The COVID-19 pandemic was first reported in Wuhan, China, on 31st December 2019, and was declared a public health emergency of international concern on January 30th, 2020. The disease has since spread widely to over 180 countries. Zimbabwe has had over 2 months to prepare for this outbreak since it was declared a public health emergency of international concern. The purpose of this review is to assess the preparedness and response of the nation ten weeks later, and to advise government on what can be done better to avert a catastrophe in Zimbabwe.
Preparedness and response plan:
Our preparedness and response plan is quite standard and meets all the requirements under the WHO recommendations. But this technical document is not complimented by appropriate implementation decisions and actions. Political will and transparency seem to be scanty. We need to examine the decisions and actions of our government while there is still time to make a difference and save Zimbabwe from disaster. This we can do by looking at each of the eight pillars of the preparedness and response plan.
1.Coordination, planning and monitoring:
Planning for this lockdown was very poorly done, because Multi-Stakeholder consultations were not done. We are wading through uncharted waters, and everybody’s contribution should have been solicited. We now have our most vulnerable people almost starving to death in their houses. People have been locked in without the most basic commodities like mealie meal, and this is undermining the lockdown.
You cannot confine a hungry man. We are beginning to see chaotic scenes at shops now, almost about to degenerate into riots, because everybody wants the staple food, and there is not enough to go around even for those who have the money. The crowding and jostling for mealie meal that we are seeing at shops is fertile ground for rapid COVID-19 spread, and our people understand that. But now they are being forced by government to choose between death from COVID-19 or death from hunger, and most people would rather take their chance with COVID-19.
This is a serious failure of planning, and may cost the nation far more than we can afford in human lives. Government should first have ensured that there are no shortages on the market before announcing the lockdown. We are not for a moment suggesting that the lockdown should have been delayed, NO! In the two and a half months lead time we had, government should have diverted all resources to fighting COVID-19 as we have always been saying. That includes making sure there is grain in the country adequate for say six months (we don’t know how long this pandemic will last, but six months gives government time to plan new interventions).
Money wasted on luxury cars for officials should have been used for grain. We cannot leave social safety nets to chance and partisan politics. Firm measures which include reliable transparent non-partisan databases of vulnerable families should have been put in place before the lockdown. Bear in mind, millions of people already needed food aid without the covid-19 outbreak. Allocating RTGS600 million without a credible formula for disbursing it is useless. People are starving, and we wonder how much of the allocated amount has been used to benefit the people. This is day 16 of the lockdown.
The government is advised to engage the health care professionals in all decision making and policy formulation. This includes procurement decisions.
The emphasis being given to sanitisers in our messaging, and even in our programming, is disproportionate. Government should do everything possible to ensure that clean potable water is available to every citizen. This has to be done as a matter of urgency. Washing hands frequently with soap and water is the mainstay of hygiene in this and other pandemics.
Hand sanitisers are useful but secondary. We urge government to urgently prioritise provision of water to the people. This will also prevent crowds from gathering around the current scanty water sources and flouting social distancing regulations. Boreholes in both rural and urban areas are undermining social distancing regulations and could prove to be serious drivers of the pandemic. Government should take this epidemic as an opportunity to upgrade infrastructure eg by rapidly drilling more boreholes to prevent crowding at water sources. All borehole drillers in the country should be in overdrive mode, and government should pay for that.
Extraordinary circumstances require extraordinary solutions, and a lot of focus and sacrifice.
In summary, our people are very compliant with the terms of the lockdown, but the government has not planned for the poor, those who live on hand to mouth daily budgets, and those without adequate supplies of potable water. Scarcity of basic commodities is also undermining the lockdown seriously. Shortage of basic commodities must be eliminated as a matter of urgency.
2.Surveillance, rapid response and case investigation:
We are not testing enough. Therefore we don’t have a clear picture of the extent of spread of the virus in Zimbabwe, bearing in mind that 80% of the infected get away with mild symptoms, according to data from those countries that have already experienced massive outbreaks. We need to know in order to plan. Let’s not bury our heads in the sand. Active case finding and event based surveillance must be intensified.
It is alarming to note that very little if any follow up and monitoring is being done for returning citizens and other immigrants. Rumors that 32 Zimbabweans flew in from the UK and government had no place to quarantine them are extremely worrisome. The UK is one of the global epicenters of the covid-19 pandemic at the moment, and it is mandatory that these people should have been quarantined. Government should respond and tell us if it is indeed true that these precious Zimbabweans were told to go home and self isolate.
It is equally alarming that our rapid response teams have neither the necessary PPE nor other tools of the trade when they come to investigate a reported suspect.
What needs to be done?
i. Let’s test massively to establish a baseline. It doesn’t do us any good to say a suspect does not meet the criteria for testing, then the same suspect is tested a little later in another country and found to be positive. It means we have missed an opportunity to isolate and treat the patient, and we have put not just our nationals, but the entire international community at risk.
ii. Let’s investigate all community deaths. There are reports of unexplained community deaths where ordinary citizens suspect COVID-19, but these deaths are not being investigated. This has the potential of giving us false statistics, and it becomes a time bomb waiting to explode.
iii. Let’s equip our rapid response teams with PPE and other equipment & consumables.
iv. Let’s decentralize COVID-19 testing to provincial laboratories and district laboratories. Every local authority must be given the mandate of testing and reporting statistics to its residents. We must devolve responsibility to the local authority, who in turn will report to head office through normal channels for a composite report. There is nothing to hide.
3. Points of entry:
Reports of people walking across the border without being screened by a port health official, and without their details being taken for follow up in their district of destination, do not inspire much hope in this fight. We must beef up our human resources particularly at busy ports like Beitbridge, and we must protect the health workers at the ports with appropriate PPE. Record keeping and transmission to the provinces must be meticulous, and actual follow up must be done, whether by phone or in person. Remember, a carrier of the virus may be afebrile at the time of crossing the border.
4. National Laboratory System:
Our laboratories are not capable of doing enough tests. We are relying too much on donations. What has GoZ done in this outbreak? The 500 tests donated by WHO seem to be the only ones working, and therefore we are using them sparingly and missing cases.
Does the government really have to rely on Higher Life Foundation to purchase the balance of the extraction reagent needed for us to start using the donated reagents from China (via the AU)? Without decentralizing our testing services, and without increasing testing capacity, we are wasting our lockdown period. We are making people suffer for no gain. In this lockdown period we must map out our epidemic, that means we must test a lot. We must isolate all cases, and that can’t be done because we are not testing.
The people of Gwanda who are complaining about a new malaria with strange symptoms (which include sore throat) that is killing people at an unusually high rate should have been answered long back. All those deceased and their close contacts should have been tested, and the people given accurate & scientific answers. Have we tested for COVID-19 in Mat South, considering its proximity to South Africa?
Why should villagers lead us in coming up with a differential diagnosis when we have health professionals in the province? Could it be because the professionals are incapacitated by lack of testing capability, lack of training, and lack of PPE? The continued ignorance about COVID-19 among health professionals is extremely dangerous at this point in time, and ordinary citizens are beginning to notice and complain. Where is the donated money going?
5. Risk communication and community engagement:
Public trust for the government is at an all time low, because of the general perception that statistics are being suppressed, government is not putting enough resources into the COVID-19 response, health workers are untrained, unsure, and very exposed due to lack of PPE, and government’s preparedness claims have been exposed as imaginary by the sequence of events in the few fatalities we have already had. Relatives of the deceased are consistently disputing government’s official narrative of what exactly happened, and this is embarrassing. Government needs to rescue its image immediately by remedying these ills during this 21 day lockdown.
Ignorance among the healthcare workers induces in them fear and paralysis, and this lockdown will have been wasted if we go for the next week without equipping our front line soldiers with knowledge and clear guidelines and protocols for dealing with COVID-19, in addition to PPE.
Police brutality has negative consequences for our response plan. Treat humans with the dignity the creator endowed each one of us with. No one is immune to COVID-19. Treat others as you would want to be treated.
The ministry must respond timeously to misleading social media reports. For example, did the ministry really authorize traditional healers to start treating covid-19 patients with traditional herbs? How are the vulnerable populations going to be protected from these experiments? The silence of the ministry (MoHCC) to these and other media outbursts is worrying.
6. Case management:
Lack of training for health care workers, both in private and public practice, is sticking out like a sore thumb. We have no prospect of conquering COVID-19 if we ignore training and equipping of health workers. If the training program had continued from the time training of trainers was done, by now every doctor and every nurse would have been trained. What’s gone wrong with our covid-19 preparedness training program?
The issue of institutional quarantine cannot be over emphasized for visitors from COVID-19 countries, which is virtually every country now. Those in self isolation should be monitored. That is not happening. Government should urgently capacitate provincial and central hospitals with special covid-19 intensive care units, complete with ventilators and ready to admit.
It is pleasing to note that most local authorities have taken the initiative to set up isolation facilities on their own. But it is equally disturbing to learn that government wants to take over management of municipal clinics for the purposes of COVID-19. We think that the government is seriously misdirected on this matter. This move has no value addition to our COVID-19 response plan.
It is our considered view that the government must avail resources to local authorities to do what they have always done, i.e. help government to deal with public health threats within their jurisdictions. We have GoZ funds, and we have donated funds, and these should be passed on to local authorities. I’m sure donors will find it more cost effective to deal directly with local authorities, which is where the action is.
7. Infection prevention and control:
This pillar is yet to be visited in its entirety. We urge government to deal urgently with infection prevention & control before we have catastrophic results among our valued health care workers. Provision of PPE and antiseptics is key. We should not sacrifice our health workers because we don’t want to prioritise their lives. We need every single one of them alive.
8. Logistics, procurement and supply management:
There is need for transparency in procurement. This is not a time for self enrichment. We are in a crisis. The proliferation of self testing kits must be dealt with immediately. Any test kits for use in the country must first be approved by the relevant arm of government. These self testing kits have not been proved, and could give citizens a false sense of security due to false negatives, and accelerate the spread of covid-19. Government must issue a statement on self-testing kits.
As a nation we should not rely entirely on donor funding. This is the time when survival of the nation should supersede any other national program. All resources should now be diverted to the COVID-19 response. Other programs will kick in later once we survive this onslaught. Let’s show the international community our seriousness by deploying our funds first, and they will come on board once they realize we are serious. Bear in mind that the usual donor countries are suffering under their own load of the pandemic.
We have a good technical document on the preparedness & response plan, but implementation is close to zero. We are ignoring the actions that will make this lockdown meaningful and effective. Simply noting that Zimbabweans are complying with the lockdown order does not translate into halting the epidemic. We must investigate all suspects, identify cases, isolate & treat cases, and do thorough contact tracing; then we may succeed in halting the spread of covid-19. Our aim as the MDC-A is to illuminate the deadly blind spots in our path as a nation, and to help government to make better decisions. Together we will conquer COVID-19.
Dr Henry Madzorera
Secretary for Health and Child Welfare, MDC-A.