As the COVID-19 Pandemic rages in Italy, Spain, Iran, South Korea, and the United States of America, and has now been exported to Africa, the award-winning infectious disease scientist, Dr. Dougbeh Chris Nyan has strongly admonished African countries to close all external borders, restrict internal travels, and conduct vigorous mass testing persons for COVID-19 infection.
Dr. Nyan has also advised against taking Chloroquine for COVID-19 now as the drug is under investigation for COVID-19 infection. In January this year Dr. Nyan alerted African countries about the COVID-19 outbreak in China and advised them to beginning preparing for a possible cross-border transmission into Africa. Already, more than 35 countries in Africa have reported imported cases. Following is a full text of the interview conducted by Bai Best and Robin Dopoe of the Daily Observer on March 21, 2020 and carried by this media.
1. What do you make of the government's existing health protocols now that cracks have been seen in the system (evidence Ministry of Information press release announcing the country third case)?
Firstly, I do call for a total Lock-Down of Liberia and other African countries and conduct a vigorous mass laboratory testing for the COVID-19 infection to know who is infected, and, hence preventing the spread of the virus. All non-essential private and government businesses should be closed down. All air and ground travels into Liberia and other African countries should be prohibited or cancelled; close all borders and restrict internal travels to a minimum; and, all citizens as well as foreign residents should be mandated to say in-doors for at least three to four weeks, while frontline healthcare workers implement measures against the COVID-19 pandemic.
Secondly, I think that the Ministry of Information should not be the one communicating health matters, particularly when it comes to public health pandemic issues that require expert-communication. This is meant to avoid miscommunication and to protect patients’ confidentiality.
Thirdly, National Public Health Institutes and the Ministry of Health should maintain STRICT CONFIDENTIALITY about ordinary patients who are detected positive for COVID-19 infection. It is a type of shamming, emotional abuse, and violation of patients’ rights by the government to release or make public the names of ordinary patients.
Now to your main question, I think that there are evidently some major gaps and lapses in the current protocol being used by the Ministry of Health and the National Public Health Institute of Liberia in its response to the COVID-19 Pandemic that has already hit Liberia. Remember that I warned the government about the outbreak since January this year and this should have given the government sufficient time to prepare. Now we can see that the delay in preparing, the lack of proper enforcement of screening regulations at the airport, the selective quarantine of persons arriving into the country, giving free passage to some persons arriving from the US and high-risk countries of Europe, and the lack of adequate funding and healthcare manpower are among several deficiencies of Liberia’s current response efforts to the COVID-19 Pandemic. It is tough, but NPHIL seems to be doing the best it can.
2. What change(s) can you recommend with regard to surveillance?
As I have stated before, this COVID-19 pandemic poses a serious threat to Liberia and other African countries, and this cannot be sugar-coated in any manner. We see how the virus is ravaging the developed countries and is being imported to Africa. Hence, anyone (be it a government official or ordinary citizen) arriving from a high-risk country like the United States, Britain, Italy, South Korea, China, Iran, etc. must definitely be quarantined for the 14-day period. Such quarantined persons under investigation must then be properly monitored for physical signs of the COVID-19 infection and via at least three laboratory testings during the period of their quarantine. I think such an amendment in the surveillance protocol could be helpful.
3. From your expert point of view, what do you make of the virus spreading, looking at the current cases in the country?
What is happening in Italy at the moment could well play out in Liberia and other African countries if proper preventive measures are not enforced. Social distancing helps a lot, but I strongly suggest that a total lock-down will be far more effective as was evidently done in Wuhan to control or stop viral spread in the population. This virus spreads vertically via person-to-person contact and has been determined to increase exponentially. I hope government considers shutting down non-essential functions in the country as soon as possible, or almost immediately within the next 24 hours.
4. Are there any trends or nuances that Liberia should take note of to help stop further spreading?
We are witnessing what is happening across the world, first in Wuhan-China, then Iran, and now in Italy which has registered over 54,000 confirmed cases and almost 5,000 total deaths. Italy, with its highly developed healthcare system, acted very late. It did not prepare soon enough; the United States with all is sophisticated medical and public health systems is also presently not well-equipped, very unprepared, and is still scrambling for safety equipment (PPEs) for frontline healthcare workers and ventilators for needed patients. Now factories in the US and Britain are being activated to produce masks and ventilators. Liberia is one of the largest rubber-producing countries in the world, but Liberia cannot even produce latex gloves (or condoms for that matter).
These trending examples present serious warnings to Liberia and other African countries with already weak healthcare systems. Liberia’s healthcare system may crumble under the weight of an uncontrolled COVID-19 spread if the necessary preventive measures are not strictly implemented and conducted in a timely fashion. Providing adequate funding to public health institutes, prompt decisions and actions by government, availability of trained healthcare personnel, and availability of material and robust testing equipment will provide workable solution to stopping the further spread of the COVID-19 in Liberia and other affected African countries.
5. The government recently disclosed that it has 500 testing kits, which are clearly severely limited. Health authorities are saying that they will only test if there are symptoms. In lieu of tests, what options do we have in Liberia if people start to show symptoms?
While I have not seen that disclosure, I would think that the Ministry of Health and the National Public Health Institute of Liberia will need more testing kits if it is to effectively monitor the spread of the virus in Liberia. I would suggest that laboratory testing be very vigorous and conducted on all arriving persons, on all quarantined persons presently under investigation for COVID-19 infection, and on all traced persons who were in contact with an infected case. For a population of about 4.5 million persons, this will required that government secures at least 10,000 test kits to begin with, each kit containing 100 tests. Presently, there is a high probability that there could be a lot of positive cases roaming out there in the population that are missed or undetected due of Liberia’s limited testing capacity. Infected persons who are not tested could unknowingly be spreading the virus from one person to another. The present three known positive cases may just be a tip of the ice-berg. That is why a total lock-down of the country is very imperative, in addition to social distancing and other preventive measures. Hence, government needs to act immediately.
6. Are there any locally available remedies that can help people to self-treat in case it comes to this?
I don’t advise anyone to self-medicate. And, I say again Do Not Self-Medicate! Don’t even think about using Chloroquine. I know a lot of people have been hearing in the news about Chloroquine treatment of COVID-19 infection. This is still undergoing additional clinical trials to investigate as to whether Chloroquine is safe in the treatment of COVID-19 infection and whether it really works in treating COVID-19 infection. In this regard, the US National Institutes of Health (NIH) and other medical centers will be conducting controlled studies to evaluate earlier promising results reported by colleagues in China. Hence for now, do not see Chloroquine as a kind of “magic bullet” against COVID-19 infection. At this point, there must be a strict compliance with Social-Distancing; no hand-shaking; no hugging and no kissing; perform constant hand-washing with soap; sneeze and cough in the inner angle of the elbow; and, preform self-monitoring for signs such as fever, coughing, sneezing, headache, diarrhea, vomiting, and headache, among others.
Lastly, the government of Liberia needs to commit enough money to the NPHIL’s efforts of conducting these preventive, containment, and mitigation exercises against the COVID-19 pandemic in Liberia.