Initial tests suggest E. coli behind spate of gastrointestinal cases in Aswan, health minister says

"We're afraid to drink tap water, and we can't afford bottled water," Nadia Hammad, a resident of Sadaqa al-Gadeeda neighborhood in Aswan, told Mada Masr, expressing a sense of panic and fear spreading about the safety of drinking water as a spate of cases of acute gastroenteritis emerges in Egypt’s south.

Health Minister Khaled Abdel Ghaffar, who has acknowledged that over 128 people have been hospitalized since September 11 due to the infection, announced on Monday that initial analyses indicate that the cases may be caused by the Escherichia coli (E. coli) bacteria.

Abdel Ghaffar reassured the public that drinking water has been checked and is safe for consumption.

Yet residents of the area have already lived through days of speculation and uncertainty, with many concerned about what they can do to avoid its spread. Others are rushing to pharmacies to obtain the medicines needed to treat symptoms.

Here’s what we know about the situation so far.

How widespread is the infection, and how serious?

Over the weekend, Health Minister Khaled Abdel Ghaffar told journalists that 128 cases have been admitted to hospitals since the crisis began, with 106 still hospitalized, some in intensive care.

On Monday, he acknowledged five recent deaths in the area, which he said were not definitively linked to the emergence of the bacterial infection. He said that cases have lessened over the past 48 hours.

Yet testimonies have been shared of fatalities due to gastroenteritis in the Daraw district and Abu al-Rish village in recent days. Mada Masr obtained a death certificate dated September 19 from Aswan University Hospital, indicating that one resident died from "complete circulatory, respiratory and cardiac arrest" caused by "severe gastroenteritis leading to dehydration, kidney failure and a stroke."

Mada Masr spoke to the son of the deceased, who said his father lived in Aswan but worked in Abu al-Rish. "My father began vomiting and had diarrhea on the morning of September 16. That night, we took him to the university hospital, where his blood pressure measured 40/70. He was admitted to intensive care, and passed away on Thursday afternoon."

The head of Aswan security directorate was present at the hospital when we arrived, monitoring the cases. There were about 200 people with the same symptoms," he recalled, adding that "the doctors don’t know what it is."

Where are the cases occurring?

Patients suffering with the symptoms are distributed across four hospitals in Aswan at present, the health minister said, pointing to the Sadaqa Specialty Hospital, Masala Specialized Hospital, Aswan University Hospital, and Daraw Central Hospital. 

Many cases were concentrated in Abu al-Rish and surrounding villages, yet testimonies gathered by Mada Masr confirmed cases of gastroenteritis within the city of Aswan itself, with at least one severe enough to require admission to intensive care.

How are patients being treated? 

Since cases were first reported and until Saturday night, Masala Hospital (formerly the Aswan Fever Hospital) has been admitting daily cases of gastroenteritis, often accompanied by severe dehydration which leads to impaired kidney function, according to a doctor at the hospital who spoke to Mada Masr on condition of anonymity. The doctor pointed to an extreme level of secrecy around the admission and treatment of patients, "even among the doctors themselves." "The emergency doctor doesn’t know the diagnosis of the patient being admitted," they said.

"The hospital is in a state of emergency, with doctors' leave prohibited, and admissions are currently limited to gastroenteritis cases. No cases of fever or blood transfusions are being admitted because there’s no space in the ICU or intermediate care units." "People are criticizing us, thinking we don’t want to admit them. It’s because everyone is in a state of panic."

The doctor also said that "the situation is bad because people are coming to the hospital very late, by which time their kidney function has already been compromised." As a result, "about 30 percent of the patients who arrive at the hospital are being transferred to the dialysis unit."

The Health Ministry's emergency department sent an initial protocol for handling the cases on September 19 — about eight days after the cases first spread — of which Mada Masr reviewed a copy. 

The son of the man who died due to his symptoms on September 19 explained that hospital resources are very limited, complicating treatment. "There are no tests at the university hospital. We had to get CT scans and lab work done outside, and even the medications, IV fluids and cannulas — everything we had to buy from outside. Many people can't afford it and don’t know what to do."

Omayma, a pharmacist working near the Sadaqa General Hospital in Aswan echoed the story. She told Mada Masr that she dispensed medication to four patients with acute gastroenteritis within the first three hours of her shift on Sunday. "The hospital doesn’t have medicines, so patients are coming here to buy intestinal antiseptics like Antinal and Flagyl, the antibiotic Doxycost and oral rehydration salts, as well as cannulas," she said, adding that "these cases aren’t from Abu al-Rish or the villages being reported as affected, they’re from the Sadaqa neighborhood."

Three residents of Abu al-Rish, the area most affected, told Mada Masr that they had resorted to buying bottled water and no longer trusted even their home water filters. Meanwhile, two other sources told Mada Masr that they had been warned by friends and relatives working at the governorate’s water company to stop drinking tap water and to either use water stored from before the crisis or bottled water.

What is causing the infection and its spread? 

Abdel Ghaffar suggested that E. coli is likely the cause this morning, though he’s yet to confirm that it's behind the symptoms and suggest what might have caused the bacteria to spread. Public statements have posed potential causes ranging from temporary contamination of drinking water to contaminated sweets sold at festivities for Mawlid al-Nabi. 

The government maintains that the situation is “under control," and that fear is being fueled by "malicious rumors." 

Abdel Ghaffar ruled out coronavirus and monkeypox during Monday’s press conference, and said the ministry has nothing of that sort to hide. 

He also pushed back against rumors that the surge in cases is an outbreak of cholera, one of the main rumors which has gained traction among residents, in light of the disease’s spread in neighboring Sudan, amid the chaos caused by the war there.

Speaking on Saturday, Abdel Ghaffar suggested instead that, "it could be due to contaminated food or water, either locally sourced or they have received some that may cause such cases," adding that food and water analyses would be conducted and released later. On Monday, he announced that water and wastewater treatment analyses showed that water was safe, and said further analyses would be released within 48 hours. The precise cause is still unknown, he continued.

Several Aswan city residents told Mada Masr that the Health Ministry and supply system officials conducted inspection campaigns on the markets on Sunday, prompting the temporary closure of butchers, poultry shops, juice vendors and grocery stores.

In an attempt to quell the panic, a series of official statements were released on Sunday, including a public appearance by the Aswan governor, who drank tap water on camera to reassure residents. Aswan MP Reham Abdel Nabi also swore that she, the governor and the general secretary had all consumed tap water, adding that “tap water is better now than it was before," attributing the improvement to cleaning the filters at water treatment plants and increasing chlorine levels to purify the water.

Abdel Nabi told Mada Masr that patient samples had been flown to central laboratories in Cairo, with results expected on Monday. She reiterated an earlier suggestion from the governor, linking the illness to contaminated sweets sold at "extremely cheap prices" during the Mawlid al-Nabi celebrations.

In the absence of clear information until Monday, speculation abounded. Social media media users proffered theories ranging from cholera to water contamination caused by the KIMA petrochemical plant. Fact-checking platform Matsda2sh suggested on Sunday that the contamination might be caused by the mixing of flood water with drinking water, which water treatment plants couldn’t handle.

KIMA denied any involvement in the events in Aswan in a statement addressing the stock exchange on Sunday. The company stressed that it undergoes regular inspections by environmental and occupational health authorities, stating that its industrial wastewater is treated and directed to the Allaqi wastewater treatment plant, operated by Aswan Drinking Water and Sanitation Company.