THE first cases of COVID-19 were confirmed in Wuhan, China, in December 2019, and a few months later the disease became a worldwide pandemic. To date over 7 million infections have been reported. Zimbabwe has reported 356 cases, which include 4 deaths and 54 recoveries.
By Grant Murewanhema
Transmission patterns include imported disease, sporadic disease, clusters of disease and community transmission. In community transmission, clusters of cases are reported in the communities without clear linkage to imported cases.
Most of the cases reported in Zimbabwe so far have been among residents returning from other countries, or else have been contact-traceable to returning residents or contacts of returning residents. Therefore we have not reported any proper community transmission in the country, which, ideally is a good thing.
One of the biggest questions I frequently get asked is whether we are testing enough, and if we are targeting the right population for testing. Despite a comprehensive testing strategy as published by the MoHCC in April 2020, our testing seems to be concentrated to quarantine centres and returning residents. 55 000 tests have been done to date, which include a paltry 24 000 PCR tests. RT-PCR is the recommended diagnostic standard worldwide, and is generally expensive, each costing in excess of USD$50 in Zimbabwe. With the current economic mess in the country its easy to see why we have not been able to test as widely as we should.
To understand the true COVID-19 burden, we need to up-scale our testing game to community testing, particularly in possible hotspots, which include Harare, Masvingo and Matebeleland South. We also need to test a great proportion of healthcare practitioners, particularly nurses and doctors, and possibly all in-patients. This requires a substantial resource allocation but it would give us an idea the burden of disease. In a country where the majority of disease has either been asymptomatic or mild it is important to know who the potential transmitters could be, apart from returning residents.
Testing will also enable us to understand the pattern of disease in this country, as compared to what has been reported elsewhere. Our country has not seen an upsurge of severe acute respiratory infections (SARIs), and influenza-like illnesses (ILIs), or any unusual infections, which could serve as proxies for the burden of COVID-19. Whilst we did report an increase in malaria deaths at some point, these were actually confirmed to be plasmodium falciparum malaria in a number of cases and coincided with the malaria season.
The clinical evidence on the ground thus does not so far point to an increased burden of COVID-19. If we do have a huge burden of undetected COVID-19 in the country, how does the disease here then differ from what has been reported in South Africa, UK, USA, China, Europe and elsewhere? It would be important for us to understand these differences for defining strategies to deal with the disease.
Conventional PCR using standard protocols as highlighted above is expensive, thus scientists, locally and abroad, must find innovative ways of testing for COVID-19 with lower costs but comparable accuracy. One possible way is to increase the testing on GeneXpert platforms. The GeneXpert machines are widely used for testing for tuberculosis and there are several of them in several districts across the country. They require special programming and cartridges to use them for COVID-19 testing, but once this is done, testing can be done at district or provincial levels. This should ease the burden especially at the National Microbiology Reference Laboratory and at the National Virology Laboratory.
To understand the areas I highlighted and to plan strategically, it is important that the government and other relevant stakeholders come together and find ways of improving our testing capacity as a matter of urgency. Resources should be committed to this and ways of efficiently utilising them without them being directed to political campaigns or landing in the hands of corrupt officially must be rapidly defined.
I believe Zimbabwe can go through this pandemic well with collective effort and commitment from all relevant stakeholders including local and returning residents.
About the author: Dr Grant Murewanhema writes in his own personal capacity as a Public Health Specialist.