COVID-19 IN ZIMBABWE: WHERE ARE WE GOING?

ZIMBABWE recorded its first case of COVID-19 on 20 March 2020, but until 2 weeks ago we had less than 50 cases. This trend is significantly different from what was observed in Europe, America, the UK and China, which saw exponential increases in infections once they had recorded their first cases.

By Dr Grant Murewanhema

Others have argued that we have not been testing enough, but the situation on the ground has been very stable. On the clinical side, we have not witnessed a significant spike in clinically suggestive cases, and thus our reports may be giving a semblance of the truth. Rumours of people dying in their homes and bodies being certified dead in car parks have largely remained unverified.

In the past two weeks however, we have had a huge spike in the number of detected cases, with the total currently standing at 174 cases. Of these, 29 have recovered spontaneously, and unfortunately four demised.

The rest of these cases have been asymptomatic, requiring very little medical intervention, and not requiring any hospitalisation. Our institutions, which are incapacitated to handle a large scale outbreak, have therefore been spared for now, which is a desirable situation.

Supportive treatments for COVID-19 have proved costly elsewhere, and have placed a huge strain on healthcare resources, moreso in the advanced settings.

In terms of the trend of infections so far, the majority of infections have been detected among Zimbabwean residents who are coming back from foreign countries where they are either resident or had visited for one or the other reason. We are expecting more residents to return as some lose their sources of livelihood, and some have lost their jobs from cruise ships, restaurants and the hospitality industry at large, due to reduced business.

The other remaining infections have largely been contact traceable to returning residents, and only very few cases have been difficult to trace. Returning residents have been coming from South Africa, Botswana, the UK, and Mozambique among other countries. There has also been an argument regarding the origin of infections, as many new cases are detected through routine surveillance for returnees in quarantine centres, who are otherwise asymptomatic.

The conditions in the quarantine centres have been observed to be less than ideal in many instances, with massive breaches in infection prevention and control protocols, including lack of physical distancing and sharing of common amenities.

Thus, these quarantine centres may be the new hotspot for infections if the conditions are not improved, and especially as more residents return. Satisfactory is the fact that these returnees are quarantined, and those picked up to be positive are sent to isolation centres; therefore, this could help contain the situation. Worrisome is the fact that there have been security breaches in some of the centres, some of the quarantined crowds are becoming rowdy, and a number of them have absconded from quarantine centres, all across the country.

As much as the number of infections is increasing, we have to move forward as a people. We cannot live with restrictive measures for longer, as our economy was already on its knees when they were first introduced, and now its almost dead. Hyperinflation has returned, as the exchange rate of the United States Dollar to the ‘local currency’ has soared over the roof in the past few weeks, and the prices of basic commodities have gone beyond the reach of the majority. For a country with one of the highest unemployment rates in the world, the population can only hold on for so long.

The majority of our people are employed in the informal sector, and any extra day spent at home is detrimental to their survival. Consequently, many have started breaching restrictive measures to try and make ends meet.

So far we now know from evidence from elsewhere that only 10-15% of patients with COVID-19 will develop significant disease, and even then only a small proportion if these will require serious interventions including hospitalisation and ventilation. The proportion of people with COVID-19 who die from the disease is even much smaller and this mainly includes the elderly, those with co-morbidities, and elsewhere the Black, Asian and Minority Ethnic Communities. Research is largely ongoing to elucidate explanations for the disproportionate trend towards significant BAME mortality in the UK.

The case fatality has generally been much lower across Africa, and even disease severity, for reasons we dont know as yet, but obviously this has been great for us. The infectivity rates have certainly been much lower across our continent.

We have come to accept, or must come to accept, that we are going to live with COVID-19 for much longer than initially anticipated, as we still have no effective vaccine. Vaccination traditionally is the best way to deal with rapidly spreading infectious diseases to reduce transmission, morbidity and mortality.

The most important aspect to deal with, moving forward, without effective treatment or vaccination, therefore is human behaviour. We know the mode of spread of the virus, and we know the measures we can take to combat the spread, therefore why is the disease still spreading. The answer is simple, humans are social beings with trends towards socialisation. We have to mix, we have to travel, we have to work etc in order for us to survive.

Shifting our mindset from a fatal disease to a disease that we are going to live with for a longer time should help us to refocus and work on our own human behaviour. We now have to assume the responsibility for infection prevention and control at individual level. We can no longer wait for governments to impose restrictive measures on us when we know the disease is here. The responsibility to protect the vulnerable groups within society is in our hands, and our behaviour in the future must reveal that we also think of protecting others as we think about ourselves, so that we protect our society. As we slowly return to our usual activities of daily living to survive, we must embrace the new normal. The new normal includes physical distancing, avoiding avoidable forms of human contact, avoiding unnecessary mass gatherings, frequent hand hygiene and rapid self-isolation upon emergence of suggestive symptoms. This way we maximise our own protection and that of others.

As we go into the future, and until such a time when effective vaccination becomes available, or nature eradicates COVID-19, we have to become responsible citizens, as we complement public health efforts to protect our societies. We need to strike a balance between returning back to our livelihoods and protecting ourselves.

About the writer: Dr Grant Murewanhema writes in his own personal capacity as a public health expert, and all views expressed here are entirely personal.)

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