ZIMBABWE witnessed its third spike of COVID-19 in the past 24 hours, confirming 73 positive cases, and unfortunately also witnessed a facility death of a young female patient, aged 21, bringing the total number of officially reported deaths to 8. We should always note the careful choice of words, such as officially reported, and confirmed.
By Dr Grant Murewanhema
THE COVID-19 SITUATION IN THE COUNTRY
So do we know the actual COVID-19 situation in Zimbabwe? How accurate are the numbers we report, and are we doing enough community testing? I have posed these questions before, and will pose them again here. The reported numbers are accurate to the official extent, because these are the tested people, and they are reported as they are. But these numbers may not represent the actual situation on the ground. We may have many more people with COVID-19 in the community who are undiagnosed, because our testing capacity is grossly constrained. I have highlighted previously that a single RT-PCR, the diagnostic gold standard, costs USD$50-75, which is quite steep considering the economic mess the country finds itself in due to systematic corruption and abuse of resources. On the other hand, the other alternative, the GeneXpert is not yet widely in use in the country. Serological point of care assays otherwise known as rapid tests are not used for confirmatory purposes.
What do I think about the local transmission in the country? We have mainly concentrated our testing on points of entry and quarantine centres, and we have done very little community testing. Institutional testing is quite limited, and unfortunately, currently healthcare workers across the board are incapacitated and unable to report for duty. There is no COVID-19 screening taking place at the entrance of the main hospitals and even COVID-19 suspected are walking into the hospitals unscreened; this is dangerous and potentially exposing many to COVID-19.
There are three patterns of local transmission: sporadic, clustering and community transmission. In sporadic transmission, individual cases are reported in different places with no clear epidemiologic link. Clusters of COVID-19 imply that a group of people who can be linked in a community test positive for the disease around the same time, whereas community transmission implies that many people or multiple clusters in different communities start testing positive without clear links to confirmed cases or returnees. In Zimbabwe we have reported a number of local cases, but without comprehensive community testing we cant tell the pattern of transmission we are experiencing. I have emphasized the need for all to be vigilant in all places at all times, because you cannot tell who has the disease or not.
So what do we need to do moving forward? There are various levels of responsibility for control of the pandemic, which includes governemnt, local communities, healthcare facilities, point of entry, schools, churches and other religious organisations, and the individual. The society has embraced in the disease in some places, and are calling for life to move on. In other places there is a scaring level of ignorance of the possible devastating effects of COVID-19 should there be widespread community transmission, and in some places there is absolutely zero care. There is a huge knowledge deficit, which the responsible authorities have failed to fill in. Unfortunately, whenever there is a knowledge deficit, somebody will fill in the gap, albeit with wrong information.
The government needs to act up more responsibly. They are responsible for testing and educating the masses. Further lockdowns may not be the best, given their devastating effects on local communities and people’s lives. Measures to protect the community involve appropriately sensitising communities, upscaling community testing and improving the working conditions of frontline workers. It is quite sad that healthcare practitioners are on a crippling industrial action at this point and nobody is bothering to address their grievances. Should we start experiencing massive transmission as is occurring in South Africa, there will be nobody to work in the facilities and provide the needed supportive treatments. This is a time to kill greed, systematic corruption and selfishness and prioritise the needs of the population.
Wider consultative forums with various stakeholders including local and international partners are needed to optimise community testing, information and knowledge dissemination and capacitating healthcare workers to discharge their duties. Without addressing the big elephant in the room, which is poor conditions of service and appalling remuneration for all in the civil service we are going nowhere. Teachers, police, the army and administrative workers are all critical in the control of COVID-19, which is a national health security threat. Somebody somewhere up there needs to be serious about addressing these challenges.
As individuals we have the capacity to protect ourselves, and we must act responsibly. Lets not become complacent, and lets not assume that the risk is for somebody else. We have previously emphasized that you could be young and fit, be able to fight the infection, but you can be a vector to the next vulnerable host and facilitate their death. The latest death of a 21 year old should also alert that even the young are not invincible. Practise physical distancing and avoid unnecessary public appearances. Wear your protective face masks and wash your hands or sanitise them frequently. The decision to re-open churches is a rational decision, which hopefully was seriously considered and balanced against the risks of exposing people to infection. Churches must put in place adequate measures to protect their congregants if they are to hold services, and must ensure that they stick to recommended numbers.
WE REMAIN HOPEFUL BUT WE MUST BE COGNISANT OF THE FOLLOWING:
Every citizen has a huge responsibility upon their shoulders, to protect themselves and their communities against COVID-19. Whilst we must not become overly anxious there is a renewed need for a call for all of us to exercise extreme vigilance at all times, otherwise we may have another disaster on top of the man-made pre-existing disaster in Zimbabwe. Lets all work hard in our fight against COVID-19.
(Dr Grant Murewanhema is a Public Health Specialist; and all opinions are independent).