Jesmed F Suma: Sierra Leone Telegraph: 18 April 2020:
Fellow Sierra Leoneans, as cases of the corona virus disease COVID 19 continue to ravage the world and outstretch health care systems of countries with the most sophisticated healthcare infrastructure like the US, the government of Sierra Leone is one of many African governments struggling to stop the spread of the virus.
Our public health system is very weak and inadequate, creating vulnerabilities for the spread of the virus with possible devastating impact. The truth is, over and above all measures taken to limit the spread of the virus, the best way to know whether the virus is spreading among the public or not is by testing.
Without an adequate supply of the right effective testing kits and proper personal protective equipment to conduct as many tests as necessary of people showing the slightest symptoms, the detection of an outbreak in any community and control of the spread thereafter will be difficult.
Since the government is not transparent about what they are doing, many are wondering about their level of preparedness to stop the spread of the corona virus, after failing to stop its outbreak in the first place. Just as the outbreak of Ebola in March 2014 exposed the weakness of our healthcare system, this new pandemic is putting to test the country’s preparedness to respond to health emergencies.
Unfortunately, despite having had the opportunity to observe for months what other countries are doing to combat the new virus and prepare, the government of Sierra Leone does not seem to be ready; neither in terms of logistics, planning, deployment of assets, and command nor in terms of control capacity. Although Government has spent allegedly hundreds of millions of dollars over the years on healthcare, we are still acutely dependent on health assistance from our foreign partners and NGOs.
In this article I’ll attempt to offer recommendations on how the government could have planned to contain the spread of the virus and also highlight few important facts about the virus that every Sierra Leonean must know. These are facts gathered from various articles I’ve read on the subject and interviews I’ve watched of renowned epidemiologists.
This virus is not a joke. The virus has already infected over one million, three hundred and ninety-three thousand, one hundred and thirty (1,393,130) victims globally as of April 8th, 2020, of which over eighty-two thousand two hundred and ninety-one (82, 291) have already died.
According to a recent expert analysis of the reason why the US is facing a more serious challenge with containment than any other western country in the world, is because the US failed to start testing early enough, which could have helped her to identify and quarantine the first set of infected victims. Therefore, the need to test cannot be overemphasized.
Here are the stark realities of the situation in Sierra Leone that should give reason to this government to be concerned about the dangers posed by this virus:
It is a fact that many of those infected by the Corona Virus tend to be asymptomatic, meaning they can be carrying the virus without showing symptoms and yet still be contagious, spreading the disease unknowingly.
In the case of Sierra Leone, the first two confirmed cases are individuals who have enough knowledge of the symptoms and the dangers of the virus that made them voluntarily present themselves for testing: one is a medical doctor, the other’s spouse is also said to be a medical doctor.
Before presenting themselves for testing, they may have come into contact with several people, primary contacts who must be traced together with those that they in turn would have been in contact with. Whether this contact tracing and quarantine can be done effectively is a relevant question, considering the failures of the healthcare personnel to isolate the very first confirmed case who was under quarantine for 14 days and who was only found out when he self-diagnosed at the end of the quarantine period.
Many low-income Sierra Leoneans are usually wary to go to the hospital when they are sick because of the fear of not having the means to cover the cost of treatment. Therefore, if the government does not create enough public awareness for the public to know that the Corona Virus test is FREE and set up several testing centres where free tests would be available to anyone with symptoms, many people may continue to resort to their usual method of self-medication sometimes using herbal medicines.
The measures taken so far by the government to contain the spread of the virus, although necessary, have been inadequate and poorly planned. As a result, they are causing very serious disruptions of the livelihood of millions of Sierra Leoneans and disproportionately impacting poor households as well as small and informal businesses. This is likely to further deepen the hardship these families are going through already with devastating impact in the months to come.
We already know that Corona infection spreads when an infected person coughs or sneezes, passing on the virus to another person within a 3 to 6 foot range if the droplets reach him and go through his nostrils or eyes into the lungs. Therefore, the best way to prevent infection is to avoid being exposed. This was why I commended the efforts of the government for launching a campaign of awareness which encouraged the public to regularly wash hands or use disinfectant. This was why I supported the quarantining of suspects and the imposing of a nationwide lock down, which are all good measures required to help contain its spread.
But, imposing severe restrictions on the movement of the population in a bid to stop the spread of coronavirus without planning for the life-threatening challenges that these measures will definitely result in for the public, is completely unacceptable.
Requiring that incoming air travellers from the West be quarantined for at least 14 days was good, but doing so without medical personnel to regularly check their temperature and security personnel to strictly enforce the rule did pose serious risks to public health. Those were some of the lapses that led to the outbreak in the first place.
Here is what I think the government should have done differently to limit our exposure to the risk of deaths:
Long before the outbreak, at least during the time corona was breaking outside the epicentre of Wuhan and into European cities, the Sierra Leone government in collaboration with WHO, NGOs and other partners in the healthcare sector, should have conducted a nationwide crash course of emergency healthcare personnel, specifically to learn more about the Corona virus, including the different ways to prevent its spread as well as how to care for confirmed victims.
Next we should have launched emergency call numbers, deployed these trained healthcare personnel to specific healthcare centres or units within hospitals, exclusively selected for the treatment of Corona patients across the country, at least one in every district, making sure that there is adequate supply of Personal Protective Equipment and other relevant logistics for each team.
Having just one or a limited number of testing centre, requiring every suspected case to be driven to Freetown for a test, exposes more people to the risk of infection than having each district with its own testing centre. There are reasonable instant testing kits available in the market already. South Korea is a leading supplier of these testing kits.
In terms of funds, the government may not have enough but they do have an adequate sum of money if managed judiciously which should be enough to secure the right amount of logistics to help stop the spread. Initially the government had allocated about Le 2 billion Leones equivalent to Two hundred Thousand dollars ($200,000) from the emergency funds towards the fight against corona; and the World Bank has now given the government an additional seven and half million dollars grants towards the same effort. One can argue that the government now has enough funds to secure adequate logistics to prevent its spread.
Secure at least 7 multi-purpose Mobile Clinics equipped with apparatus to handle testing and other medical services. For an average cost of $250,000 each, this can be done and after Corona these same mobile clinics can be used to support our currently ill-equipped health system.
In terms of the lockdown, three important measures should have been included in the planning from the onset:
The President should have used the powers of the State of Emergency to secure supply chains of essential products, such a food, water and medicines. This would have made it easier to determine the adequacy of the stock pile of items like rice, onions, sugar, milk from every major importer and it would have made it easier to prevent any hoarding and or price gauging which usually takes place during emergencies causing supply/demand shock.
In any emergency situation, those people with means tend to stock up on all essential supplies since they can afford it, creating an artificial shortage, making it hard for the poor to have access to these essential products even if they later have the means to purchase them. Therefore, adequate preparations should have been made to ensure that specific essential stores are open in specific locations across the country. With police supervision, passes can be issued in a coordinated way for individuals in neighbourhoods to shop for essential food supplies at specific times and locations making sure that old people who are more susceptible to the virus are kept indoors.
Over 68% of Sierra Leoneans are multi-dimensionally poor. Therefore, most people live day by day, which means that if they don’t go out for a day to engage in their usual petty trading, begging or to do menial jobs in order to eke out a living, they will not be able to eat on that day. Locking them down for days means possible starvation for them and their children. Therefore, the government should have considered Free Food distribution for certain neighbourhood especially for the children.
With respect to adults, the government should have contracted with and financed certain ”COOKERY” food vendors to sell plates of rice at half price subsidized by the government at specific congested neighbourhoods across the major cities.
During the three days lockdown we witnessed security personnel including military personnel administering unsightly draconian corporal punishment on citizens in their neighbourhood, some of whom were out to fetch water or look for food. In my opinion while the role of security forces in responding to an outbreak may be relevant, they could have been deployed judiciously under the guidance of health providers. The health officials should have been the people to determine when a situation warranted the use of force such as when the civilian resists or refuses to accept instructions.
We should try to train our security personnel both police and military to recognize the fact that they can be a force for good to build the trust and confidence level between them and those civilians they are meant to protect. Quarantine does not mean citizens should be locked up in their homes continuously. Someone sitting at their veranda should not be seen as a violation of the lock down rule. Therefore, the use of force should be the last option and must be applied only in dealing with civilians that pose some physical threat.
Considering the seriousness of the danger this virus poses, it is my view that every healthcare personnel in the country should be tested if possible after every few weeks and be given at least one set of Personal Protective Equipment especially face masks, gowns and thermometer. Our healthcare community must be protected and paid well right now. The fight against this virus is as serious as fighting war against a visible enemy. We should not joke with it. Each nurse, doctor or anyone working in our healthcare system should be deployed in neighbourhoods when not in the hospitals to conduct basic random temperature test.
The earlier we detect anyone with the slightest symptoms the better it will be for us to contain the spread of the virus. If we decide to wait for members of the public to voluntarily present themselves for basic temperature test, then we will not capture a good number of those who may be symptomatic. Therefore, random temperature test should be sporadic but frequent. I am worried, very worried because I know the level of terror we are subjected to here in the US by the daily news of deaths of hundreds of innocent victims. This can devastate the entire country and may not spare anyone even the main policy makers.
I find it ridiculous to see heads of departments wasting limited State resources in the name of trying to enforce the lock down as if we don’t have enough security and medical personnel to do so. Every dime they spend while out and about is a cost on the taxpayers, yet they are not expert in the area of healthcare or security.
Part of the risks we are faced with also, is the lack of trust by the general public in the government’s ability to separate those who may be suffering from other tropical diseases like malaria and yellow fever after the usual preliminary temperature test, from those confirmed to be Corona, for fear that they may be dumped in the same centre even before the actual tests are conducted as was the case during the Ebola outbreak.
During Ebola there were accounts of people suspected to have Ebola just by having high temperature, symptoms similar to that of any other tropical disease like malaria. But because temperature test was the preliminary test conducted before the actual Ebola test, those with high fever were immediately suspected of having Ebola and were taken straight to an Ebola centre without any protection to wait for the actual Ebola test to be conducted. In some cases, they got infected at the very centres resulting in them eventually coming back to be quarantined to die at an Ebola centre. Therefore, families were hesitant to report suspected cases.
We need to be very cognizant of this fear and find a way to address the concern by making sure people with high fever are not held in the same locality with or near people confirmed to be corona virus infected until actual tests are conducted.
Focusing on the epidemiological impact of the outbreak is one thing, but also planning for the economic consequences which may well be more devastating than the healthcare impact is another. In my next article on this subject I plan to look into what type of stimulus measures the government should consider, to help in the recovery process after the outbreak.
While the above recommendations may not be exhaustive, they are worth considering as we plan ahead for any other need for a lockdown.
In conclusion, here are some key facts about corona that every Sierra Leonean must know:
What is Corona Virus and how is it different from Ebola?
Both Corona and Ebola are viruses and not bacteria, so they cannot be cured with antibiotics. But Corona is very different from EBOLA in many ways starting with the fact that CORONA is a pneumonia like respiratory virus that attacks the lungs causing shortness of breath, dry cough and high fever.
The symptoms are high temperature, dry cough and sneezing but some people are asymptomatic, meaning that they may be infected but do not show symptoms, and in most cases do not realize that they are infected. While others may show signs much later after their Pre-Symptomatic period. Despite not showing symptoms they may still be contagious without knowing it. Whereas, Ebola is a filovirus causing profuse bleeding and fever, in most cases internal bleeding.
Corona is spread by being in close contact with an infected person who coughs or sneezes within 3 to 6 feet range and droplets get on you through your nose or eyes. Or if you touch a surface with cough/sneeze droplets of an infected person and you transfer such to your nose or eyes. Whereas Ebola is spread mostly by direct exposure to the bodily fluid of an infected person such as physical contact.
Therefore, while Ebola is far more deadly having an average death rate of about 50% of all infected persons, Corona has an average death rate ranging from 2% to 4% of infected person. However, Corona is far more contagious hence spread quickly infecting far more people than Ebola. For instance, while Ebola may infect 100 people within a given period and place, Corona without containment could infect 5,000 more people within the same period and place. Therefore, though 50% maybe the average for Ebola about 50 out of every 100, 3% of 5,000 which is (150) is higher than 50% of 100 which is (50). For this reason, Corona kills far more people than Ebola.
Is there any cure for Corona?
Currently, there is no cure for the COVID 19 virus and no vaccine has been developed. Therefore, detecting cases quickly, isolating victims, tracing their contacts to minimise further transmission and care for infected patients to build up their immune system to fight the virus are key to saving lives.
But those with underlying conditions and weak immune system may need more supportive care such as the use of ventilators because they are exposed to more risks due to weak immune system. That is why wherever there is a corona virus outbreak older people predominantly above 55 years are more like to be affected and even to die because of weak immune system.
I would like to end by reminding our government officials that unless we strive to strengthen our healthcare institutional capacity, we will constantly be reacting to medical emergencies instead of being proactive. (Photo) Author – Jesmed Suma).
This is the second time we are given a unique opportunity to build on these infrastructures using donor funds. They should not make the mistakes of the previous kleptomaniac government who preferred to embezzle the funds and squander the opportunity, rather than invest in our healthcare infrastructure.
I hope the current government will not make the same mistakes. Out of the $7.7 Million that the government currently has available, if managed judiciously and we do not face any serious spread of the virus, they should be able to commit at least $3 Million to the building of a new modern hospital. Even if it is just a small medical research and diagnostic centre attached to the School of Medicine of the University of Sierra Leone it will be a good investment.
Feel free to comment and share your opinion on the article.
Jesmed F Suma. Tel 908-759-4332 or Sumatuinc@gmail.com
(I’m neither a journalist nor a medical personnel but just a concerned Diaspora based Sierra Leonean business executive and public policy expert, so feel free to weigh in).