on Wednesday, 29 April 2020.

Dear Colleagues,

Here is a pertinent and timely discussion on how to get out of the challenge of lock down from Dr. Patrick Kadama from ACHEST. Enjoy!

The Corona virus (SARS – CoV2) which causes the Corona Virus Disease 2019 (COVID-19) is not going to go away. People are going to have to learn to live with it; doing business and having social relations as, for example like they did with HIV/AIDS. Presently however COVID-19 has no cure or vaccine and as a result countries have sought to slow down the spread of the infection by instituting “lock downs ” to protect people and prevent their healthcare systems from becoming overwhelmed.

Lock downs impose stressful conditions on society and countries are now looking for measures to exit the unsustainable current socio-economic restrictions. A practical approach is to establish a system of National Alerts, with indicators as triggers for easing restrictions such as the New Zealand alert system for COVID-19. Given the limited knowledge about the new disease, the exit will be pragmatic and step wise, focusing on a multi-sector framework based on the following three objectives:

a) Get people back to work to revive economic activities and support livelihoods. (b) Minimize transmission of SARS-CoV2 infection under the new normal; (c) Institute Governance and leadership measures, for strengthening stewardship capability for social services to manage new norms.

Get people back to work to revive social and economic activities:

Opening up economic activities should be gradual and not allowed to cause a flare up in infections. This will be achieved through scale up and strengthening of health and safety measures in workplaces prior to easing restrictions. Populations need to comply with new workplace hygiene and safety measures including sustaining new social conduct standards at work. Health and safety measures for public and private transport also need re-definition.

The return of economic activities should at best be prioritized and phased by sub-population risk profile. Age based relaxations can also start early allowing the young to go back to work, while shielding the seniors and those with underlying health conditions. African countries have up to 80% of the population young and living in sparsely populated rural settings. These should be among the first to benefit from relaxation of restrictions.

Urban business in informal settings should be given early priority for resumption of work due to their low level of reserves and resilience. Employers will have to develop post lock down guidelines on return to work taking this into account. Schools with children could reopen early, care being taken to test the teachers and preparing parents for their roles.

A return to large religious congregations, public meetings and sports, including social and political gatherings should not be rushed, but gradually phased in.

Minimize transmission of SARS-CoV2 infection under the new normal:

It is critical to accelerate the strengthening of health systems by scaling up testing to identify suspected infected cases, to safely isolate, treat and trace the contacts of COVID 19 infected individuals. Comprehensive national guidelines and protocols need to be developed to include public health measures anchored in Integrated People Centered Community Health that can reach every household in the country. Current measures to manage national borders will need to be continued and strengthened with guidelines on physical spacing of passengers flow and rapid testing on arrival and quarantine facilities and this includes opening up of air transport.

Research, learning and innovation should be encouraged for use of technology and locally generated solutions that are relevant to the culture and resources available to each country and society. Financial and human resources for this huge undertaking and budget re-allocations will be needed. Fortunately, many African countries have established dedicated resource mobilization committees that leverage the participation of the private sector to support this pandemic control.

Institute Governance and leadership, reforms for strengthening the stewardship of social services:

Leadership should be from the top with the Head of State in the forefront. This is critical to pull the whole country together to mobilize all sectors for a cohesive national response for strengthening social services stewardship capacity as well as new norms in social conduct and relations. Mobilizing the community is critical for success. Relaxation of lock down will be underpinned by adherence to the current preventive measures as the new normal in social conduct and relations. Social and physical distancing, regular hand washing, personal hygiene, use of sanitizers and precautions when coughing and sneezing, among others, are the new normal in order to suppress the spread of infections as lock down is eased.

Reforms for multi-sectoral action require setting up of appropriate structures. A high level politically led national committee supported by technical sub-committees such as the Scientific, Transport, Finance, Security and others as needed. All these should be coordinated by one command center that receives and processes and distributes information. They all need active participation and leadership of multi-disciplinary technical experts to develop and operationalize a flexible national strategic plan that is regularly evaluated and adjusted in the face of experiences.

In conclusion, let us accept that COVID-19 is here with us and will not go away until a vaccine or a cure is found. Lifestyle as we knew it before this pandemic may never be the same again. Let the people in all countries join hands with their governments to navigate the complex measures needed for exiting lock down. Together, we will overcome.

What do you all think?


Dr. Patrick Kadama

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