By Dr Wilbroad Mutale, MD, MPhil, PhD
5th August, 2020
Correspondence: email author on: firstname.lastname@example.org
As the number of those killed by the corona virus globally and locally swell, the question which arises in every mind, is whether this global threat is being handled with the right tools and attitude and whether the vulnerable population understand what is at stake and their role in stopping the spread and prevent death.
The cycle of how the virus spreads is fairly well understood by now and measures to break this cycle have been publicized globally and locally. The terms social distancing, face mask, handwashing and quarantining are all over the internet and other media platforms. So, in the face of this crucial understanding, why do we still observe this rapid increase in infections and deaths?
For the Global leadership, I will leave it for another day, but first, Charity begins at home, which for me is Zambia and then Africa.
At the time of this reflection, Zambia had recorded over 6,000 confirmed cases of corona virus and over 150 deaths, both directly and indirectly linked to Corona virus.
This number is a gross underestimate because we are only able to do a limited number of tests per day , mainly in urban centres or provincial centres and test results take long to come out. In addition, symptoms come approximately 5-14 days after infection, ,meaning those with infection are still out there and what we are seeing today, is what happened two weeks ago!
What can we understand from the people brought in-dead at our hospitals as we have recently witnessed? There are very few explanations:
1) the disease kills so fast that before you have time to go to the clinic you die, or
2) the people did not know what they were suffering from or were not aware that Corona is a serious disease or
3) my last point which is these people cannot access services and are therefore dying at home. Lack of access could be due to individual reasons, but in this context health systems barriers and challenges could take a significant proportion of the blame.
I would like to address our response in the past few months and highlight some opportunities.
• The Ministry of Health is leading the response, with the Minister Dr Chilufya and his team being in the fore front of the response.
• The Zambian National Public Health institute, a very new institution is the lead institution in coordinating the response
• WHO, CDC, USAID , UNICEF are the main partners and donors to the response.
• Several local organizations and NGO’s have shown willingness to join the response, especially in risk communication but they generally lack funding and so cannot provide consistent and coherent messaging.
• Economic response, mainly pronouncement by Ministry of Finance to provide loan’s not grants through banks to struggling small businesses.
• The major intervention has been lockdown of the economic activities initially and then semi-lockdown and now “new normal”, whatever this means. However, it suffices to say that this new normal brings in mixed messages, a recipe for confusing the general public.
• Wearing of face masks: While this is mandatory, it has been inconsistent by most leaders and general public, perhaps under the pretext of “ new normal”. We have therefore seen people not obeying public health guidelines either due to arrogance, lack of awareness or inability. Whatever the reason, this has opened opportunity for the virus to infiltrate compounds, markets, hospitals, minibuses to mention but a few.
Finally, I would like to mention that leadership is such a crucial ingredient in the Covid fight. This is at all levels but more important at national level, as it sets the tone for everyone in the country that we are under attack and we all must do the same thing regardless of political or religious affiliation.
Challenges and opportunities:
1) Limited Funding to the response. I have had opportunities to talk with different stakeholders, colleagues and friends, the biggest challenge we face is lack of funding, to develop a robust national response. The funds from government are very little compared to what we need and donors have been unable to cover the gap in commensurate with the size of the country and its people.
Not that people have not given, but for the scale of the problem at hand, we need millions of dollars to invest in for example, social protection for those locked down, businesses need grants not loans and using banks is a wrong avenue knowing the bad experiences that most Zambians have with bank loans.
2) Perception of corruption: This is linked to trust and transparency. Can donors really trust the Ministry of health with funds under the current circumstances? This is a big question that those entrusted with leadership power should answer. Personally, I do not want anyone to lose a job or be suspended, but what do our values and morals tells us about the kind of people we need to lead such a fight? This is where leadership becomes so important. Failure to address perception and concerns from donors and members of the public, undermines the COVID fight significantly.
3) Lack of local research and data to guide future response. While we have to praise those firefighting the corona in the hospitals, communities and other places, this cannot replace strategic thinking, to predict future patterns and required resources to handle different scenarios. Very little research has happened locally and I fear the current surge was long predicated by mathematical models but it was dismissed mostly as based on assumptions not local data. This has continued , there is no national funding for research even when the president said this was time for researchers “to go to work”. Unless we appreciate and invest in local data and research, we cannot know where the epidemic will go in the next 3 months or year.
4) Politicizing the response: We have heard the COVID fight being reduced to political party lines and we have seen for example parliament open when we are fighting a very serious pandemic. The results was that we have lost some members of parliament and workers. This again points to leadership at all levels. We have to all do the same thing, lockdown is lock down regardless of the institution or party. Otherwise, we are encouraging hypocrisy whose consequences are there for all to see.
5) Lack of social protection and failure to create a social movement to eliminate corona in Zambia. Studies have shown that wearing masks by everyone consistently for 14 days, can literally wipe out the virus in a population. Like the story of condoms and HIV infection, the key words are “consistent” and “proper use”. This is linked to availability and quality. This language is required for masks. But in our settings where social distancing and water supply remain a luxury in shanty compounds, our main hope are masks. But do people have access? If they do are they wearing them properly and consistently. Looking at various compounds and markets in Zambia, masks are not being used and might be out of reach for many. This is a gap we can and must close! Let us start “facemask lockdown”!! Everyone get ready and get your mask and go for 14 days!! We start on a given day. Let us see what will happen!
6) Health system challenges: If only we can conduct local research on transmission dynamics, understand who is getting the disease and what numbers we expect in the next few months, we can start to plan ahead to avoid firefighting. How many doctors do we need if the infection reaches 100,000? How many ICU and hospitals beds? What community models are working well and how do we prepare them for a surge in infection?
7) Heath worker protection: As a doctor, I believe that the covid fight is lost by a fraction whenever we lose a health worker. I have lost friends already and I have several who are sick now. Unless we make deliberate effort to protect our health workers, we risk losing them to Covid and the whole health system will collapse! Research has shown globally that health workers are being intimidated to say the truth about lack of PPE and other protections and ending up being infected and dying. This is the time for doctor and nurse organizations to standup on behalf of their members and ensure they have everything they need to safely fight COVID 19. This is fighting “a good fight” but to do so, they need the PPE everyday and all the time!
This is our only country. History has shown that epidemics can wipe out entire populations. We have a good opportunity to learn from the past few months of Corona infection in Zambia and globally. Posterity will judge everyone harshly if we fail to rise to the challenge. We need individuals to take responsibility but most of all, we need our leaders to lead by example with integrity and consistency.
For the frontline health workers, keep up the good fight and I hope we will all hold the rope while you work underground!!
God bless mother Zambia.