Since the world became acutely aware of the COVID-19 pandemic, emanating from Wuhan, Hubei Province, China, every country has had an opportunity to protect its citizens from the invariable outcomes of the situation with more than 1 million people worldwide.
The obstacles have been many but the principal one has been a tension between protecting the citizenry at the cost of limiting individual freedoms and placing undue stress on economies in the service of public health. There have been other issues, mainly the challenge of providing fact-based scientific information to populations with varying degrees of preparedness and understanding of the core concepts of disease infection and transmission on a global scale.
In the United States it has become clear that at least eight weeks was wasted on administrative dithering and unnecessary political infighting. This has led to an exceptionally high infection and mortality rate, surpassing those of Italy and China to date. The USA is sadly still to achieve Covid-19-sensibility.
The initial steps taken in Ghana, after promoting hand-washing and not touching one’s face, in response to the rapidly unfolding pandemic, have largely been in the right direction but implementation could have been better. Allowing a 48-hour window to elapse prior to implementing the partial lockdown of the country, led to crowding in markets, which was antithetical to the whole idea of social distancing, partly the reason for which the lockdown was being implemented. Additionally, it led to numerous individuals fleeing from Accra and Kumasi to yet unaffected areas of the country. This has made further contact tracing of already identified and exposed individuals, more expensive and difficult.
Information from frontline healthcare workers in the regions and districts confirm that they are poorly equipped to handle large numbers of infected patients because of the current lack of PPE’s and the fact that they are having to purchase these from their current budgets.
Many have expressed concerns about the poor and and how the lockdown affects their daily livelihood. When a lockdown is properly implemented and managed, it allows for free movement of people for specific purposes at specific times. The role of security forces, includes managing these nuances and allowing the population to go about their daily business, while observing social distancing. Therefore, instead of bluntly stopping people from shopping for food, the security forces should be teaching and aiding people who are lined up for any activity, to stay 6 feet away from each other in the pursuit of those goals.
We continue to learn from the mistakes of countries who are sadly ahead of us in this process. The whole idea of social distancing is to ensure that the virus has further to travel from a carrier or a sick individual to a healthy person, making it more likely that new cases will occur at a slower rate, so as not to overwhelm our healthcare system.
This can also be achieved by ensuring that everyone has an adequate facial barrier or mask. These do not have to be imported but can be made by local tailors and seamstresses and sold to the entire population. Though some may doubt the contribution of facial masks, in medicine in an intervention does no harm, it is best to implement it, while one continues to evaluate its effectiveness. Current evidence from Taiwan and the Czech Republic strongly suggests that for those who for various reasons cannot practice social distancing, masks will help in reducing the spread of the virus.
The president’s COVID-19 Trust Fund should focus largely on capacity building and sustainable interventions such as purchasing PPE’s for frontline healthcare workers and supporting small business people and entrepreneurs in Ghana, to make masks for the whole population.
I have seen recent unconfirmed reports that the intent is to return children to school in Ghana by mid-April. This may be a risky proposition because at least 35% of individuals with COVID-19 may be asymptomatic active carriers. Those, testing positive who are identified in the community through our current methods, represent a small proportion of the large army of invisible transmitters of the disease among us.
My recommendation would be to support large scale masking of the population when individuals go into public places and at home, if many share a living space. If children are to return to school, all school personnel and children should wear masks or this lifting of the lid on our blockade will lead to an overwhelming spread of the virus in the weeks and months ahead, erasing current gains.Fabric masks must be washed daily, meaning each individual should ideally hve two or more.
Very soon, the numbers of infected and the dead that are published every day, will include family, friends and colleagues. This is now our reality within the Ghanaian community in the United States. It is better to have done more to prevent the spread of COVID-19 united as a nation, devoid of any political goals, than to look back and say, “if only we had been more disciplined, more forthright and more unyielding, we could have saved more lives”.
T. P. Manus Ulzen is Professor of Psychiatry and Behavioral Medicine at the University of Alabama, Annual Visiting Professor at the University of Cape Coast School of Medical Sciences and author of “Java Hill: An African Journey” – A historiography of Ghana.
This article is dedicated to the memory of Dr. (Mrs.) Antoinette “Toni” Williams Akita a devoted wife, great mother, a loving grandmother, a truly cherished friend and a public health pediatrician who served the State of New York in her time.