AFTER a period of relative stability from March to May 2021, Zimbabwe entered into the much dreaded third wave of the COVID-19 local epidemic. The current wave, which began at the beginning of June, has seen a substantial rise in the number of confirmed and hospitalised cases and fatalities over the past three weeks.
By Dr Grant Murewanhema
Reports of full or overwhelmed health facilities have started emerging, with increasing numbers of symptomatic people with severe to critical illness. Sadly, in the past seven days, we have also two medical practitioners who have succumbed to the disease, Dr Shah and Dr Gwisai. May their souls rest in eternal peace.
An analysis we did of the second wave which occurred between December and January showed that the majority of cases then were locally acquired, and increased movement of people and complacency were largely responsible. When the first wave faded, people largely became complacent, stopped practising recommended infection prevention and control protocols and large unsanctioned gatherings resurfaced.
Politicians and musicians were largely responsible for the large gatherings, but religious organisations including Pentecostal and apostolic churches were also responsible. Massive funerals and weddings also reappeared, and there were clusters of cases detected in educational institutions.
Similarly, when the epicurve started flattening after the second wave, complacency started creeping in again. The country started receiving huge volumes of international travelers, with relaxation of testing and quarantine requirements. Celebrities, felebrities and politicians started the large gatherings again, without face masks, physical distancing and not observing any prevention protocols. The delta variant, imported from India, was detected in the Midlands a few weeks ago, prompting a localised lockdown, but the extent of spread was largely unknown.
As the third wave flourishes, different patterns have been noted. Mashonaland West is the current epicentre of the outbreak in Zimbabwe, unlike the previous outbreaks when Harare and Bulawayo accounted for 60% of the burden. The current wave is characterised by very high positivity rates, as much as 30%. Such positivity rates imply either gross undertesting, or undetected widespread community transmission.”
We can’t say with certainty why Mashonaland West is the hardest hit province currently, but we can postulate that this may be related to increased movements between the province and Zambia, which has been hard hit by the current wave, and open tobacco sales floors with huge movements of people and uncontrolled social gatherings have also contributed.
When the first wave and second wave occurred, the government imposed very strict total lockdowns and put in place several measures to restrict movements of people and contain the outbreaks. However, during this current wave, the government has shown marked reluctance, instead opting for localised lockdowns, and designating certain areas as hotspots. We are not certain of the effectiveness of the first and second lockdowns, and neither are we sure of the effectiveness of the current localised lockdowns.
However, what we are sure of is that lockdowns do break chains of transmission, but need to be accompanied by active surveillance, with isolation of confirmed cases, effective contact tracing and quarantining of contacts. With a largely unvaccinated population, these measures, together with treatment of confirmed cases, and alongside the well-known prevention protocols, remain the crux of epidemic control.
The battle is between dealing effectively with the outbreak whilst the population suffers from the adverse socio-economic consequences of restrictive measures. Zimbabwe has a very high unemployment rate, with the majority of people surviving through informal jobs, and from hand-to-mouth. There is non-existent social support from higher structures, and the people have to fend for themselves even during times of distress. It is therefore not surprising that people often opt to continue working in order to sustain their families. Total lockdowns have had other adverse socioeconomic consequences, have disrupted healthcare provision, and affected lower and tertiary education, which might ultimately affect the quality of education.
With the government showing a marked reluctance for strict control, the responsibility for preventing infections is left to the public. People have to be reminded and remind themselves once again that the power for control of this wave is within their hands, as human behavior largely remains the major determinant of spread. As is often said, the virus does not move, but is moved by the people.
How much time people spend in queues, in supermarkets and in other places remains an important determinant of transmission, and people’s willingness to comply with preventive measures such as wearing face masks correctly, physical distancing, hand hygiene and cough etiquette is critical. Also importantly, once again, people with flu symptoms must isolate and prioritise being tested. Seeking treatment in recognised institutions remains crucial.
The importance of responsibility at personal, family and societal level cannot be overemphasized. Let’s take charge of the control of the current wave, to avoid walking into uncharted territories and losing our friends and relatives.
(Dr Grant Murewanhema; Epidemiologist and Public and Reproductive Health specialist).
