There have been multiple Coronavirus outbreaks in the pasts, SARS-CoV-1 was first reported in Asia in February 2003, though cases subsequently were tracked to late 2002. This virus quickly spread to about 26 countries mostly in the Far East and Toronto, Canada before being contained after about four months. Epidemiologists localized its source to Guangdong Province in China where it was believed to have originated from bats. Another coronavirus MERS-CoV was first reported in Saudi Arabia in 2012 and quickly spread to more than 27 other countries through travel from the Middle East. Since 2012, WHO reports suggests that about 27 countries have reported cases of MERS including Algeria, Austria, Bahrain, China, Egypt, France, Germany, Greece, Islamic Republic of Iran, Italy, Jordan, Kuwait, Lebanon, Malaysia, the Netherlands, Oman, Philippines, Qatar, Republic of Korea, Kingdom of Saudi Arabia, Thailand, Tunisia, Turkey, United Arab Emirates, United Kingdom, United States, and Yemen. MERS-CoV reportedly spread to humans from camels but the original source of this virus is believed to be bats with transmission into camel populations in the distant past.
If one considers the spread of these two epidemics it is evident that with the exception of two Middle Eastern Countries, Egypt and Tunisia, the continent of Africa was relatively spared in both prior coronavirus epidemics. In the initial spread of SARS-CoV-2 most in African whilst still concerned may have hoped they would be spared. Many stories were heard suggesting possible protective traits for people of African descent. Which have been shown to be completely false as many Africans have already died of this disease.
Another theory that appeared was the possibility of reduced transmission as ambient temperatures increased which had many hoping that summer weather in the Northern Hemisphere could lead to a waning of the pandemic. We are in Spring with rising temperatures and the pandemic rages on with new community transmissions in many African countries including South Africa which is just transitioning from its summer into fall.
On the continent, South Africa has the largest number of cases, reporting 927 cases as at 3/26/2020 with the first death recently reported per a BBC article. President Cyril Ramaphosa just declared a lockdown with deployment of the army to maintain order. South Africa is a relatively wealthy country in Africa, but a lockdown will have its own challenges in this country with vast numbers of its black populations living in townships that date far into the apartheid era. The poverty and the dense living conditions in these townships would pose a challenge to any attempts at social distancing.
In my own country of birth Ghana, I have been having sleepless nights over how social distancing would look like in densely populated communities, like Nima, Maamobi, Bokum and Zongo in Accra. Our lifestyle even in many of our villages where I had opportunity to spend many a few days and weeks as a medical student and in my early days as a physician are so communal that the degree of social distancing required to control SARS-CoV-2 would be difficult to effectively maintain.
At this time Ghana is topping 136 cases and 3 deaths based on WHO data from 3/26/2020. This is a major problem in a nation with scarce resources for intensive care. The question that one may ask is, what must an African nation like Ghana do to protect their population. The President in an address to the nation has declared a state of emergency. The nation is aggressively pursuing a policy of isolation quarantine and testing all contacts of known cases. If you live in Ghana there are a few things that you can do to protect yourself.
For the people and ordinary citizens
Hand washing can never be over-emphasized, if you don’t have access to soap and running water then a hand sanitizer if you can get some will be helpful.
Avoid person to person contact as much as possible, stick to your household contacts. Make sure to keep each other accountable.
Handling cash, could be a concern since the virus has been shown to survive for close to 17 days on surfaces. So far most believe the risk is small but one can never be too careful. Use cashless payments when you can and wash your hands after handling cash.
If you miss your friends, try and call by phone or use video call. Technology has made things a lot easier to stay in touch without really touching your friends.
Stay at home, if you need to go somewhere go by private car if you have one. If you can walk go at a time when there are less likely to be many people around. Maintain a 6 feet distance from others. If you need to use public transport this can be very complicated since surfaces in such vehicles could harbor the virus if someone with the virus has been in them recently. Using a face mask could be beneficial in public places especially indoors. The value of face masks in brief outdoor interactions of a few minutes is unknown.
Unfortunately the social distancing guidelines assumes we are all middle class westerners.
For the Government and Public Health Authorities
I know you are getting an earful from your people and everyone is giving you more advice than you need to hear.
Just know that whatever you do you are not going to be praised for getting it right all the time.
These are uncertain times and the information is changing more rapidly than any one person can keep track of. Get a couple of smart well informed people around you to offer good advice.
Whatever you decide to do, have a mechanism to evaluate to find out of if it is working. The question is how long must one take to evaluate any decision? I cannot advice on that there is no one size fits all, just always ask yourself why; like why are our people dying more than what has been seen in other places?
Get personal protective equipment for your healthcare workers and make sure you have a good supply chain set up. If needed conscript a local company to produce.
Consider developing treatment protocols that can be used by doctors and will be easy to evaluate. The New York City trials which was rolled out a few days ago, may be an example.
You will need ventilators, but you have always needed these and never had enough. This is the time to really get down to making changes that matter in the health system because even the president can get Coronavirus and the hospitals in South Africa, United States and UK are already full and will not be too happy to take another coronavirus victim taking well needed ventilators from its own people.
I can go on and on, but I believe I have said enough, there is more advice out there than anyone can keep track of so I would not add more to that.
Leonard Sowah is a physician in Baltimore, Maryland
Image Credit: Soweto View via Good Free Photos
Aerial view of Maamobi – Achievers Book Club