COVID-19: Evidence-Based approach to Ensure Better outcomes

Read Time: 5 minutes

Motivated by the constant COVID-19 bad news out of Ghana in the past couple of weeks, news that has touched me and many others personally. I put together a evidence-based approach to ensure better outcomes in the country with regard to COVID-19.

If you are unable or unwilling to read the longer article, at least take these three takeaways:

I. The best scientific evidence as of now when it comes to battling COVID-19 is as follows:
“Mask wearing, good air flow and frequent rapid tests are more important than surface cleaning, temperature checks and plexiglass” in battling the virus.

II. The emergence of more transmissible coronavirus strains is a challenge that must be met head-on to avoid potentially disastrous outcomes such high death rates, an imploded healthcare system and an economy in freefall.

III. It is obvious anecdotally and through reported numbers that Ghana has rapid community spread. The SOONER a concerted strategy to slow this spread is PUT IN MOTION, the less painful it will be for everyone. ACTION is required.

Now for the long story. This is based largely on the attached article from the WSJ; it is a clearly written and detailed summary of what we know to date of the epidemiology of COVID-19. Some key points and their implications.

  1. Approximately, 50% of infections are transmitted by people without symptoms. Which means that when you have widespread community spread as seen in the urban centers of Ghana today, assume that a non-trivial percentage of the people you met are transmitting the virus.
  2. Tiny airborne particles (“aerosols”) that linger in the air and travel more than 6 feet play a major role in transmitting the virus. Talking loudly and breathing deeply creates aerosols which linger in the air. Generally, indoor environments will be affected most, but even poorly ventilated outdoor spaces can be compromised. The worse the ventilation, the more the aerosols linger. When indoors or in a car, using an air conditioner that lacks the capability to filter and sanitize air-flow is a NO-NO especially when in the company of people outside your bubble.
  3. BRIEF encounters with an infected person can lead to infection. In addition to time spent together, the chances of getting infected in a particular scenario depend on ventilation, crowding and the chance that the infected person will generate aerosols e.g., by shouting, singing etc. Important ==> Spend little to no time indoors with people outside your household or bubble.
  4. Washing your hands frequently is a basic element of keeping yourself safe. But see point 3 above. If you are in a gathering with an asymptomatic individual who is talking loudly and spewing aerosols, washing your hands is not going to keep you safe. But mask wearing compliance by everyone reduces the chance of such aerosols being present and infecting others.
  5. Gatherings that involve personal interaction such as weddings, funerals, church have the potential to turn into super spreader events when you have asymptomatic individuals and aerosolization. This is why such gatherings must be reined in. Widespread mask compliance and limits on crowds and travel are key to reducing community spread in Ghana. Especially as we lack the capability to do widespread and free testing.
  6. REPEATING: Masks work and the more masks the better. Use a medical grade mask if possible. 2 masks are better than one. You get the point.
  7. When community spread is rampant like we see in Ghana right now, contact tracing is ineffective. You slow and hopefully reverse the transmission by getting people to stay put, you get them to wear masks when they have to move about and you reduce gatherings and crowds to the bare minimum.
  8. Which brings us to the charged questions of to LOCKDOWN or not! There are very good arguments for not locking given the particular circumstances of the informal sector BUT there are creative ways to possibly get to the same destination without a total shutdown. An enforceable curfew in the big urban areas will reduce people movement velocity. A time limited shutdown of lets say a week or two could provide breathing space for other interventions to be put in place.
  9. Our religious conundrum. Let’s move the conversation about whether or not churches/mosques/shrines should be open or not to a more useful place. What about a Govt partnership in which these institutions become the primary vehicle for delivering necessary interventions e.g., food to citizens who need such help under a short lockdown? What if certain mega institutions e.g. those churches that have shown they can run universities for instance, set up temporary hospitals (in conjunction with the health authorities) to handle the overflow of patients who can’t be admitted to regular hospitals due to capacity limits? They will obviously be compensated by the Govt for such services.
    1. How bad is the situation? The rapid increase in cases and deaths point to the possibility of more contagious strains; these could be imported or we could have our own home grown version. As per the John Hopkins database (accessible by Googling Ghana COVID numbers), we have entered a phase of exponential growth of COVID-19 cases over the past three weeks. The trend lines are the important thing here (it is quite obvious that there is serious undercounting of numbers here) as they directionally tell us where we are headed (and it is very scary) if we don’t QUICKLY change things.
    2. These are the 7 day averages of new cases in Ghana: Jan 25 => 581 ; Jan 18 => 262 ; Jan 11 -=>152 ; Jan 4 -=>95; let’s do some math here that my brain can understand. From Jan 4 to Jan 11, percentage growth of new cases => 60%; from Jan 11 to Jan 18 => 72%; from Jan 18 to Jan 25 => 121%. I believe this is what the mathematicians say is exponential growth! NOTE: Every day of delay ensures built-in growth of new infections and deaths. Time is of the ESSENCE.

In short, there is widespread community spread in Ghana and we see that in deaths of people around us. Something has to give or we will have very high death rates. Yes, take care of yourself but know that you will only be safe if the entire community is safe. Time to use your network and push the policy makers to make smart informed choices. I am doing that myself. It is time to actively engage in ensuring that this virus doesn’t devastate the country and affect all of us in ways we cannot even fathom today.

In the Spanish flu of 1918/1919, the Gold Coast was one of hardest hit countries in the world. The soldiers and laborers who fought in World War I brought it home and it spread rapidly along the trading routes and railways. Out of a Gold Coast population of 2.2million, it is conservatively estimated that 100,000 people lost their lives. That is 4.5% of the population then!!! If we don’t get COVID-19 under control and end up with similar fatality rates, you are talking 1.35m people dead out of a population of 30million. Let us not even entertain that possibility! We are at war with the virus. We should act accordingly and put every possible option on the table for debate. Enough said!

Nana D. Manu
Jan 27

Notes for those of us obsessed with footnotes 🙂 => for more on the Spanish Flu Ghana story via the Historical Society of Ghana

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