In the United Arab Emirates, the coronavirus test comes to you.
Sweeping through working-class housing blocks and crowded migrant labor camps, government health teams administer the mandatory nasal swabs—and then isolate positive cases.
In more affluent areas, those with spare cash and no desire to visit one of many drive-through clinics can book a home visit on their own terms, with the results sent to their phones by the end of the day.
A fresh Covid-19 test result is required to drive from one of the country's two main cities, Dubai, to its capital, Abu Dhabi. Many service workers—from taxi drivers to waiters to shop assistants in malls—are required to undergo frequent screening. For people in several categories, including those over 50 or with other risk factors, it is free.
"One of the most important tactics of handling any pandemic is testing, testing, testing. It's an investment that pays for itself," said Anwar Sallam, chief medical officer of SEHA, the health-care provider that operates Abu Dhabi's public-hospital system and runs Covid-19 testing centers in all seven emirates of the U.A.E. "The government has made access to testing extremely easy, and all these measures have made us contain, to a very large extent, the spread of the virus," he said.
A federation of 10 million residents, the U.A.E. has already conducted over 4.5 million tests, and aims to reach six million within two months. That is the world's highest testing rate among countries with more than a million inhabitants, and more than three times the current rate in the U.S. Other wealthy Gulf monarchies, such as Bahrain, with nearly the same testing rate as the U.A.E., and their rival Qatar, are pursuing a similar approach.
That has allowed their economies to restart. In Dubai, the airport has reopened to tourists, as long as they take the test, and most venues—from restaurants to cinemas to gyms and beach resorts—operate almost normally. Field hospitals set up months ago to deal with the expected surge of cases now stand without patients.
Not all the Gulf monarchies went for mass testing. The region's most populous nation, Saudi Arabia, and the less affluent Oman, haven't adopted the strategy—and are struggling with more severe outbreaks as a result. Though Saudi Arabia has ramped up efforts in recent weeks, so far the kingdom has tested less than 8% of its population, with some asymptomatic people reporting they had been turned away.
More testing means that more cases are recorded, skewing international comparisons—and risk perceptions. Qatar and Bahrain lead the world in the number of cumulative coronavirus infections per million people, while the U.A.E. has reported more cumulative confirmed cases per million than such pandemic hot spots as Italy or the U.K .
That is one reason why none of the Gulf monarchies were included earlier this month on the European Union 's list of countries whose citizens are allowed to visit the bloc. (The U.S., unlike Canada, Australia and New Zealand, also didn't make the list.)
"The way we deal with this pandemic will really impact how we deal with future pandemics," said Khalid Belhoul, undersecretary at the U.A.E. foreign ministry. "We don't want decisions that contradict best practices. On one hand the World Health Organization is telling member states to test. But another assessment tells: If you test a lot you will have a lot of cases, and you will not be considered a safe country," he said.
In the U.A.E., the daily number of cases—after a rebound in late June—has now fallen below 300 for several days. The test positivity rate, a marker of whether the disease is spreading, is as low as 0.4%, compared with nearly 20% in Florida.
All the Gulf states report some of the world's lowest death rates from the virus. The total number of reported Covid-19 deaths in the U.A.E. since February stands at 340, representing 0.6% of its diagnosed cases. By comparison, Arizona—with a significantly smaller population—has reported 2,784 coronavirus fatalities.
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The high proportion of fit, relatively young foreign workers in the populations of many Gulf states has helped blunt the effect of the virus, which is much more lethal among the elderly , epidemiologists say. So did the widespread availability of masks and hand sanitizer.
When the first coronavirus outbreak started in Wuhan in January, several Gulf states moved quickly to secure testing equipment and reagents, placing orders with suppliers in the U.S., Europe and Asia—and using their wealth to outbid rivals. At SEHA in Abu Dhabi, the new equipment has removed the need for qualified lab technicians to prepare nasal swabs for processing. Instead, the operator just has to insert the swab into the machine, with the automated procedure delivering results within four hours.
A critical outcome of this blanket testing approach in the Gulf has been the discovery of a far larger percentage of asymptomatic cases than in the West.
While the U.S. Centers for Disease Control and Prevention currently estimates that 40% of Covid-19 infections are asymptomatic, the percentage of asymptomatic cases in the U.A.E. was 70% to 75% in the spring, and has reached 95% now, said Dr. Sallam. In Kuwait, Bahrain and Qatar, too, more than 80% of those who test positive show no symptoms of the disease, health officials and doctors there say. Many of these individuals probably wouldn't have been identified in a less comprehensive testing environment—and would have gone on to infect others.
"Our strategy is to test all, the one who's having symptoms or even not having symptoms," said Waleed Khalifa Al Manea, undersecretary of the Bahrain ministry of health. "The asymptomatic is a larger number than the symptomatic. They don't have to get to the hospitals, they don't have to get any treatment, it's not a big burden on the country. But home isolation will reduce the spread of the disease," Dr. Al Manea said.
In Qatar, which has already tested one-sixth of its population, officials agree that this approach has saved lives, with only 159 recorded fatalities amid 107,000 positive cases. "Being able to detect cases early and treat them immediately has helped prevent further complications," said Dr. Abdullatif Al Khal, chairman of the country's national strategic group on Covid-19.