The call by the Ghana Medical Association and a section of Ghanaians, asking for a lockdown is a good call, but it should be looked at critically. Personally, I think the option to lockdown is becoming necessary and inevitable, given the fact that our confirmed positive cases keep escalating every day.
However, it should be noted that the majority of the cases that are being reported are cases occurring among those in mandatory quarantine. This population is much more controlled, preventing them from shedding the virus among the larger population.
Of course, there have been reports of community spread in the larger population coupled with speculations of some travelers entering the country without observing the COVID-19 protocols for individuals arriving from affected countries.
So yes, we could have other persons who are currently not under the government’s mandatory quarantine but are living among the larger population, serving as risks to other individuals in the larger population. And that is the reason why we cannot take chances, but ask for a lockdown.
Do we need a total lockdown? Maybe not for now. What we do need now is probably some level of selective lockdown, given the fact that the majority of our case count so far are occurring among those under government’s mandatory quarantine. The lockdown should be implemented gradually, where our first level of lockdown should probably be a lockdown affecting the two epicenters – Accra and Kumasi, backed by strict enforcements, learn some lessons from its implementation before extending the measure to other areas.
For instance, we lockdown Accra and Kumasi (current epicenters, identified by the Ghana Health Service and the Ministry of Information), followed by other locations – regions, districts and communities, informed by the information available to the surveillance team. I don’t know what data and information that is available to the COVID-19 response team at the moment with respect to their scientific projections of spread of COVID-19 in Ghana. If they have information and data available that suggests that we could have wide spread of suspected cases across the country, then a complete lockdown will be necessary. On the other hand, if the data/evidence available to the team do suggest that suspected cases could still be confined to the aforementioned epicenters, then the option to lockdown the two major cities and gradual extension to other regions will be prudent.
As we implement these levels of lockdowns, we need to continue to intensify our public awareness and education activities across every nook and cranny of the country, so that no one is left behind. It is also important that the health education materials/contents take into consideration all the dialects in Ghana. This vital component is missing in our local communities at the moment, paving way for a lot of misconceptions, misinformation, myths, fear and panic among the local people.
Government in its attempt to implement any of the levels of lockdown should involve all the necessary stakeholders, particularly traditional leaders. If the implementation of any of the levels of a lockdown is going to take the usual approach where policies are made at the top without involvement of the local authorities, then I am afraid, we might not be successful. Chiefs and local leaders should be invited to the table, their roles should be clearly defined, so that they become the implementers of the lockdown in their various communities when the need arises. I have always said we have not been successful in our fight against Ghana’s poor sanitation situation because our traditional leaders have been left behind by successive governments in the implementation chain. A lockdown will not be effective in my mother’s village if the “Headman” in that village doesn’t know what his role is in the enforcement of the lockdown.
The ramifications (economic, health and food security) of a complete countrywide lockdown is something we should not take lightly. Issues of food security and further impoverishment of people who are already impoverished must be taken into serious consideration. If a total lockdown is not properly implemented, we may end up worsening the immunity statuses of vulnerable populations (children, pregnant and lactating mothers, the aged, the homeless, HIV patients etc.) which will eventually contribute to increasing their risk levels for the contraction of COVID-19.
I don’t really know the composition of the COVID-19 response team, but other Public Health professionals in the team should have conducted some kind of prospective health impact assessment on a lockdown decision. This assessment will enable the team generate some evidence of possible health consequences a lockdown will have on various segments of the population, maximize the positive health benefits and minimize potential adverse effects on the population. This data would have aided leadership in making an informed decision, grounded in evidence, should we decide to go for a total or gradual lockdown.
By now, as we are considering whether to lockdown or not to lockdown, government and relevant agencies and our country’s COVID-19 response team, should also take a critical look at the Standard Operating Protocols put forward by the CDC Africa. Paramount among such protocols is for countries in Africa, including Ghana, have plans for continuity of essential public health operations – i.e. maternal and child health programs, immunizations et cetera, while we make efforts to contain this novel virus in various African countries (CDC Africa, 2020).
Also, quite apart from the call on the COVID-19 response team by a section of Ghanaians to step up its game on timely dissemination of information, it’s also important that the research team should be giving us information on likely exposure locations – regions, districts or towns. This, when done, could help raise the perceived susceptibility levels among the population and could facilitate the desired behaviour modifications desired against COVID-19 and yield positive health outcomes for our containment efforts. After all, one of the purposes of any public health surveillance is to disseminate timely information for action.
At this point, it is important to commend government and the COVID-19 response team with respect to the leadership they have showcased thus far. The decision to close our borders (even though it came a bit late) and mandatory quarantine of Ghanaians and other foreign nationals arriving in Ghana from affected countries, stand tall among all the efforts they have made thus far.
I believe there are tougher decisions ahead, and may God grant the President and the COVID-19 response team that extra strength and knowledge to make the right decisions toward the defeat of this virus as soon as possible. Kudos to all clinicians and frontline healthcare providers who are putting their lives on the line, serving this country to defeat COVID-19.
May God bless our homeland Ghana and deliver us from this novel virus.
Author: Samson Gbolu
Health Promotion Activist and Social Entrepreneur.