Preparing For A Lockdown; Some Useful Suggestions For Ghana

What is the Corona Virus

Coronaviruses (CoV) are a large family of viruses that cause illness ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV). The novel coronavirus (SARS-CoV-2) is a new strain which has not previously been identified in humans. Signs of infection include respiratory symptoms such as cough, shortness of breath, difficulty breathing and fever. In more severe cases, pneumonia, severe acute respiratory syndrome, kidney failure and death can occur.

Medical management of COVID 19

A limited range of drugs in support but no cure – Chloroquine proving to be effective along with anti-viral therapies. CHQ best for Ghana given its low cost and our familiarity with the drug. Government has to be persuaded to re-start mass production of CHQ and its use under strict medical guidelines. Countries currently using CHQ are the United States, China UK, Italy, France, India. Ghana needs to urgently integrate CHQ into our system of management and the government needs to move fast on this as other countries are starting to move.

Need to look very closely at the current model that we intend to use to treat people

• Is there anything we can change?
• What can we build?
• Define and rapidly construct C-19Treatments Units which are alternative to the full-scale hospital ICU
• Rapid work needs to be undertaken to define what lockdown means in the Ghana context and it has to be communicated to people

Quarantine/Lockdown

The physical isolation of all or parts of the population is one of the principal weapons currently being deployed to combat C-19 across the word In the absence of a vaccine or cure for the disease, and given the incredible virility of C-19 through various forms of contact, the principal weapon is the use of physical barriers at the scale of the city, the neighbourhood, the community, the block, the house, and the individual body so as to containing C-19 and halt its spread.

My position on lockdown

For me, whether to have a lockdown or not is not the issue. A lockdown is inevitable at a point. The real issue is how to implement and manage a lockdown within the Ghana context.

The objective of a lockdown

The objective would be for the nation to master the management of the disease, control its spread and if possible terminate community-acquired infections and achieve tolerable levels of clinical and hospital care that does not overwhelm our fragile health delivery system.

Duration of a lockdown

• Lockdown will have to last from 1 month to 3 months and perhaps more – two weeks only is completely unrealistic
• We can go into lockdown now but it can only max 3- days to one-week maximum in our current situation but after that, there will be trouble
• Effective lockdown requires an extremely wide range of measures to support people
• Within a week after we go into lockdown, Government must come out with a comprehensive programme to address all aspects of lockdown

The current visible focus of government (but a lot is happening behind the scenes)

Ghana government system engaged in active case finding and contact tracing, quarantine of high-risk contacts, isolation and care for patients. Appears to be reasonably successful with suspect case isolation, rapid diagnosis, and contact tracing.

Ghana system of management

In an ideal world, we would have the following

• sufficient test kits
• well-stocked and identified isolation/quarantine hospitals/wards;
• adequate number of medical personnel; medicines and vaccines, personal protection equipment like gloves, masks, gowns, shoes; disinfection mats and disinfectants;
• cross-ministerial and cross-country management teams, with in-built and inter-ministerial daily meetings and briefings;
• identified government spokesperson who will be the face of the management team; identified international liaison person – to liaise with other regional, continental and international governments and the WHO),
• daily governmental updates to the citizenry at pre-determined times and pre-determined media channel to give them the facts (what policies are working and what changes are needed), calm nerves, explain why certain decisions have been made or may need to be changed, allay their fears and generally assure them that the government is on top of the problem and is doing all it can to return the country to normal within the shortest possible time.

This is starting to happen as we speak although it is still slow. But we do have elements of a streamlined management system

Problems and issues facing the Ghana government and that must be progressively mastered over the period of the lockdown – not everything can be done at once or needs to be done at once

• People have mastered a particular way of life to survive over the years in normal times. What happens when all of a sudden an unplanned interruption occurs in their way of life?
• Principal problem facing Ghana government is that it has to move on testing, surveillance, laboratory strengthening, emergency operations centre support, epidemiology expertise, outbreak response capacity (including risk communication and health promotion), and the ability to base decisions on data – 50,000 diagnostic kits ordered and Jack Ma also donating some – clearly not enough
• Most emergency workers have no cars of their own Ambulance service is laughable
• Community pharmacies are major health outlets but not yet put in shape to handle the crisis
• Radio stations are the functional emergency frequencies – the government has no national system for reaching the people
• It is common knowledge that for most salaried workers earning below 1k per month it difficult to cover the whole month with their salary so they are constantly running deficits
• How do people have access to food and other essentials to survive if the lockdown stretches over days given our income levels, especially those who earn daily wages. Like taxi drivers, labourers etc. If they don't go to work, they'll starve. Most families live ‘hand to mouth’ and on a daily basis how do we assist them to cope
• How do we ensure that there is enough food in the system since people would have to stock at certain points during the lockdown
• How do we replenish stocks? How do we ensure the stability of prices
• How many homes have fridges to preserve food and how many people can store food for a week?
• Can the government make food available for people locked down in the homes
• Can food be supplied for a period of months in case government want to supply at the doorstep
• Most of our staples are perishable, the plantain, cassava, yam cocoyam, vegetables, fruits. What planning goes into ensuring that these supply chains are not interrupted to ensure the continuous flow of food
• Those that could be stored, rice, maize, gari, sugar etc., Plans will have to be made to ensure that we have in place adequate supplies during the lockdown since imports will not be flowing as in normal times – we must build this up rapidly immediately after the first week
• For salaried workers, it might be useful to activate the consumer cooperative shops that used to be in almost every workplace during the 70s, 80s and early 90s. These were run by the unions and workplace welfare committees. Government can support companies to give a special lock down ‘food basket’ on a long term credit basis to all worker
• The food basket would contain key food items like, rice, oil, sugar, gari, maize. Some detergents and toiletries could be added
• Community intervention would be a bigger challenge. But this is where assemblies and MPs, as well as traditional rulers, would have to prove their relevance
• Government outreach would be effective also if organised professional groups are utilised like the teachers(GNAT, UTAG etc. and drivers GPRTU, PROTOA) etc
• But above all Government must be careful not to single-handedly issue measures.
• The government must from this week have sector-wide consultations and meetings with stakeholders and take their inputs so the final measures that are announced reflect a national consensus. That build-up alone would engender massive support and ownership that ensures concerted national action as we saw during the PNDC era

Suggest a 90 Day Emergency set of Measures – Economic and Social

Week 1 – Broader Economic Measures to support a lockdown

• Emergency Revision of budget with tailored economic measures that are fit for purpose but requires information
• A quick survey of hardest-hit segments of the economy – Tourism/Hotels/Travel / Air and Land/Traders ( small / medium / Mkt women )
• Speedy emergency clearing of raw materials from Port to pharmaceutical manufacturers at the forefront of providing drugs for supportive care
• Companies that have the capacity for workers to work remotely from work site should encourage workers to work off-site from home

Week 2 to Week 3 – Support Measures

• Special lending rates; rollover of loans and overdrafts;
• Minimum daily wage payments to workers in the segments of economy targeted and hardest hit
• People whose income has dried up for the next six months.
• Income support will need to be administered through the companies, trade associations, district assemblies
• Large corporates – increased capital allowances/tax breaks for those who do not lay off workers
• The capped discount interest rate for borrowing for the next 90 days or three months
• The $100 million can about $25m (25%) be used and applied to fund some of these emergency 90-day support measures.

Managing school closures – what can be done here?

THE $100 MILLION CAN ABOUT $25M (25%) BE USED AND APPLIED TO FUND SOME OF THESE EMERGENCY 90 DAY SUPPORT MEASURES

Health communication aspect of lockdown

• Public health information currently too generic to support a lockdown – we need to go beyond basic information about C-19 that has been offered so far by the public health campaigns. Lockdown issues are different.
• Currently, we are focused on “What is Ebola? How is it spread? What are the symptoms? How long does it last?”
• But Lockdown phase that is coming deals with an additional set of issues – we need health messaging that addresses 'higher-order,' practical information to manage a lockdown for 4 weeks to six weeks
• What are we going to do with compound houses?
• How do I manage a family of children, including infants and toddlers, in quarantine?”
• “How do I transport someone to a hospital or clinic without promoting infection?”
• What does my community do with an exposed and infectious body when the health
• teams do not come to collect it?”
• How to properly care for sick people
• How to isolate sick people
• How to transport sick people safely
• How to isolate corpses
• How to maintain personal and household hygiene and use hygiene materials
• How to make use of available PPE=
• How to properly disinfect homes.
• Care and management of families and young children where parents or care-givers are sick or die or are outside the home
• During lockdown breaks to buy food, people need to stand apart as they line up to enter a supermarket or pharmacy – lines can be drawn showing where people need to stand

Clear that heightened attention to sanitation would prohibit the spread of the virus

Governmental, NGO, and bilateral support required to sponsor heightened sanitation in private and public latrines, to include the distribution of buckets, ash, and bleach for washing, and locally obtainable personal protective equipment (PPE) gear like raincoats, rain boots, and plastic bags.

Lessons from Liberia and Sierra Leone

The quarantines or lockdowns applied in the two countries

• In Liberia, the Johnson Sirleaf government declared a state of emergency on August 7, 2014, and placed three counties (Bomi, Lofa, and Cape Mount) under quarantine four days later. Quarantines of various scales were used throughout the duration of the crisis,
• Liberia took the extraordinary step of implementing a cordon sanitaire around one of the poorest neighbourhoods in the capital city, Monrovia – met by riots – we must avoid this
• In September 2014 Sierra Leone imposed a three-day national shut-down, and at moments it effectively placed more than a third of its population under indefinite quarantine orders – local unrest but did not reach the scale of the protests in Liberia

Important to note that COVID quarantine different from Ebola quarantine in a large number of ways. Even so lessons from these experiences that are relevant to us are as follows:

• People needed to be convinced that the disease was real
• A critical role of trusted local leaders, both formally appointed or selected or informally powerful and influential
• Basic needs – physical and non-physical must be met for the quarantine to be successful
• Defined and constructed Ebola control units which were appropriate to treatment without being full-scale hospitals or wards were highly successful– more like the field stations that you set up during wars – ETCs were critical in bringing the situation in Liberia under control
• Local community and household-based structures critical to bringing Ebola under control – local social networks are essential for controlling infectious disease outbreaks – without them, formal public health and biomedical interventions will fail or will mask serious problems
• Ebola was beaten by mobilizing everybody – women's groups, youth groups, local zonal heads, political groups, clinics, church-based organizations, non-governmental organizations, and recreational clubs.
• Messages had to constantly change to fit the situation
• Continuity of messages and continuity of message delivery is a critical issue

Are we going to bring in international partners to support us? Which international partners are we going to be bring in to support us? NGOs, Cuba, China itself

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