Coronavirus disease (COVID-19) is a respiratory illness that can easily be spread from person to person. The virus that causes COVID-19 is Novel Coronavirus that was first discovered during an investigation into an outbreak in Wuhan, China.
Patients with COVID-19 do have mild to severe respiratory illness with symptoms of fever, coughing and difficulty in breathing. Some other patients do have Pneumonia and Multiple Organ failure which causes death.
World Health Organization (WHO) Director-General; Dr. Tedros Adhanon Ghebreyesus, on 11th March 2020 declared COVID-19 as a pandemic. This was when the disease had spread in many parts of the world.
According to WHO, it took more than three months to reach the first 100,000 confirmed cases worldwide but it took less than a week for the number to double from five hundred thousand to a million.
As at 11/04/2020 (8:00am), the global confirmed cases of the coronavirus had reached 1,610,909 with 99,690 deaths and over 400,000 recoveries.
The pandemic has hit almost all parts of the world with leaders putting in much efforts to arrest the situation. Governments are implementing scientifically proven measures which seem to be a little effective in preventing and controlling the spread of the deadly disease.
Some of these core public health measures include screening, quarantine, isolation and social distancing among others. The above measures are more essential especially when an infectious disease has no specific vaccine and medication for prevention and treatment.
Popular among efforts by governments to help combat the pandemic is the partial lockdown in highly affected parts of the country. The question is: do all Ghanaians really understand the essence of quarantine, isolation and social distancing as well as what goes into these public health measures, the role of government and citizens when these public health measures are implemented? To break the chain of transmission of coronavirus infection it is vital we consider the following public health measures.
I will begin with “Quarantine”, Leprosy, mentioned in both Old and New testaments, is the first documented disease for which quarantine was imposed. The plague of the 14th century gave rise to the modern concept of quarantine. The Black Death first appeared in Europe in 1347. Over the course of four years, it killed between 40 million and 50 million people in Europe and somewhere between 75 million and 200 million worldwide. In 1377, the seaport in Ragusa, modern day Dubrovnik, Ships traveling from areas with high rates of plague were required to stay offshore for 30 days before docking. Anyone onboard who was healthy at the end of the waiting period was presumed unlikely to spread the infection and allowed onshore.
The thirty days was eventually extended to 40 days, giving rise to the term quarantine, from the Italian word “quaranta” which means “for 40”. It was in Ragusa that the first law to enforce the act of quarantine was implemented.
Quarantine in general means the separation of a person or people reasonably believed to have been exposed to a communicable disease but not yet symptomatic from others who have not been so exposed in order to prevent the possible spread of the disease. With COVID-19, the Centers for Disease Control and Prevention (CDC) has recommended a 14-day period of quarantine to monitor for symptoms. Quarantine can be at quarantine centers or at home. Once a quarantined person begins to show symptoms of a particular infectious disease, he or she is removed for isolation. In the case of COVID- 19, fever, coughing, difficulty in breathing are the early symptoms. Quarantine helps in early detection of infectious diseases for management and helps limit further spread of the disease.
Isolation refers to the separation of a person or people known or reasonably believed to be infected or sick from those who are not infected or healthy in order to prevent spread of the disease. Isolation may be voluntary, or compelled by governmental or public health authorities. Isolation can be done in specific isolation centers in the health facilities, or at home using specific bedroom with washroom and toilet facility specific for the sick. Home isolation is more effective when the condition is at mild stage. When severe, the patient needs to be moved to intensive care unit at isolation centers to help properly treat the patient. Isolation is essential as it helps in early treatment of the infected person and also help prevent the spread of the disease to others.
Social distancing is a public health practice that aims to prevent sick people from coming in close contact with healthy people in order to reduce opportunities for disease transmission. It can include large-scale measures like canceling group events or closing public spaces, as well as individual decisions such as avoiding crowds. The CDC defines social distancing as it applies to COVID-19 as "remaining out of congregate settings, avoiding mass gatherings, and maintaining distance (approximately 6 feet or 2 meters) from others when possible”.
Why social distancing? With COVID-19, the goal of social distancing is to slow down the outbreak in order to reduce the chance of infection among high-risk populations and to reduce the burden on health care systems and workers. Experts describe this as "flattening the curve," which refers to the ability to prevent surges in illness that could overwhelm healthcare systems. If that can happen, then there will be less people with disease, and less people needing hospitalization and ventilators at any one time.
Conditions and principles of quarantine and isolation.
To begin, isolated individuals must be confined separately from quarantined individuals, secondly, the health status of isolated and quarantined individuals must be monitored regularly to determine if they continue to require isolation or quarantine. Thirdly, if a quarantined individual subsequently becomes infected or is reasonably believed to have become infected with a contagious disease he or she must promptly be removed to isolation. Fourthly, the needs of individuals who are isolated or quarantined shall be addressed in a systematic and competent fashion, including but not limited to, providing adequate food, clothing, shelter, means of communication with those in isolation or quarantine and outside these settings, and competent medical care. Also, outside premises used for isolation and quarantine shall be maintained in a safe and hygienic manner and be designed to minimize the likelihood of further transmission of infection or other harms to individuals isolated and quarantined. Again, isolation and quarantine must be immediately terminated when an individual poses no substantial risk of transmitting a contagious or possibly contagious disease to others. Lastly, cultural and religious beliefs shall be respected in addressing the needs of individuals in establishing and maintaining isolation and quarantine premises.
Serious situations call for strict measures as the COVID- I9 confirmed cases has continuously increased. As the case in Ghana has reach 566 with 8 deaths, as at 12th April, 2020 19: 10:24 GMT and is covering other regions, the government of Ghana has extended the initial partial lockdown to two weeks. It is essential for all to comply with the lockdown and adhere to social distancing to help reduce the spread of the disease.
The government has put in efforts to reduce the burden of citizens through its stimulus packages such us reduction of utility bills, incentives for health workers among others. I urge the government and state officials to ensure effective implementation of the stimulus packages in a way to benefit all.
Ministry of health and Ghana health services should continue to put public health staffs such as Disease Control Officers, Health Information Officers, Nutrition Officers, Mental Health and Health Promotion as well as Environmental Health Officers for surveillance, contact tracing, data collection and management, dietary and psychological counselling, environmental hygiene and other clinical staffs for case management by resourcing them to help combat this global pandemic. During these difficult times, we have to stay connected, even if we are physically apart. We have to help each other and not allow ourselves to succumb to feeling of fear and hopelessness.
If we remain united and resolute, then we will surely overcome this pandemic. I believe in the years to come; everyone will be able to take pride in how they responded to this challenge.
Written by: Anyimadu Kwasi Andrews
Technical Officer, Disease Control /BPH Disease Control