The essence of the provision of any public service, including health, is to benefit the general population. In a Public Health Emergency of International Concern (PHEIC), this is even more poignant. This is because the poor management of such situations could have far-reaching consequences in the short, medium and long-term.
Pandemics have been known to define nations and their political, as well as technocratic leaders. The current COVID-19 pandemic is one such situation.
COVID-19 is a new coronavirus of animal origin first encountered in Wuhan, China, in December 2019. Since then, it has spread relatively quickly across the world affecting currently 61.3% of the 194 World Health Organisation (WHO)-member states. This situation will have a significant impact on the world even in countries like Ghana that have seen a few reported cases as compared to some countries in the West and Asia. So far, the following are known:
1. The short, medium and long-term economic cost has not been fully elucidated. However, the loses on the Financial Times Stock Exchange (FTSE-100) Index alone in the week ending 28th of February 2020 of £200 Billion surpassed the total global loses of SARS (£38.6 Billion), MERS (£6.6 Billion) and Ebola (£1.70 Billion) put together. This total is also surpassed by the potential loses to the airline industry of £100 Billion as indicated by the International Air Transport Association (IATA).
2. Well-resourced health systems like the Chinese (GHSI 48.2), Italian (GHSI 56.2) and South Korean (GHSI 70.2) have had significant challenges fighting off the virus once it has taken hold. The Global Health Security (GHS) Index is the first comprehensive assessment and benchmarking of health security and related capabilities across the 195 countries that up the States Parties to the International Health Regulations (IHR 2005). It measures countries preparedness towards dealing with an epidemic. Ghana's GHSI is 35.5.
3. Though the current mortality rate is 3.6%, the disease has been shown to cause significant morbidity in patients above the age of 60 and those with underlying chronic health conditions like hypertension, diabetes and asthma. For those over the age of 70, 21.9% (2 in 10) of confirmed cases lose their lives.
4. Personal hygiene, proper handwashing, the regular use of sanitisers and the avoidance of crowded spaces are effective means of minimising the risk of infection and person to person transmission.
5. Major multi-nationals have had to significantly alter their work patterns to minimise the spread of the disease and large cities and countries have been put in lockdown mode.
Though Ghana has 152 confirmed cases with a Case Mortality Rate (CMR) of 3.3% (well below the global CMR of 4.9%), we must be aware of the ramifications of this global pandemic especially, when it is well established that the CMR globally has increased just as the number of confirmed cases has. It must be emphasised that even if the current situation pertains and our CMR remains low, this will still have a significant impact on our society. The major areas could be the following:
a. Health: Our primary health system has traditionally relied on the Outpatient Department (OPD) model where the sick and health walk in to queue to seek healthcare. This often makes many of these spaces crowded. In a pandemic like COVID-19, it only takes one infected person to enter such a space and cause contagion. Under these circumstances, is it time to relook at this model?
b. Economic: As a net consumer of goods and services, any disruptions in the global economy ripples down to Ghana. Currently, there are indications that the aspects of the Sinohydro agreement will be delayed due to disruptions in the Chinese economy. Should this happen, this could have a significant `impact on the government's development agenda. Already, importers of vehicle spares have been complaining about the impact of the global spread on their economic activities. There could be an economic impact on the pharmaceutical supply chain too. Also, with airlines cutting down on flights and the appetite for flying at a low, there could be an impact on foreign direct investments (FDIs). What adjustments if any, are need to be made to our economic outlook?
c. Social: We are by default a communal society. Our systems rely on handshakes, hugs, communal eating and crowded social events. These include church and mosque activities, funerals, chop bars, open-air drinking spots, musical concerts etc. all of which bring us into proximity of other humans. With the level of virulence, COVID-19 has shown, this way of life will come under serious scrutiny. Aa a society, do we understand the ramifications of these behaviours and are we ready to alter them?
d. Educational: It is known that people below the age of twenty when infected with COVID-19 hardly show no signs or symptoms. Data available worldwide indicates there have been no mortalities attributable to this pandemic for those been 0 years -9 years. From ages 10 to 30 years, the mortality rate is 0.2%. This means the youth when infected could be carriers spreading the infection to the wider population without even knowing. This presents us with a challenge in making sure students in the JHS and SHS have an adequate understanding of the current risks and are taking personal hygiene seriously. Congestion, especially in our boarding schools, maybe a concern.
e. Geopolitics: It is known that 10 Guineans have tested positive for COVID-19 and are in isolation. Also, the exposure across the West African sub-region seems to be similar. With that in mind, what is the level of health communication between Ghana and these countries? What is the level of monitoring at our land borders and how porous are they? How was it that the Guineans got through our neighbouring countries when they were carriers? Should our neighbouring countries fail to contain the pandemic how easily can sub-regional contagion make Ghana vulnerable? Should that happen could that lead to political tension? Research and development for a vaccine are already proceeding at pace, what should be our strategy to make a global contribution? Are there any learnings from the Ebola and Malaria vaccine trials that Ghana can benefit from?
i. What is Ghana's COVID-19 action plan and what are our priority areas?
ii. How visible is the plan? Does the press have access to this plan? Is it available online?
iii. Has the level of communication to health professionals been adequate covering their personal protection, reporting of suspected cases and patient care?
iv. What is the level of preparedness of our health system to manage complicated cases if it gets pressured?
v. Is the level of public engagement adequate taking cognisance of the human movement that greeted the limited shutdown?
vi. With confirmed cases in all our neighbouring countries, what is the level of preparedness at our unapproved land borders?
vii. What is the level of public education and the role of organisations like Information Services and the National Council for Civic Education (NCCE)?
viii. What are the roles of civil society, churches, the press etc in promoting public education and how well resourced are they?
ix. What are the political ramifications of COVID-19 in this election year and should there be any, will this pandemic have an impact of electoral fortunes?
Kwame Sarpong Asiedu is a Democracy & Development (D&D) Fellow in Health at CDD-Ghana. He is a pharmacist by profession, with 19 years of practice, including lecturing in Ghana and the United Kingdom. He previously held various senior leadership roles at Alliance Boots, now Walgreens Boots Alliance, rising to the position of Head of Pharmacy Operations for East Anglia. Asiedu is a member of the Royal Pharmaceutical Society of Great Britain, Institute of Pharmacy Management International, and The Pharmaceutical Society of Ghana.