The following is a guest post by Bertha Serwa Ayi, MD, FACP, FIDSA, MBA
On February 28 I wrote a post on this blog about national preparedness plans and I drew an analogy between SARS-CoV-2 and a beast on the loose. The watchful eyes of the World Health Organization and all segments of our society could not stop its march. It has travelled full circle around the world and ignited fires wherever humans live. Some nations have taken a harder hit than others.
The common enemy, the beast, has united the world ways we could never have imagined.
The WHO has been at the forefront in the fight against this beast. In Geneva, with the backdrop of the WHO logo, a middle-aged man will start the day with pleasantries and predictably say, “As of 6 am this morning there are… confirmed cases of COVID-19.” He is Dr. Tedros Adhanom Ghebreyesus, an Ethiopian-born microbiologist and director-general of the WHO. He has become a household name as daily briefings and interactions with the media by audio and video have become the mainstay of our news cycle. During this period, the WHO has organized a multinational team to pay a ten-day working visit to China. The report from this team has driven initiatives like lock downs, social distancing, treatment methods and enhanced learning on various aspects COVID-19 disease around the world. The WHO has developed 50 technical guidelines for testing and training for member states, in addition to sharing vital information on a daily basis. They have been an important source of healthcare supplies, and online training of healthcare workers and invested into research and development. This month they launched the SOLIDARITY trial involving over 90 countries to evaluate Remdisivir, Chloroquine Sulfate, antiretroviral and Interferon beta 1a to obtain efficacy of their use and enhance best practices. Their Solidarity Response Fund has raised over $800 million USD. On April 9 2020 it launched the UN COVID-19 supply chain task force to assist with logistics in the face of a pandemic whose management has been characterized by hiccups of lack of ventilators, Personal protective equipment and shortage of test kits.
The United States
America is still in shock that its number dead is far beyond what China saw and closely mimics Italy and Spain. It never imagined it will record eight times the numbers China was reporting. It is our new reality. Social distancing is recommended and not enforced. Almost 290 million of its 300 million people have been asked to stay at home. In a handful of states people still have no limitations on movement. How much of this has driven its cases past half a million by April 15 is unclear.
The nation Ghana has displayed remarkable resilience in fighting off the beast as it tries to engage it in battle. Eight people have died. It reported its first case on March 12. After the nation recorded its 6th confirmed case, all imported, it imposed a travel ban on nations with more than 200 case count on March 15th. This was soon followed a week later by a ban on all in bound air travel effective March 23 2020. The 48 hours following the travel ban will see 1030 visitors in the country who were all placed in a mandatory quarantine in very plush residential settings. 10.14% of these individuals will test positive greatly ballooning its confirmed cases to 313 as of today and cementing the rationale for the travel restriction. Currently there is a lockdown in the two major cities identified as hotspots, Accra, its capital and Kumasi, both economic machines of this nation. It has sealed off inbound travel of any form of persons by land or sea. 11 of its cases include travelers from neighboring Burkina Faso who sneaked into the country.
The nation is on the alert. Most people have exercised discipline. Testing at the nation’s laboratories by real time PCR is free. There is a plan to equip a total of 35 laboratories around the country to greatly enhance testing capacity. It may stick with PCR based testing to avoid the false negative rates associated with the rapid antibody tests or at best use it and confirm with a PCR test. The testing sites are busy places as people are able to get same day appointments or simple walk ins are welcome. It has not faced the same bottle neck which restricts testing to only those with symptoms in several European countries. All identified contacts of infected persons undergo testing. All healthcare workers and frontline security personnel are being tested. It is acquiring new ventilators in the setting of the quadrupling of the cost of ventilators in case of a possible surge of cases of critical cases. It has rolled out an expansive social mitigation plan of absorbing all the water bills for the nation from April through June as a commitment to ensuring that citizens wash their hands. Staple foods like traditional waakye, a rice and beans meal, kenkey and coco, both corn based meals can be obtained for free from vendors for the next three months in the areas where a lockdown has been enforced as part of the Coronavirus Alleviation Program (CAP). The CAP was announced by the country’s fully engaged leadership in their 5th National address on COVID-19 on April 5.
Innovation is high. A young man, Jude Osei, has received global and national acclaim for inventing a remarkably efficient solar powered hand wash basin that he had fabricated out of an oil drum which dispenses soap and allows a 25 second lapse to ensure proper hand washing before water is dispensed. Local industries have stepped up to produce 150,000 face masks a day for distribution to citizens. Online education for high students has kicked in as all sectors of government have made COVID-19 a priority agenda. Frontline healthcare workers have been given priority for receiving personal protective equipment, they can go to work with fully paid transportation, they will receive a 50% increase in salary for the months April, May and June and they will be tax exempt for the same period. This is unprecedented. It is determined to learn from the lessons that have plagued America and the European Union and reduce death and harm to its citizens.
The European Union
The member states of the European Union have been on a 30-day lock down since March 30. They have been the hardest hit. Hopefully, predictably they will reap the benefits of cordon solitaire in about two weeks after the lock down is over. On April 8 it called for a common digital platform to be used by member states for contact tracing and ensure intercountry operability disease tracking.
Australia closed its borders to all noncitizens on March 20 after a 24-hour notice instead of the usual 48 hour notice. It has lost 50 people with its population at 25 million. This could go on for six months. New Zealand closed its borders on March 19and has recorded only one death in a country with 5 million people. The police enforce strict social distancing.
In South America, Brazil is bracing for the worst as studies indicate that its first cases were a group of 300 or so travelers who arrived from mostly (54.8%) Italy between February and March 5 with a few from China (9.3%) and from France (8.3%), thereby sparking a large outbreak about to explode shortly. It has a case load of 16,000 and is the most affected country in South America.
The word solidarity is sweet. Togetherness. That is what Ghebreyesus has preached since this pandemic started. Together we will win the fight against this unseen enemy. I hope a year from now, we will be writing how we vanquished the beast because the world came together and you played your part.
Bertha Serwa Ayi, MD, FACP, FIDSA, MBA is an adjunct Assistant Professor of Medicine at the Kansas Health Sciences 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 Johns 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 Nebraska 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. Dr. Ayi is an adjunct lecturer at the University of Allied Health Sciences, in Ghana, She is in private practice.