Africa: Where is Africa located 2 months after the COVID-19 outbreak?

05/02/2020 World



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Cape Town: More than 34,000 cases of COVID-19 have been confirmed in Africa in the two months since the first confirmed case of the disease on the continent, with more than 1,500 lives lost. Dr. Matshidiso Moeti, Regional Director of the World Health Organization (WHO) for Africa, said that physical distancing and national blockades are some of the measures used to mitigate the spread of the new coronavirus, reducing the total number of cases when combined with increased testing.

South Africa is one of the countries with the most confirmed cases and evidence. Its Minister of Health, Dr. Zwelini Mkhize from South Africa, provided information on how his country tried to cope with the pandemic during the WHO briefing organized by the World Economic Forum (WEF).

“We have addressed this as a national campaign led by the president along with several cabinet ministers, business, civil society and members of opposition parties. We all agreed on an approach as a coherent unit.” Mkhize said, he shared statistics on South African infection and death rates.

“Since the first confirmed case on March 5, we have had 5,350 cases reported. Of those, we have had 2,073 recoveries and 103 deaths. This gives us a mortality rate of about 1.3%.”

Mkhize said the government’s approach was based on projections that the eventual number of cases would be too large for the nation’s hospitals to treat properly. “We needed to take containment measures to flatten the curve. There had to be a proactive approach to determining the number of positive cases before they reached hospitals, (and) treating them in time so that we did not expect an avalanche to descend to our facilities. Health “.

The South African government trained and deployed 60,000 health workers who have been supported by non-governmental organizations, including the President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund. “At this point, six million people have been screened for symptoms and temperatures.”

Mkhize said the infections arose from “conglomerate outbreaks,” when church meetings, factories and stores can cause groups of people to become infected together.

Speaking from Accra, an epidemiologist and former director of the Noguchi Memorial Research Institute, Professor Kojo Ansah Koram said that Ghana’s modus operandi was to quarantine people suspected of having the disease, especially travelers, from the start.

“I think this was good because at the time we weren’t sure what was going on. But for a group of about 1,000 travelers, the decision was made to quarantine and test them. Then we found out that more than 10% were positive.” Professor Koram especially noted the fact that infected travelers were asymptomatic, which determined Ghana’s way forward. “From that experience, the decision was made to trace suspected cases, including contacts of people who had been in hospitals, and to conduct the tests as widely as possible.”

Koram said Ghana’s death rate is around 1%. “At the beginning, we underestimated our testing capabilities, so we were a bit overwhelmed, but we managed to overcome this. We have now conducted more than 110,000 or 120,000 tests.”

“Since March 12 we have had 1,671 positive cases. Unfortunately, we have lost about 16, and we have had around 190 recoveries … We have 1,483 cases under active observation. Most of them are in isolation centers with no symptoms.”

Accra is the epicenter of the outbreak in Ghana, Koram said, with more than 80% of cases in the nation’s capital. The disease also spread to Kumasi with people in other regions of the country who apparently caught it from people who had been in the southern Ghanaian city. “When the decision was made to close Accra, a grace period was granted. Some people left Accra, a considerable part of whom went to other regions.”

questions and answers session

Recent reports suggest serious problems in Dar es Salaam. No figures have been released. How concerned is WHO about the situation in Tanzania?

Moeti: “Before talking specifically about Tanzania, we are looking at countries that adopt a response approach at different speeds. The main measures include case identification, contact tracing, isolation and quarantine when necessary. On top of that , the physical distancing measures that have been most widely implemented in cities and countries. What we have observed is that Tanzania took time to implement these measures, particularly physical distancing. For example, while schools were closed, Places of worship were kept open so that the gathering of people continued to take place indoors, as well as in shopping areas and markets, which is an aspect of our countries that has been very difficult to impose. On top of that, after Dar en Salaam was recognized as the epicenter of travel prevention from there it took time to regulate what sign ifica, as Prof. Koram mentioned, when Ghana announced that Accra was being closed, there was a grace period in which people traveled outside the city and there managed to spread the virus. This, we believe, was happening in Tanzania. In addition, we observe and receive reports from neighboring countries that truck drivers, people on the road carrying cargo from all over Tanzania, have tested positive in several neighboring countries. So we continue through our team in the country and working with technical partners on the ground to advise the government, to provide them with the knowledge that WHO has with the guidelines that we have and with the experience that we have from other countries to make those decisions. data-driven policies that will allow the government to stay on top of the situation and hopefully start to see a curve curve. “

South Africa and Ghana have a more or less similar death rate. These are low figures compared to the rest of the world. Which do you think are responsible for the low mortality rates in Africa?

Mkhize: “I think for us in Africa what would be helpful would be for us to do our best and use our health workers and field operators to search for and find people with suspicious symptoms, test them early before any complications, and then in the process we could isolate them if they are found to be positive. I think that will be very helpful in reducing the number of people who could overwhelm our system. We also found that there are many people who are asymptomatic, especially the younger ones. And therefore it is important for us to always have an idea of ​​the prevalence of infection in the community. Regarding mortality, I think it’s a bit early to explain what it could be, but we believe that Africa has been largely behind the rest of the world in the onset of the outbreak. It may be early for us. Second, we’ve noticed that younger, healthier people tend to better manage the infection. Most of the patients who have succumbed have had comorbidities. and underlyin g cardiovascular, lung and kidney diseases or HIV and immunocompromised situations due to cancers. We believe this is an important factor and the majority of deaths were from people over the age of 60. I think our preparation should be to create more triage centers in each hospital and each clinic so that people who enter with symptoms should separate themselves from the rest. from the patients. In addition, we have to create field hospital beds so that an asymptomatic person cannot return to their crowded community and cannot isolate themselves. At the moment, we have very few people in the ICU (intensive care unit): about 30 of them and about 15 are on ventilators, so most of the people who were able to isolate themselves at home are receiving treatment in the home because of the ability to contain the infection. So I think we have to learn on the go. “

The President of Tanzania recommended the use of steam inhalation to combat the new coronavirus. As an epidemiologist, what is your experience in providing scientific advice to political leaders, and what is the best way for political leaders to communicate … when it comes to offering advice on the pandemic, Professor Koram?

Koram: “Well for me, and probably for those that I will work with, you work from the position of strength: what you know and you try to make sure that your recommendations are based on what is known, so we need to collect data and see what is true and what is not true in our population. If, for example, you said, based on epidemiology, “let’s close the place, we trace everyone”, that’s fine, but if you’re in a place like Accra, where there is a great majority of people in the informal sector, for example, then you should take that advice in addition to what will happen to that population that has to go out every day to get their daily bread. You can give pure scientific advice, but you have to bear in mind that it must be managed in context and I think that those who have to make the decision, ministers and presidents, have a really difficult job. “

Now that South Africa is facilitating phase blocking, what is your measurement measure to decide how to move from one phase to the next?

Mkhize: “The lifting of the blockade was mainly due to the scientific approach that indicated that the five weeks we had would give a maximum change in the peak of the curve, that if we had to move the blockade for another month or two months, it would hardly change that trajectory The blocking phase has to take into account two main issues: The first is the transmission rate The second is the availability of health services to respond to the burden of positive patients in any particular This means that each party The country has a different rating that we will be evaluating and, of that, the metropolitan areas are the ones that we are concerned with have a high transmission rate, therefore, we have to balance the extent to which we are going to alleviate certain restrictions, against the need to contain the spread of infection. When we talk about a risk-adjusted return to normal, it means that we are going to Start from areas where there is a high transmission rate and the lowest level of system readiness. Wherever such a situation exists, therefore, we will not facilitate economic and social activities as much, but slowly as we increase our responsiveness, we will find it easier to slowly open up to other areas. So, for example, in areas with a large increase in the infection rate like Mangaung, in the last three weeks they have been able to stop that rate in very few cases, which means that their response level and transmission level has changed from being Very high to moderate, and therefore allows a different response than, if compared, Cape Town, where the transmission rate is very high and continues to increase. The number of beds, the staff and the tests we have to do must be brought to a level where they can match in order to begin to contain the increase in the number of infected people. Therefore, the balance will be case by case, district by district, area by area. “

Regarding the spread of COVID-19 in conflict zones, particularly in the DRC, Libya, Somalia, but especially Burkina Faso, is there anything you, Dr. Moeti, or Dr. Yao can add about the situations there?

Moeti: “We are very concerned about people living in conflict conditions, refugee camps and other precarious situations, as is the case in some of the Sahel countries, such as the Central African Republic and South Sudan, where we are working with our humanitarian partners and governments to back up the response, primarily to prevent the virus from entering these communities, some of which are in remote areas. “

Manager of Emergency Operations of the World Health Organization in Africa, Dr. Michel Yao: “The main challenge is access. We recall what happened in eastern Congo with Ebola. Access is a critical element for teams on the ground to extend their response, mainly the surveillance component, as well as the installation of Testing and treatment facilities is a huge challenge and, as Dr. Moeti mentioned, it is where a partnership is required, working closely with all humanitarian partners to access these areas. “

How will the focus of resources and attention in COVID-19 affect the fight against other diseases that the ministries of health (and) governments are trying to tackle? Do you expect fresh increases or outbreaks in other disease areas?

Mkhize: “I think it is an interesting question because we deal with that issue every day. The reality is that we have to give an immediate response to the COVID-19 challenge, but at the same time, we understand that unless our health services are capable to balance other comorbidities, then we have a challenge: a lot of people who have diabetes, hypertension, chest infections, tuberculosis, HIV / AIDS and cancers, all of this must be managed while we are dealing with this. this is why which has been allocated an additional amount of resources to help the department obtain additional human resources so that we do not have patients with COVID-19 displacing other patients in need, and also to end a situation in which the triage at the entrance of Hospitals must allow people to be treated for other conditions, at the same time that we have to control the growing wave of infections by r COVID-19. Therefore, we must keep a balance because in our case we are concerned that • More than five million people are on antiretroviral treatment: that treatment cannot be withdrawn and their treatment program cannot be undermined because it will create a new problem. It is a very difficult balance, but we have to try to manage it. “