War on Covid-19: Why Tanzania must unite in flattening the curve

Tuesday March 24 2020

 

By Bakari Machumu Executive Editorbmachumu@tz.nationmedia.com

Seventeen days after Cabinet minister Ummy Mwalimu appealed to the public to take precautions against the coronavirus, Tanzania reported its first case, that is, on March 16, 2020.
The minister responsible for the Health, Community Development, Gender, Elderly and Children docket, urged the public to avoid shaking hands, hugging and kissing as a way to prevent infection.
According to the World Health Organisation (WHO), coronaviruses are common and spread through being in proximity to an infected person and inhaling droplets generated when they cough or sneeze, or touch a surface where these droplets land and then touch one’s face, nose or eyes.
Her announcement was echoed by top national leaders’ gestures, demonstrating ‘new ways of greeting each other’ as captured by media outlets, including Mwananchi and The Citizen newspapers.
First, it was Prime Minister Kassim Majaliwa greeting ATCL crew members at Julius Nyerere International Airport in Dar es Salaam by simply putting together his palms at a distance, followed by President John Magufuli’s “foot-shake” with then ACT-Wazalendo party adviser Seif Shariff Hamad at State House two days later. Again, Vice President Samia Hassan Suluhu and Mama Gertrude Mongella were pictured crossing their arms in abiding to the advisory.
The minister’s caution, on February 29, came 60 days after China had alerted the WHO of having “several cases of unusual pneumonia” in Wuhan, a port city of 11 million people in the central Hubei province.
Come January 7, a new virus had been identified. According to WHO, “the novel virus was named 2019-nCoV” from the coronavirus family. The family includes Severe Acute Respiratory Syndrome (SARS), among others. SARS was identified in 2003.
WHO later officially renamed the disease Covid-19, “and the virus that causes it to be known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
In its March 22 Covid-19 Situational Report (62), WHO recorded 292,142 cases, 12,784 deaths confirmed in 159 countries and 25 territories, with China alone totalling 81,498 cases and 3,267 fatalities. Sadly, there were 26,069 new cases, 1,600 new deaths within 24 hours (March 21) globally. Meanwhile, as of Sunday, March 22, Tanzania had confirmed twelve cases with neighbouring Rwanda 17, Kenya 15 and Uganda one.
In a live broadcast on March 16, Ms Mwalimu revealed Tanzania’s first case of a 46-year-old Tanzanian who had arrived in the country a day earlier from Belgium. On March 17, Mr Majaliwa ordered the immediate closure of all schools for 30 days as part of measures to curb the spread (the order was extended to all colleges and universities a day later). In addition, the government banned public gatherings, including seminars, workshops, political and sports events.


Why has the fear of coronavirus spread so fast?
Unlike previous epidemics, on the one hand, experts say Covid-19 is highly infectious, while on the other, media advancement and attention has made it top of mind.
Media advancements come with their positives and negatives, depending on how you look at it. Back in 1990 when Saddam Hussein invaded Kuwait, then US President George Bush (Sr.) conducted historic diplomatic mobilisation and had the UN Security Council unanimously pass Resolution No.628 “to force Iraq out of Kuwait” after the January 15, 1991 deadline.
Eventually, coalition forces did it. It was at a time when broadcasting was moving to a new era. For the first time, millions of people could watch – from the comfort of their living rooms – the likes of Bernard Shaw of CNN reporting live as missiles lightened up Iraq skies.
Fast forward to December 2019, and the coronavirus attacks. We are not only in the world of live broadcasting, but also big data, data journalism, artificial intelligence (AI) and social media frenzy. With AI, we are able to process huge amounts of data in the blink of an eye and give you a world map of how the spread is moving fast and in real time. With all these, if not managed well, come fear.
On the other hand, however, experts point out the speed at which the coronavirus can spread.
Quoting international scientific journals, Prof Mohammed Janabi, Executive Director of Jakaya Kikwete Cardiac Institute, says although Covid-19 kills about 2 per cent of infected people on average, it is ten times more dangerous than other forms of flu if preventive measures to slow it down are not followed, and more so, at individual level.
Why? Because it spreads through coming into contact with a sick or carrier person, or touching tainted door handles, table surfaces, etc. So far, there is no cure, with vaccination expected to “take up to 18 months”.  
According to the World Economic Forum Covid Action Platform, the coronavirus has spread much more quickly than SARS or Middle East Respiratory Symptoms (MERS). However, latest data suggests that it is “less deadly than either SARS or MERS”.
Within weeks, noted WEF, the virus had “infected more people than SARS did in months, leading WHO to declare the outbreak a global emergency. That is, 30 days after China had informed the organisation. It has since declared it a pandemic after the virus reached all continents.
MERS, which started in Saudi Arabia in 2012, took eight years to infect almost 2,500 people.
Quoting latest statistics, WEF notes that the fatality rate of Covid-19 is about 2.2 per cent, although disease experts say it can be plus or minus that level considering unconfirmed cases. Comparatively, SARS and MERS killed about ten and 35 per cent of infected people, respectively.
WEF notes that for every 50 people who were infected with MERS, SARS and Covid-19, the fatality rate was 17, five and one person, respectively. Comparatively, the spread of the three types of flu virus indicates that it took MERS 903 days or 2.5 years to infect 1,000 people. While it took SARS 130 days to infect 1,000 people, Covid-19 has taken just 48 days!
According to an Al Jazeera chronology of events chart, on January 11 China announced its first death from the virus. And on Valentine’s Day, Egypt became the first country in Africa to confirm a case, as Europe experienced its first death in France.
February 29 saw South Korea report its highest daily number of confirmed cases yet, 813, bringing the country’s total to 3,150 with 17 deaths. Iran also reported that the number of its cases had jumped from 388 cases to 593 in 24 hours, with the death toll reaching 43.  
Fast forward to March 21, and WHO had recorded 3,267 deaths in China, Egypt eight and France (562), just to mention but a few. As for South Korea and Iran, the death toll had moved from 17 to 104; and from 43 to 1,556, respectively, within 21 days! Meanwhile, while African region had 739 cases with 20 fatalities, Italy, with 53,578 cases thus far, had been hit pretty hard, with 4,827 deaths!

Lessons from successes and failures across the globe
With countries working around the clock to minimise Covid-19 effects – which are threatening to cripple the world economy, analysts are in agreement that the best way out is rapid response by way of assessing magnitude of the problem and put swift measures to “flatten the curve”.
A quick review at what has worked and what hasn’t, points out countries which have been successful in containing the spread, while some haven’t been so lucky.
For instance, it is evident that some of the most seriously affected countries today were either not agile or strategic enough or both, focusing on “wishing it away” as a Chinese problem. The impact is proving to be devastatingly painful both health-wise and socio-economically. Italy, now the epicentre outside China, lost 795 lives on March 21 – the highest number of deaths ever in a day. Similarly, Covid-19 has spread in all 50 states in the US, a situation analysts attribute to low testing and control measures at the early stages. The US had recorded 15,219 cases and 201 deaths as of March 21. As of yesterday, March 23, CNN reported 34,407+ cases and 414+ deaths in the US.
On the other hand, however, South Korea, which was hit hard at the beginning, managed to turn the tide through a massive testing campaign to establish magnitude of the problem and minimise the spread.
Likewise, China, instituted tough measures, including locking down, coupled with a massive testing campaign which has seen the spread subside sharply.
Two weeks after WHO had identified the coronavirus in China, the disease had spread among over 550 people, claiming 17 lives, leading to the quarantining of Wuhan, Xiantao and Chibi cities. More cities were later put in lockdown.

The South Korean way
South Korea had to deal with a massive 5,000 cases associated with the Shincheonji Church, were a 61-years old woman who had attended service twice in a week – alongside some 500 packed members – tested positive.
South Korea’s success story came mainly from innovative approaches involving drive-through testing to global positioning systems (GPS) tracking.
Through swabbing at drive-through clinics, it reduced congestions at health facilities and to medical workers.
As of last week, South Korea, a country of over 50 million people, was testing 5,200 people out of a million inhabitants, compared to the US (329 million people) which was testing 74 people out of one million, according to Worldometer.com and United States Census Bureau.  
According to CNN, a South Korea biotech company “developed a test in three weeks, linking people in need of testing to 96 laboratories”.
And, by providing GPS locations of people confirmed to have Covid-19 – through an app – the government was able to alert the population of locations to avoid.
Equally important, extensive isolation of infected people, plus tracing and quarantining their contacts was enforced. For those not infected, effective practicing of “social distancing” added to the magic.
Although South Korea did not impose lockdowns on its cities, a combination of above measures saw it reduce the spread from its peak to just 147 cases on March 20. Despite this success, South Korea remains vigilant as possibility of a resurgence remains high.

The Chinese approach
Chinese measures on the other hand included lockdowns and massive facilities in testing, bed capacity – including building a 1,000-bed facility in six days – equipment and strict enforcement of quarantines, among others.
In an article titled China’s aggressive measures have slowed the coronavirus, Kai Kupferschmidt and Jon Cohen wrote: “Chinese hospitals overflowing with Covid-19 patients a few weeks ago now have empty beds.”
Apart from building the hospital, the government deployed medical workers to the epicentre from other parts of the country, including a team of 9,000 people dispatched within Wuhan to contacts of infected people.
According to a joint scientists’ mission report by WHO and the Chinese government released on February 28, China’s bold approach – which included also electronic surveillance measures – “had contained the rapid spread of Covid-19”.
China was equally aggressive in implementing “social distancing” directive. The two writers outline measures to include “cancelling sporting events, shuttering theatres, extending schools breaks, cancelling of the Lunar New Year celebrations, with many businesses closing shop. Anyone who went outdoors had to wear a mask.
Authorities reportedly used phone apps, mostly AliPay and WeChat, to enforce restrictions by “tracking people’s movements and even stop people with confirmed infections from travelling.”
According to mission member Gabriel Leung, dean of the Li Ka Shing, Faculty of Medicine at the University of Hong Kong, “Every person has sort of a traffic light system,”… colour codes on mobile phones—in which green, yellow, or red designate a person’s health status, allowing guards at train stations and other checkpoints to know who to let through.
Noted the report in part: “China has rolled out perhaps the most ambitious, agile, and aggressive disease containment effort in history.”
Asked what countries should do in the wake of high death toll in Italy, a country of 60 million people, exceeding populous China (1.3 billion people) so far, Dr Mike Ryan, Executive Director WHO Health Emergencies Programme, said countries need to do more beyond social distancing.
Each country has its own health system. It is important to scale up contacts tracing. He was speaking at the CNN/ Facebook Coronavirus Global town hall, hosted by Anderson Cooper and Dr Sanjay Gupta.

Flattening the curve is every Tanzanian’s/resident’s business
While we may not be as hi-tech as South Korea, or as bold and aggressive as China, our focus should be on borrowing a leaf from the two models and many others, based on the established scope of the problem.
According to MedCram.com, a team of scientists from prominent universities and institutions investigating “aerosol and surface stability of the virus (SARS-Cov-2)” have established that upon coughing or sneezing, viable viruses could be detected in droplets after three hours, or up to four hours on copper, or could last for 24 hours on cardboard and up to two to three days on plastic and stainless steel. The key is not touching things but cleaning surfaces frequently.
At this point it is important to acknowledge the robustness of the government’s decision to restrict gatherings – leading to closure of educational facilities across the country within 48 hours of reporting Tanzania’s first case.
Reports by Ms Mwalimu that teams had been deployed to trace contacts in Arusha and in Dar es Salaam is yet another step in the right direction.
And the directive issued by President Magufuli last Sunday to the national task force led by the Prime Minister and assisted by the Health minister and others – that people entering the country from coronavirus-affected nations self-isolate at their own cost for 14 days, travel to such countries be banned, the national laboratory facility be strengthened, all border posts be equipped with modern testing and protection kits, unnecessary local travel be discouraged and, above all, misinformation and fake news be curbed – cement measures towards flattening the curve.
The challenge remains with enforcement of hygiene recommended for public transport and social distancing. This calls for individual efforts and self-discipline first.
As Dr Jeff Pothof, University of Wisconsin (UW Health) Health Chief and Quality Safety Officer in the US puts it: “If we practice social distancing and good hygiene it will help slow the virus so that everyone who wants medical care will be treated.”
The main objective of social distancing is to reduce contact with potentially infected people, thus breaking the transmission chain. How institutions and companies work, how individuals go about their daily schedules, which include satisfying desires, wants and needs, will have to change.
Initiatives taken to use technology as demonstrated by the recent SADC Council of Ministers chaired from Dar es Salaam and last Friday’s video conference between PM Majaliwa and regional commissioners, regional administrative secretaries and regional chief medical officers from his office in Mlimani in the capital Dodoma point to the need to stay safe and ensure business continuity amidst the pandemic.  Companies, embassies and international organisations are reducing contacts within their respective functions by doing non-critical duties remotely, while critical ones remain onsite.
Individually, breaking the chain of transmission calls for you and me to do what is within our means – washing hands/ sanitizing regularly, avoiding handshakes, congested areas, hugging and kissing, sneezing and coughing in an uncivilised manner.   
As Los Angeles mayor Eric Garcetti put it when urging residents to take steps to protect themselves, their loved ones and neighbours: “We are entering a critical period, these are common-sense measures.”
And no one puts it better when it comes to playing your part than Dr Sanjay Gupta of CNN when urging Americans to stay home: “Act as if you might be carrying the coronavirus.”
We can learn from each other. One may ask why should we while our numbers are not as alarming as is the case in Europe, the US, or like earlier days in China?
The answer is simple. Left unchecked, we will have more infected people, and if they turn critical, in a short period of time our system will be overwhelmed.
Simply put, consider a health facility with a capacity to admit just 100 patients a day. It can easily admit 10,000 patients a year (365 days). That is 28 patients a day. But if 10,000 patients are hospitalised in a period of two months (60 days), the hospital will be receiving 167 patients a day, 67 above its limit. This is a situation no country wishes to find itself in. And for sure, you do not want to be patient number 101, let alone 167.
Unfortunately, Wuhan City, Italy and Iran went or are going through that phase. Sadly, analysts’ caution that the US is headed that route too.   
That is why all initiatives announced by the government and taken by companies, and indeed by you as an individual, will contribute to keeping the infection rate in Tanzania in line with what we can manage over time. You can slow down the virus. Be part of flattening the curve. Take all the necessary precautions. Follow all the guidelines issued by authorities. And even more, have faith!


Bakari Machumu is the Executive Editor of Mwananchi Communications Ltd, publishers of Mwananchi, The Citizen, Mwanaspoti and online outlets. Follow him on Twitter: @bmachumu, LinkedIn: Bakari Machumu