#COVID-19: Zim Should Adopt SMART Lockdown Model- Health Policy Expert Warns

ZIMBABWE should desist from copying and pasting other countries’ COVID-19 containment measures and adopt a SMART lockdown model peculiar to the country’s health and economic demands, a top health policy expert has warned.

By Michael Gwarisa

Zimbabwe instituted its initial lockdown on March 30, 2020 before extending it by another two weeks. President Emmerson Mnangagwa also extended the lockdown by another 14 days  which will be ending in a few days’ time though under much relaxed conditions.

However, Zimbabwe has in the past few weeks been accused of replicating South Africa’s lockdown measures without considering its limitations and strengths regarding its COVID-19 response.

In an interview with HealthTimes, Zimbabwe lawyers for Human Rights (ZLHR) program manager  Programme Manager for Special Projects and Imperial College of London trained Health Policy Expert Mr Tinashe Mundawarara said Zimbabwe has to consider its own limitations around testing and case management before adopting any further restrictions.

This makes it impossible to map an accurate disease scenario. We may need a SMART LOCKDOWN model which is not copied elsewhere but is managed say at provincial level. We cannot continue as it is and neither can we go to before lockdown. We need to be smart and ease lockdown in a way that is smart and will not result in disease spike.

“The smart model is ideal because we are not sure of  the correct disease scenario in Zimbabwe owing to few people being tested and  the extent of the spread of the disease in the communities. By Smart model I am calling for suppression of covid-19 in Zimbabwe. This means keeping the numbers as low as they are for an indefinite period of time,” Said Mr Mundawarara.

Even though the country has witnessed a decline in the number of cases recorded per day, Mr Mundawarara said blindly opening the economy would reverse the gains that have already been realised to plunge the nation into an even worse health catastrophe.

“Smart lockdown is actually a panacea to the problem of lack of resources. We should stop a waiting game and move the frontiers to the communities, it’s cheaper, localised and hence cost effective because the community responds to what it sees. If there s no infection, then resources are deployed elsewhere

“We have no option but to suppress because we don’t have enough hospital beds and health care resources to deal with extreme disease scenarios and our health system can easily become saturated. Suppression is better than mitigation because we do not have a high demand of beds now, we do not have a strain on our medical staff and all other resources that can be strained in  a dire disease scenario.

“The question becomes, what do we do in such a situation where time is seemingly on our side and we know if things get worse we won’t cope? The answer is, “let’s keep the figures of secondary infections low”. Secondary infections are the number of infections each case generates. This is where we begin to talk of the Non Pharmaceutical Interventions (NPI) as key considerations for a smart model.”

He added that sectors and Spaces have to be ranked to ascertain their “ status” in a Smart lockdown model.

“We then say, let’s prioritise spaces and  sectors relative to their economic value to the country and their susceptibility to promote/manage or mitigate widespread human contact, itself a key driver of secondary infections e.g we look say sporting activities, their economic value, potential of generating secondary infections, feasibility of implementing NPIs and actual plans that the players in that sector generate to address disease suppression. This is important because these cease to be economic or business spaces or sectors only but are key players in Covid Suppression and prevention as  the Smart model will have to localise.”

He added that devolution was key in  the implementation of the SMART lockdown model and he called for military-civilian partnerships towards the responses at a provincial level.

[pullquote]“The politics now has to appreciate that covid-19 is a desperate situation and it has to give way to reason. Whilst power in health response currently lies in some office in Harare, the disease is in communities, and at times hundred kilometers away from these offices. Smart model is about giving communities a chance and no strategy is more effective like devolution[/pullquote]

“With smart model we will probably have to witness the strength of devolution. Lockdown measures and involuntary restrictions have to be eased depending on management of COVID-19 and suppression measures each province is undertaking and their success and failure in that respect. I propose a Smart model that prioritise communities as functional structures of infectious disease control.”

He said community people should be involved in identifying cases, ensuring medical care for those unwell and ensuring that NPIs are implemented in the local communities.

“This is very key for a smart model that prioritise disease surveillance and early detection of infections.  Churches, community structures and other social stations in the community become the primary response and frontline assets to ensure suppression measures. This organized structure will eventually feed into the provincial response.

We are not yet sure of our disease scenario and we are not sure of our public health capabilities in the face of a dire disease scenario. We also need a smart model because we believe we cannot continue like this given the economic and social impact of Covid-19 in Zim communities and business sector.”

Objectives of a smart lockdown model according to Mr Mundawarara include among other things suppression of cases, lessen the economic impact of the disease on the country as well as increase key economic, financial and other activities with no significant influence on the spread and impact of covid-19.

“Smart lockdown for example can: Limit transport in and out of a particular province, Subject visitors to the province to testing and quarantine and limit certain activities and public places available in that particular province.

“Localised response means communities organise their public health security and safety. Just like in Wuhan where neighbourhood committees and communist party structures would check temperatures, organize medical care and food, the smart model should localise response. It works and Wuhan is an example of the importance of disease surveillance, community in achieving positive outcomes in infectious disease suppression.”

Meanwhile,  he added that the informal sector has to change and adapt in a smart way. as well.

“Infectious diseases of this nature demand so. The issue is to throw back the question to the informal sector in formulating policy and ask, “ As informal sector, how can you make your spaces safe and not drive infections? What are the measures and policies that are need for you to continue your economic activities without harming public health security? They have to answer these questions.”

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