by Sara Suliman and Fatoumatta Darboe*
COVID-19 (Coronavirus disease 2019) has become a household name for the disease caused by a new strain of coronavirus (SARS-CoV2), which has rapidly become a global epidemic crisis. SARS-CoV2 infections have been slow to enter Africa, potentially as a result of early travel restrictions imposed by multiple African countries. However, COVID-19 cases are officially established now in almost every African nation, which means tactics aimed at border patrols, although important to continue, are insufficient by themselves to curb community-based transmission. The early country-wide trajectories of these infections look very similar to those in other countries in the pandemic. Hence, the progression of the epidemic is very likely to resemble that of other regions unless unprecedented, rapid and coordinated measures are imposed immediately across the entire continent. Otherwise, COVID-19 is bound to spread and cause irreversible damage to African nations and their healthcare systems. Since treatments and vaccines for COVID-19 are still under development, the goal should be to limit the spread of the virus to prevent at once overwhelming an already devastated healthcare infrastructure and overstretched healthcare workforce in many African countries. Slowing down the virus transmission would buy time while other biomedical interventions, such as vaccines, are being developed and tested.
For the African context specifically, measures such as social distancing are hampered by the urban design and informal labor sectors, which render home isolation for extended periods of time, an impractical reality in most African nations. Although physical distancing is not intended to be an infringement on human rights or individual freedoms, governments ought to protect citizens by ensuring adequate access to supplies, which would also mitigate the possibility of civil unrest as a result of real financial pressures. Therefore, ensuring equitable distribution of supplies, particularly to vulnerable communities should be a central priority in COVID-19-issued lockdowns. Panic stocking of supplies before lockdowns globally has widened the socioeconomic gaps since it has been largely restricted to rich elites, while this financial capacity to “stock up” was certainly not reflective of the masses. Hence, having a clear plan for financial relief and distribution of supplies to vulnerable communities, especially to residents of informal settlements and workers who rely on informal labor, should be prioritized. The sustainability of the lockdown will rely on everyone having enough food and basic sanitary supplies, as well as medications for other medical conditions, which will not suddenly cease to exist during periods of COVID-19 management.
A second lesson we are quickly learning from the experience of other nations is the importance of prioritizing the safety and protection of healthcare workers. As the global demand increases exponentially in the upcoming days and weeks, donations from abroad although appreciated in the short term will no longer meet the long term demand. This necessitates that we create resources to immediately manufacture personal protective equipment (PPE), especially if Africa-based manufacturers could be temporarily diverted from other industries to fit this urgent demand. Failure to provide PPEs may result in the providers falling sick, and transmitting the infection to other patients, as well as to their communities, thus exacerbating the crisis. This also means dividing care into restricted COVID-19-designated areas away from other health services, to prevent cross-transmission to other providers and patients. It is critical to develop an immediate contingency plan to all other healthcare services, particularly those demanding similar expertise such as tuberculosis (TB), another deadly respiratory disease, where the specialists will inevitably be diverted to extinguish COVID-19 fires. Interruptions to TB and HIV treatments and services, for example, will indirectly increase the mortality rates caused by COVID-19’s demand on the system and healthcare providers, if these other conditions are left unattended or deprioritized.
In the long run, this crisis will highlight and exacerbate many existing deficiencies and inequalities in the African healthcare on a level never experienced in modern history. Some of these healthcare systems may collapse entirely if immediate action is not taken. These are unprecedented times that call for urgent action. The end result may in fact be a re-imagination of more equitable societies and healthcare systems, not only in Africa but globally. For now, time is running out, and these two lessons need to be learned.
The opinions expressed in this article are of the authors and do not reflect their employers or institutions.
*Dr. Sara Suliman, NEF Fellow from the Sudan, is an Instructor of Medicine at Harvard University.
Dr. Fatoumatta Darboe is a Gambian Postdoctoral Researcher in the Medical Research Council, The Gambia Unit.