#TalkingCOVI-19WithDrGrant: From 550 To 3500 cases In 1 Month: What’s next?

THE first case of COVID-19 was reported in Zimbabwe on 20 March 2020, and it took almost 4 months to get to 500 cases. There was widespread hope that we could contain the spread. For that entire period, the majority of cases were confirmed among returning residents from South Africa, and were diagnosed at points of entry and quarantine centres. However, the past month (July) has seen an uprecedented rise in cases, with over 2000 new cases diagnosed, and 490 cases diagnosed in the past 24 hours.

By Dr Grant Murewanhema

It has always been Zimbabwe’s hope that we would contain the situation, but eventually, its getting out of hand. It is becoming clearer that we have no proper strategies for containing this disease. The Ministry of Health currently has no substantive Minister and Permanent Secretary, leaving a huge leadership vacuum.

It is at times such as these that proper technocrats should be in charge of this important ministry. Over the past 2 years the Ministry was presided over by one of the most controversial ministers ever in its history.

There is a clear lack of political commitment to resolve the impasses within the public health sector in Zimbabwe. Nurses, doctors and other healthcare workers continue with a crippling industrial action over possibly the worst salaries across the globe. In the past few weeks the salaries of nurses have been eroded to less than USD$40 and those of junior doctors to less than USD$50. Thus the majority of healthcare professionals live at less that one-tenth the estimated bread basket by the Consumer Council of Zimbabwe. How they are even expected to be able to commute to work remains a huge puzzle. No sane leadership would surely expect then to continue reporting for duty if they cant afford transport, let alone the basic necessities of daily living.

The hospitals have no basic personal protective equipment. Surprisingly, at a recent burial, funeral parlor staff were clad in state-of-the-art hazmat suits and visors, which have not been seen by critical staff at central hospitals. Expecting healthcare workers to discharge any duties under such conditions is extremely inhumane. The collateral damage happening in this country is unimaginable, and in the meanwhile, nobody cares. Recently, there were heartbreaking reports of seven stillbirths out of eight caesarean deliveries in one night at a central hospital in Harare.

Now, back to COVID-19; the trajectory has taken a different turn together, and we are entering uncharted territories. Community transmission is extremely difficult to handle for our impoverished nation. This week has not only seen more cases being reported; it has seen many deaths being confirmed as well. Reports of people collapsing and dying in the community which were previously denied seem to be revealing themselves, and the disease is sparing no class, with loss of some high profile people in the past few days. People collapsing and dying in the community speaks volumes regarding the extent of community transmission which is undetected. Its quite apparent that these deaths are only a tip of the iceberg, and there is more going on in the community.

The testing falls far off the targets, with the country having strategised to conduct at least 40 000 tests every month. The test, treat and isolate strategy is not implementable in a country with a non-existent healthcare system, and its clear that PCR testing is very expensive for us. Given these circumstances, the responsible authorities clearly have to think of the next steps, to contain this outbreak now before its too late. The Ministry needs competent leadership which is substantive as soon as possible, to give direction. Zimbabwe needs differentiated approaches to contain this outbreak, given its peculiar economic status (the country has no economy at all).

Blanket approaches may even be more detrimental to the well-being of the people than COVID-19 itself. Its clear that Harare, Bulawayo, Midlands and Matabeleland South need more aggressive approaches, and people from these provinces must not be allowed to enter into other provinces; and movements within the provinces themselves must be limited.

The re-opening of churches must be seriously reconsidered in the context of recent developments, and so must all other mass gatherings. Mbare Musika and Magaba are ticking time bombs which must also be closed. There is absolutely no physical distancing, wearing of masks or appropriate hygienic practices in those places, and risk perception seems to be very minimal. COVID-19 is not a political game, its real, and it decimated countries elsewhere, killing thousands of people per day. Zimbabweans, are we ready for that?

Education efforts in the community must be intensified, especially on risk perception and infection prevention and control. Emphasis must be on individual responsibility; people must look after themselves. Zimbabwe is a militarised state, and asking for security forces to intervene in maintaining order and restricting movements may not be in our best interests. The brutality of our military and police is a well-known phenomenon, having murdered 20000 people in Bulawayo during Gukurahundi; and having continued to commit atrocities against fellow humans in recent years. We need to be responsible citizens on our own without use of force against us.

We need to re-intensify efforts on hand-washing or sanitizing with alcohol base solutions, physical distancing and wearing of facemasks. Whilst these practices are not entirely protective, used properly and together more infections can be prevented. With no prospects of an effective vaccine in the near future, the success of our prevention strategies centres on appropriate human behaviour and understanding. With the complacency that has been setting in over the past few days, we risk an explosion of cases in the next few weeks.

The government must quickly come in to address the plight of the healthcare workers,  mobilise resources for testing widely and seriously think about urgently recapacitating the hospitals. Urgent engagement with international partners is needed. With no room for seeking treatment in foreign lands, all Zimbabweans regardless of political and social standing need timely access to intervention in our public institutions. Wider consultative forums with technocrats in public health is required now, more than ever, to salvage the situation before it spirals out of control.

(Personal opinion by Dr Grant Murewanhema)

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