ZIMBABWE reported the first cases of COVID-19 in March 2020, and unfortunately a fatality was reported early then, which saw many in the country getting scared. Projections from elsewhere had predicted an exponential, uncontrollable spread of SARS-CoV-2 in Sub-Saharan Africa, which would see the continent being overwhelmed with cases and deaths. Fortunately, several months into the pandemic, most of Africa has done well, witnessing an impressive picture where most infected individuals at worst developed mild symptoms, otherwise in most cases they remained asymptomatic.
By Dr Grant Murewanhema
The course of the outbreak was quite insidious in Zimbabwe from March to June; however, there were sharp increases in reported cases towards the end of July, and in early August. Since then the numbers of daily confirmed cases have considerably come down, and the number of hospitalised cases have also significantly dropped, as well as community deaths. Recently, only 1 case was confirmed over a period of 24 hours, out of hundreds of tests, with a positivity way below one percent. Currently, the cumulative number of cases stands at 8110, with 7643 recoveries and 231 deaths, leaving the country with 206 active cases.
The pertinent question at the moment is whether the outbreak is over in Zimbabwe now, or we have an untrue picture. This unfortunately, is not a straightforward question so to speak. Indeed, the daily numbers of positive cases are low, widespread community transmission seems to have ceased, there is no real clustering of cases, and most new cases seem to be quite sporadic, though over 90% of recent positive cases have been reported among local rather than returning residents.
Debate hovers around the strength of the surveillance system, including surveillance for Severe Acute Respiratory Infections (SARIs) and Influenza-like Illnesses (ILIs). Surveillance is the cornerstone of infectious diseases outbreaks control, and a weak surveillance system may portray a false picture, with resultant inappropriate public health measures.”
The testing strategy remains unclear to many, several months into the pandemic. Who are we targeting for testing in Zimbabwe? Are we targeting the right population? Testing the wrong population might yield a false picture. Initially testing was more directed towards returning residents, which made more sense then, considering that most cases were imported. However, at the stage when we reached community transmission, more efforts should have been directed at testing symptomatic people, contacts of confirmed cases and active case finding in society.
Test, treat and isolate has been the mainstay of COVID-19 control. Without testing, you can’t treat and isolate, and community transmission continues unchecked and unabated.
The clinical situation on the ground reflects minimal symptomatic cases of COVID-19, and hospital admissions have also markedly reduced. However, from the outset, the majority of cases, at least over 80-85% were asymptomatic and never required admission/treatment. At this point we then need to remind ourselves why we need to test for a disease that seems way less dangerous in this part of the world than in America, UK, Asia and Europe.
The elderly, diabetic and hypertensives and those with other comorbidities remain at substantial risk of fatal COVID-19 if they contract it, and it this segment of the population that we need to continue protecting. Whilst the vibrant youth may be able to cope well the disease, the mentioned vulnerable groups above may not stand it, and the youthful may thus act as vectors of infection to the next vulnerable persons.
So, the picture on the ground seems to agree with the low numbers of cases being detected, despite an unclear testing strategy, constrained testing capacity and weak active case finding. However, the situation calls for all us to strongly guard against complacency, thinking about those countries that are already experiencing second waves. Most sections of the population have started relaxing, moving around without face-masks, and are slowly forgetting about proper frequent hand hygiene. Physical distancing has become literally forgotten in many public spaces. It is this complacency that will lead us to a second wave of COVID-19, and who knows, the next time it may be so unforgiving.