As We Battle The Covid-19 Pandemic, Lets Not Forget The Avoidable Non-Covid Causes Of Morbidity And Mortality

Dr Grant Marewanhema

ITS now six months since Zimbabwe reported its first case of COVID-19. The cases have exceeded 5000, with 130 officially confirmed deaths. The trajectory of the pandemic in the country so far has been better than what is being experienced in South Africa, which has since surpassed  the 500 000 mark with over 10 000 fatalities. Fear and anxiety have been high in Zimbabwe, especially given the dilapidated state of the public health system, the perennial industrial actions by healthcare workers over deplorable salaries, the obsolete equipment in most hospitals, and the huge cost burden for treatment in the private sector.

By Dr Grant Murewanhema

Attention has been drawn to COVID-19 containment activities including testing, treating, contact tracing and other activities aimed at containing the outbreak. These seem to be now failing, with over 75% of the reported cases now being local. In fact the country has conceded that we have reached community transmission, which if unchecked could spell disaster for the country. Nevertheless, we remain hopeful that we will defeat COVID-19 with all our concerted efforts.

At the start of the lockdown in March 2020, many critical health services were stopped, which include HIV Care and Treatment services, Outpatient Clinics at central hospitals, care for patients with cancers and patients with other chronic illnesses.

Unfortunately it is these neglected groups of people who have the greatest odds of dying from COVID-19, should they contract the virus with sub-optimal control of the co-morbidities.

Testing and counseling services for HIV at Municipal Clinics were initially functional but they have started being disrupted, with strikes by City of Harare nurses. The high numbers of healthcare workers who are contracting the infection also mean further staff shortages as these and their contacts have to go into isolation and quarantine.

Six months into the pandemic, the number of people dying from the communities are increasing. People are dying in the community, something which should not be happening in 2020, because they have nowhere to go to, private or public.

Whilst some of these people dying in the community are confirmed to have died from COVID-19 at postmortem, the number of people who are dying from preventable non-COVID causes is probably much higher. Serious audits at the end may really reveal a serious genocide. Meanwhile the higher authorities are not showing any solid plans to resuscitate healthcare or reasonably resolve the current impasse with healthcare workers.

People are dying now yes, but we also have to think of other people who are going to die for some years after the pandemic because they were not treated during the pandemic. Cancer growth is progressive and knows no pandemic. Uncontrolled hypertension is bad for the heart and can result in strokes. Poorly controlled diabetes, apart frok putting one at risk of dying from COVID-19, has long term multi-system effects which can be debilitating. Failure to access antiretroviral therapy many mean emergence of viral resistance and the need for expensive second line and salvage regimens.

We have to think about the pregnant mothers failing to access essential antenatal and postnatal care, and we also have to think about the babies who are missing their immunisation schedules now; will they ever catch-up. The DRC has experienced resurgence of measles owing to disrupted immunisations during the ebola viral disease outbreak. Screening programmes for cervical cancer are disrupted, and women are failing to access family planning services. The result could be an increase in unintended pregnancies and unsafe terminations with resultant overwhelming infections and deaths. The list of the possible negative repercussions of the COVID-19 is far stretching.

An urgent recourse to dialogue and restrategising is critical now more than ever. Healthcare goes way beyond COVID-19; and the indirect effects of the pandemic are far more devastating than the pandemic itself in a country that still has less than 10000 infections. Infection prevention and control in the community and at facilities is our gateway to control.

The government must now come in quickly to address the plight of the striking healthcare workers, providing adequate personal protective equipment for safe and confident discharge of duties, and must capacitate the hospitals to become functional urgently. The public must take to the forefront of demanding their right to healthcare, hold the government responsible and remind the officials of the Nolan Principles.

We need to set our priorities right and do something right, at least just this once, before we lose a substantial proportion of our population to avoidable non-COVID causes.

(Written by Dr Grant Murewanhema, an Independent Epidemiologist and Public Health Expert)

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