Herbert M’cleod: Sierra Leone Telegraph: 19 April 2020:
Just seen a letter to the President requesting 14-days “… full lockdown to flatten the curve in the rising number of COVID-19 cases across the country.” My first question was: what curve?
So far we haven’t seen any curve presented for Sierra Leone, so I assume that the curve here reflects the number of cases tested positive over time. However, as we have a limited number of test kits, only primary contacts are being tested.
As of today we have no idea whether many more people are infected without showing any of the symptoms or avoiding hospital and taking care of themselves at home. If there were such cases, those would not feature in the cumulative number of cases presented in the daily bulletins.
If we undertake 10 tests a day because that is all we can afford, the maximum positive cases we will have in any given day will be 10.
Lockdown or not
A lockdown is argued as a mechanism to slow the transmission. Unfortunately, our reality in Sierra Leone means that in the urban areas households sometime contain up to 30+ people who would have to be kept in very close quarters for 14 days and nights. Hence the likelihood of even more rapid spread in such large households when they are locked up together becomes even higher.
As the country started tests only in February, and only for those few suspected cases, we have no idea whether some asymptomatic cases had slipped through earlier. Especially given our porous borders with lenient guards at the borders.
Thus, the number of positive cases now being reported might not be the actual number of cases in the country and therefore not reflecting the extent of the spread in the country. Who knows, we may even be at the tail end of the “curve” but because of little knowledge about the virus’ behavior in our circumstance, we are assuming that what we see in the North applies here. OR in the middle of the Curve, but we may well have been spared severe cases and even deaths. We have no idea because we have not been testing corpses.
It is too late now for a full two-week national lockdown, even if we could pull it off perfectly (strong community support, fair and adequate distribution of food and essential supplies, regular cleaning and disinfection, access to health services etc.).
What we do know is that we have porous borders, and that many of our businesspeople travel to China regularly – especially in December. To think that our first case only emerged with the tested index case on 31 March is to live in denial. Hence the increase in number after the first tested-positive case is, in my opinion just an interesting statistic for comparison purposes.
Thus, I will argue that using a “flattening of the curve” a la USA, in order to SLOW, not stop the transmission is not helpful for us and may even be counterproductive, given all the negatives associated with full Lockdowns.
Incidentally, S. Africa is reporting a dramatic increase in gender-based violence during their lockdowns Lagos and some cities faced defiant citizens, Malawians went to the courts to force their Government to delay their planned Lockdown.
Here is what We know
- About 80% of positive cases go around without symptoms, for the rest, most can be treated at early stages. Better to focus on that. Prevent casual contamination – masks, disinfection etc what Government is already doing, and plan for a surge in hospitalisation
- We know natural immunity is first line of defence. Let’s help the population bolster that by education on nutrition etc.
- We know infection can arise from contaminated surfaces. So let’s disinfect massively.
There are so many ideas floating around that are more effective than lockdowns.
My next question is lockdown for what?
In the developed countries, the response is that lockdowns will slow transmission thus avoiding hospitals being overwhelmed. So, partial lockdowns are imposed while simultaneously, temporary hospitals are planned and constructed, plus other measures introduced.
We should be doing that now rather than focus on Lockdowns. Our security forces would be better employed in preparing temporary facilities, training health workers, repairing access roads to certain communities, ensuring ambulances are in good condition etc. NOW. Not patrolling a 14 days full lockdown. By the way, this would help clarify that the war is not the state against the people but everyone against the virus.
Indeed, rather than impose a full Lockdown with its known negative consequences for the average citizen, we need to be helping Government prepare; massive recruitment and training of contact tracers, preparing health workers for cases of infected patients with severe symptoms, (these are not Ebola patients) and getting better coordination, transparency and messaging at the national level.
I just wished our scientists, epidemiologists and health specialists in Africa could be networking and coordinating research on what is taking place locally to provide answer to us laymen, or we will continue to proffer counsel based on what we see in the developed countries, that will continue to confuse our decision makers.
About the author
Herbert M’cleod is the Chairman of Standard Bank, Sierra Leone. Author and researcher of Sierra Leone Fragility Report.