variation between ethnic groups in a population. 50 Due to surge in COVID-19 patients during the pandemic and the demand to increase medical services accordingly, field hospitals were launched and effectively operated in several Arab countries like the KSA, UAE, Tunisia, and Jordan. 57 – 60 For example, in the KSA, the Ministry of Health established four field hospitals in high-risk areas with a capacity of +1100 beds each. 57 This expansion in health infrastructure during a short time of pandemic would strengthen the health care system for any future surge of infectious disease. In response to the pandemic, electronic disease surveillance has been improved in several Arab countries. This was highly contributed to detect, monitor, response, control and prevent disease. Also, it allowed decision maker to implement any necessary measure based on the collected data. In Saudi Arabia, the Saudi Data and Artificial Intelligence Authority (SDAIA) developed the Tawakkalna App which was used to monitor individual movement during quarantine and give notifications to users when they have been in an area of positive cases, and to prove vaccination status. 61 In Oman, Tarassud Plus platform was used as a hub for the same purposes. 62 One of the implications of COVID-19 crisis was the hesitancy toward vaccination. Articles showed that the prevalence of vaccination hesitancy found to be 5.4%-63.8% in Saudi Arabia, 12%-79% in Egypt, 10.4%-80.1% in Jordan, 26%-57.3% in Qatar and 47% in Algeria. 63 This hesitancy was related to many factors including fear about side effect, insufficient time for vaccine testing, concerns on safety and effectiveness of vaccination. 63 , 64 Information that was acquired online through nonscientific resources found to increase this hesitancy. 63 Studies recommended that the dissemination of information should be through scientific/governmental websites. 65 , 66 Educational campaigns through television and social media are recommended to inform the public of the benefits of COVID-19 vaccine. 67 The healthcare system in Arab countries focused on treating COVID-19 patients, leading to the postponement of some non-urgent surgeries and outpatient appointments. Telemedicine was employed to reduce the burden on in-person facilities through virtual clinics, as seen in Saudi Arabia. 57 Additionally, several Arab countries, including Oman and Saudi Arabia, provided a 24/7 toll-free hotline for inquiries and support throughout the pandemic. 57 , 62 During the COVID-19 pandemic, digital technologies emerged as a crucial field to ensure public safety, health, and the continuation of commercial and social activities. According to the Arab Information and Communication Technology Organization (AICTO) platform, many Arab countries developed technology projects in response to the situation. For instance, Jordan launched two initiatives during the pandemic: “You are not with us, we are with you” to enhance psychological health, and “Mouneh” for shopping. 68 Saudi Arabia’s digital infrastructure supported society with 19 apps and platforms during the pandemic, facilitating public services in health, education, economy, telecommunications, and other sectors. Examples include “Mawid” and “Sehhaty” for health services, and “Ein,” a unique app for transitioning public schools to e-learning. 69 Strengths and limitations A key strength of this study is its comprehensive follow-up and collection of COVID-19 data in each Arab country for three consecutive years. In addition, accurate monthly data were obtained from the Ministry of Health in each country and verified with the Worldometer data for COVID-19. However, there are a few limitations in our study. First, no distinction was made between Arabs and non-Arabs in the reported health data since many non-Arabs work in Arab countries. Second, COVID-19 hospitalizations are lower after being fully vaccinated, so many patients might not be included in these statistics. Third, many Arab countries lack information about COVID-19 vaccine boosters. Fourth, the lack of gender and age data in numerous Arab countries prevented us from conducting thorough comparisons and assessing potential risk factors. Finally, this study could not identify an association between COVID-19 related deaths and comorbidities due to the absence of risk factors such as hypertension, diabetes, respiratory system disease, and cardiovascular disease in the data extracted. Conclusions Although the number of confirmed, death, and recovered cases of COVID-19 have greatly reduced in the last quarter of 2022 in most Arab countries, further efforts to address the need to re-campaign on COVID-19 vaccines and raise awareness programs about boosters must be implemented. COVID-19 has had a relatively smaller impact on Arab countries than on other countries that have been significantly affected. Data availability Underlying data No data are associated with this article. References 1. Paraskevis D, Kostaki EG, Magiorkinis G, et al. : Full-genome evolutionary analysis of the novel corona virus (2019- nCoV) rejects the hypothesis of emergence as a result of a recent recombination event. Infect. Genet. Evol. 2020; 79 : 104212. PubMed Abstract | Publisher Full Text | Free Full Text 2. Oran DP, Topol EJ: Prevalence of Asymptomatic SARS-CoV-2 Infection: A Narrative Review. Ann. Intern. Med. 2020; 173 (5): 362–367. PubMed Abstract | Publisher Full Text | Free Full Text 3. Vimercati L, Stefanizzi P, De Maria L, et al. : Large-scale IgM and IgG SARS-CoV-2 serological screening among healthcare workers with a low infection prevalence based on nasopharyngeal swab tests in an Italian university hospital: Perspectives for public health. Environ. Res. 2021; 195 : 110793. PubMed Abstract | Publisher Full Text | Free Full Text 4. Tourni M, Ricciardi W: The economic value of vaccination: why prevention is wealth. J. Mark Access Health Policy. 2015; 3 : 29414. PubMed Abstract | Publisher Full Text | Free Full Text 5. World Health Organization: Global advisory committee on vaccine safety, 3-4 Dec 2003. Weekly Epidemiological Rec. 2004; 79 (3): 16–20. 6. Saadh MJ, Jaber SA: Efficacy of COVID-19 vaccines. Microb. Pathog. 2022; 171 : 105729. Publisher Full Text 7. Mathieu E, Ritchie H, Ortiz-Ospina E, et al. : A global database of COVID-19 vaccinations. Nat. Hum. Behav. 2021; 5 (7): 947–953. Publisher Full Text 8. Oliver JW, Gregory B, Jaspreet T, et al. : Global impact of the first year of COVID-19 vaccination: a mathematical modelling study. Lancet Infect. Dis. 2022; 22 (9): 1293–1302. 9. Tracking Coronavirus Vaccinations Around the World: 2021. [Accessed December 28, 2022]. Reference Source 10. Butt AA, Guerrero MD, Canlas EB, et al. : Evaluation of mortality attributable to SARS-CoV-2 vaccine administration using national level data from Qatar. Nat. Commun. 2023; 14 (1): 24. PubMed Abstract | Publisher Full Text | Free Full Text 11. CDC: Centers for Disease Control and Prevention. Selected Adverse Events Reported after COVID-19 Vaccination.2021. Reference Source 12. Classification of Omicron (B.1.1.529): SARS-CoV-2 Variant of Concern.2021. [Accessed December 11 2022]. Reference Source 13. Callaway E: Heavily mutated coronavirus variant puts scientists on alert. Nature. 2021; 600 : 21. PubMed Abstract | Publisher Full Text 14. Ahmed W, Bivins A, Smith WJM, et al. : Detection of the Omicron (B.1.1.529) variant of SARS-CoV-2 in aircraft wastewater. Sci. Total Environ. 2022; 820 : 153171. PubMed Abstract | Publisher Full Text | Free Full Text 15. Andrews N, Stowe J, Kirsebom F, et al. : COVID-19 vaccine effectiveness against the Omicron (B.1.1.529) Variant. N. Engl. J. Med. 2022; 386 : 1532–1546. Publisher Full Text 16. Ren SY, Wang WB, Gao RD, et al. : Omicron variant (B.1.1.529) of SARS-CoV-2: mutation, infectivity, transmission, and vaccine resistance. World J. Clin. Cases. 2022; 10 : 1–11. PubMed Abstract | Publisher Full Text | Free Full Text 17. Accorsi EK, Britton A, Fleming-Dutra KE, et al. : Association between 3 doses of mRNA COVID-19 vaccine and symptomatic infection caused by the SARS-CoV-2 omicron and Delta variants. JAMA. 2022; 327 : 639–651. PubMed Abstract | Publisher Full Text | Free Full Text 18. Lustig Y, Gonen T, Melzer L, et al. : Superior immunogenicity and effectiveness of the third compared to the second BNT162b2 vaccine dose. Nat. Immunol. 2022; 23 (6): 940–946. PubMed Abstract | Publisher Full Text 19. Report 49 - Growth, population distribution and immune escape of Omicron in England.2022. [Accessed December 27, 2022]. Reference Source 20. Rabaan AA, Al-Ahmed SH, Sah R, et al. : SARS-CoV-2/COVID-19 and advances in developing potential therapeutics and vaccines to counter this emerging pandemic. Ann. Clin. Microbiol. Antimicrob. 2020; 19 : 40. PubMed Abstract | Publisher Full Text | Free Full Text 21. Uttarilli AS, Amalakanti PR, Kommoju S, et al. : Super-rapid race for saving lives by developing COVID-19 vaccines. J. Integr. Bioinform. 2021; 18 : 2–43. 22. Rief W: Fear of adverse effects and COVID-19 Vaccine hesitancy: recommendations of the treatment expectation expert group. JAMA Health Forum. 2021; 2 (4): e210804. PubMed Abstract | Publisher Full Text 23. WHO COVID-19 vaccine tracker: 2023. [Accessed January 01, 2023]. Reference Source 24. Commission on Social Determinants of Health: Closing the gap in a generation: health equity through action on the social determinants of health: final report of the commission on social determinants of health. World Health Organization; 2008; 2022 . . [Accessed December 30, 2022]. Reference Source 25. Alwahaibi N, Al-Maskari M, Al-Dhahli B, et al. : A review of the prevalence of COVID-19 in the Arab world. J. Infect. Dev. Ctries. 2020; 14 : 1238–1245. Publisher Full Text 26. Alwahaibi N, Al Maskari M, Al Dhahli B, et al. : One-year Review of COVID-19 in the Arab World. Qatar Med. J. 2021; 2021 : 66. PubMed Abstract | Publisher Full Text | Free Full Text 27. Rapidly escalating COVID-19 cases amid reduced virus surveillance forecasts a challenging autumn and winter in the WHO European Region. World Health Organization; 2022. [Accessed February 07, 2023]. Reference Source 28. Truelove S, Smith C, Qin M, et al. : Projected resurgence of COVID-19 in the United States in July—December 2021 resulting from the increased transmissibility of the Delta variant and faltering vaccination. Elife. 2022; 11 (11): e73584. PubMed Abstract | Publisher Full Text | Free Full Text 29. Asi YM; Two Years of COVID-19 in the Arab World: Social, Economic, and Political Effects. Washington DC: Arab Center; 2022. [Accessed February 15, 2023]. Reference Source 30. Rached J: The case for COVID-19 public inquiries for the Arab world.2021. [Accessed February 07, 2023]. Reference Source 31. Falah HH: Legal and Health Response to COVID-19 in the Arab Countries. Risk Manag. Healthc. Policy. 2021; 14 (14): 1141–1154. Publisher Full Text 32. Fawzy MS, AlSadrah SA: COVID-19 and Saudi Arabia: Awareness, Attitude, and Practice. J. Multidiscip. Healthc. 2022; 26 (15): 1595–1618. 33. Al-Tawfiq JA, Memish ZA: COVID-19 in the Eastern Mediterranean Region and Saudi Arabia: prevention and therapeutic strategies. Int. J. Antimicrob. Agents. 2020; 55 (5): 105968. PubMed Abstract | Publisher Full Text | Free Full Text 34. Alumran A: Role of Precautionary Measures in Containing the Natural Course of Novel Coronavirus Disease. J. Multidiscip. Healthc. 2020; 13 (13): 615–620. Publisher Full Text 35. Qaqish A, Al-Omari M, Abbas MM, et al. : Two years of COVID-19 pandemic in Jordan: A focus on epidemiology and vaccination. J. Glob. Health. 2022; 12 (12): 03063. PubMed Abstract | Publisher Full Text | Free Full Text 36. Yousef TK: The COVID-19 pandemic in the Gulf: Impact, Response, and Implications. Middle East Council of Global Affairs. Policy notes.2022. [Accessed February 07, 2023]. Reference Source 37. Alrasheedi A: COVID-19 Statistics in the Arab World by the End of October 2022: A Cross-Sectional Study. Cureus. 2022; 14 (12): e32670. PubMed Abstract | Publisher Full Text | Free Full Text 38. Qatar scraps COVID entry test requirement for World Cup fans: 2022. [Access February 8, 2023]. Reference Source 39. Chouikha A, Fares W, Laamari A, et al. : Molecular Epidemiology of SARS-CoV-2 in Tunisia (North Africa) through Several Successive Waves of COVID-19. Viruses. 2022; 14 (3): 624. PubMed Abstract | Publisher Full Text | Free Full Text 40. Pandemics That Changed History: As human civilizations rose, these diseases struck them down. editors-updated.2021. [Access February 2, 2023]. Reference Source Reference Source 41. Bianchi FP, Tafuri S, Migliore G, et al. : on behalf of the Control Room Working Group. BNT162b2 mRNA COVID-19 vaccine effectiveness in the prevention of SARS-CoV-2 infection and symptomatic disease in five-month follow-up: a retrospective cohort study. Vaccines. 2021; 9 (10): 1143. PubMed Abstract | Publisher Full Text | Free Full Text 42. Ashcroft P, Lehtinen S, Angs D, et al. : Quantifying the impact of quarantine duration on COVID-19 transmission. Elife. 2021; 10 : e63704. PubMed Abstract | Publisher Full Text | Free Full Text 43. Sinuraya RK, Nuwarda RF, Postma MJ, et al. : Vaccine hesitancy and equity: lessons learned from the past and how they affect the COVID-19 countermeasure in Indonesia. Global Health. 2024; 20 (1):11. PubMed Abstract | Publisher Full Text | Free Full Text 44. Hoxha I, Agahi R, Bimbashi A, et al. : Higher COVID-19 Vaccination Rates Are Associated with Lower COVID-19 Mortality: A Global Analysis. Vaccines. 2022; 11 (1): 74. PubMed Abstract | Publisher Full Text | Free Full Text 45. Ismail AlHosani F, Eduardo Stanciole A, Aden B, et al. : Impact of the Sinopharm’s BBIBP-CorV vaccine in preventing hospital admissions and death in infected vaccinees: Results from a retrospective study in the emirate of Abu Dhabi, United Arab Emirates (UAE). Vaccine. 2022; 40 (13): 2003–2010. PubMed Abstract | Publisher Full Text | Free Full Text 46. Belayachi J, Obtel M, Mhayi A, et al. : Long term effectiveness of inactivated vaccine BBIBP-CorV (Vero Cells) against COVID-19 associated severe and critical hospitalization in Morocco. PLoS One. 2022; 17 (12): e0278546. PubMed Abstract | Publisher Full Text | Free Full Text 47. Chemaitelly H, Tang P, Hasan MR, et al. : Waning of BNT162b2 vaccine protection against SARS-CoV-2 infection in Qatar.N. Engl. J. Med.2021; 385 (24): e83. PubMed Abstract | Publisher Full Text | Free Full Text 48. Johanna N, Citrawijaya H, Wangge G: Mass screening vs lockdown vs combination of both to control COVID-19: A systematic review. J. Public Health Res. 2020; 9 (4): jphr.2020.2011. PubMed Abstract | Publisher Full Text | Free Full Text 49. Hong KH, Lee SW, Kim TS, et al. : Guidelines for laboratory diagnosis of coronavirus disease 2019 (COVID-19) in Korea. Ann. Lab. Med. 2020; 40 (5): 351–360. Publisher Full Text 50. Hisaka A, Yoshioka H, Hatakeyama H, et al. : Global comparison of changes in the number of test-positive cases and deaths by coronavirus infection (COVID-19) in the world. J. Clin. Med. 2020; 9 (6): 1904. PubMed Abstract | Publisher Full Text | Free Full Text 51. Esteve A, Permanyer I, Boertien D, et al. : National age and coresidence patterns shape COVID-19 vulnerability. Proc. Natl. Acad. Sci. U. S. A. 2020; 117 : 16118–16120. PubMed Abstract | Publisher Full Text | Free Full Text 52. Jardine R, Wright J, Samad Z, et al. : Analysis of COVID-19 burden, epidemiology and mitigation strategies in Muslim majority countries. East Mediterr. Health J. 2020; 26 (10): 1173–1183. Publisher Full Text 53. Alshahrani NZ, Alshahrani SM, Alshahrani AM, et al. : Compliance of the Gulf Cooperation Council airlines with COVID-19 mitigation measures. J. Travel Med. 2021; 28 (2). PubMed Abstract | Publisher Full Text | Free Full Text 54. Chen H, Shi L, Zhang Y, et al. : Response to the COVID-19 pandemic: comparison of strategies in six countries. Front. Public Health. 2021; 9 : 9. PubMed Abstract | Publisher Full Text | Free Full Text 55. Chen S, Igan DO, Pierri N, et al. : Tracking the economic impact of COVID-19 and mitigation policies in Europe and the United States. IMF Working Papers. 2020; 125. Publisher Full Text 56. Kassem AM: COVID-19: Mitigation or suppression? Arab J. Gastroenterol. 2020; 21 (1): 1–2. Publisher Full Text 57. AlFattani A, AlMeharish A, Nasim M, et al. : Ten public health strategies to control the Covid-19 pandemic: the Saudi Experience. IJID Reg. 2021; 1 :12–19. PubMed Abstract | Publisher Full Text | Free Full Text 58. Al Hosany F, Ganesan S, Al Memari S, et al. : Response to COVID-19 pandemic in the UAE: A public health perspective. J. Glob. Health. 2021; 11 :03050. PubMed Abstract | Publisher Full Text | Free Full Text 59. Meddeb K, Toumi R, Boussarsar M: Lessons learned from the COVID-19 pandemic in a North African country (Tunisia). Tunis. Med. 2022; 100 (8-9):568–571. PubMed Abstract 60. Qutob RA, Ajlouni MT, Abufaraj M, et al. : Viewpoint: Jordan’s public and surveillance health policies: During and after COVID-19. Jordan J. Pharm. Sci. 2020; 13 (3):1–10. 61. Khan A, Alsofayan Y, Alahmari A, et al. : COVID-19 in Saudi Arabia: the national health response. East Mediterr Health J. 2021; 27 (11):1114–1124. Publisher Full Text 62. Al Khalili S, Al Maani A, Al Wahaibi A, et al. : Challenges and opportunities for public health service in Oman from the COVID-19 pandemic: Learning lessons for a better future. Front. Public Health. 2021; 9 : 770946. PubMed Abstract | Publisher Full Text | Free Full Text 63. Alam Z, Mohamed S, Nauman J, et al. : Hesitancy toward vaccination against COVID-19: A scoping review of prevalence and associated factors in the Arab world. Hum. Vaccin. Immunother. 2023; 19 (2):2245720. PubMed Abstract | Publisher Full Text | Free Full Text 64. Magadmi RM, Kamel FO: Beliefs and barriers associated with COVID-19 vaccination among the general population in Saudi Arabia. BMC Public Health. 2021; 21 (1):1438. PubMed Abstract | Publisher Full Text | Free Full Text 65. Fayed AA, Al Shahrani AS, Almanea LT, et al. : Willingness to receive the COVID-19 and seasonal influenza vaccines among the Saudi population and vaccine uptake during the initial stage of the national vaccination campaign: A cross-sectional survey. Vaccines (Basel). 2021; 9 (7):765. PubMed Abstract | Publisher Full Text | Free Full Text 66. Al Naam YA, Elsafi SH, Alkharraz ZS, et al. : Factors related to COVID-19 vaccine hesitancy in Saudi Arabia. Public Health Pract (Oxf). 2022; 3 : 100258. PubMed Abstract | Publisher Full Text | Free Full Text 67. Abu Farha RK, Alzoubi KH; Khabour OF et al. : Exploring perception and hesitancy toward COVID-19 vaccine: A study from Jordan. Hum. Vaccin. Immunother. 2021; 17 (8):2415–2420. PubMed Abstract | Publisher Full Text | Free Full Text 68. COVID-19 – Arab ICT Initiatives. ( n.d.). AICTO. [Accessed May 19 2024]. http://www.aicto.org/covid19-arab-ict-initiatives-2/#1587407103508-407b8962-d3f4 69. Hassounah M, Raheel H, Alhefzi M: Digital Response During the COVID-19 Pandemic in Saudi Arabia. J. Med. Internet Res. 2020; 22 (9): e19338. Publisher Full Text Comments on this article Comments (0) Version 3 VERSION 3 PUBLISHED 08 Nov 2023 ADD YOUR COMMENT Comment Author details Author details 1 Department of Biomedical Science, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Muscat Governorate, Oman 2 Department of Biology, College of Science, Sultan Qaboos University, Muscat, Muscat Governorate, Oman Nasar Alwahaibi Roles: Conceptualization, Formal Analysis, Methodology, Supervision, Writing – Original Draft Preparation, Writing – Review & Editing Muna Al Maskari Roles: Formal Analysis, Investigation, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing Samiya Al-Jaaidi Roles: Formal Analysis, Investigation, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing Buthaina Al Dhahli Roles: Formal Analysis, Investigation, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing Halima Al Issaei Roles: Formal Analysis, Investigation, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing Shadia Al Bahlani Roles: Formal Analysis, Investigation, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (3) version 3 Revised Published: 29 May 2024, 12:1448 https://doi.org/10.12688/f1000research.142541.3 version 2 Revised Published: 09 May 2024, 12:1448 https://doi.org/10.12688/f1000research.142541.2 version 1 Published: 08 Nov 2023, 12:1448 https://doi.org/10.12688/f1000research.142541.1 Copyright © 2024 Alwahaibi N et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Alwahaibi N, Al Maskari M, Al-Jaaidi S et al. COVID-19 in the Arab countries: Three-year study [version 3; peer review: 2 approved, 1 approved with reservations] . F1000Research 2024, 12 :1448 ( https://doi.org/10.12688/f1000research.142541.3 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 3 VERSION 3 PUBLISHED 29 May 2024 Revised Views 0 Cite How to cite this report: Zahid MN. Reviewer Report For: COVID-19 in the Arab countries: Three-year study [version 3; peer review: 2 approved, 1 approved with reservations] . F1000Research 2024, 12 :1448 ( https://doi.org/10.5256/f1000research.166903.r284092 ) The direct URL for this report is: https://f1000research.com/articles/12-1448/v3#referee-response-284092 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 07 Jun 2024 Muhammad Nauman Zahid , College of Science, University of Bahrain, Sakhir, Southern Governorate, Bahrain Approved VIEWS 0 https://doi.org/10.5256/f1000research.166903.r284092 The authors have addressed my questions and ... Continue reading READ ALL The authors have addressed my questions and I am satisfied with the revised version. Competing Interests: No competing interests were disclosed. Reviewer Expertise: Virology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Zahid MN. Reviewer Report For: COVID-19 in the Arab countries: Three-year study [version 3; peer review: 2 approved, 1 approved with reservations] . F1000Research 2024, 12 :1448 ( https://doi.org/10.5256/f1000research.166903.r284092 ) The direct URL for this report is: https://f1000research.com/articles/12-1448/v3#referee-response-284092 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: A. Alrasheedi A. Reviewer Report For: COVID-19 in the Arab countries: Three-year study [version 3; peer review: 2 approved, 1 approved with reservations] . F1000Research 2024, 12 :1448 ( https://doi.org/10.5256/f1000research.166903.r284091 ) The direct URL for this report is: https://f1000research.com/articles/12-1448/v3#referee-response-284091 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 04 Jun 2024 Ahmad A. Alrasheedi , Department of Family and Community Medicine, College of Medicine, Qassim University, Buraydah, Al Qassim Region, Saudi Arabia Approved VIEWS 0 https://doi.org/10.5256/f1000research.166903.r284091 The authors have addressed the concerns and made the necessary amendments ... Continue reading READ ALL The authors have addressed the concerns and made the necessary amendments (we suggested) to this version. I think this study can be indexed. Competing Interests: No competing interests were disclosed. Reviewer Expertise: Preventive medicine, COVID-19, DM, and critical studies. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT A. Alrasheedi A. Reviewer Report For: COVID-19 in the Arab countries: Three-year study [version 3; peer review: 2 approved, 1 approved with reservations] . F1000Research 2024, 12 :1448 ( https://doi.org/10.5256/f1000research.166903.r284091 ) The direct URL for this report is: https://f1000research.com/articles/12-1448/v3#referee-response-284091 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Version 1 VERSION 1 PUBLISHED 08 Nov 2023 Views 0 Cite How to cite this report: Amer Y. Reviewer Report For: COVID-19 in the Arab countries: Three-year study [version 3; peer review: 2 approved, 1 approved with reservations] . F1000Research 2024, 12 :1448 ( https://doi.org/10.5256/f1000research.156102.r223543 ) The direct URL for this report is: https://f1000research.com/articles/12-1448/v1#referee-response-223543 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 11 May 2024 Yasser Amer , King Saud University Medical City, Riyadh, Saudi Arabia Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.156102.r223543 This study represents a comprehensive and well-conducted follow-up and collection of COVID-19 data in 22 Arab countries for three consecutive years. The authors obtained accurate monthly data from the official websites of the Ministry of Health in each country ... Continue reading READ ALL This study represents a comprehensive and well-conducted follow-up and collection of COVID-19 data in 22 Arab countries for three consecutive years. The authors obtained accurate monthly data from the official websites of the Ministry of Health in each country in addition to verifying those against the data from the websites of the WHO, World COVID-vaccinations tracker, and Worldometer for COVID-19. The abstract, introduction, and methods were well written, clear, and appropriate to the research topic. I would like to suggest enriching the discussion with this subtitle: "Implications for clinical practice and public health practice". Here are some elements for the respected authors to consider as relevant to the study aim:- Strengthen Healthcare Infrastructure : Examples 1: Invest in healthcare infrastructure, including hospitals, clinics, and medical supplies, to ensure preparedness for future pandemics. Example 2: Enhance the capacity of healthcare systems to accommodate a surge in patients during emergencies. Improve Disease Surveillance : Example 1: Develop and maintain robust surveillance systems to detect and monitor infectious diseases promptly. Example 2: Enhance the sharing of data and information among Arab countries and with international health organizations. Promote Vaccination Campaigns : Example 1: Implement comprehensive and equitable vaccination campaigns to achieve herd immunity against COVID-19 and future infectious diseases. Example 2: Combat vaccine hesitancy through targeted public health messaging and education. Enhance Telemedicine and Digital Health : Example 1: Expand telemedicine and digital health services to improve access to healthcare and reduce the burden on in-person facilities. Example 2: Ensure the privacy and security of electronic health records and telemedicine platforms. Prepare for Variants : Example 1: Develop strategies to monitor and respond to emerging variants of concern, including the rapid adjustment of vaccines and therapeutics.Example 2: Invest in genomic sequencing capabilities for timely variant detection. Strengthen Public Health Messaging : Example 1: Enhance public health communication strategies to provide accurate and timely information to the public during health crises. Example 2: Address misinformation and disinformation through targeted campaigns. Invest in Research and Development : Example 1: Allocate resources for research into infectious diseases, epidemiology, and vaccine development to better prepare for future pandemics. Example 2: Foster collaboration between academia, industry, and public health agencies. Prepare for Healthcare Workforce Challenges : Example 1: Develop contingency plans for healthcare workforce shortages during health emergencies. Example 2: Support the mental health and well-being of healthcare workers. Improve International Collaboration : Example: Foster regional and international collaboration in disease surveillance, response, and research. Example 2: Participate in global initiatives to ensure equitable access to vaccines and treatments. Health Equity and Vulnerable Populations : Example 1: Prioritize health equity in policies and interventions, addressing disparities that affect vulnerable populations. Example 2: Ensure access to healthcare and social support for marginalized communities. The following 4 articles below may be helpful in writing up or re-writing these points, if you agree on them, or additional points to be additional take-home messages for the readers. These are 2 additional online resources:- 1- WHO’s response to COVID-19 in the Eastern Mediterranean Region Independent review by Dalberg Advisors February 2023 https://cdn.who.int/media/docs/default-source/evaluation-office/who-s-response-to-covid-19-in-the-emr---independent-review_february-2023_final.pdf?sfvrsn=130ab01a_3&download=true 2- Distributional Impacts of COVID-19 in the Middle East and North Africa Region: https://www.worldbank.org/en/region/mena/publication/distributional-impacts-of-covid-19-in-the-middle-east-and-north-africa-region#:~:text=The%20report's%20findings%20suggest%20a,and%20how%20many%20people%20work). Is the topic of the review discussed comprehensively in the context of the current literature? Yes Are all factual statements correct and adequately supported by citations? Yes Is the review written in accessible language? Yes Are the conclusions drawn appropriate in the context of the current research literature? Yes References 1. Mandil A, Mabry R, Milani B, Nour M, et al.: Mapping of health innovations in response to the COVID-19 pandemic in Eastern Mediterranean and selected Arab Countries. East Mediterr Health J . 2022; 28 (2): 130-143 PubMed Abstract | Publisher Full Text 2. Alam Z, Mohamed S, Nauman J, Al-Rifai RH, et al.: Hesitancy toward vaccination against COVID-19: A scoping review of prevalence and associated factors in the Arab world. Hum Vaccin Immunother . 2023; 19 (2): 2245720 PubMed Abstract | Publisher Full Text 3. Titi MA, Wahabi H, Elmorshedy H, Shata Z, et al.: Mental health impact of the first wave of COVID-19 pandemic on healthcare workers in 12 Arab countries. East Mediterr Health J . 2022; 28 (10): 707-718 PubMed Abstract | Publisher Full Text 4. Abid M, Gheraia Z, Abdelli H, Sekrafi H, et al.: COVID-19 pandemic and economic impacts in Arab countries: Challenges and policies. Research in Globalization . 2022; 5 . Publisher Full Text Competing Interests: No competing interests were disclosed. Reviewer Expertise: Evidence-Based Healthcare, Clinical Practice Guidelines, Pediatrics and Child healthcare, Healthcare Informatics, Healthcare Quality and Safety, Healthcare services research, Improvement research, and Implementation research. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Amer Y. Reviewer Report For: COVID-19 in the Arab countries: Three-year study [version 3; peer review: 2 approved, 1 approved with reservations] . F1000Research 2024, 12 :1448 ( https://doi.org/10.5256/f1000research.156102.r223543 ) The direct URL for this report is: https://f1000research.com/articles/12-1448/v1#referee-response-223543 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 26 Jun 2024 Nasar Alwahaibi , Department of Biomedical Science, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman 26 Jun 2024 Author Response We would like to express our gratitude to the reviewer for the positive feedback and valuable comments. Below are our detailed responses to the reviewer's queries. This study ... Continue reading We would like to express our gratitude to the reviewer for the positive feedback and valuable comments. Below are our detailed responses to the reviewer's queries. This study represents a comprehensive and well-conducted follow-up and collection of COVID-19 data in 22 Arab countries for three consecutive years. The authors obtained accurate monthly data from the official websites of the Ministry of Health in each country in addition to verifying those against the data from the websites of the WHO, World COVID-vaccinations tracker, and Worldometer for COVID-19. The abstract, introduction, and methods were well written, clear, and appropriate to the research topic. I would like to suggest enriching the discussion with this subtitle: "Implications for clinical practice and public health practice". Here are some elements for the respected authors to consider as relevant to the study aim:- Strengthen Healthcare Infrastructure : Examples 1: Invest in healthcare infrastructure, including hospitals, clinics, and medical supplies, to ensure preparedness for future pandemics. Example 2: Enhance the capacity of healthcare systems to accommodate a surge in patients during emergencies. Improve Disease Surveillance : Example 1: Develop and maintain robust surveillance systems to detect and monitor infectious diseases promptly. Example 2: Enhance the sharing of data and information among Arab countries and with international health organizations. Promote Vaccination Campaigns : Example 1: Implement comprehensive and equitable vaccination campaigns to achieve herd immunity against COVID-19 and future infectious diseases. Example 2: Combat vaccine hesitancy through targeted public health messaging and education. Enhance Telemedicine and Digital Health : Example 1: Expand telemedicine and digital health services to improve access to healthcare and reduce the burden on in-person facilities. Example 2: Ensure the privacy and security of electronic health records and telemedicine platforms. Prepare for Variants : Example 1: Develop strategies to monitor and respond to emerging variants of concern, including the rapid adjustment of vaccines and therapeutics. Example 2: Invest in genomic sequencing capabilities for timely variant detection. Strengthen Public Health Messaging : Example 1: Enhance public health communication strategies to provide accurate and timely information to the public during health crises. Example 2: Address misinformation and disinformation through targeted campaigns. Invest in Research and Development : Example 1: Allocate resources for research into infectious diseases, epidemiology, and vaccine development to better prepare for future pandemics. Example 2: Foster collaboration between academia, industry, and public health agencies. Prepare for Healthcare Workforce Challenges : Example 1: Develop contingency plans for healthcare workforce shortages during health emergencies. Example 2: Support the mental health and well-being of healthcare workers. Improve International Collaboration : Example: Foster regional and international collaboration in disease surveillance, response, and research. Example 2: Participate in global initiatives to ensure equitable access to vaccines and treatments. Health Equity and Vulnerable Populations : Example 1: Prioritize health equity in policies and interventions, addressing disparities that affect vulnerable populations. Example 2: Ensure access to healthcare and social support for marginalized communities. The following 4 articles below may be helpful in writing up or re-writing these points, if you agree on them, or additional points to be additional take-home messages for the readers. References Mandil A, Mabry R, Milani B, Nour M, et al.: Mapping of health innovations in response to the COVID-19 pandemic in Eastern Mediterranean and selected Arab Countries. East Mediterr Health J . 2022; 28 (2): 130-143 PubMed Abstract | Publisher Full Text 2. Alam Z, Mohamed S, Nauman J, Al-Rifai RH, et al.: Hesitancy toward vaccination against COVID-19: A scoping review of prevalence and associated factors in the Arab world. Hum Vaccin Immunother . 2023; 19 (2): 2245720 PubMed Abstract | Publisher Full Text Titi MA, Wahabi H, Elmorshedy H, Shata Z, et al.: Mental health impact of the first wave of COVID-19 pandemic on healthcare workers in 12 Arab countries. East Mediterr Health J . 2022; 28 (10): 707-718 PubMed Abstract | Publisher Full Text 4. Abid M, Gheraia Z, Abdelli H, Sekrafi H, et al.: COVID-19 pandemic and economic impacts in Arab countries: Challenges and policies. Research in Globalization . 2022; 5 . Publisher Full Text These are 2 additional online resources:- 1- WHO’s response to COVID-19 in the Eastern Mediterranean Region Independent review by Dalberg Advisors February 2023 https://cdn.who.int/media/docs/default-source/evaluation-office/who-s-response-to-covid-19-in-the-emr---independent-review_february-2023_final.pdf?sfvrsn=130ab01a_3&download=true 2- Distributional Impacts of COVID-19 in the Middle East and North Africa Region: https://www.worldbank.org/en/region/mena/publication/distributional-impacts-of-covid-19-in-the-middle-east-and-north-africa-region#:~:text=The%20report's%20findings%20suggest%20a,and%20how%20many%20people%20work). Response As per the reviewer's suggestion, two paragraphs discussing the "Implications for clinical practice and public health practice" have been added to the discussion section. Consequently, more references have been added. We would like to express our gratitude to the reviewer for the positive feedback and valuable comments. Below are our detailed responses to the reviewer's queries. This study represents a comprehensive and well-conducted follow-up and collection of COVID-19 data in 22 Arab countries for three consecutive years. The authors obtained accurate monthly data from the official websites of the Ministry of Health in each country in addition to verifying those against the data from the websites of the WHO, World COVID-vaccinations tracker, and Worldometer for COVID-19. The abstract, introduction, and methods were well written, clear, and appropriate to the research topic. I would like to suggest enriching the discussion with this subtitle: "Implications for clinical practice and public health practice". Here are some elements for the respected authors to consider as relevant to the study aim:- Strengthen Healthcare Infrastructure : Examples 1: Invest in healthcare infrastructure, including hospitals, clinics, and medical supplies, to ensure preparedness for future pandemics. Example 2: Enhance the capacity of healthcare systems to accommodate a surge in patients during emergencies. Improve Disease Surveillance : Example 1: Develop and maintain robust surveillance systems to detect and monitor infectious diseases promptly. Example 2: Enhance the sharing of data and information among Arab countries and with international health organizations. Promote Vaccination Campaigns : Example 1: Implement comprehensive and equitable vaccination campaigns to achieve herd immunity against COVID-19 and future infectious diseases. Example 2: Combat vaccine hesitancy through targeted public health messaging and education. Enhance Telemedicine and Digital Health : Example 1: Expand telemedicine and digital health services to improve access to healthcare and reduce the burden on in-person facilities. Example 2: Ensure the privacy and security of electronic health records and telemedicine platforms. Prepare for Variants : Example 1: Develop strategies to monitor and respond to emerging variants of concern, including the rapid adjustment of vaccines and therapeutics. Example 2: Invest in genomic sequencing capabilities for timely variant detection. Strengthen Public Health Messaging : Example 1: Enhance public health communication strategies to provide accurate and timely information to the public during health crises. Example 2: Address misinformation and disinformation through targeted campaigns. Invest in Research and Development : Example 1: Allocate resources for research into infectious diseases, epidemiology, and vaccine development to better prepare for future pandemics. Example 2: Foster collaboration between academia, industry, and public health agencies. Prepare for Healthcare Workforce Challenges : Example 1: Develop contingency plans for healthcare workforce shortages during health emergencies. Example 2: Support the mental health and well-being of healthcare workers. Improve International Collaboration : Example: Foster regional and international collaboration in disease surveillance, response, and research. Example 2: Participate in global initiatives to ensure equitable access to vaccines and treatments. Health Equity and Vulnerable Populations : Example 1: Prioritize health equity in policies and interventions, addressing disparities that affect vulnerable populations. Example 2: Ensure access to healthcare and social support for marginalized communities. The following 4 articles below may be helpful in writing up or re-writing these points, if you agree on them, or additional points to be additional take-home messages for the readers. References Mandil A, Mabry R, Milani B, Nour M, et al.: Mapping of health innovations in response to the COVID-19 pandemic in Eastern Mediterranean and selected Arab Countries. East Mediterr Health J . 2022; 28 (2): 130-143 PubMed Abstract | Publisher Full Text 2. Alam Z, Mohamed S, Nauman J, Al-Rifai RH, et al.: Hesitancy toward vaccination against COVID-19: A scoping review of prevalence and associated factors in the Arab world. Hum Vaccin Immunother . 2023; 19 (2): 2245720 PubMed Abstract | Publisher Full Text Titi MA, Wahabi H, Elmorshedy H, Shata Z, et al.: Mental health impact of the first wave of COVID-19 pandemic on healthcare workers in 12 Arab countries. East Mediterr Health J . 2022; 28 (10): 707-718 PubMed Abstract | Publisher Full Text 4. Abid M, Gheraia Z, Abdelli H, Sekrafi H, et al.: COVID-19 pandemic and economic impacts in Arab countries: Challenges and policies. Research in Globalization . 2022; 5 . Publisher Full Text These are 2 additional online resources:- 1- WHO’s response to COVID-19 in the Eastern Mediterranean Region Independent review by Dalberg Advisors February 2023 https://cdn.who.int/media/docs/default-source/evaluation-office/who-s-response-to-covid-19-in-the-emr---independent-review_february-2023_final.pdf?sfvrsn=130ab01a_3&download=true 2- Distributional Impacts of COVID-19 in the Middle East and North Africa Region: https://www.worldbank.org/en/region/mena/publication/distributional-impacts-of-covid-19-in-the-middle-east-and-north-africa-region#:~:text=The%20report's%20findings%20suggest%20a,and%20how%20many%20people%20work). Response As per the reviewer's suggestion, two paragraphs discussing the "Implications for clinical practice and public health practice" have been added to the discussion section. Consequently, more references have been added. Competing Interests: None Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 26 Jun 2024 Nasar Alwahaibi , Department of Biomedical Science, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman 26 Jun 2024 Author Response We would like to express our gratitude to the reviewer for the positive feedback and valuable comments. Below are our detailed responses to the reviewer's queries. This study ... Continue reading We would like to express our gratitude to the reviewer for the positive feedback and valuable comments. Below are our detailed responses to the reviewer's queries. This study represents a comprehensive and well-conducted follow-up and collection of COVID-19 data in 22 Arab countries for three consecutive years. The authors obtained accurate monthly data from the official websites of the Ministry of Health in each country in addition to verifying those against the data from the websites of the WHO, World COVID-vaccinations tracker, and Worldometer for COVID-19. The abstract, introduction, and methods were well written, clear, and appropriate to the research topic. I would like to suggest enriching the discussion with this subtitle: "Implications for clinical practice and public health practice". Here are some elements for the respected authors to consider as relevant to the study aim:- Strengthen Healthcare Infrastructure : Examples 1: Invest in healthcare infrastructure, including hospitals, clinics, and medical supplies, to ensure preparedness for future pandemics. Example 2: Enhance the capacity of healthcare systems to accommodate a surge in patients during emergencies. Improve Disease Surveillance : Example 1: Develop and maintain robust surveillance systems to detect and monitor infectious diseases promptly. Example 2: Enhance the sharing of data and information among Arab countries and with international health organizations. Promote Vaccination Campaigns : Example 1: Implement comprehensive and equitable vaccination campaigns to achieve herd immunity against COVID-19 and future infectious diseases. Example 2: Combat vaccine hesitancy through targeted public health messaging and education. Enhance Telemedicine and Digital Health : Example 1: Expand telemedicine and digital health services to improve access to healthcare and reduce the burden on in-person facilities. Example 2: Ensure the privacy and security of electronic health records and telemedicine platforms. Prepare for Variants : Example 1: Develop strategies to monitor and respond to emerging variants of concern, including the rapid adjustment of vaccines and therapeutics. Example 2: Invest in genomic sequencing capabilities for timely variant detection. Strengthen Public Health Messaging : Example 1: Enhance public health communication strategies to provide accurate and timely information to the public during health crises. Example 2: Address misinformation and disinformation through targeted campaigns. Invest in Research and Development : Example 1: Allocate resources for research into infectious diseases, epidemiology, and vaccine development to better prepare for future pandemics. Example 2: Foster collaboration between academia, industry, and public health agencies. Prepare for Healthcare Workforce Challenges : Example 1: Develop contingency plans for healthcare workforce shortages during health emergencies. Example 2: Support the mental health and well-being of healthcare workers. Improve International Collaboration : Example: Foster regional and international collaboration in disease surveillance, response, and research. Example 2: Participate in global initiatives to ensure equitable access to vaccines and treatments. Health Equity and Vulnerable Populations : Example 1: Prioritize health equity in policies and interventions, addressing disparities that affect vulnerable populations. Example 2: Ensure access to healthcare and social support for marginalized communities. The following 4 articles below may be helpful in writing up or re-writing these points, if you agree on them, or additional points to be additional take-home messages for the readers. References Mandil A, Mabry R, Milani B, Nour M, et al.: Mapping of health innovations in response to the COVID-19 pandemic in Eastern Mediterranean and selected Arab Countries. East Mediterr Health J . 2022; 28 (2): 130-143 PubMed Abstract | Publisher Full Text 2. Alam Z, Mohamed S, Nauman J, Al-Rifai RH, et al.: Hesitancy toward vaccination against COVID-19: A scoping review of prevalence and associated factors in the Arab world. Hum Vaccin Immunother . 2023; 19 (2): 2245720 PubMed Abstract | Publisher Full Text Titi MA, Wahabi H, Elmorshedy H, Shata Z, et al.: Mental health impact of the first wave of COVID-19 pandemic on healthcare workers in 12 Arab countries. East Mediterr Health J . 2022; 28 (10): 707-718 PubMed Abstract | Publisher Full Text 4. Abid M, Gheraia Z, Abdelli H, Sekrafi H, et al.: COVID-19 pandemic and economic impacts in Arab countries: Challenges and policies. Research in Globalization . 2022; 5 . Publisher Full Text These are 2 additional online resources:- 1- WHO’s response to COVID-19 in the Eastern Mediterranean Region Independent review by Dalberg Advisors February 2023 https://cdn.who.int/media/docs/default-source/evaluation-office/who-s-response-to-covid-19-in-the-emr---independent-review_february-2023_final.pdf?sfvrsn=130ab01a_3&download=true 2- Distributional Impacts of COVID-19 in the Middle East and North Africa Region: https://www.worldbank.org/en/region/mena/publication/distributional-impacts-of-covid-19-in-the-middle-east-and-north-africa-region#:~:text=The%20report's%20findings%20suggest%20a,and%20how%20many%20people%20work). Response As per the reviewer's suggestion, two paragraphs discussing the "Implications for clinical practice and public health practice" have been added to the discussion section. Consequently, more references have been added. We would like to express our gratitude to the reviewer for the positive feedback and valuable comments. Below are our detailed responses to the reviewer's queries. This study represents a comprehensive and well-conducted follow-up and collection of COVID-19 data in 22 Arab countries for three consecutive years. The authors obtained accurate monthly data from the official websites of the Ministry of Health in each country in addition to verifying those against the data from the websites of the WHO, World COVID-vaccinations tracker, and Worldometer for COVID-19. The abstract, introduction, and methods were well written, clear, and appropriate to the research topic. I would like to suggest enriching the discussion with this subtitle: "Implications for clinical practice and public health practice". Here are some elements for the respected authors to consider as relevant to the study aim:- Strengthen Healthcare Infrastructure : Examples 1: Invest in healthcare infrastructure, including hospitals, clinics, and medical supplies, to ensure preparedness for future pandemics. Example 2: Enhance the capacity of healthcare systems to accommodate a surge in patients during emergencies. Improve Disease Surveillance : Example 1: Develop and maintain robust surveillance systems to detect and monitor infectious diseases promptly. Example 2: Enhance the sharing of data and information among Arab countries and with international health organizations. Promote Vaccination Campaigns : Example 1: Implement comprehensive and equitable vaccination campaigns to achieve herd immunity against COVID-19 and future infectious diseases. Example 2: Combat vaccine hesitancy through targeted public health messaging and education. Enhance Telemedicine and Digital Health : Example 1: Expand telemedicine and digital health services to improve access to healthcare and reduce the burden on in-person facilities. Example 2: Ensure the privacy and security of electronic health records and telemedicine platforms. Prepare for Variants : Example 1: Develop strategies to monitor and respond to emerging variants of concern, including the rapid adjustment of vaccines and therapeutics. Example 2: Invest in genomic sequencing capabilities for timely variant detection. Strengthen Public Health Messaging : Example 1: Enhance public health communication strategies to provide accurate and timely information to the public during health crises. Example 2: Address misinformation and disinformation through targeted campaigns. Invest in Research and Development : Example 1: Allocate resources for research into infectious diseases, epidemiology, and vaccine development to better prepare for future pandemics. Example 2: Foster collaboration between academia, industry, and public health agencies. Prepare for Healthcare Workforce Challenges : Example 1: Develop contingency plans for healthcare workforce shortages during health emergencies. Example 2: Support the mental health and well-being of healthcare workers. Improve International Collaboration : Example: Foster regional and international collaboration in disease surveillance, response, and research. Example 2: Participate in global initiatives to ensure equitable access to vaccines and treatments. Health Equity and Vulnerable Populations : Example 1: Prioritize health equity in policies and interventions, addressing disparities that affect vulnerable populations. Example 2: Ensure access to healthcare and social support for marginalized communities. The following 4 articles below may be helpful in writing up or re-writing these points, if you agree on them, or additional points to be additional take-home messages for the readers. References Mandil A, Mabry R, Milani B, Nour M, et al.: Mapping of health innovations in response to the COVID-19 pandemic in Eastern Mediterranean and selected Arab Countries. East Mediterr Health J . 2022; 28 (2): 130-143 PubMed Abstract | Publisher Full Text 2. Alam Z, Mohamed S, Nauman J, Al-Rifai RH, et al.: Hesitancy toward vaccination against COVID-19: A scoping review of prevalence and associated factors in the Arab world. Hum Vaccin Immunother . 2023; 19 (2): 2245720 PubMed Abstract | Publisher Full Text Titi MA, Wahabi H, Elmorshedy H, Shata Z, et al.: Mental health impact of the first wave of COVID-19 pandemic on healthcare workers in 12 Arab countries. East Mediterr Health J . 2022; 28 (10): 707-718 PubMed Abstract | Publisher Full Text 4. Abid M, Gheraia Z, Abdelli H, Sekrafi H, et al.: COVID-19 pandemic and economic impacts in Arab countries: Challenges and policies. Research in Globalization . 2022; 5 . Publisher Full Text These are 2 additional online resources:- 1- WHO’s response to COVID-19 in the Eastern Mediterranean Region Independent review by Dalberg Advisors February 2023 https://cdn.who.int/media/docs/default-source/evaluation-office/who-s-response-to-covid-19-in-the-emr---independent-review_february-2023_final.pdf?sfvrsn=130ab01a_3&download=true 2- Distributional Impacts of COVID-19 in the Middle East and North Africa Region: https://www.worldbank.org/en/region/mena/publication/distributional-impacts-of-covid-19-in-the-middle-east-and-north-africa-region#:~:text=The%20report's%20findings%20suggest%20a,and%20how%20many%20people%20work). Response As per the reviewer's suggestion, two paragraphs discussing the "Implications for clinical practice and public health practice" have been added to the discussion section. Consequently, more references have been added. Competing Interests: None Close Report a concern COMMENT ON THIS REPORT Views 0 Cite How to cite this report: A. Alrasheedi A. Reviewer Report For: COVID-19 in the Arab countries: Three-year study [version 3; peer review: 2 approved, 1 approved with reservations] . F1000Research 2024, 12 :1448 ( https://doi.org/10.5256/f1000research.156102.r233650 ) The direct URL for this report is: https://f1000research.com/articles/12-1448/v1#referee-response-233650 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 11 May 2024 Ahmad A. Alrasheedi , Department of Family and Community Medicine, College of Medicine, Qassim University, Buraydah, Al Qassim Region, Saudi Arabia Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.156102.r233650 Overall, this study is excellent and worth accepting as the authors evaluated the spread of the COVID-19 pandemic in a critical region, the Arab world, over three years (2020-2022). Understanding the epidemiology of COVID-19 in the Arab world and comparing ... Continue reading READ ALL Overall, this study is excellent and worth accepting as the authors evaluated the spread of the COVID-19 pandemic in a critical region, the Arab world, over three years (2020-2022). Understanding the epidemiology of COVID-19 in the Arab world and comparing it to the world could help researchers and decision-makers explore the best ways to deal with COVID-19 and may provide lessons for a more effective response to public health emergencies in the future. However, there are some suggestions to improve the article. 1- Type of the study : Is this a review article or an original research? Based on the article's methodology and structure, this article is considered original (research article). The authors extracted primary/secondary data (raw data) from online websites and then analyzed and interpreted the data. In contrast, a review article or paper is based on other published articles. Review articles generally summarize the existing literature on a topic in an attempt to explain the current state of understanding of the topic. Therefore, this is not a review article because the authors did not base their methodology on a review of previous studies/research. The authors should reconsider this part! 2- Suppose this article is considered an original study, which it appears to be. In that case, it is preferable to change the word “ review ” in the title to another word, for example, “study,” so that the title is: “COVID-19 in the Arab countries: A three-year study” or “COVID-19 in the Arab countries: A study after three years”. 3- In the "conclusions" section of the Abstract, Confirmed what? Confirmed cases or confirmed deaths. A word is missing! 4- In the first line of the "Introduction" section, which coronavirus is? It is the novel coronavirus, or as it is named, SARS-CoV-2. In contrast, the disease caused by this virus is called COVID-19. I suggest it be written as "… declared coronavirus disease 2019 (COVID-19) as …". 5- In the second sentence of the "Introduction" section, which years? 2020-2022 or 2021-2023; please specify! 6- The reference No. 5 is old (2004). Is there any recent one? 7- In paragraph 4 of the "Introduction" section, please remove the phrase "the coronavirus." To be "… many different variants of SARS-CoV-2, including …". Also, in this statement: as long as the coronavirus SARS-CoV-2 remains. Please remove the phrase "the coronavirus". 8- In the "Methods" section, please provide the link/reference for each website if possible (Worldometer...). 9- The exclusion criterion was unofficial information regarding COVID-19 in all Arab countries ,... This phrase ( unofficial information regarding COVID-19 in all Arab countries ) should be removed because it is known from the inclusion criteria (exclusion criteria are not the opposite of inclusion criteria). 10- The following information was collected from each Arab country: total population, median age, number of monthly confirmed, ... Confirmed what? Please make it clear. 11- "Results" section: All Arab countries utilized real-time polymerase chain reaction (RT-PCR) as the testing method for SARS-CoV-2. I suggest to transfer this sentence to the "Introduction" section. 12- UAE (19,632,329) recorded then the highest number of tests per million population (PMP), followed by Bahrain (5,960,320), and then Oman (4,695,724). Rephrasing the sentence to be clear, I suggest, " The UAE recorded the highest number of tests per million population (PMP) with 19,632,329, followed by Bahrain (5,960,320), and then Oman (4,695,724)." Always add "the" before UAE, USA, and UK while mentioned in the text. 13- The people in Qatar and the United Arab Emirates ... have [أع1] Use the abbreviation: the UAE. 14- Table 1: Please identify the abbreviations in the table (Add footnotes), even if they have already been mentioned in the text. Please check the population number of Mauritania. 15- Table 2: define the abbreviations in the table (Add footnotes): UEA, SA, and PMP, as well as for other tables. Also, in column 10 (Q1-22), some numbers are not uniform in the way they are written. 16- In the "Discussion" section, New Year season New Year season? Do you mean influenza season, where URTIs, including coronaviruses, increase? 17- Another reason for the spike increase is the slow uptake of the vaccine in many countries. Which countries? of the world, including Arab countries or in many Arab countries? 18- During the first, second, and third quarters of 2020, the pandemic was under control in most Arab countries due to ... Using the probability form, such as "mostly due to" or "probably because," is better. 19- The first quarter of 2022 was a shockwave as it was recorded with the highest-ever number of COVID-19 confirmed cases with 3,235,665 peaked by Jordan with a total number of 630,811. To be clearer, I suggest you rephrase it to be: "During the first quarter of 2022, which was a shockwave, the Arab countries recorded the highest number of confirmed COVID-19 cases ever reported between 2020 and 2022. The total number of cases was 3,235,665, with Jordan reporting the highest number of cases at 630,811." 20- Qatar was reported with the highest number of confirmed cases of COVID-19 in the fourth quarter of 2022 Suggesting to rephrase by adding among Arab countries. 21- In paragraph no. 12, ...Australia, USA , and Turkey have performed tests more than their populations. DEFINE USA: please write the United States of America . 22- In the "Strengths and limitations" section, However, there are a few limitations in our review . study or review? This will depend on your classification. 23- Although the number of confirmed , death, and subsequently recovered cases of... Confirmed what? Please make it clear. Thank you for your valuable study. Is the topic of the review discussed comprehensively in the context of the current literature? Yes Are all factual statements correct and adequately supported by citations? Yes Is the review written in accessible language? Yes Are the conclusions drawn appropriate in the context of the current research literature? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Family Medicine, Public Health, Common Health Problems (such as DM, HTN, Dyslipidemia, and Depression), and Epidemiology/Prevention of Infectious diseases such as COVID-19 and Influenza. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT A. Alrasheedi A. Reviewer Report For: COVID-19 in the Arab countries: Three-year study [version 3; peer review: 2 approved, 1 approved with reservations] . F1000Research 2024, 12 :1448 ( https://doi.org/10.5256/f1000research.156102.r233650 ) The direct URL for this report is: https://f1000research.com/articles/12-1448/v1#referee-response-233650 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 26 Jun 2024 Nasar Alwahaibi , Department of Biomedical Science, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman 26 Jun 2024 Author Response We would like to extend our gratitude to the reviewer for his positive feedback and valuable comments. Listed below are our responses, addressing each query from the reviewer in detail. ... Continue reading We would like to extend our gratitude to the reviewer for his positive feedback and valuable comments. Listed below are our responses, addressing each query from the reviewer in detail. Overall, this study is excellent and worth accepting as the authors evaluated the spread of the COVID-19 pandemic in a critical region, the Arab world, over three years (2020-2022). Understanding the epidemiology of COVID-19 in the Arab world and comparing it to the world could help researchers and decision-makers explore the best ways to deal with COVID-19 and may provide lessons for a more effective response to public health emergencies in the future. However, there are some suggestions to improve the article. Response Thank you 1- Type of the study : Is this a review article or an original research? Based on the article's methodology and structure, this article is considered original (research article). The authors extracted primary/secondary data (raw data) from online websites and then analyzed and interpreted the data. In contrast, a review article or paper is based on other published articles. Review articles generally summarize the existing literature on a topic in an attempt to explain the current state of understanding of the topic. Therefore, this is not a review article because the authors did not base their methodology on a review of previous studies/research. The authors should reconsider this part! Response As suggested by the reviewer, the title has been changed. 2- Suppose this article is considered an original study, which it appears to be. In that case, it is preferable to change the word “ review ” in the title to another word, for example, “study,” so that the title is: “COVID-19 in the Arab countries: A three-year study” or “COVID-19 in the Arab countries: A study after three years”. Response The title has been changed to “COVID-19 in the Arab countries: A three-year study” 3- In the "conclusions" section of the Abstract, Confirmed what? Confirmed cases or confirmed deaths. A word is missing! Response To make it clearer, we removed “subsequently” as follows: Although the number of confirmed, death, and recovered cases of COVID-19 have greatly reduced in the last quarter of 2022 in most Arab countries. 4- In the first line of the "Introduction" section, which coronavirus is? It is the novel coronavirus, or as it is named, SARS-CoV-2. In contrast, the disease caused by this virus is called COVID-19. I suggest it be written as "… declared coronavirus disease 2019 (COVID-19) as …". Response As suggested, the sentence has been rephrased. 5- In the second sentence of the "Introduction" section, which years? 2020-2022 or 2021-2023; please specify! Response We referred to 2020 – 2022. 6- The reference No. 5 is old (2004). Is there any recent one? Response Yes, it is old but we have cited the original source. 7- In paragraph 4 of the "Introduction" section, please remove the phrase "the coronavirus." To be "… many different variants of SARS-CoV-2, including …". Also, in this statement: as long as the coronavirus SARS-CoV-2 remains. Please remove the phrase "". Response “The coronavirus” has been removed. 8- In the "Methods" section, please provide the link/reference for each website if possible (Worldometer...). Response The links to the WHO and Worldometer are updated daily. In addition, the links to the ministries of health are no longer accessible. 9- The exclusion criterion was unofficial information regarding COVID-19 in all Arab countries ,... This phrase ( unofficial information regarding COVID-19 in all Arab countries ) should be removed because it is known from the inclusion criteria (exclusion criteria are not the opposite of inclusion criteria). Response “Unofficial information regarding COVID-19 in all Arab countries” has been removed. 10- The following information was collected from each Arab country: total population, median age, number of monthly confirmed, ... Confirmed what? Please make it clear. Response We meant confirmed cases “number of monthly confirmed, death, and recovered cases, 11- "Results" section: All Arab countries utilized real-time polymerase chain reaction (RT-PCR) as the testing method for SARS-CoV-2. I suggest to transfer this sentence to the "Introduction" section. Response “All Arab countries utilized real-time polymerase chain reaction (RT-PCR) as the testing method for SARS-CoV-2” has been removed. 12- UAE (19,632,329) recorded then the highest number of tests per million population (PMP), followed by Bahrain (5,960,320), and then Oman (4,695,724). Rephrasing the sentence to be clear, I suggest, " The UAE recorded the highest number of tests per million population (PMP) with 19,632,329, followed by Bahrain (5,960,320), and then Oman (4,695,724)." Always add "the" before UAE, USA, and UK while mentioned in the text. Response As suggested, have been corrected. 13- The people in Qatar and the United Arab Emirates ... have [أع1] Use the abbreviation: the UAE. Response Has been corrected. 14- Table 1: Please identify the abbreviations in the table (Add footnotes), even if they have already been mentioned in the text. Please check the population number of Mauritania. Response Those abbreviations were initially defined in all tables at the time of submission then, the journal editors removed them. You are right, the population of Mauritania is 4,736,139. This information has been corrected and the countries in Table 1 have been reordered. 15- Table 2: define the abbreviations in the table (Add footnotes): UEA, SA, and PMP, as well as for other tables. Also, in column 10 (Q1-22), some numbers are not uniform in the way they are written. Response Those abbreviations were initially defined in all tables at the time of submission then, the journal editors removed them. The numbers in column 10 (Q1-22) have been corrected. 16- In the "Discussion" section, New Year season New Year season? Do you mean influenza season, where URTIs, including coronaviruses, increase? Response Yes, to make it clearer, the sentence has been modified to influenza season. 17- Another reason for the spike increase is the slow uptake of the vaccine in many countries. Which countries? of the world, including Arab countries or in many Arab countries? Response The sentence had been modified. 18- During the first, second, and third quarters of 2020, the pandemic was under control in most Arab countries due to ... Using the probability form, such as "mostly due to" or "probably because," is better. Response The sentence had been modified. 19- The first quarter of 2022 was a shockwave as it was recorded with the highest-ever number of COVID-19 confirmed cases with 3,235,665 peaked by Jordan with a total number of 630,811. To be clearer, I suggest you rephrase it to be: "During the first quarter of 2022, which was a shockwave, the Arab countries recorded the highest number of confirmed COVID-19 cases ever reported between 2020 and 2022. The total number of cases was 3,235,665, with Jordan reporting the highest number of cases at 630,811." Response As suggested, the sentence had been rephrased. 20- Qatar was reported with the highest number of confirmed cases of COVID-19 in the fourth quarter of 2022 Suggesting to rephrase by adding among Arab countries. Response As suggested, the sentence had been modified. 21- In paragraph no. 12, ...Australia, USA , and Turkey have performed tests more than their populations. DEFINE USA: please write the United States of America . Response The USA has been defined. 22- In the "Strengths and limitations" section, However, there are a few limitations in our review . study or review? This will depend on your classification. Response Has been changed to “study”. 23- Although the number of confirmed , death, and subsequently recovered cases of... Confirmed what? Please make it clear. Response We removed subsequently to be clearer: “ Although the number of confirmed, death, and subsequently recovered cases of COVID-19 have greatly reduced in the last quarter of 2022 in most Arab countries, further efforts to address the need to re-campaign on COVID-19 vaccines and raise awareness programs about boosters must be implemented”. Thank you for your valuable study. We would like to extend our gratitude to the reviewer for his positive feedback and valuable comments. Listed below are our responses, addressing each query from the reviewer in detail. Overall, this study is excellent and worth accepting as the authors evaluated the spread of the COVID-19 pandemic in a critical region, the Arab world, over three years (2020-2022). Understanding the epidemiology of COVID-19 in the Arab world and comparing it to the world could help researchers and decision-makers explore the best ways to deal with COVID-19 and may provide lessons for a more effective response to public health emergencies in the future. However, there are some suggestions to improve the article. Response Thank you 1- Type of the study : Is this a review article or an original research? Based on the article's methodology and structure, this article is considered original (research article). The authors extracted primary/secondary data (raw data) from online websites and then analyzed and interpreted the data. In contrast, a review article or paper is based on other published articles. Review articles generally summarize the existing literature on a topic in an attempt to explain the current state of understanding of the topic. Therefore, this is not a review article because the authors did not base their methodology on a review of previous studies/research. The authors should reconsider this part! Response As suggested by the reviewer, the title has been changed. 2- Suppose this article is considered an original study, which it appears to be. In that case, it is preferable to change the word “ review ” in the title to another word, for example, “study,” so that the title is: “COVID-19 in the Arab countries: A three-year study” or “COVID-19 in the Arab countries: A study after three years”. Response The title has been changed to “COVID-19 in the Arab countries: A three-year study” 3- In the "conclusions" section of the Abstract, Confirmed what? Confirmed cases or confirmed deaths. A word is missing! Response To make it clearer, we removed “subsequently” as follows: Although the number of confirmed, death, and recovered cases of COVID-19 have greatly reduced in the last quarter of 2022 in most Arab countries. 4- In the first line of the "Introduction" section, which coronavirus is? It is the novel coronavirus, or as it is named, SARS-CoV-2. In contrast, the disease caused by this virus is called COVID-19. I suggest it be written as "… declared coronavirus disease 2019 (COVID-19) as …". Response As suggested, the sentence has been rephrased. 5- In the second sentence of the "Introduction" section, which years? 2020-2022 or 2021-2023; please specify! Response We referred to 2020 – 2022. 6- The reference No. 5 is old (2004). Is there any recent one? Response Yes, it is old but we have cited the original source. 7- In paragraph 4 of the "Introduction" section, please remove the phrase "the coronavirus." To be "… many different variants of SARS-CoV-2, including …". Also, in this statement: as long as the coronavirus SARS-CoV-2 remains. Please remove the phrase "". Response “The coronavirus” has been removed. 8- In the "Methods" section, please provide the link/reference for each website if possible (Worldometer...). Response The links to the WHO and Worldometer are updated daily. In addition, the links to the ministries of health are no longer accessible. 9- The exclusion criterion was unofficial information regarding COVID-19 in all Arab countries ,... This phrase ( unofficial information regarding COVID-19 in all Arab countries ) should be removed because it is known from the inclusion criteria (exclusion criteria are not the opposite of inclusion criteria). Response “Unofficial information regarding COVID-19 in all Arab countries” has been removed. 10- The following information was collected from each Arab country: total population, median age, number of monthly confirmed, ... Confirmed what? Please make it clear. Response We meant confirmed cases “number of monthly confirmed, death, and recovered cases, 11- "Results" section: All Arab countries utilized real-time polymerase chain reaction (RT-PCR) as the testing method for SARS-CoV-2. I suggest to transfer this sentence to the "Introduction" section. Response “All Arab countries utilized real-time polymerase chain reaction (RT-PCR) as the testing method for SARS-CoV-2” has been removed. 12- UAE (19,632,329) recorded then the highest number of tests per million population (PMP), followed by Bahrain (5,960,320), and then Oman (4,695,724). Rephrasing the sentence to be clear, I suggest, " The UAE recorded the highest number of tests per million population (PMP) with 19,632,329, followed by Bahrain (5,960,320), and then Oman (4,695,724)." Always add "the" before UAE, USA, and UK while mentioned in the text. Response As suggested, have been corrected. 13- The people in Qatar and the United Arab Emirates ... have [أع1] Use the abbreviation: the UAE. Response Has been corrected. 14- Table 1: Please identify the abbreviations in the table (Add footnotes), even if they have already been mentioned in the text. Please check the population number of Mauritania. Response Those abbreviations were initially defined in all tables at the time of submission then, the journal editors removed them. You are right, the population of Mauritania is 4,736,139. This information has been corrected and the countries in Table 1 have been reordered. 15- Table 2: define the abbreviations in the table (Add footnotes): UEA, SA, and PMP, as well as for other tables. Also, in column 10 (Q1-22), some numbers are not uniform in the way they are written. Response Those abbreviations were initially defined in all tables at the time of submission then, the journal editors removed them. The numbers in column 10 (Q1-22) have been corrected. 16- In the "Discussion" section, New Year season New Year season? Do you mean influenza season, where URTIs, including coronaviruses, increase? Response Yes, to make it clearer, the sentence has been modified to influenza season. 17- Another reason for the spike increase is the slow uptake of the vaccine in many countries. Which countries? of the world, including Arab countries or in many Arab countries? Response The sentence had been modified. 18- During the first, second, and third quarters of 2020, the pandemic was under control in most Arab countries due to ... Using the probability form, such as "mostly due to" or "probably because," is better. Response The sentence had been modified. 19- The first quarter of 2022 was a shockwave as it was recorded with the highest-ever number of COVID-19 confirmed cases with 3,235,665 peaked by Jordan with a total number of 630,811. To be clearer, I suggest you rephrase it to be: "During the first quarter of 2022, which was a shockwave, the Arab countries recorded the highest number of confirmed COVID-19 cases ever reported between 2020 and 2022. The total number of cases was 3,235,665, with Jordan reporting the highest number of cases at 630,811." Response As suggested, the sentence had been rephrased. 20- Qatar was reported with the highest number of confirmed cases of COVID-19 in the fourth quarter of 2022 Suggesting to rephrase by adding among Arab countries. Response As suggested, the sentence had been modified. 21- In paragraph no. 12, ...Australia, USA , and Turkey have performed tests more than their populations. DEFINE USA: please write the United States of America . Response The USA has been defined. 22- In the "Strengths and limitations" section, However, there are a few limitations in our review . study or review? This will depend on your classification. Response Has been changed to “study”. 23- Although the number of confirmed , death, and subsequently recovered cases of... Confirmed what? Please make it clear. Response We removed subsequently to be clearer: “ Although the number of confirmed, death, and subsequently recovered cases of COVID-19 have greatly reduced in the last quarter of 2022 in most Arab countries, further efforts to address the need to re-campaign on COVID-19 vaccines and raise awareness programs about boosters must be implemented”. Thank you for your valuable study. Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 26 Jun 2024 Nasar Alwahaibi , Department of Biomedical Science, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman 26 Jun 2024 Author Response We would like to extend our gratitude to the reviewer for his positive feedback and valuable comments. Listed below are our responses, addressing each query from the reviewer in detail. ... Continue reading We would like to extend our gratitude to the reviewer for his positive feedback and valuable comments. Listed below are our responses, addressing each query from the reviewer in detail. Overall, this study is excellent and worth accepting as the authors evaluated the spread of the COVID-19 pandemic in a critical region, the Arab world, over three years (2020-2022). Understanding the epidemiology of COVID-19 in the Arab world and comparing it to the world could help researchers and decision-makers explore the best ways to deal with COVID-19 and may provide lessons for a more effective response to public health emergencies in the future. However, there are some suggestions to improve the article. Response Thank you 1- Type of the study : Is this a review article or an original research? Based on the article's methodology and structure, this article is considered original (research article). The authors extracted primary/secondary data (raw data) from online websites and then analyzed and interpreted the data. In contrast, a review article or paper is based on other published articles. Review articles generally summarize the existing literature on a topic in an attempt to explain the current state of understanding of the topic. Therefore, this is not a review article because the authors did not base their methodology on a review of previous studies/research. The authors should reconsider this part! Response As suggested by the reviewer, the title has been changed. 2- Suppose this article is considered an original study, which it appears to be. In that case, it is preferable to change the word “ review ” in the title to another word, for example, “study,” so that the title is: “COVID-19 in the Arab countries: A three-year study” or “COVID-19 in the Arab countries: A study after three years”. Response The title has been changed to “COVID-19 in the Arab countries: A three-year study” 3- In the "conclusions" section of the Abstract, Confirmed what? Confirmed cases or confirmed deaths. A word is missing! Response To make it clearer, we removed “subsequently” as follows: Although the number of confirmed, death, and recovered cases of COVID-19 have greatly reduced in the last quarter of 2022 in most Arab countries. 4- In the first line of the "Introduction" section, which coronavirus is? It is the novel coronavirus, or as it is named, SARS-CoV-2. In contrast, the disease caused by this virus is called COVID-19. I suggest it be written as "… declared coronavirus disease 2019 (COVID-19) as …". Response As suggested, the sentence has been rephrased. 5- In the second sentence of the "Introduction" section, which years? 2020-2022 or 2021-2023; please specify! Response We referred to 2020 – 2022. 6- The reference No. 5 is old (2004). Is there any recent one? Response Yes, it is old but we have cited the original source. 7- In paragraph 4 of the "Introduction" section, please remove the phrase "the coronavirus." To be "… many different variants of SARS-CoV-2, including …". Also, in this statement: as long as the coronavirus SARS-CoV-2 remains. Please remove the phrase "". Response “The coronavirus” has been removed. 8- In the "Methods" section, please provide the link/reference for each website if possible (Worldometer...). Response The links to the WHO and Worldometer are updated daily. In addition, the links to the ministries of health are no longer accessible. 9- The exclusion criterion was unofficial information regarding COVID-19 in all Arab countries ,... This phrase ( unofficial information regarding COVID-19 in all Arab countries ) should be removed because it is known from the inclusion criteria (exclusion criteria are not the opposite of inclusion criteria). Response “Unofficial information regarding COVID-19 in all Arab countries” has been removed. 10- The following information was collected from each Arab country: total population, median age, number of monthly confirmed, ... Confirmed what? Please make it clear. Response We meant confirmed cases “number of monthly confirmed, death, and recovered cases, 11- "Results" section: All Arab countries utilized real-time polymerase chain reaction (RT-PCR) as the testing method for SARS-CoV-2. I suggest to transfer this sentence to the "Introduction" section. Response “All Arab countries utilized real-time polymerase chain reaction (RT-PCR) as the testing method for SARS-CoV-2” has been removed. 12- UAE (19,632,329) recorded then the highest number of tests per million population (PMP), followed by Bahrain (5,960,320), and then Oman (4,695,724). Rephrasing the sentence to be clear, I suggest, " The UAE recorded the highest number of tests per million population (PMP) with 19,632,329, followed by Bahrain (5,960,320), and then Oman (4,695,724)." Always add "the" before UAE, USA, and UK while mentioned in the text. Response As suggested, have been corrected. 13- The people in Qatar and the United Arab Emirates ... have [أع1] Use the abbreviation: the UAE. Response Has been corrected. 14- Table 1: Please identify the abbreviations in the table (Add footnotes), even if they have already been mentioned in the text. Please check the population number of Mauritania. Response Those abbreviations were initially defined in all tables at the time of submission then, the journal editors removed them. You are right, the population of Mauritania is 4,736,139. This information has been corrected and the countries in Table 1 have been reordered. 15- Table 2: define the abbreviations in the table (Add footnotes): UEA, SA, and PMP, as well as for other tables. Also, in column 10 (Q1-22), some numbers are not uniform in the way they are written. Response Those abbreviations were initially defined in all tables at the time of submission then, the journal editors removed them. The numbers in column 10 (Q1-22) have been corrected. 16- In the "Discussion" section, New Year season New Year season? Do you mean influenza season, where URTIs, including coronaviruses, increase? Response Yes, to make it clearer, the sentence has been modified to influenza season. 17- Another reason for the spike increase is the slow uptake of the vaccine in many countries. Which countries? of the world, including Arab countries or in many Arab countries? Response The sentence had been modified. 18- During the first, second, and third quarters of 2020, the pandemic was under control in most Arab countries due to ... Using the probability form, such as "mostly due to" or "probably because," is better. Response The sentence had been modified. 19- The first quarter of 2022 was a shockwave as it was recorded with the highest-ever number of COVID-19 confirmed cases with 3,235,665 peaked by Jordan with a total number of 630,811. To be clearer, I suggest you rephrase it to be: "During the first quarter of 2022, which was a shockwave, the Arab countries recorded the highest number of confirmed COVID-19 cases ever reported between 2020 and 2022. The total number of cases was 3,235,665, with Jordan reporting the highest number of cases at 630,811." Response As suggested, the sentence had been rephrased. 20- Qatar was reported with the highest number of confirmed cases of COVID-19 in the fourth quarter of 2022 Suggesting to rephrase by adding among Arab countries. Response As suggested, the sentence had been modified. 21- In paragraph no. 12, ...Australia, USA , and Turkey have performed tests more than their populations. DEFINE USA: please write the United States of America . Response The USA has been defined. 22- In the "Strengths and limitations" section, However, there are a few limitations in our review . study or review? This will depend on your classification. Response Has been changed to “study”. 23- Although the number of confirmed , death, and subsequently recovered cases of... Confirmed what? Please make it clear. Response We removed subsequently to be clearer: “ Although the number of confirmed, death, and subsequently recovered cases of COVID-19 have greatly reduced in the last quarter of 2022 in most Arab countries, further efforts to address the need to re-campaign on COVID-19 vaccines and raise awareness programs about boosters must be implemented”. Thank you for your valuable study. We would like to extend our gratitude to the reviewer for his positive feedback and valuable comments. Listed below are our responses, addressing each query from the reviewer in detail. Overall, this study is excellent and worth accepting as the authors evaluated the spread of the COVID-19 pandemic in a critical region, the Arab world, over three years (2020-2022). Understanding the epidemiology of COVID-19 in the Arab world and comparing it to the world could help researchers and decision-makers explore the best ways to deal with COVID-19 and may provide lessons for a more effective response to public health emergencies in the future. However, there are some suggestions to improve the article. Response Thank you 1- Type of the study : Is this a review article or an original research? Based on the article's methodology and structure, this article is considered original (research article). The authors extracted primary/secondary data (raw data) from online websites and then analyzed and interpreted the data. In contrast, a review article or paper is based on other published articles. Review articles generally summarize the existing literature on a topic in an attempt to explain the current state of understanding of the topic. Therefore, this is not a review article because the authors did not base their methodology on a review of previous studies/research. The authors should reconsider this part! Response As suggested by the reviewer, the title has been changed. 2- Suppose this article is considered an original study, which it appears to be. In that case, it is preferable to change the word “ review ” in the title to another word, for example, “study,” so that the title is: “COVID-19 in the Arab countries: A three-year study” or “COVID-19 in the Arab countries: A study after three years”. Response The title has been changed to “COVID-19 in the Arab countries: A three-year study” 3- In the "conclusions" section of the Abstract, Confirmed what? Confirmed cases or confirmed deaths. A word is missing! Response To make it clearer, we removed “subsequently” as follows: Although the number of confirmed, death, and recovered cases of COVID-19 have greatly reduced in the last quarter of 2022 in most Arab countries. 4- In the first line of the "Introduction" section, which coronavirus is? It is the novel coronavirus, or as it is named, SARS-CoV-2. In contrast, the disease caused by this virus is called COVID-19. I suggest it be written as "… declared coronavirus disease 2019 (COVID-19) as …". Response As suggested, the sentence has been rephrased. 5- In the second sentence of the "Introduction" section, which years? 2020-2022 or 2021-2023; please specify! Response We referred to 2020 – 2022. 6- The reference No. 5 is old (2004). Is there any recent one? Response Yes, it is old but we have cited the original source. 7- In paragraph 4 of the "Introduction" section, please remove the phrase "the coronavirus." To be "… many different variants of SARS-CoV-2, including …". Also, in this statement: as long as the coronavirus SARS-CoV-2 remains. Please remove the phrase "". Response “The coronavirus” has been removed. 8- In the "Methods" section, please provide the link/reference for each website if possible (Worldometer...). Response The links to the WHO and Worldometer are updated daily. In addition, the links to the ministries of health are no longer accessible. 9- The exclusion criterion was unofficial information regarding COVID-19 in all Arab countries ,... This phrase ( unofficial information regarding COVID-19 in all Arab countries ) should be removed because it is known from the inclusion criteria (exclusion criteria are not the opposite of inclusion criteria). Response “Unofficial information regarding COVID-19 in all Arab countries” has been removed. 10- The following information was collected from each Arab country: total population, median age, number of monthly confirmed, ... Confirmed what? Please make it clear. Response We meant confirmed cases “number of monthly confirmed, death, and recovered cases, 11- "Results" section: All Arab countries utilized real-time polymerase chain reaction (RT-PCR) as the testing method for SARS-CoV-2. I suggest to transfer this sentence to the "Introduction" section. Response “All Arab countries utilized real-time polymerase chain reaction (RT-PCR) as the testing method for SARS-CoV-2” has been removed. 12- UAE (19,632,329) recorded then the highest number of tests per million population (PMP), followed by Bahrain (5,960,320), and then Oman (4,695,724). Rephrasing the sentence to be clear, I suggest, " The UAE recorded the highest number of tests per million population (PMP) with 19,632,329, followed by Bahrain (5,960,320), and then Oman (4,695,724)." Always add "the" before UAE, USA, and UK while mentioned in the text. Response As suggested, have been corrected. 13- The people in Qatar and the United Arab Emirates ... have [أع1] Use the abbreviation: the UAE. Response Has been corrected. 14- Table 1: Please identify the abbreviations in the table (Add footnotes), even if they have already been mentioned in the text. Please check the population number of Mauritania. Response Those abbreviations were initially defined in all tables at the time of submission then, the journal editors removed them. You are right, the population of Mauritania is 4,736,139. This information has been corrected and the countries in Table 1 have been reordered. 15- Table 2: define the abbreviations in the table (Add footnotes): UEA, SA, and PMP, as well as for other tables. Also, in column 10 (Q1-22), some numbers are not uniform in the way they are written. Response Those abbreviations were initially defined in all tables at the time of submission then, the journal editors removed them. The numbers in column 10 (Q1-22) have been corrected. 16- In the "Discussion" section, New Year season New Year season? Do you mean influenza season, where URTIs, including coronaviruses, increase? Response Yes, to make it clearer, the sentence has been modified to influenza season. 17- Another reason for the spike increase is the slow uptake of the vaccine in many countries. Which countries? of the world, including Arab countries or in many Arab countries? Response The sentence had been modified. 18- During the first, second, and third quarters of 2020, the pandemic was under control in most Arab countries due to ... Using the probability form, such as "mostly due to" or "probably because," is better. Response The sentence had been modified. 19- The first quarter of 2022 was a shockwave as it was recorded with the highest-ever number of COVID-19 confirmed cases with 3,235,665 peaked by Jordan with a total number of 630,811. To be clearer, I suggest you rephrase it to be: "During the first quarter of 2022, which was a shockwave, the Arab countries recorded the highest number of confirmed COVID-19 cases ever reported between 2020 and 2022. The total number of cases was 3,235,665, with Jordan reporting the highest number of cases at 630,811." Response As suggested, the sentence had been rephrased. 20- Qatar was reported with the highest number of confirmed cases of COVID-19 in the fourth quarter of 2022 Suggesting to rephrase by adding among Arab countries. Response As suggested, the sentence had been modified. 21- In paragraph no. 12, ...Australia, USA , and Turkey have performed tests more than their populations. DEFINE USA: please write the United States of America . Response The USA has been defined. 22- In the "Strengths and limitations" section, However, there are a few limitations in our review . study or review? This will depend on your classification. Response Has been changed to “study”. 23- Although the number of confirmed , death, and subsequently recovered cases of... Confirmed what? Please make it clear. Response We removed subsequently to be clearer: “ Although the number of confirmed, death, and subsequently recovered cases of COVID-19 have greatly reduced in the last quarter of 2022 in most Arab countries, further efforts to address the need to re-campaign on COVID-19 vaccines and raise awareness programs about boosters must be implemented”. Thank you for your valuable study. Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Zahid MN. Reviewer Report For: COVID-19 in the Arab countries: Three-year study [version 3; peer review: 2 approved, 1 approved with reservations] . F1000Research 2024, 12 :1448 ( https://doi.org/10.5256/f1000research.156102.r247533 ) The direct URL for this report is: https://f1000research.com/articles/12-1448/v1#referee-response-247533 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 01 Apr 2024 Muhammad Nauman Zahid , College of Science, University of Bahrain, Sakhir, Southern Governorate, Bahrain Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.156102.r247533 The authors have made an interesting attempt at “COVID-19 in the Arab countries: Three-year review.” The manuscript is interesting; however, the authors need to justify the scientific writing of the manuscript. Some of the general comments are provided below: ... Continue reading READ ALL The authors have made an interesting attempt at “COVID-19 in the Arab countries: Three-year review.” The manuscript is interesting; however, the authors need to justify the scientific writing of the manuscript. Some of the general comments are provided below: Considering the usage of several sources, what steps were taken to address any potential contradictions or inconsistencies discovered in the data collected? In order to maintain the dataset's integrity, how were possible duplicate items found and dealt with? What variables could account for the variations in COVID-19 cases and fatalities that were noted during the three years from January 2020 to December 2022? Could these tendencies have been impacted by any significant policy changes or events? Taking into account the possible influence of variables including climate, public health initiatives, and alterations in population behavior, how were seasonal fluctuations in COVID-19 incidence and death taken into account in the analysis? Could you provide further details about any possible biases or confounding factors, such as variations in healthcare access, population demographics, or government response tactics, that would affect how these cross-regional comparisons are interpreted? According to the manuscript, vaccination campaigns were a major factor in the decline of COVID-19 cases, fatalities, and hospital admissions in Arab nations. Can you offer more proof or analysis to back up this claim, such as comparisons of COVID-19 results before and after vaccination campaigns or research on the efficacy of vaccines? How were public opinions of vaccine safety and efficacy, vaccine hesitancy, and disinformation addressed during the vaccination campaign discussion? Were any tactics put in place to enhance vaccination uptake and remove obstacles to access? Is the topic of the review discussed comprehensively in the context of the current literature? Yes Are all factual statements correct and adequately supported by citations? Yes Is the review written in accessible language? Yes Are the conclusions drawn appropriate in the context of the current research literature? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Virologist I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Zahid MN. Reviewer Report For: COVID-19 in the Arab countries: Three-year study [version 3; peer review: 2 approved, 1 approved with reservations] . F1000Research 2024, 12 :1448 ( https://doi.org/10.5256/f1000research.156102.r247533 ) The direct URL for this report is: https://f1000research.com/articles/12-1448/v1#referee-response-247533 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 09 May 2024 Nasar Alwahaibi , Department of Biomedical Science, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman 09 May 2024 Author Response We would like to take this opportunity to express our thanks to the reviewer for the positive feedback and helpful comments. Below are our responses, point-by-point to the queries ... Continue reading We would like to take this opportunity to express our thanks to the reviewer for the positive feedback and helpful comments. Below are our responses, point-by-point to the queries of the reviewer. The authors have made an interesting attempt at “COVID-19 in the Arab countries: Three-year review.” The manuscript is interesting; however, the authors need to justify the scientific writing of the manuscript. Some of the general comments are provided below: Considering the usage of several sources, what steps were taken to address any potential contradictions or inconsistencies discovered in the data collected? Response We use the Ministry of Health official websites in each Arab country as an initial source as they provide daily data, then verified with the WHO and Worldometer sources. In case of different data, which is not common, we referred to the Ministry of Health in each Arab country . In order to maintain the dataset's integrity, how were possible duplicate items found and dealt with? Response The data are not duplicated, but sometimes there are differences between the WHO and Worldometer sources as they are reported at different times on the Ministry of Health's official websites. What variables could account for the variations in COVID-19 cases and fatalities that were noted during the three years from January 2020 to December 2022? Could these tendencies have been impacted by any significant policy changes or events? Response The variables or factors that could account for the variations in COVID-19 cases and fatalities are mentioned in the discussion section and these include lockdown measures, mitigation strategies (such as implementing social distancing), employment and scale of diagnostic testing and vaccine intake, timely response of governments, weak healthcare system (physical resources and healthcare personnel and under reporting) and hence, all of these could be attributed to the “healthcare policy” of each country. Other variables include the occurrence of virus-related factors such as the fast-spreading Omicron variant, the UK variant, and the Alpha variant. Population or demographic characteristics such as age was also identified as a potential factor that may have influenced infection and death rates. We demonstrate in the discussion section that the ability of “healthcare systems to respond promptly against the COVID-19” such as implementing strict lockdown measures and mitigation strategies significantly reduced confirmed cases and fatalities. We also show in the discussion that countries that employed heavy testing protocols revealed higher number of cases and that under-reporting could have played a role in countries that did not employ large-scale testing. Taking into account the possible influence of variables including climate, public health initiatives, and alterations in population behavior, how were seasonal fluctuations in COVID-19 incidence and death taken into account in the analysis? Response According to the data of COVID-19 fluctuations, the spikes of Covid-19 were connected to the spread waves but not the climate. For example, in Tunisia, the peaked deaths were in the third quarter of 2021 which is considered as hot climate whereas in Lebanon the peaked deaths were in the first quarter of 2021 which is considered as a cold climate. According to the public health initiatives (e.g. vaccination) and positive alteration in population behaviors, we mentioned in the paper how these two factors affected the decrease in the death’s numbers. Could you provide further details about any possible biases or confounding factors, such as variations in healthcare access, population demographics, or government response tactics, that would affect how these cross-regional comparisons are interpreted? Response This is very good question, however, population demographics such as gender and age are not reported. Thus, we have added the following sentence as a limitation: The lack of gender and age data in numerous Arab countries prevented us from conducting thorough comparisons and assessing potential risk factors. Regarding the government response tactics, we have already mentioned in the discussion section that: During the first, second, and third quarters of 2020, the pandemic was under control in most Arab countries due to the implementation of extreme precautionary measures. The major measures include land, sea, and air route closure, nighttime or all-day curfew and lockdown, school and universities closure, worship places closure, prohibition of gatherings, closure of shops, malls, beaches, public parks, and gardens, cancellation of all cultural and sports events, festivals, seminars, and scientific meetings, and suspension of work in all government and private sectors. Regarding the access to healthcare facilities during COVID-19 crises, this information is not available in all Arab countries. We know that GCC countries offered free medical treatment and vaccinations to all residents but this information is missing in other Arab countries. According to the manuscript, vaccination campaigns were a major factor in the decline of COVID-19 cases, fatalities, and hospital admissions in Arab nations. Can you offer more proof or analysis to back up this claim, such as comparisons of COVID-19 results before and after vaccination campaigns or research on the efficacy of vaccines? Response Our results did not study the comparison of COVID-19 before and after vaccination campaigns. As suggested, the following paragraph has been added in the discussion section: Research conducted in the United Arab Emirates regarding the inactivated BBIBP-CorV (Sinopharm) vaccine revealed that its efficacy against severe COVID-19 outcomes was 80% for hospitalization, 92% for critical care admission, and 97% for preventing death. 46 In addition, a study conducted in Morocco on the long-term efficacy of the inactivated BBIBP-CorV vaccine revealed a decrease in effectiveness, dropping from 88% to 64% six months after vaccination. 47 Furthermore, in Qatar, a different study demonstrated that the efficacy of BBIBP-CorV vaccine against SARS-CoV-2 infections decreased gradually, with a more rapid decline observed after the fourth month. This decline resulted in about 20% protection at five to seven months following vaccination. However, the vaccine's efficacy remained nearly 96% effective in preventing hospitalization and death six months after vaccination. 48 How were public opinions of vaccine safety and efficacy, vaccine hesitancy, and disinformation addressed during the vaccination campaign discussion? Were any tactics put in place to enhance vaccination uptake and remove obstacles to access? Response The following sentence has been added in the discussion section: Certain tactics were used to enhance public awareness and acceptance of vaccine during these campaigns. One of the most effective tactics was to address public opinions of vaccine safety and efficacy by disseminating accurate information through authorized channels. This information was in different languages to reach out all in the community. Community engagement and healthcare guidance were also helpful. During the vaccination process, the uptake of vaccine was enhanced by removing any obstacle that might delay such a process. For example, setting up vaccination centers in different locations with an easy access and quick appointment. These centers had big area to accommodate more people at each time. Community outreach existed for those who could not go to these centers. 44 We would like to take this opportunity to express our thanks to the reviewer for the positive feedback and helpful comments. Below are our responses, point-by-point to the queries of the reviewer. The authors have made an interesting attempt at “COVID-19 in the Arab countries: Three-year review.” The manuscript is interesting; however, the authors need to justify the scientific writing of the manuscript. Some of the general comments are provided below: Considering the usage of several sources, what steps were taken to address any potential contradictions or inconsistencies discovered in the data collected? Response We use the Ministry of Health official websites in each Arab country as an initial source as they provide daily data, then verified with the WHO and Worldometer sources. In case of different data, which is not common, we referred to the Ministry of Health in each Arab country . In order to maintain the dataset's integrity, how were possible duplicate items found and dealt with? Response The data are not duplicated, but sometimes there are differences between the WHO and Worldometer sources as they are reported at different times on the Ministry of Health's official websites. What variables could account for the variations in COVID-19 cases and fatalities that were noted during the three years from January 2020 to December 2022? Could these tendencies have been impacted by any significant policy changes or events? Response The variables or factors that could account for the variations in COVID-19 cases and fatalities are mentioned in the discussion section and these include lockdown measures, mitigation strategies (such as implementing social distancing), employment and scale of diagnostic testing and vaccine intake, timely response of governments, weak healthcare system (physical resources and healthcare personnel and under reporting) and hence, all of these could be attributed to the “healthcare policy” of each country. Other variables include the occurrence of virus-related factors such as the fast-spreading Omicron variant, the UK variant, and the Alpha variant. Population or demographic characteristics such as age was also identified as a potential factor that may have influenced infection and death rates. We demonstrate in the discussion section that the ability of “healthcare systems to respond promptly against the COVID-19” such as implementing strict lockdown measures and mitigation strategies significantly reduced confirmed cases and fatalities. We also show in the discussion that countries that employed heavy testing protocols revealed higher number of cases and that under-reporting could have played a role in countries that did not employ large-scale testing. Taking into account the possible influence of variables including climate, public health initiatives, and alterations in population behavior, how were seasonal fluctuations in COVID-19 incidence and death taken into account in the analysis? Response According to the data of COVID-19 fluctuations, the spikes of Covid-19 were connected to the spread waves but not the climate. For example, in Tunisia, the peaked deaths were in the third quarter of 2021 which is considered as hot climate whereas in Lebanon the peaked deaths were in the first quarter of 2021 which is considered as a cold climate. According to the public health initiatives (e.g. vaccination) and positive alteration in population behaviors, we mentioned in the paper how these two factors affected the decrease in the death’s numbers. Could you provide further details about any possible biases or confounding factors, such as variations in healthcare access, population demographics, or government response tactics, that would affect how these cross-regional comparisons are interpreted? Response This is very good question, however, population demographics such as gender and age are not reported. Thus, we have added the following sentence as a limitation: The lack of gender and age data in numerous Arab countries prevented us from conducting thorough comparisons and assessing potential risk factors. Regarding the government response tactics, we have already mentioned in the discussion section that: During the first, second, and third quarters of 2020, the pandemic was under control in most Arab countries due to the implementation of extreme precautionary measures. The major measures include land, sea, and air route closure, nighttime or all-day curfew and lockdown, school and universities closure, worship places closure, prohibition of gatherings, closure of shops, malls, beaches, public parks, and gardens, cancellation of all cultural and sports events, festivals, seminars, and scientific meetings, and suspension of work in all government and private sectors. Regarding the access to healthcare facilities during COVID-19 crises, this information is not available in all Arab countries. We know that GCC countries offered free medical treatment and vaccinations to all residents but this information is missing in other Arab countries. According to the manuscript, vaccination campaigns were a major factor in the decline of COVID-19 cases, fatalities, and hospital admissions in Arab nations. Can you offer more proof or analysis to back up this claim, such as comparisons of COVID-19 results before and after vaccination campaigns or research on the efficacy of vaccines? Response Our results did not study the comparison of COVID-19 before and after vaccination campaigns. As suggested, the following paragraph has been added in the discussion section: Research conducted in the United Arab Emirates regarding the inactivated BBIBP-CorV (Sinopharm) vaccine revealed that its efficacy against severe COVID-19 outcomes was 80% for hospitalization, 92% for critical care admission, and 97% for preventing death. 46 In addition, a study conducted in Morocco on the long-term efficacy of the inactivated BBIBP-CorV vaccine revealed a decrease in effectiveness, dropping from 88% to 64% six months after vaccination. 47 Furthermore, in Qatar, a different study demonstrated that the efficacy of BBIBP-CorV vaccine against SARS-CoV-2 infections decreased gradually, with a more rapid decline observed after the fourth month. This decline resulted in about 20% protection at five to seven months following vaccination. However, the vaccine's efficacy remained nearly 96% effective in preventing hospitalization and death six months after vaccination. 48 How were public opinions of vaccine safety and efficacy, vaccine hesitancy, and disinformation addressed during the vaccination campaign discussion? Were any tactics put in place to enhance vaccination uptake and remove obstacles to access? Response The following sentence has been added in the discussion section: Certain tactics were used to enhance public awareness and acceptance of vaccine during these campaigns. One of the most effective tactics was to address public opinions of vaccine safety and efficacy by disseminating accurate information through authorized channels. This information was in different languages to reach out all in the community. Community engagement and healthcare guidance were also helpful. During the vaccination process, the uptake of vaccine was enhanced by removing any obstacle that might delay such a process. For example, setting up vaccination centers in different locations with an easy access and quick appointment. These centers had big area to accommodate more people at each time. Community outreach existed for those who could not go to these centers. 44 Competing Interests: None Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 09 May 2024 Nasar Alwahaibi , Department of Biomedical Science, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman 09 May 2024 Author Response We would like to take this opportunity to express our thanks to the reviewer for the positive feedback and helpful comments. Below are our responses, point-by-point to the queries ... Continue reading We would like to take this opportunity to express our thanks to the reviewer for the positive feedback and helpful comments. Below are our responses, point-by-point to the queries of the reviewer. The authors have made an interesting attempt at “COVID-19 in the Arab countries: Three-year review.” The manuscript is interesting; however, the authors need to justify the scientific writing of the manuscript. Some of the general comments are provided below: Considering the usage of several sources, what steps were taken to address any potential contradictions or inconsistencies discovered in the data collected? Response We use the Ministry of Health official websites in each Arab country as an initial source as they provide daily data, then verified with the WHO and Worldometer sources. In case of different data, which is not common, we referred to the Ministry of Health in each Arab country . In order to maintain the dataset's integrity, how were possible duplicate items found and dealt with? Response The data are not duplicated, but sometimes there are differences between the WHO and Worldometer sources as they are reported at different times on the Ministry of Health's official websites. What variables could account for the variations in COVID-19 cases and fatalities that were noted during the three years from January 2020 to December 2022? Could these tendencies have been impacted by any significant policy changes or events? Response The variables or factors that could account for the variations in COVID-19 cases and fatalities are mentioned in the discussion section and these include lockdown measures, mitigation strategies (such as implementing social distancing), employment and scale of diagnostic testing and vaccine intake, timely response of governments, weak healthcare system (physical resources and healthcare personnel and under reporting) and hence, all of these could be attributed to the “healthcare policy” of each country. Other variables include the occurrence of virus-related factors such as the fast-spreading Omicron variant, the UK variant, and the Alpha variant. Population or demographic characteristics such as age was also identified as a potential factor that may have influenced infection and death rates. We demonstrate in the discussion section that the ability of “healthcare systems to respond promptly against the COVID-19” such as implementing strict lockdown measures and mitigation strategies significantly reduced confirmed cases and fatalities. We also show in the discussion that countries that employed heavy testing protocols revealed higher number of cases and that under-reporting could have played a role in countries that did not employ large-scale testing. Taking into account the possible influence of variables including climate, public health initiatives, and alterations in population behavior, how were seasonal fluctuations in COVID-19 incidence and death taken into account in the analysis? Response According to the data of COVID-19 fluctuations, the spikes of Covid-19 were connected to the spread waves but not the climate. For example, in Tunisia, the peaked deaths were in the third quarter of 2021 which is considered as hot climate whereas in Lebanon the peaked deaths were in the first quarter of 2021 which is considered as a cold climate. According to the public health initiatives (e.g. vaccination) and positive alteration in population behaviors, we mentioned in the paper how these two factors affected the decrease in the death’s numbers. Could you provide further details about any possible biases or confounding factors, such as variations in healthcare access, population demographics, or government response tactics, that would affect how these cross-regional comparisons are interpreted? Response This is very good question, however, population demographics such as gender and age are not reported. Thus, we have added the following sentence as a limitation: The lack of gender and age data in numerous Arab countries prevented us from conducting thorough comparisons and assessing potential risk factors. Regarding the government response tactics, we have already mentioned in the discussion section that: During the first, second, and third quarters of 2020, the pandemic was under control in most Arab countries due to the implementation of extreme precautionary measures. The major measures include land, sea, and air route closure, nighttime or all-day curfew and lockdown, school and universities closure, worship places closure, prohibition of gatherings, closure of shops, malls, beaches, public parks, and gardens, cancellation of all cultural and sports events, festivals, seminars, and scientific meetings, and suspension of work in all government and private sectors. Regarding the access to healthcare facilities during COVID-19 crises, this information is not available in all Arab countries. We know that GCC countries offered free medical treatment and vaccinations to all residents but this information is missing in other Arab countries. According to the manuscript, vaccination campaigns were a major factor in the decline of COVID-19 cases, fatalities, and hospital admissions in Arab nations. Can you offer more proof or analysis to back up this claim, such as comparisons of COVID-19 results before and after vaccination campaigns or research on the efficacy of vaccines? Response Our results did not study the comparison of COVID-19 before and after vaccination campaigns. As suggested, the following paragraph has been added in the discussion section: Research conducted in the United Arab Emirates regarding the inactivated BBIBP-CorV (Sinopharm) vaccine revealed that its efficacy against severe COVID-19 outcomes was 80% for hospitalization, 92% for critical care admission, and 97% for preventing death. 46 In addition, a study conducted in Morocco on the long-term efficacy of the inactivated BBIBP-CorV vaccine revealed a decrease in effectiveness, dropping from 88% to 64% six months after vaccination. 47 Furthermore, in Qatar, a different study demonstrated that the efficacy of BBIBP-CorV vaccine against SARS-CoV-2 infections decreased gradually, with a more rapid decline observed after the fourth month. This decline resulted in about 20% protection at five to seven months following vaccination. However, the vaccine's efficacy remained nearly 96% effective in preventing hospitalization and death six months after vaccination. 48 How were public opinions of vaccine safety and efficacy, vaccine hesitancy, and disinformation addressed during the vaccination campaign discussion? Were any tactics put in place to enhance vaccination uptake and remove obstacles to access? Response The following sentence has been added in the discussion section: Certain tactics were used to enhance public awareness and acceptance of vaccine during these campaigns. One of the most effective tactics was to address public opinions of vaccine safety and efficacy by disseminating accurate information through authorized channels. This information was in different languages to reach out all in the community. Community engagement and healthcare guidance were also helpful. During the vaccination process, the uptake of vaccine was enhanced by removing any obstacle that might delay such a process. For example, setting up vaccination centers in different locations with an easy access and quick appointment. These centers had big area to accommodate more people at each time. Community outreach existed for those who could not go to these centers. 44 We would like to take this opportunity to express our thanks to the reviewer for the positive feedback and helpful comments. Below are our responses, point-by-point to the queries of the reviewer. The authors have made an interesting attempt at “COVID-19 in the Arab countries: Three-year review.” The manuscript is interesting; however, the authors need to justify the scientific writing of the manuscript. Some of the general comments are provided below: Considering the usage of several sources, what steps were taken to address any potential contradictions or inconsistencies discovered in the data collected? Response We use the Ministry of Health official websites in each Arab country as an initial source as they provide daily data, then verified with the WHO and Worldometer sources. In case of different data, which is not common, we referred to the Ministry of Health in each Arab country . In order to maintain the dataset's integrity, how were possible duplicate items found and dealt with? Response The data are not duplicated, but sometimes there are differences between the WHO and Worldometer sources as they are reported at different times on the Ministry of Health's official websites. What variables could account for the variations in COVID-19 cases and fatalities that were noted during the three years from January 2020 to December 2022? Could these tendencies have been impacted by any significant policy changes or events? Response The variables or factors that could account for the variations in COVID-19 cases and fatalities are mentioned in the discussion section and these include lockdown measures, mitigation strategies (such as implementing social distancing), employment and scale of diagnostic testing and vaccine intake, timely response of governments, weak healthcare system (physical resources and healthcare personnel and under reporting) and hence, all of these could be attributed to the “healthcare policy” of each country. Other variables include the occurrence of virus-related factors such as the fast-spreading Omicron variant, the UK variant, and the Alpha variant. Population or demographic characteristics such as age was also identified as a potential factor that may have influenced infection and death rates. We demonstrate in the discussion section that the ability of “healthcare systems to respond promptly against the COVID-19” such as implementing strict lockdown measures and mitigation strategies significantly reduced confirmed cases and fatalities. We also show in the discussion that countries that employed heavy testing protocols revealed higher number of cases and that under-reporting could have played a role in countries that did not employ large-scale testing. Taking into account the possible influence of variables including climate, public health initiatives, and alterations in population behavior, how were seasonal fluctuations in COVID-19 incidence and death taken into account in the analysis? Response According to the data of COVID-19 fluctuations, the spikes of Covid-19 were connected to the spread waves but not the climate. For example, in Tunisia, the peaked deaths were in the third quarter of 2021 which is considered as hot climate whereas in Lebanon the peaked deaths were in the first quarter of 2021 which is considered as a cold climate. According to the public health initiatives (e.g. vaccination) and positive alteration in population behaviors, we mentioned in the paper how these two factors affected the decrease in the death’s numbers. Could you provide further details about any possible biases or confounding factors, such as variations in healthcare access, population demographics, or government response tactics, that would affect how these cross-regional comparisons are interpreted? Response This is very good question, however, population demographics such as gender and age are not reported. Thus, we have added the following sentence as a limitation: The lack of gender and age data in numerous Arab countries prevented us from conducting thorough comparisons and assessing potential risk factors. Regarding the government response tactics, we have already mentioned in the discussion section that: During the first, second, and third quarters of 2020, the pandemic was under control in most Arab countries due to the implementation of extreme precautionary measures. The major measures include land, sea, and air route closure, nighttime or all-day curfew and lockdown, school and universities closure, worship places closure, prohibition of gatherings, closure of shops, malls, beaches, public parks, and gardens, cancellation of all cultural and sports events, festivals, seminars, and scientific meetings, and suspension of work in all government and private sectors. Regarding the access to healthcare facilities during COVID-19 crises, this information is not available in all Arab countries. We know that GCC countries offered free medical treatment and vaccinations to all residents but this information is missing in other Arab countries. According to the manuscript, vaccination campaigns were a major factor in the decline of COVID-19 cases, fatalities, and hospital admissions in Arab nations. Can you offer more proof or analysis to back up this claim, such as comparisons of COVID-19 results before and after vaccination campaigns or research on the efficacy of vaccines? Response Our results did not study the comparison of COVID-19 before and after vaccination campaigns. As suggested, the following paragraph has been added in the discussion section: Research conducted in the United Arab Emirates regarding the inactivated BBIBP-CorV (Sinopharm) vaccine revealed that its efficacy against severe COVID-19 outcomes was 80% for hospitalization, 92% for critical care admission, and 97% for preventing death. 46 In addition, a study conducted in Morocco on the long-term efficacy of the inactivated BBIBP-CorV vaccine revealed a decrease in effectiveness, dropping from 88% to 64% six months after vaccination. 47 Furthermore, in Qatar, a different study demonstrated that the efficacy of BBIBP-CorV vaccine against SARS-CoV-2 infections decreased gradually, with a more rapid decline observed after the fourth month. This decline resulted in about 20% protection at five to seven months following vaccination. However, the vaccine's efficacy remained nearly 96% effective in preventing hospitalization and death six months after vaccination. 48 How were public opinions of vaccine safety and efficacy, vaccine hesitancy, and disinformation addressed during the vaccination campaign discussion? Were any tactics put in place to enhance vaccination uptake and remove obstacles to access? Response The following sentence has been added in the discussion section: Certain tactics were used to enhance public awareness and acceptance of vaccine during these campaigns. One of the most effective tactics was to address public opinions of vaccine safety and efficacy by disseminating accurate information through authorized channels. This information was in different languages to reach out all in the community. Community engagement and healthcare guidance were also helpful. During the vaccination process, the uptake of vaccine was enhanced by removing any obstacle that might delay such a process. For example, setting up vaccination centers in different locations with an easy access and quick appointment. These centers had big area to accommodate more people at each time. Community outreach existed for those who could not go to these centers. 44 Competing Interests: None Close Report a concern COMMENT ON THIS REPORT Comments on this article Comments (0) Version 3 VERSION 3 PUBLISHED 08 Nov 2023 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 3 Version 3 (revision) 29 May 24 read read Version 2 (revision) 09 May 24 Version 1 08 Nov 23 read read read Muhammad Nauman Zahid , University of Bahrain, Sakhir, Bahrain Ahmad A. Alrasheedi , Qassim University, Buraydah, Saudi Arabia Yasser Amer , King Saud University Medical City, Riyadh, Saudi Arabia Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Zahid M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 07 Jun 2024 | for Version 3 Muhammad Nauman Zahid , College of Science, University of Bahrain, Sakhir, Southern Governorate, Bahrain 0 Views copyright © 2024 Zahid M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The authors have addressed my questions and I am satisfied with the revised version. Competing Interests No competing interests were disclosed. Reviewer Expertise Virology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Zahid MN. Peer Review Report For: COVID-19 in the Arab countries: Three-year study [version 3; peer review: 2 approved, 1 approved with reservations] . F1000Research 2024, 12 :1448 ( https://doi.org/10.5256/f1000research.166903.r284092) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/12-1448/v3#referee-response-284092 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 A. Alrasheedi A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 04 Jun 2024 | for Version 3 Ahmad A. Alrasheedi , Department of Family and Community Medicine, College of Medicine, Qassim University, Buraydah, Al Qassim Region, Saudi Arabia 0 Views copyright © 2024 A. Alrasheedi A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The authors have addressed the concerns and made the necessary amendments (we suggested) to this version. I think this study can be indexed. Competing Interests No competing interests were disclosed. Reviewer Expertise Preventive medicine, COVID-19, DM, and critical studies. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) A. Alrasheedi A. Peer Review Report For: COVID-19 in the Arab countries: Three-year study [version 3; peer review: 2 approved, 1 approved with reservations] . F1000Research 2024, 12 :1448 ( https://doi.org/10.5256/f1000research.166903.r284091) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/12-1448/v3#referee-response-284091 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Amer Y. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 11 May 2024 | for Version 1 Yasser Amer , King Saud University Medical City, Riyadh, Saudi Arabia 0 Views copyright © 2024 Amer Y. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions This study represents a comprehensive and well-conducted follow-up and collection of COVID-19 data in 22 Arab countries for three consecutive years. The authors obtained accurate monthly data from the official websites of the Ministry of Health in each country in addition to verifying those against the data from the websites of the WHO, World COVID-vaccinations tracker, and Worldometer for COVID-19. The abstract, introduction, and methods were well written, clear, and appropriate to the research topic. I would like to suggest enriching the discussion with this subtitle: "Implications for clinical practice and public health practice". Here are some elements for the respected authors to consider as relevant to the study aim:- Strengthen Healthcare Infrastructure : Examples 1: Invest in healthcare infrastructure, including hospitals, clinics, and medical supplies, to ensure preparedness for future pandemics. Example 2: Enhance the capacity of healthcare systems to accommodate a surge in patients during emergencies. Improve Disease Surveillance : Example 1: Develop and maintain robust surveillance systems to detect and monitor infectious diseases promptly. Example 2: Enhance the sharing of data and information among Arab countries and with international health organizations. Promote Vaccination Campaigns : Example 1: Implement comprehensive and equitable vaccination campaigns to achieve herd immunity against COVID-19 and future infectious diseases. Example 2: Combat vaccine hesitancy through targeted public health messaging and education. Enhance Telemedicine and Digital Health : Example 1: Expand telemedicine and digital health services to improve access to healthcare and reduce the burden on in-person facilities. Example 2: Ensure the privacy and security of electronic health records and telemedicine platforms. Prepare for Variants : Example 1: Develop strategies to monitor and respond to emerging variants of concern, including the rapid adjustment of vaccines and therapeutics.Example 2: Invest in genomic sequencing capabilities for timely variant detection. Strengthen Public Health Messaging : Example 1: Enhance public health communication strategies to provide accurate and timely information to the public during health crises. Example 2: Address misinformation and disinformation through targeted campaigns. Invest in Research and Development : Example 1: Allocate resources for research into infectious diseases, epidemiology, and vaccine development to better prepare for future pandemics. Example 2: Foster collaboration between academia, industry, and public health agencies. Prepare for Healthcare Workforce Challenges : Example 1: Develop contingency plans for healthcare workforce shortages during health emergencies. Example 2: Support the mental health and well-being of healthcare workers. Improve International Collaboration : Example: Foster regional and international collaboration in disease surveillance, response, and research. Example 2: Participate in global initiatives to ensure equitable access to vaccines and treatments. Health Equity and Vulnerable Populations : Example 1: Prioritize health equity in policies and interventions, addressing disparities that affect vulnerable populations. Example 2: Ensure access to healthcare and social support for marginalized communities. The following 4 articles below may be helpful in writing up or re-writing these points, if you agree on them, or additional points to be additional take-home messages for the readers. These are 2 additional online resources:- 1- WHO’s response to COVID-19 in the Eastern Mediterranean Region Independent review by Dalberg Advisors February 2023 https://cdn.who.int/media/docs/default-source/evaluation-office/who-s-response-to-covid-19-in-the-emr---independent-review_february-2023_final.pdf?sfvrsn=130ab01a_3&download=true 2- Distributional Impacts of COVID-19 in the Middle East and North Africa Region: https://www.worldbank.org/en/region/mena/publication/distributional-impacts-of-covid-19-in-the-middle-east-and-north-africa-region#:~:text=The%20report's%20findings%20suggest%20a,and%20how%20many%20people%20work). Is the topic of the review discussed comprehensively in the context of the current literature? Yes Are all factual statements correct and adequately supported by citations? Yes Is the review written in accessible language? Yes Are the conclusions drawn appropriate in the context of the current research literature? Yes References 1. Mandil A, Mabry R, Milani B, Nour M, et al.: Mapping of health innovations in response to the COVID-19 pandemic in Eastern Mediterranean and selected Arab Countries. East Mediterr Health J . 2022; 28 (2): 130-143 PubMed Abstract | Publisher Full Text 2. Alam Z, Mohamed S, Nauman J, Al-Rifai RH, et al.: Hesitancy toward vaccination against COVID-19: A scoping review of prevalence and associated factors in the Arab world. Hum Vaccin Immunother . 2023; 19 (2): 2245720 PubMed Abstract | Publisher Full Text 3. Titi MA, Wahabi H, Elmorshedy H, Shata Z, et al.: Mental health impact of the first wave of COVID-19 pandemic on healthcare workers in 12 Arab countries. East Mediterr Health J . 2022; 28 (10): 707-718 PubMed Abstract | Publisher Full Text 4. Abid M, Gheraia Z, Abdelli H, Sekrafi H, et al.: COVID-19 pandemic and economic impacts in Arab countries: Challenges and policies. Research in Globalization . 2022; 5 . Publisher Full Text Competing Interests No competing interests were disclosed. Reviewer Expertise Evidence-Based Healthcare, Clinical Practice Guidelines, Pediatrics and Child healthcare, Healthcare Informatics, Healthcare Quality and Safety, Healthcare services research, Improvement research, and Implementation research. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 26 Jun 2024 Nasar Alwahaibi, Department of Biomedical Science, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman We would like to express our gratitude to the reviewer for the positive feedback and valuable comments. Below are our detailed responses to the reviewer's queries. This study represents a comprehensive and well-conducted follow-up and collection of COVID-19 data in 22 Arab countries for three consecutive years. The authors obtained accurate monthly data from the official websites of the Ministry of Health in each country in addition to verifying those against the data from the websites of the WHO, World COVID-vaccinations tracker, and Worldometer for COVID-19. The abstract, introduction, and methods were well written, clear, and appropriate to the research topic. I would like to suggest enriching the discussion with this subtitle: "Implications for clinical practice and public health practice". Here are some elements for the respected authors to consider as relevant to the study aim:- Strengthen Healthcare Infrastructure : Examples 1: Invest in healthcare infrastructure, including hospitals, clinics, and medical supplies, to ensure preparedness for future pandemics. Example 2: Enhance the capacity of healthcare systems to accommodate a surge in patients during emergencies. Improve Disease Surveillance : Example 1: Develop and maintain robust surveillance systems to detect and monitor infectious diseases promptly. Example 2: Enhance the sharing of data and information among Arab countries and with international health organizations. Promote Vaccination Campaigns : Example 1: Implement comprehensive and equitable vaccination campaigns to achieve herd immunity against COVID-19 and future infectious diseases. Example 2: Combat vaccine hesitancy through targeted public health messaging and education. Enhance Telemedicine and Digital Health : Example 1: Expand telemedicine and digital health services to improve access to healthcare and reduce the burden on in-person facilities. Example 2: Ensure the privacy and security of electronic health records and telemedicine platforms. Prepare for Variants : Example 1: Develop strategies to monitor and respond to emerging variants of concern, including the rapid adjustment of vaccines and therapeutics. Example 2: Invest in genomic sequencing capabilities for timely variant detection. Strengthen Public Health Messaging : Example 1: Enhance public health communication strategies to provide accurate and timely information to the public during health crises. Example 2: Address misinformation and disinformation through targeted campaigns. Invest in Research and Development : Example 1: Allocate resources for research into infectious diseases, epidemiology, and vaccine development to better prepare for future pandemics. Example 2: Foster collaboration between academia, industry, and public health agencies. Prepare for Healthcare Workforce Challenges : Example 1: Develop contingency plans for healthcare workforce shortages during health emergencies. Example 2: Support the mental health and well-being of healthcare workers. Improve International Collaboration : Example: Foster regional and international collaboration in disease surveillance, response, and research. Example 2: Participate in global initiatives to ensure equitable access to vaccines and treatments. Health Equity and Vulnerable Populations : Example 1: Prioritize health equity in policies and interventions, addressing disparities that affect vulnerable populations. Example 2: Ensure access to healthcare and social support for marginalized communities. The following 4 articles below may be helpful in writing up or re-writing these points, if you agree on them, or additional points to be additional take-home messages for the readers. References Mandil A, Mabry R, Milani B, Nour M, et al.: Mapping of health innovations in response to the COVID-19 pandemic in Eastern Mediterranean and selected Arab Countries. East Mediterr Health J . 2022; 28 (2): 130-143 PubMed Abstract | Publisher Full Text 2. Alam Z, Mohamed S, Nauman J, Al-Rifai RH, et al.: Hesitancy toward vaccination against COVID-19: A scoping review of prevalence and associated factors in the Arab world. Hum Vaccin Immunother . 2023; 19 (2): 2245720 PubMed Abstract | Publisher Full Text Titi MA, Wahabi H, Elmorshedy H, Shata Z, et al.: Mental health impact of the first wave of COVID-19 pandemic on healthcare workers in 12 Arab countries. East Mediterr Health J . 2022; 28 (10): 707-718 PubMed Abstract | Publisher Full Text 4. Abid M, Gheraia Z, Abdelli H, Sekrafi H, et al.: COVID-19 pandemic and economic impacts in Arab countries: Challenges and policies. Research in Globalization . 2022; 5 . Publisher Full Text These are 2 additional online resources:- 1- WHO’s response to COVID-19 in the Eastern Mediterranean Region Independent review by Dalberg Advisors February 2023 https://cdn.who.int/media/docs/default-source/evaluation-office/who-s-response-to-covid-19-in-the-emr---independent-review_february-2023_final.pdf?sfvrsn=130ab01a_3&download=true 2- Distributional Impacts of COVID-19 in the Middle East and North Africa Region: https://www.worldbank.org/en/region/mena/publication/distributional-impacts-of-covid-19-in-the-middle-east-and-north-africa-region#:~:text=The%20report's%20findings%20suggest%20a,and%20how%20many%20people%20work). Response As per the reviewer's suggestion, two paragraphs discussing the "Implications for clinical practice and public health practice" have been added to the discussion section. Consequently, more references have been added. View more View less Competing Interests None reply Respond Report a concern Amer Y. Peer Review Report For: COVID-19 in the Arab countries: Three-year study [version 3; peer review: 2 approved, 1 approved with reservations] . F1000Research 2024, 12 :1448 ( https://doi.org/10.5256/f1000research.156102.r223543) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/12-1448/v1#referee-response-223543 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 A. Alrasheedi A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The author(s) is/are employees of the US Government and therefore domestic copyright protection in USA does not apply to this work. The work may be protected under the copyright laws of other jurisdictions when used in those jurisdictions. 11 May 2024 | for Version 1 Ahmad A. Alrasheedi , Department of Family and Community Medicine, College of Medicine, Qassim University, Buraydah, Al Qassim Region, Saudi Arabia 0 Views copyright © 2024 A. Alrasheedi A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The author(s) is/are employees of the US Government and therefore domestic copyright protection in USA does not apply to this work. The work may be protected under the copyright laws of other jurisdictions when used in those jurisdictions. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Overall, this study is excellent and worth accepting as the authors evaluated the spread of the COVID-19 pandemic in a critical region, the Arab world, over three years (2020-2022). Understanding the epidemiology of COVID-19 in the Arab world and comparing it to the world could help researchers and decision-makers explore the best ways to deal with COVID-19 and may provide lessons for a more effective response to public health emergencies in the future. However, there are some suggestions to improve the article. 1- Type of the study : Is this a review article or an original research? Based on the article's methodology and structure, this article is considered original (research article). The authors extracted primary/secondary data (raw data) from online websites and then analyzed and interpreted the data. In contrast, a review article or paper is based on other published articles. Review articles generally summarize the existing literature on a topic in an attempt to explain the current state of understanding of the topic. Therefore, this is not a review article because the authors did not base their methodology on a review of previous studies/research. The authors should reconsider this part! 2- Suppose this article is considered an original study, which it appears to be. In that case, it is preferable to change the word “ review ” in the title to another word, for example, “study,” so that the title is: “COVID-19 in the Arab countries: A three-year study” or “COVID-19 in the Arab countries: A study after three years”. 3- In the "conclusions" section of the Abstract, Confirmed what? Confirmed cases or confirmed deaths. A word is missing! 4- In the first line of the "Introduction" section, which coronavirus is? It is the novel coronavirus, or as it is named, SARS-CoV-2. In contrast, the disease caused by this virus is called COVID-19. I suggest it be written as "… declared coronavirus disease 2019 (COVID-19) as …". 5- In the second sentence of the "Introduction" section, which years? 2020-2022 or 2021-2023; please specify! 6- The reference No. 5 is old (2004). Is there any recent one? 7- In paragraph 4 of the "Introduction" section, please remove the phrase "the coronavirus." To be "… many different variants of SARS-CoV-2, including …". Also, in this statement: as long as the coronavirus SARS-CoV-2 remains. Please remove the phrase "the coronavirus". 8- In the "Methods" section, please provide the link/reference for each website if possible (Worldometer...). 9- The exclusion criterion was unofficial information regarding COVID-19 in all Arab countries ,... This phrase ( unofficial information regarding COVID-19 in all Arab countries ) should be removed because it is known from the inclusion criteria (exclusion criteria are not the opposite of inclusion criteria). 10- The following information was collected from each Arab country: total population, median age, number of monthly confirmed, ... Confirmed what? Please make it clear. 11- "Results" section: All Arab countries utilized real-time polymerase chain reaction (RT-PCR) as the testing method for SARS-CoV-2. I suggest to transfer this sentence to the "Introduction" section. 12- UAE (19,632,329) recorded then the highest number of tests per million population (PMP), followed by Bahrain (5,960,320), and then Oman (4,695,724). Rephrasing the sentence to be clear, I suggest, " The UAE recorded the highest number of tests per million population (PMP) with 19,632,329, followed by Bahrain (5,960,320), and then Oman (4,695,724)." Always add "the" before UAE, USA, and UK while mentioned in the text. 13- The people in Qatar and the United Arab Emirates ... have [أع1] Use the abbreviation: the UAE. 14- Table 1: Please identify the abbreviations in the table (Add footnotes), even if they have already been mentioned in the text. Please check the population number of Mauritania. 15- Table 2: define the abbreviations in the table (Add footnotes): UEA, SA, and PMP, as well as for other tables. Also, in column 10 (Q1-22), some numbers are not uniform in the way they are written. 16- In the "Discussion" section, New Year season New Year season? Do you mean influenza season, where URTIs, including coronaviruses, increase? 17- Another reason for the spike increase is the slow uptake of the vaccine in many countries. Which countries? of the world, including Arab countries or in many Arab countries? 18- During the first, second, and third quarters of 2020, the pandemic was under control in most Arab countries due to ... Using the probability form, such as "mostly due to" or "probably because," is better. 19- The first quarter of 2022 was a shockwave as it was recorded with the highest-ever number of COVID-19 confirmed cases with 3,235,665 peaked by Jordan with a total number of 630,811. To be clearer, I suggest you rephrase it to be: "During the first quarter of 2022, which was a shockwave, the Arab countries recorded the highest number of confirmed COVID-19 cases ever reported between 2020 and 2022. The total number of cases was 3,235,665, with Jordan reporting the highest number of cases at 630,811." 20- Qatar was reported with the highest number of confirmed cases of COVID-19 in the fourth quarter of 2022 Suggesting to rephrase by adding among Arab countries. 21- In paragraph no. 12, ...Australia, USA , and Turkey have performed tests more than their populations. DEFINE USA: please write the United States of America . 22- In the "Strengths and limitations" section, However, there are a few limitations in our review . study or review? This will depend on your classification. 23- Although the number of confirmed , death, and subsequently recovered cases of... Confirmed what? Please make it clear. Thank you for your valuable study. Is the topic of the review discussed comprehensively in the context of the current literature? Yes Are all factual statements correct and adequately supported by citations? Yes Is the review written in accessible language? Yes Are the conclusions drawn appropriate in the context of the current research literature? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Family Medicine, Public Health, Common Health Problems (such as DM, HTN, Dyslipidemia, and Depression), and Epidemiology/Prevention of Infectious diseases such as COVID-19 and Influenza. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 26 Jun 2024 Nasar Alwahaibi, Department of Biomedical Science, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman We would like to extend our gratitude to the reviewer for his positive feedback and valuable comments. Listed below are our responses, addressing each query from the reviewer in detail. Overall, this study is excellent and worth accepting as the authors evaluated the spread of the COVID-19 pandemic in a critical region, the Arab world, over three years (2020-2022). Understanding the epidemiology of COVID-19 in the Arab world and comparing it to the world could help researchers and decision-makers explore the best ways to deal with COVID-19 and may provide lessons for a more effective response to public health emergencies in the future. However, there are some suggestions to improve the article. Response Thank you 1- Type of the study : Is this a review article or an original research? Based on the article's methodology and structure, this article is considered original (research article). The authors extracted primary/secondary data (raw data) from online websites and then analyzed and interpreted the data. In contrast, a review article or paper is based on other published articles. Review articles generally summarize the existing literature on a topic in an attempt to explain the current state of understanding of the topic. Therefore, this is not a review article because the authors did not base their methodology on a review of previous studies/research. The authors should reconsider this part! Response As suggested by the reviewer, the title has been changed. 2- Suppose this article is considered an original study, which it appears to be. In that case, it is preferable to change the word “ review ” in the title to another word, for example, “study,” so that the title is: “COVID-19 in the Arab countries: A three-year study” or “COVID-19 in the Arab countries: A study after three years”. Response The title has been changed to “COVID-19 in the Arab countries: A three-year study” 3- In the "conclusions" section of the Abstract, Confirmed what? Confirmed cases or confirmed deaths. A word is missing! Response To make it clearer, we removed “subsequently” as follows: Although the number of confirmed, death, and recovered cases of COVID-19 have greatly reduced in the last quarter of 2022 in most Arab countries. 4- In the first line of the "Introduction" section, which coronavirus is? It is the novel coronavirus, or as it is named, SARS-CoV-2. In contrast, the disease caused by this virus is called COVID-19. I suggest it be written as "… declared coronavirus disease 2019 (COVID-19) as …". Response As suggested, the sentence has been rephrased. 5- In the second sentence of the "Introduction" section, which years? 2020-2022 or 2021-2023; please specify! Response We referred to 2020 – 2022. 6- The reference No. 5 is old (2004). Is there any recent one? Response Yes, it is old but we have cited the original source. 7- In paragraph 4 of the "Introduction" section, please remove the phrase "the coronavirus." To be "… many different variants of SARS-CoV-2, including …". Also, in this statement: as long as the coronavirus SARS-CoV-2 remains. Please remove the phrase "". Response “The coronavirus” has been removed. 8- In the "Methods" section, please provide the link/reference for each website if possible (Worldometer...). Response The links to the WHO and Worldometer are updated daily. In addition, the links to the ministries of health are no longer accessible. 9- The exclusion criterion was unofficial information regarding COVID-19 in all Arab countries ,... This phrase ( unofficial information regarding COVID-19 in all Arab countries ) should be removed because it is known from the inclusion criteria (exclusion criteria are not the opposite of inclusion criteria). Response “Unofficial information regarding COVID-19 in all Arab countries” has been removed. 10- The following information was collected from each Arab country: total population, median age, number of monthly confirmed, ... Confirmed what? Please make it clear. Response We meant confirmed cases “number of monthly confirmed, death, and recovered cases, 11- "Results" section: All Arab countries utilized real-time polymerase chain reaction (RT-PCR) as the testing method for SARS-CoV-2. I suggest to transfer this sentence to the "Introduction" section. Response “All Arab countries utilized real-time polymerase chain reaction (RT-PCR) as the testing method for SARS-CoV-2” has been removed. 12- UAE (19,632,329) recorded then the highest number of tests per million population (PMP), followed by Bahrain (5,960,320), and then Oman (4,695,724). Rephrasing the sentence to be clear, I suggest, " The UAE recorded the highest number of tests per million population (PMP) with 19,632,329, followed by Bahrain (5,960,320), and then Oman (4,695,724)." Always add "the" before UAE, USA, and UK while mentioned in the text. Response As suggested, have been corrected. 13- The people in Qatar and the United Arab Emirates ... have [أع1] Use the abbreviation: the UAE. Response Has been corrected. 14- Table 1: Please identify the abbreviations in the table (Add footnotes), even if they have already been mentioned in the text. Please check the population number of Mauritania. Response Those abbreviations were initially defined in all tables at the time of submission then, the journal editors removed them. You are right, the population of Mauritania is 4,736,139. This information has been corrected and the countries in Table 1 have been reordered. 15- Table 2: define the abbreviations in the table (Add footnotes): UEA, SA, and PMP, as well as for other tables. Also, in column 10 (Q1-22), some numbers are not uniform in the way they are written. Response Those abbreviations were initially defined in all tables at the time of submission then, the journal editors removed them. The numbers in column 10 (Q1-22) have been corrected. 16- In the "Discussion" section, New Year season New Year season? Do you mean influenza season, where URTIs, including coronaviruses, increase? Response Yes, to make it clearer, the sentence has been modified to influenza season. 17- Another reason for the spike increase is the slow uptake of the vaccine in many countries. Which countries? of the world, including Arab countries or in many Arab countries? Response The sentence had been modified. 18- During the first, second, and third quarters of 2020, the pandemic was under control in most Arab countries due to ... Using the probability form, such as "mostly due to" or "probably because," is better. Response The sentence had been modified. 19- The first quarter of 2022 was a shockwave as it was recorded with the highest-ever number of COVID-19 confirmed cases with 3,235,665 peaked by Jordan with a total number of 630,811. To be clearer, I suggest you rephrase it to be: "During the first quarter of 2022, which was a shockwave, the Arab countries recorded the highest number of confirmed COVID-19 cases ever reported between 2020 and 2022. The total number of cases was 3,235,665, with Jordan reporting the highest number of cases at 630,811." Response As suggested, the sentence had been rephrased. 20- Qatar was reported with the highest number of confirmed cases of COVID-19 in the fourth quarter of 2022 Suggesting to rephrase by adding among Arab countries. Response As suggested, the sentence had been modified. 21- In paragraph no. 12, ...Australia, USA , and Turkey have performed tests more than their populations. DEFINE USA: please write the United States of America . Response The USA has been defined. 22- In the "Strengths and limitations" section, However, there are a few limitations in our review . study or review? This will depend on your classification. Response Has been changed to “study”. 23- Although the number of confirmed , death, and subsequently recovered cases of... Confirmed what? Please make it clear. Response We removed subsequently to be clearer: “ Although the number of confirmed, death, and subsequently recovered cases of COVID-19 have greatly reduced in the last quarter of 2022 in most Arab countries, further efforts to address the need to re-campaign on COVID-19 vaccines and raise awareness programs about boosters must be implemented”. Thank you for your valuable study. View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern A. Alrasheedi A. Peer Review Report For: COVID-19 in the Arab countries: Three-year study [version 3; peer review: 2 approved, 1 approved with reservations] . F1000Research 2024, 12 :1448 ( https://doi.org/10.5256/f1000research.156102.r233650) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/12-1448/v1#referee-response-233650 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Zahid M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 01 Apr 2024 | for Version 1 Muhammad Nauman Zahid , College of Science, University of Bahrain, Sakhir, Southern Governorate, Bahrain 0 Views copyright © 2024 Zahid M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The authors have made an interesting attempt at “COVID-19 in the Arab countries: Three-year review.” The manuscript is interesting; however, the authors need to justify the scientific writing of the manuscript. Some of the general comments are provided below: Considering the usage of several sources, what steps were taken to address any potential contradictions or inconsistencies discovered in the data collected? In order to maintain the dataset's integrity, how were possible duplicate items found and dealt with? What variables could account for the variations in COVID-19 cases and fatalities that were noted during the three years from January 2020 to December 2022? Could these tendencies have been impacted by any significant policy changes or events? Taking into account the possible influence of variables including climate, public health initiatives, and alterations in population behavior, how were seasonal fluctuations in COVID-19 incidence and death taken into account in the analysis? Could you provide further details about any possible biases or confounding factors, such as variations in healthcare access, population demographics, or government response tactics, that would affect how these cross-regional comparisons are interpreted? According to the manuscript, vaccination campaigns were a major factor in the decline of COVID-19 cases, fatalities, and hospital admissions in Arab nations. Can you offer more proof or analysis to back up this claim, such as comparisons of COVID-19 results before and after vaccination campaigns or research on the efficacy of vaccines? How were public opinions of vaccine safety and efficacy, vaccine hesitancy, and disinformation addressed during the vaccination campaign discussion? Were any tactics put in place to enhance vaccination uptake and remove obstacles to access? Is the topic of the review discussed comprehensively in the context of the current literature? Yes Are all factual statements correct and adequately supported by citations? Yes Is the review written in accessible language? Yes Are the conclusions drawn appropriate in the context of the current research literature? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Virologist I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 09 May 2024 Nasar Alwahaibi, Department of Biomedical Science, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman We would like to take this opportunity to express our thanks to the reviewer for the positive feedback and helpful comments. Below are our responses, point-by-point to the queries of the reviewer. The authors have made an interesting attempt at “COVID-19 in the Arab countries: Three-year review.” The manuscript is interesting; however, the authors need to justify the scientific writing of the manuscript. Some of the general comments are provided below: Considering the usage of several sources, what steps were taken to address any potential contradictions or inconsistencies discovered in the data collected? Response We use the Ministry of Health official websites in each Arab country as an initial source as they provide daily data, then verified with the WHO and Worldometer sources. In case of different data, which is not common, we referred to the Ministry of Health in each Arab country . In order to maintain the dataset's integrity, how were possible duplicate items found and dealt with? Response The data are not duplicated, but sometimes there are differences between the WHO and Worldometer sources as they are reported at different times on the Ministry of Health's official websites. What variables could account for the variations in COVID-19 cases and fatalities that were noted during the three years from January 2020 to December 2022? Could these tendencies have been impacted by any significant policy changes or events? Response The variables or factors that could account for the variations in COVID-19 cases and fatalities are mentioned in the discussion section and these include lockdown measures, mitigation strategies (such as implementing social distancing), employment and scale of diagnostic testing and vaccine intake, timely response of governments, weak healthcare system (physical resources and healthcare personnel and under reporting) and hence, all of these could be attributed to the “healthcare policy” of each country. Other variables include the occurrence of virus-related factors such as the fast-spreading Omicron variant, the UK variant, and the Alpha variant. Population or demographic characteristics such as age was also identified as a potential factor that may have influenced infection and death rates. We demonstrate in the discussion section that the ability of “healthcare systems to respond promptly against the COVID-19” such as implementing strict lockdown measures and mitigation strategies significantly reduced confirmed cases and fatalities. We also show in the discussion that countries that employed heavy testing protocols revealed higher number of cases and that under-reporting could have played a role in countries that did not employ large-scale testing. Taking into account the possible influence of variables including climate, public health initiatives, and alterations in population behavior, how were seasonal fluctuations in COVID-19 incidence and death taken into account in the analysis? Response According to the data of COVID-19 fluctuations, the spikes of Covid-19 were connected to the spread waves but not the climate. For example, in Tunisia, the peaked deaths were in the third quarter of 2021 which is considered as hot climate whereas in Lebanon the peaked deaths were in the first quarter of 2021 which is considered as a cold climate. According to the public health initiatives (e.g. vaccination) and positive alteration in population behaviors, we mentioned in the paper how these two factors affected the decrease in the death’s numbers. Could you provide further details about any possible biases or confounding factors, such as variations in healthcare access, population demographics, or government response tactics, that would affect how these cross-regional comparisons are interpreted? Response This is very good question, however, population demographics such as gender and age are not reported. Thus, we have added the following sentence as a limitation: The lack of gender and age data in numerous Arab countries prevented us from conducting thorough comparisons and assessing potential risk factors. Regarding the government response tactics, we have already mentioned in the discussion section that: During the first, second, and third quarters of 2020, the pandemic was under control in most Arab countries due to the implementation of extreme precautionary measures. The major measures include land, sea, and air route closure, nighttime or all-day curfew and lockdown, school and universities closure, worship places closure, prohibition of gatherings, closure of shops, malls, beaches, public parks, and gardens, cancellation of all cultural and sports events, festivals, seminars, and scientific meetings, and suspension of work in all government and private sectors. Regarding the access to healthcare facilities during COVID-19 crises, this information is not available in all Arab countries. We know that GCC countries offered free medical treatment and vaccinations to all residents but this information is missing in other Arab countries. According to the manuscript, vaccination campaigns were a major factor in the decline of COVID-19 cases, fatalities, and hospital admissions in Arab nations. Can you offer more proof or analysis to back up this claim, such as comparisons of COVID-19 results before and after vaccination campaigns or research on the efficacy of vaccines? Response Our results did not study the comparison of COVID-19 before and after vaccination campaigns. As suggested, the following paragraph has been added in the discussion section: Research conducted in the United Arab Emirates regarding the inactivated BBIBP-CorV (Sinopharm) vaccine revealed that its efficacy against severe COVID-19 outcomes was 80% for hospitalization, 92% for critical care admission, and 97% for preventing death. 46 In addition, a study conducted in Morocco on the long-term efficacy of the inactivated BBIBP-CorV vaccine revealed a decrease in effectiveness, dropping from 88% to 64% six months after vaccination. 47 Furthermore, in Qatar, a different study demonstrated that the efficacy of BBIBP-CorV vaccine against SARS-CoV-2 infections decreased gradually, with a more rapid decline observed after the fourth month. This decline resulted in about 20% protection at five to seven months following vaccination. However, the vaccine's efficacy remained nearly 96% effective in preventing hospitalization and death six months after vaccination. 48 How were public opinions of vaccine safety and efficacy, vaccine hesitancy, and disinformation addressed during the vaccination campaign discussion? Were any tactics put in place to enhance vaccination uptake and remove obstacles to access? Response The following sentence has been added in the discussion section: Certain tactics were used to enhance public awareness and acceptance of vaccine during these campaigns. One of the most effective tactics was to address public opinions of vaccine safety and efficacy by disseminating accurate information through authorized channels. This information was in different languages to reach out all in the community. Community engagement and healthcare guidance were also helpful. During the vaccination process, the uptake of vaccine was enhanced by removing any obstacle that might delay such a process. For example, setting up vaccination centers in different locations with an easy access and quick appointment. These centers had big area to accommodate more people at each time. Community outreach existed for those who could not go to these centers. 44 View more View less Competing Interests None reply Respond Report a concern Zahid MN. Peer Review Report For: COVID-19 in the Arab countries: Three-year study [version 3; peer review: 2 approved, 1 approved with reservations] . F1000Research 2024, 12 :1448 ( https://doi.org/10.5256/f1000research.156102.r247533) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. 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