COVID-19: A doctor explores preparedness in Ghana

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Dr. Bertha Serwa Ayi

The following is a guest post by Dr. Bertha Serwa Ayi

A beast is on the loose. A disease named COVID-19. Wall Street has eyes on the beast and its potential to turn a bull market into a bear market. Like a beast with a fire-lit tail it is going from country to country lighting up fires that devour human lives. The smoke of symptoms of infected patients is the first clue about its presence. By the time firefighters get there to quench the fire, there are four or five other fires. It is off to the next country. Globally it has sickened more than 82,000 people, and taken more than 2,800 lives. China, the world’s most populous nation with 1.4 billion people and its Hubei province has been the epicenter. Maybe that is about to change.

Last weekend the outbreak took an epic turn that could turn it into a pandemic. Italy has had to face this reality in a rude awakening. In Northern Italy, 50,000 people are under quarantine, schools are closing as the outbreak seems to be spiraling uncontrollable out of hand like a tsunami with 220 infected and seven reported dead in one day and 322 confirmed cases and 11 elderly people dead the next day. It is also fast becoming an epicenter. On Friday February 20, Iran reported its first two cases and within 72 hours there were over 61 cases and 12 deaths and the deputy minister of health infected. There is no patient zero. Iran is now an epicenter and four new countries Iraq, Afghanistan, Bahrain and Oman have reported cases thought to be related to the rapid upsurge of cases in Iran. Given the capacity for transmission by asymptomatic cases, these new countries could become epicenters as well. Within four weeks South Korea has surpassed all countries as the country with the most cases outside China with a total of almost 1000 confirmed cases mostly due to in country human to human transmission. 231 of these were new cases in 24 hours with twelve deaths total. Iran, Italy and South Korea together are fast becoming the new epicenters outside of China. South Korea has no quarantine plans but has promised to undertake mass testing.

It seems the world is waiting and watching, nail-biting to see what will happen if it takes root in Africa. Although its healthcare infrastructure lags behind the world it is wields great experience in surveillance for poliomyelitis, cholera and Ebola virus and may be better prepared than other systems.

Ghana, located on the West Coast of Africa is a case in point. The country is ready for the first few 100 cases. A case load beyond 1000s may overwhelm the current strategic plan. In a phone interview, Dr. Franklin Asiedu- Bekoe the head of the Disease Surveillance Unit of the Ghana Health Service, reiterates that his team has the country’s plan down to a science but quickly notes that when there is a large outbreak there will be setbacks. Asiedu- Bekoe summarizes his interview by saying that addressing COVID-19 is going to be a partnership between the public and the healthcare system. It is interesting to note that this is one of the five commendations the WHO team made about the strategy in China, how engaged and compliant the public was. Ghana will to revert to and modify preparedness plans by virtue of recent outbreaks of Ebola, Lassa. The countries13 ports of entry, one by air, two by sea port and ten by ground is manned by Port health authorities. The major focus for COVID- 19 identification and detection has been at its state-of-the-art airport, Kotoka International Airport (KIA), where all passengers fill out a health declaration form supplemented by non-contact temperature monitoring. Testing is undertaken at the National Influenza Center at the Noguchi Memorial Institute for Medical Research. The National Influenza Center is headed by Professor William Ampofo, a seasoned virologist who closely works with the World Health Organization, and has been studying influenza virus and coronavirus trends in the region for years. He notes that all 20 tests on suspected patients have been negative. Since Jan 23, 2500 health declaration forms have been reviewed daily. Port health staff are equipped to identify and isolate travelers who meet criteria for screening and immediately detain them in holding room where an ambulance whisks them to one of the two designated COVID-19 ready treatment hospitals. One of the two hospitals, Tema General Hospital, has a 12 bed capacity for handling these cases and has the rooms equipped with negative pressure ventilation and ventilator equipment. The other hospital Greater Accra Regional Hospital (formerly Accra Ridge Hospital) has a five bed capacity for COVID- 19 cases but no negative pressure equipped rooms. Samples collected by trained staff are run in the virology lab housed in the National Influenza Center in Virology Department of the Noguchi Memorial Institute for Medical Research. This lab, which runs 5000 respiratory samples a year, has ten staff working 12-hour shifts with a result turnaround time of six hours on average. They have run labs at 1 a.m. before Asiedu- Bekoe noted.. In addition, Ampofo mentioned that another ten-member strong staff is on standby to run a 24-hour shift if needed. Ampofo adds that as an extra surveillance measure, all respiratory samples received in the center from Dec 2019 to date have been tested for COVID-19 and have all been negative. The center is running on funds designated for respiratory viruses, it will need at least $350,000 per year for equipment maintenance, staff salaries and lab supplies if it takes on this new directive to screen and identify COVID-19. It has yet to receive that commitment from the government to sustain its level of operations. At a second reference laboratory Kumasi Center for Collaborative Research in Tropical Medicine located in Kumasi, Ghana has established COVID-19 testing capacity while the reference laboratory at the Korlebu Teaching Hospitals can quickly be mobilized for testing if the demand calls for it.

One can be ready for a guest who announces the time of their arrival and is easily recognizable. Can any one country really be ready for a respiratory virus with high transmissibility and a long incubation period? Asiedu- Bekoe notes that despite their efforts and a well thought out plan Ghana still has much to do in the coming weeks to prepare for a pandemic as WHO as directed. The two treatment centers have a combined capacity of 17 beds and not all of them are equipped with ventilators. Two treatment centers is not enough for a population of 30 million whose daily interactions would create the perfect crucible for rapid spread from infected respiratory droplets. Each of the previously designated 10 administrative centers needs an equipped treatment center. Now there are 16 administrative regions. Port health authorities need training and retraining to recognize and isolate cases if and when they show up at any of the 13 ports. Customs and Immigration personnel will need to be trained. About 200 sets of personal protective equipment are available in each of the administrative regions. The real test of the capacity to identify, isolate, manage and contain infections will be dependent on the ability to detect disease if it comes to a small remote village in the northern part of the country hours away from the reference laboratory and eons away from any treatment center. He notes simulations are planned at the ports of entry and there is the need to plan simulations at various hospitals. The glue that will hold any of these lofty infection prevention measures in place is communication. Communication between the ports of entry, the research facility, the treatment centers and contact tracing personnel will be key to the success of all their efforts and plans. The country has held public lectures to educate and answer questions and separate myths from facts about the outbreak and a national COVID-19 hotline manned by seasoned epidemiologists has been established that will answer and address questions from patients and healthcare providers. All major media channels in print, audio and video are abuzz with information on the outbreak. Awareness is high. Simulations will need to be run several times over at the airports and hospitals on the actions to take when a suspected patient shows up. Every hospital or clinic needs to put up signage to alert patients with the appropriate travel history to report to the receptionist and isolated for interview. Three years ago, an outbreak of cholera in the nation’s capital Accra, with an estimated population of 5 million, about half that of Wuhan City, exposed the need for increased bed capacity in the economically thriving nation which is one of the eight countries with the highest growth in GDP for a couple of years in a row. An outbreak of more than a 100 cases of COVID-19 will greatly challenge the health system in a country where 2000 to 3000 doctors have to care for 30 million people.

China is still battling the outbreak but has set the bar high with the high technology driven interventions that were deployed when cases peaked from January 23 to Feb 2. During this peak new cases averaged 1000 to 2500 a day with 100 deaths a day per official figures. There are still 50,000 hospitalized patients. In the past week there seems to be a slight decrease in cases and in the on Feb 24 20 provinces reported no cases. The quarantine efforts imposed on 60 million people, the largest quarantine in the history of modern medicine has been ambitious, and yet there are now three epicenters. Should all the affected countries go on lock down?

Countries will also have to pay attention to the sea ports given the recent infection on two cruise ships off of the coasts of Japan and Hong Kong. A few of whom have been repatriated back to the US in a jet with several uninfected patients. This sharing of the same air system in a plane by the mix of infected and uninfected patients could potentially lead to an outbreak in the US given the clear evidence of transmission by asymptomatic patients

The outbreak will be contained if every country plans as though they would have a sudden outbreak of a few handful cases that will rapidly spread. The ideal preparedness plan should be able to detect this outbreak within a week, effectively isolate and treat affected patients while preventing healthcare worker transmission and be able to contact trace all exposed patients within the next week. It should have the capacity to diagnose 1000’s of cases at once; have the capacity to manage critically ill patients who would need ventilator support; and the capacity to keep recovered patients from infecting the susceptible populations. Is any country really ready?

Bertha Serwa Ayi, MD, FACP, FIDSA, MBA is an adjunct Assistant Professor of Medicine at the Nebraska Medical Center, USA and an adjunct lecturer at the University of Development Studies, Ghana. She is a graduate of the University Of Ghana Medical School (UGMS Class of 1996) where she graduated with honors and received the Alcon/Paracelsus Award in Ophthalmology. She completed her Internal Medicine Residency training at Good Samaritan Hospital Inc., affiliated with John Hopkins University School of Medicine in Baltimore Maryland in 2002. Furthermore, In 2004, she completed fellowship training in Infectious Diseases at a combined training program at Creighton University Medical Center, University of Medical Center and the Veterans Administration Hospital in Omaha, Nebraska. She is  a Board Certified Infectious Disease Specialist and a fellow of the American College of Physicians (FACP) and the Infectious Disease Society of America, which produces this blog. She is in private practice.

56 thoughts on “COVID-19: A doctor explores preparedness in Ghana

    1. Bertha Ayi

      Dr. Amakwaa thank you for your feedback. It is the stark reality of the level of availability of critical care services. The nation can only build on what it already has. It gives room for asset allocation in future long term planning. Thanks once again.

      Reply
      1. Dr. Bertha Serwa Ayi

        Randell,
        Thank you for your comment. I agree. Experience from Italy and Iran teach us that most nations may need to prepare for a few cases one day and then a sudden ballooning of cases in a week suggesting subclinical infection that may have been brewing in asymptomatic patients for up to two weeks. Approximately a week ago on February 20 Italy had reported only four cases. Ten days later as of today they have 1700 confirmed cases to deal with. Every country has to prepare for such a scenario.

        Reply
    2. Isaac

      So what are we going to do about the 17 beds?
      We are not going to have all the beds we need, today but we must do something and hope for the best.
      I believe the education on prevention is the most important thing.
      Not the panicking. We will go through this without any death in Ghana, let’s have that believe and work more on the education.

      Reply
  1. Doris Johnson

    I’m so proud of your research, commitment and pure dedication of your time on the outbreak of these infectious diseases. May God grant you the wisdom and provide you with the cure. Every human being matters as we are the creature of God.
    May God protect this world especially Africa with little resources to go by.
    We applause all the global health organizations, especially (WHO) for their tremendous contributions towards these outbreaks. You’re all in our prayers.
    Dr Ayi, I salute you and proud of your achievements.

    Reply
  2. Marilyn Bartimeus

    Thank you Bertha for this informative piece.
    A lot of Ghanaians abroad are anxious about the preparedness of Ghana to deal with COVID-19 outbreak. Although it is difficult for any country to be ready for an outbreak of COVID-19, being prepared is a start.
    Thanks for the detailed explanation.

    Reply
    1. Ezekiel

      Please, is it not important for ghana to increase the testing facilities since we only have just 2?? One being in Accra and the other in Kumasi..

      Reply
  3. Daniel Quaynor

    Dr Bertha Ayi, you have given a clear and complete picture of our situation especially in Ghana. Thanks very much for your help.

    Reply
  4. Bernice Therson-Coffie

    Thank you so much Dr Bertha Ayi for your educative information. I enjoyed reading your piece. The fear of Ghana’s preparedness towards COVID-19 , has left most Ghanaians grounded from travelling back home for a visit. In all our usual personal hygiene is simply the best option. Thanks once again for your update on COVID-19.

    Reply
    1. Dr. Bertha Serwa Ayi

      Bernice,
      Thanks for your feedback. I understand your concern about returning to Ghana. Clearly the Ghana Disease Surveillance Unit are on top of the situation. Considering the rate of newly diagnosed cases around the globe, frankly Ghana and Africa may be the safest place to be at this time, if the concern is about getting infected with COVID-19, given that no cases have been detected and reported. You should allay the concerns of your fellow Ghanaian.

      Reply
  5. sally radford

    “Africa with little resources?” The continent abounds in natural resources with 1.2 billion acres of arable land to which diaspora like this doctor should return to assist in the prevention of CV and other diseases rife in the region. Curbing the growing population now over1.2 billion must be a priority, with hundreds of millions hungry, VAW, conflict and other scourges. Novel viruses will evolve as resources shrink and totalitarian hegemons hoard resources. Materialistic greed, lust and vice are taking their toll, creating a continental cacotopia. As simian HIV/AIDS spread to humans through bushmeat, so CV spreads through wildlife. During Lent, Christians should fast and eschew meat, feasting on a wide variety of cereals, nuts, seeds, beans, leaves, herbs, roots, fruits, flowers and vegetables. ACT NOW TO SAVE HUMANITY.

    Reply
  6. Pamela Amponsah Washington

    Dr Ayi,
    This is really a great piece! Highly detailed research and information, especially from our Country Ghana !
    Well done Dr. I really appreciate your assistance. And good job to all Doctors and Health Staffs in Ghana who are making all the efforts against these deadly virus COVID-19 .
    God protect us all.

    Reply
    1. Dr. Bertha Serwa Ayi

      Pamela,
      Thank you for showing your appreciation of the time and effort that went into this. I appreciate the leadership of the Ghana Health Service for their willingness to be transparent and share their work. Thank you for acknowledging the hard work and dedication of the doctors working under very limited conditions in Ghana.

      Reply
  7. Bismark Jampim Abrokwah

    Thank you Dr Ayi for your write-up. I find this preparedness an ENTRY GATE KEEPING approach with greater strength on COVID-19 screening. Although good efforts to start with but as shown in your write-up, training and retraining of VERY IMPORTANT GATE KEEPERS like the Custom Officers, Immigration Officers and the Navy should be fast tracked to avoid a transmission of an infected neighbour like Togolese, Nigerian and Nigerian who do not need visa to enter our country and often trade in Ghana. I am imagining how these foreign nationals are screened before their entry to Ghana.

    Also, the awareness on the COVID-19 is low compared to Ebola. I find this awareness close to LASSA Fever but very low compared to Ebola. I remember, the Ebola outbreak caught the attention of the religious groups in the country, particularly, Christianity. Ghana is noted to be densely populated by Christians and Muslims who revere their leaders for instructive statements. Are there any plan for the Public Health Directorate Ghana to align our Christians and Muslims leaders (faith based organizations) in the awareness creation? We should note that a faith based organization leader raising a prayer against the COVID-19 alone STEPUP the awareness strategy.

    Reply
    1. Dr. Bertha Serwa Ayi

      Bismarck,
      You are so right. The leaders at the helm of affairs are remarkably skilled and are acutely aware of the training needs. These will roll out soon.
      There is also a leader for risk management and social Mobilization, Mr. Joel Abekuliya, who is supposed to champion engaging the society and raise awareness. You make a crucial point of the need to specifically focus on religious groups. I will find a way of passing this on to him.

      Reply
  8. David Arkorful

    Thank you Dr. Bertha Ayi for your educative information. In fact I’m scared for Ghana with our limited resources in containing this virus looking at the rapid rate of newly reported cases. My concern is the level of preparedness at our ports of entries. Especially our sea ports of Tema and Takoradi. Some of us if not all will be grateful if you can share with us how close the world is in coming out with vaccines and treatments if any.

    Reply
    1. Dr. Bertha Serwa Ayi

      David,
      It is good to voice your concerns. At this point we all need calm understanding of the disease and application of accepted principles of disease containment. The health authorities are working hard to keep people safe. You do not have to be scared. There is no reported disease in Ghana.
      For medications the Chinese have about 293 ongoing clinical trials to evaluate the best medications. So far Remdisivir has proven helpful. Preliminary studies of the antimalarial medication chloroquine phosphate have also shown promise.
      By January 12 shortly after the beginning of the outbreak the Chinese scientists had sequenced the genome of the virus and shared with partners around the world. This single step was monumental in diagnosis as well as opening up for the development of several candidate vaccines. Because of the phases necessary to assess side effects and efficacy of vaccines, a vaccine will take about a year to be ready for human use.

      Reply
    1. Dr. Bertha Serwa Ayi

      Apetobi,
      Good Morning. Ghana has activated its Coronavirus Preparedness plan which it last updated on February 25. I discussed some of them in the write up. They have detailed plans focused on coordination efforts, surveillance, management and training at the ports of entry, laboratory testing, case management, risk communication and social mobilization, and finally focus on funding and working with partners like the WHO and the Naval Medical Research Center.

      Reply
  9. Justin

    I think the best way to prepare and protect our dear nation is to quarantine people traveling from affected nations for 2 weeks as been done by other nations. No nation is truly prepared for this outbreak only precautions are necessary at this moment. God bless Ghana.

    Reply
    1. Dr. Bertha Serwa Ayi

      Justin,
      That is definitely one of the methods that can contain infection considering that in the three of the healthy US citizens evacuated from Wuhan City have tested positive for the infection.

      Reply
  10. Francis Mensah

    A very insightful piece, keep up the good work.
    Question: Has the government been made aware of the need for this $350,000 per year and if it has, what is the status of it?

    Reply
    1. Dr. Bertha Serwa Ayi

      Francis,
      Thanks for your positive feedback. Yes the government has been made aware of the amount needed to operate the laboratory. Although 65 million Ghana cedis (equivalent to about 12 million US Dollars)has been pledged by the government to contain and manage this disease, 2.5 million Ghana cedis (equivalent to about $450,000 US Dollars) and has been made available mostly directed towards the purchase of personal protective equipment. I am hopeful that funds will be released in due course. Thanks for the inquiry.

      Reply
  11. Alfred Amuzu

    Great Piece Dr. Ayi, I will be discussing this topic tomorrow between 3pm – 4pm on my TV show “Ghana Agenda”. I’ll love for you to call in and gives us 10 mins of your time if your schedule will allow it. Please reach out to me at alfred@tokpaconsulting.com if you can make it.

    Thank you.

    Alfred Amuzu

    Reply
  12. George

    Covid – 19, it’s very serious, and has infected alot of people in China, I’m currently in China, and choose not to come home, I have been in the room for more than two months, no income or financial support , if it should show up in Ghana, it will be very serious, may God forbid. China with the world’s famous technology is even struggling so hard. God bless Ghana, and protect Africa and the world as a whole.

    Reply
  13. Robella Edith Akpi

    Thanks so much for the detailed information on the spread of the much anticipated virus which is devouring humans. It seems to me more of a plague than even a virus with its asymptomatic nature. It’s scary!
    Your deductions are so accurate, 17 capacity beds in total serving a country of over 30 million inhabitants.
    As you have good thoughts, you mean well for us as Ghanaians. Thanks so much once again for the analysis, we would put in extra measures in preparedness to the nCOV-19. May God help us. Amen.

    Reply
  14. Sammy Agyei

    I really enjoyed reading it and have updated my thoughts… Yes, the authorities are doing well but I think the government should show some commitment on the $350,000 the Centre needs to operate according to them to keep the center running as its stated.
    But some travelers have also said they were just asked to fill only forms at the ports of entries and allowed to go. Is that just okay?
    Also preparedness at designated hospitals are not enough for 30 million populated Country with 2000 doctors.

    Reply
    1. Dr. Bertha Serwa Ayi

      Sammy,

      Thank you for expressing your thoughts. My understanding is that the total budget for fighting COVID-19 stands at 35 million Ghana cedis which is almost 6.4 million US Dollars. The disbursement is happening in phases. The President and leadership of the country continue to get daily updates on the rapidly evolving global situation and update their plans accordingly. Currently all the Regions and several districts have designated treatment centers which greatly expands the capacity I previously noted in the write up.
      Yes, travelers fill health declaration forms and also have temperature checks. The forms are stored for epidemiological purposes. It is important that travelers state accurate information for their own safety so that in the event of contact tracing it will be easy to locate them for evaluation and monitoring.

      Reply
  15. Dr. Abdallah Ibrahim

    Dr. Ayi, Thank you for proving the detail update on Ghana’s preparedness on COVID-19. We have all been worried about how ready countries such as Ghana is.
    With the Nigerian incident, I hope Ghana learns a lesson and be firm about just allowing into the country anyone from the epicenter countries you mentioned without further screening and isolation by well trained and adequately protected GHS staff. I am very concerned that the Ghana Immigration Service staff (and their families) at airport will be far more exposed without adequate protection and preparedness. That will just be a recipe for mass infection.

    Thank you again for the insight. Go Ravens!!

    Reply
    1. Dr. Bertha Serwa Ayi

      Dr. Ibrahim,

      Thank you for your comment. It appears the staff have been well trained to undertake their tasks. I believe they will follow through to ensure their safety as well as that of all travelers and Ghanaian citizens.

      Reply
  16. Gabby

    Hi Dr Ayi,
    I really enjoyed the research work and highlighting the true state of affairs. I just hope politicians will leave everything for the technocrats to do by providing the resources and not diverting the resources for their personal gains.
    Gabby.

    Reply
  17. Maxwell Osei Owusu

    Hello Doc my first thoughts on seeing your post was on putting you on board an ngo we have in Ghana called Access Care Treatment and Support Ghana- ACTS Ghana . We provide support services for persons living with HIV and AIDS as well as prevention services for persons at high risk of HIV prevention . Am more concerned about this virus bacause am told its easier for people with weakened immune systems to get infected and we work with so many people with weak immune systems. I would love to link up with you and see how you could impact on our work in ghana

    Reply
  18. King Lucas Darko

    I didn’t see this early. I am glad to read this post from you Doc. I am an engineering student but shows much concern about health issues. The issues relating to Covid-19 is really causing a lot of negative effect and Ghana must pay conscious attention to this now with a minimal cases recorded (16 cases) before it breaks out.
    I am hoping that the world attains peace soon.

    Thank you and God bless you Doc

    Reply
  19. Pingback: COVID-19: The world faces a common enemy | Science Speaks: Global ID News

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