BY some stroke of luck, or as yet unexplained factor(s), Zimbabwe, and indeed most of Sub-Saharan Africa, have been spared from the full wrath of SARS-CoV-2, the causative coronavirus for COVID-19. For a virus that decimated populations in developed countries with advanced healthcare, the worst was expected for Africa.
By Dr Grant Murewanhema
Projections were that Africa was going to be grossly overwhelmed with cases; formal hospitals would be filled to capacity, including floors and passages, and there would be a need for makeshift hospitals. For a virus whose spread has proved inexorable in the USA, millions of Africans were expected to contract it, with several thousand or even millions requiring hospitalisation, and many dying. In fact, a socioeconomic crisis of immeasurable proportions was expected in Africa. Several months into the pandemic, these projections have failed to stand the test of time, and indeed the trajectory has generally been downward and reassuring in the past few months.
Several hypotheses have been put forward to explain why Africa was relatively spared, but so far none has been really substantiated. Background immunity owing to exposure to a high burden of infectious diseases in Africa was suggested, but SARS-CoV-2 is really novel, and Africa was also spared from the previous SARS and MERS outbreaks, so we are relatively unexposed to this group of pathogens.
Widespread BCG vaccination in childhood was suggested as a possible protective factor by some not so good studies, and the question remains unanswered, but it’s highly unlikely that BCG conferred such a high-level of protection to a virus. There are ongoing analyses to answer this question and in due course, it will be clearer. Initially, it was postulated that blacks may be resistant to the virus but this was quickly dispelled as the BAME communities in the UK were seriously affected, and blacks were also hugely affected in the USA.
Others may argue that blacks who succumbed elsewhere had comorbidities including diabetes, obesity, hypertension and others and were more exposed to hazardous work environments than their counterparts. Still, nobody can explain why much lower numbers of healthcare practitioners were affected in Zimbabwe and other African countries despite low levels of personal protective equipment.
The past week has seen a steady increase in the number of confirmed cases of COVID-19 in Zimbabwe, and a significant number of these are returnees from South Africa. This is happening at a time when the UK has been put under another lockdown, and a number of other countries are seeing an upward trend again. Zimbabwe is definitely at risk of a second wave, especially as borders re-open fully, schools re-open and mass gatherings have started again. The numbers of people attending church services have significantly gone up, and we are not sure of the extent to which preventive precautions are observed in these places of worship.
This week, we witnessed thousands of people, many without facemasks, filling the streets of Harare to bid farewell to a socialite, and another sized crowd in Domboshawa for the burial of the same.
Looking at the crowd, one can easily tell that the majority don’t give a damn about coronavirus; no facemasks, no physical distancing, no hand hygiene. It is quite highly likely that similar but maybe much smaller gatherings are occurring elsewhere.
A concept was developed in HIV prevention clinical trials, called the preventive misconception. Participants in such trials may falsely believe that they are protected from contracting HIV by the study products, and start acting carelessly, exposing themselves to higher risk of infection. One could easily assume that Zimbabweans (and other Africans), may easily be having a COVID-19 preventive misconception, perceiving protection from some unknown factor, grossly underestimating the risk of suffering from serious or even fatal COVID-19.
Risk communication teams have a mammoth task of debunking and dispelling this misconception. We live in a country where the ability to withstand public health sector pressure is severely compromised, and prevention is our best tool. As long as the population perceives low-risk of SARS-CoV-2 acquisition, our chances of getting a resurgence of uncontrollable community transmission remain quite substantial. Unfortunately, a country on its knees cannot afford further lockdowns, or travel and trade restrictions, especially as we try to limit the indirect collateral damage stemming from COVID-19 control public health interventions.
As we debunk the preventive misconception, we need to remind ourselves to go to the basics of infection prevention and control, namely physical distancing, hand hygiene, and wearing of facemasks. Its really a personal responsibility to continue avoiding unnecessary mass gatherings, and to continue educating our children, remembering that children tend to be spared from serious disease, but instead they can be super spreaders of SARS-CoV-2, taking it to vulnerable populations.
Lets keep remembering that we are all not safe until its over. Stay well, stay safe and stay healthy.
(About the Writer: Dr Grant Murewanhema as an independent Epidemiologist and Public Health Specialist)