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Covid-19: Testing, testing and more testing

Health officials conducting tests at the Big5 Lodge quarantine in Gaborone
Over 50 percent of the globe is under lockdown as Covid-19 spreads like bush fire around the world leaving behind a trail of death and untold misery for those who are hanging to their dear lives in intensive care unit facilities.

The world is left wondering, “what could we have done differently to stop this enemy?” Ironically, as the enemy advances, with a vengeance, all countries, both big and small, are taking cover indoors to save their dear lives.

Covid-19 is a different kind of enemy. The enemy is invisible but not invincible. The enemy is a coward and can be kept at bay with a splash of water and sliver of soap. But alas, the enemy is resilient, persistent and keeps on advancing.

Covid-19 has already claimed about 80,000 lives around the world. In the United States alone, an average of 1,200 people are dying everyday since the beginning of this month. The daily death average for Italy and Spain this week stood at 700 and 600 respectively. The same applies to Britain and France.

In Africa Covid-19 has claimed just over 500 lives. Nine thousand cases have been confirmed and still counting. The numbers for Africa appear relatively low compared to Europe and North America, or the rest of the world for that matter.  According to experts this does not necessarily mean that the continent might be spared the massacre visited on the other continents by Covid-19. Africa should expect the worst before it gets better.

This is not a threat but a warning. It means that African countries ought to ramp up their preparedness for the eventuality of high death rates, because it is bound to happen. It is just a matter of time. The impact on Africa, with less resources, collapsed public health systems, and a prevalence of a wide range of pre-existing diseases, not least HIV, is likely to be more catastrophic.

If what we are witnessing in South Africa is anything to go by, then the sub continent is in trouble. The enemy is swiftly gaining ground. Covid-19 has already claimed just over 20 lives in that country, and the number of confirmed cases is increasing exponentially. It is still early to pronounce on the effects, on the spread of the disease, of the 21-day lockdown imposed on the country two weeks ago.

Needless to say, Covid-19 is one of the undesired by-products of globalization. Being in the same neighbourhood with South Africa countries like Botswana, Lesotho, Eswatini  (BLE) and Mozambique can expect the Covid-19 contagion to affect their people more or less the same as their big brother just in as much as Africa could not escape the disease that started in China last December.

Unfortunately for the BLE countries they do not have as much resources as South Africa does. The three countries are overly dependent on South Africa for most of their essential goods. When the chips are down, South Africa will obviously prioritise its own people to the detriment of its neighbours should there be a shortage of supplies, be they medical, agricultural, etc.

The best protection for a country like Botswana therefore, under the circumstances, is to do all that it can to prevent the virus from spreading further. It is therefore not surprising to see the government, led by President Mokgweetsi Masisi, pulling out all the stops, for instance declaring a State of Emergency, to enable him to put in place measures to stop the enemy from advancing deeper into our territory.

The lockdown, also known as  “extreme social distancing”, was the right thing to do under the circumstances. The President must be commended for his decisiveness and leadership on this matter. And Batswana do well to comply with the guidelines of the State of Emergency because failure to do so will render government’s effort futile to slow the spread of the disease.

The government’s relief measures as well as the stimulus package that they are contemplating to cushion the livelihoods of Batswana in terms of supporting labour, business and those on social grants are also commendable. There is no doubt that if implemented they could go a long way in mitigating the effects of Covid-19 on the lives of the most vulnerable in our society.       

However, life comes before livelihood. Covid-19 is, first and foremost, a medical problem and public health challenge threatening the lives of Batswana. The Government has the solemn duty to protect the life of each and every Motswana. And this is why the Ministry of Health and Wellness is front and centre in the fight against this enemy. It would serve no purpose to save the economy when there are no people to populate them.

Our health authorities must be more strategic in their fight against Covid-19 and stop uncritically following the World Health Organization (WHO) template in their resolve to save the lives of Batswana. It is concerning that government has tended to react in a knee-jerk fashion to things that it should have long prepared for because by beginning of February it was already clear that the virus was becoming global. If the government, led by the Ministry of Health, continues on this path not only will Covid-19 violate our sovereignty, but the virus will decimate a huge portion of the population!

The biggest criticism against countries which are the hardest hit by Covid-19, like Italy, Britain and United States, is that they did not start screening, testing and tracing contacts at the initial stages of the disease. And now they are paying the price. Under different circumstances we would be saying “They were playing marbles while Rome was burning”!

This must be a lesson to Botswana and other African countries. They must learn from others’ mistakes in this regard. Fortunately, African countries do not have to reinvent the wheel. They can learn from best practices from such countries as China, South Korea, Singapore and Germany, which have managed to contain Covid-19.

While the countries that are doing badly failed to test early the ones that made it were successful because of their aggressive screening and testing programme right from the word go. And they continue to do that now. Testing, testing and more testing! Testing is one of the most important tools that the government must use to control the spread of the virus. This is not the time to be making public declarations like “we are going to ramp up testing”. Just do it. Actions speak louder than words.

As a matter of urgency government needs to embark on an aggressive campaign of screening and testing. Testing is important because then they can identify cases. But most importantly they can track and trace contacts, isolate them and treat those who are sick, before the spread of the disease gets out of control. If that does not happen the country is going fall behind the curve before it even starts rising let alone having to contend with the intractable challenge of flattening it.

Commenting on the screening and testing drive taking place in South Africa, leading vaccinologist in that country, Shabir Mahdi, said recently, “I fear, because of testing kit and material shortages, SA will be on a similar or worse infection trajectory as Spain and Italy”. He further observed, “Government cannot properly implement its isolation and quarantine strategies without knowing who's actually

infected, which is critical to this fight." The same can be said of all countries on the continent, including Botswana.

So far we are testing suspects, people who traveled abroad, and those showing symptoms. The next phase of testing, as government “ramps up” the process would be to do “mass community screening” which should start anytime now. This is an important milestone because besides detection it promotes public awareness, especially now that we have entered another stage of the pandemic - community or local transmission, following the Molepolole confirmed case over the weekend.

However, mass screening is still limited in that it targets what is perceived to be potential “hotspots” and focuses on people showing symptoms.  This method of sampling will never give us an accurate estimation of the magnitude of the problem in the country. In South Africa, where they started mass screening this week, the campaign is already being politicized as some are claiming that it is targeting black townships when the disease in that country was brought by people living in the suburbs.

Health authorities should rather use a sample that is more representative of the country’s population especially because ours is a small population. In that way they will also be able to discern where the real hotspots are. Then testing, contact tracing, isolation and treatment will be more directed and this would go a long way in “flattening the curve” and thus ease pressure on our already ailing health infrastructure, but most importantly, limit the number of possible deaths. It would also help inform policy choices going forward. Projections will be more realistic as to what is in store for us in respect of cases, deaths and more importantly, resource allocation and mobilization.

There is also need to shorten the turnaround time for production of results after testing. Presently the process is too slow as one has to wait for up to seven days before they can know if they are negative or positive for Covid-19. The testing capacity within the country must be upscaled in terms of equipment, trained personnel, and logistical support.  In Kenya they are able to test over 10,000 people in a day and the results can be out in 24 hours.  South Africa is targeting 35,000 tests a day during the mass screening campaign. Botswana should invest in testing laboratories that will be capacitated to perform this important function. Testing will cost the country much less to prevent Covid-19 as opposed to the exorbitant price that government would otherwise pay to cure the disease after the fact.

This brings me to the vexing issue of the country’s state of preparedness with regard to fighting Covid-19. One hopes that the drifting, dithering and prevarication, evident on the part of government with regard to testing has nothing to do with the usual refrain - absence of funds.

Covid-19 is the number one national security threat right now. It is the preeminent existential threat to the security of this country. As a matter of urgency the budget that was passed by parliament in February, should be reviewed to prioritize health care. This should allow for the government to scale up its preparedness in terms of training of health workers, logistics and procurement of necessary supplies.

Funds will be needed to secure and furnish quarantine and isolation centers, screening and testing centers including mobile units, intensive care units facilities and additional hospital beds, to name a few. We have seen how Covid-19 can overwhelm a country’s health infrastructure as the curve rises, and hence the need to avoid that phase of the pandemic.

Our public health infrastructure right now is in a state of disrepair even before we start feeling the impact of Covid-19. Patients are sleeping on the floor at Princess Marina Hospital and other hospitals around the country. The doctor patient ratio is too high. There are less than 200 ventilators in our hospitals countrywide. Over the last three months the price of a ventilator has doubled from about US$25,000 to $50,000 because they are in high demand.

The same applies to personal protective equipment (PPE’s), masks , gowns, goggles, gloves, etc, which are already in short supply here in Botswana exposing health workers and first responders to contracting the virus. The question is, while we hope for the best, in anticipation of the worst, have our health authorities already placed orders for procurement of these supplies given the shortage in the world market and the fact that land, air and sea travel have ground to a halt.

Regarding the difficulty of procuring medical supplies to be used in the fight against Covid-19 a spokesperson of National Health Laboratory Services (NHLS) of South Africa had this to say this week, "We order test kits and they don’t come in. It gets postponed. The flight gets cancelled. It is a huge challenge. The other challenge is the fact that the whole world is competing for the same products… We are dealing with suppliers throughout the world. It is very difficult. The team sits here in a war room-style situation, phoning suppliers. We have to find creative ways to deal with the crises."

So, time is not on the government’s side. This is a matter of life and death. Money must be made available to procure the necessary materials that are needed now because there might be a greater need in the future. This could spare Batswana the ugly sight and pain of seeing the few intensive care unit facilities around the country being overwhelmed when patients with severe symptoms of the disease are on their death-beds and doctors have to decide who should have a ventilator and survive, and who cannot not have one to die. 

In conclusion, government can do all these things and others to protect us from the spread of Covid-19, but at the end of the day, it behoves each and every one of us to play our part to support that effort by complying with the guidelines of the lockdown. The lockdown is meant to buy us time to slow down the transmission of the virus and reduce the severity of the ramifications of Covid-19. But that can only happen if we stay at home and only go out when it is absolutely necessary to do so.

Many Batswana are complying except for a few bad apples who are seen roaming the streets and driving on our roads with reckless abandon. It is because of this kind of indiscipline and bad behaviour that the Italians, Spaniards and Americans are where they are now because of the nonchalant way in which they treated advice by their respective government’s. Had they heeded the message they would have obviated this tragedy. The disciplined forces of this country should enforce the law and deal unkindly with those who do not comply to save them from themselves but more importantly stop them from putting the lives of others in danger.

* Titus Mbuya is the Managing Director of Dikgang Publishing Company. He writes this article in his personal capacity








UDC, BDP Caucus

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