Open Access Government was privileged to speak with Dr Mary Stephen, Public Health Expert at the World Health Organization African Region about the ongoing COVID-19 outbreak since it was first reported in China back in December 2019
Open Access Government spoke with Dr Mary Stephen, Public Health Expert at the World Health Organization (WHO) African Region about how the COVID-19 outbreak has evolved so far. In this interview, we find out in detail how governments and health authorities across Africa are striving to limit widespread infections.
Ebola was a prominent infection issue in the region a few years ago, which the WHO was highly involved with in terms of understanding and containing it. Here, we discover the transferable lessons WHO learnt from their work in this vein. While the connection forged with grassroots communities is essential to trace the outbreak globally, we also learn how the WHO utilises electronic data tools like AVADAR.
While manufacturers and scientists globally are estimating that a feasible vaccine will not arrive until 2021, a definitive timeline for this is not easy to determine. However, Mary stresses that COVID-19 is real and highlights very strongly the importance of employing preventive measures like staying at home, hand washing, social distancing and cough etiquette.
Governments and health authorities: Limiting widespread infections
While the global community races to slow down and eventually halt the spread of COVID-19, Mary says that in Africa, governments and health authorities are striving to limit widespread infections. The African continent countries started preparing when the outbreak was first reported in China back in December 2019. The region started getting the importation of cases later than everybody else, indeed, the first case was reported in Egypt on 14th February 2020. Also, out of the 47 countries that are part of the WHO African Region, Algeria had their first case on 25th February 2020.
As of late June 2020, we see that 47 of the 47 WHO African Region countries are reporting COVID-19 cases, but the number differs from country to country. The number of cases continues to increase, with 80% of those coming in from 10 countries. For daily updates on the confirmed cases in the WHO African Region, please visit this link.
Mary then goes on to detail the evolution of COVID-19 and the importance of ongoing training in this respect.
“When we did the readiness assessment at the beginning of COVID-19, we looked at the 47 countries before we had our first case. We saw areas where the countries had strength as well as gaps. They had strengths in coordination, surveillance, risk communication and interventions at the point of entry. They had major gaps in areas like case management, infection prevention and control. There were also gaps in the laboratories at the beginning of COVID-19, but we quickly ramped up this support and moved to the WHO African Region countries that can do the test from two to 43. In Nigeria, for instance, they have expanded to nine laboratories to carry out testing.
“For the remaining countries, we are supporting them and they have received machines to start in-country testing, but while that is ongoing they are sending their samples to the countries closest to them to test. Many countries had gaps in case management, so ICU bed capacity, and the training of health workers have been major issues in many countries as COVID-19 is a new disease. Before countries started closing borders, we carried out face to face training for several English and French-speaking countries.
“When the borders closed, we moved to virtual training, so every week, we train health workers and collaborate with post-graduate medical colleges like the West African College of Physicians on the broad spectrum of case management, we understood that, in particular, the frontline health workers had a form of mental stress so we introduced a model of psychosocial support for them.”
Collaboration and readiness
Mary then explains that the WHO is collaborating with different agencies and countries to acquire more much-needed ventilators and Oxygen supply. Nigeria, for example, had supplies from China who supplied both personal protective equipment (PPE) and ventilators. In mid-2020, WHO set up the Solidarity Supply, to give countries additional supplies of ventilators, and PPEs to treat up to 30,000 patients across the continent.
When COVID-19 commenced, the WHO African Region deployed experts for readiness before the first case occurred. WHO has supported all countries in the region to develop their plan for COVID-19 preparedness and response. While experts are still present in some of the WHO African Region countries, remote support continues to be provided in places that they cannot go. WHO African Region continues to negotiate for the humanitarian corridor to move additional human resource support to some of those countries that need experts. Mary then details her thoughts on the required interventions for the WHO countries, such as contact tracing.
“On interventions, when COVID-19 began, we recommended to the WHO African Region countries to employ the public health measures of early detection, isolation and confirmation using the laboratory to test, for the treatment of the sick and contact tracing coupled with preventative measures for the general population like hand hygiene, social distancing, and cough etiquette. When the outbreak started evolving, travellers were initially screened at a point of entry. When the outbreak evolved further, countries started restricting the movement of travellers from high-risk areas, and subsequent restrictions for all countries were made except for cargo.
“Also, the WHO African Region has several countries that are implementing a complete nationwide lockdown, like South Africa where there are the highest number of cases, but countries Niger only have lockdown in the affected areas.”
Lessons to learn from Ebola including case management
We know that Ebola was a prominent infection issue that the WHO African Region was highly involved with. We, therefore, asked Mary what transferable lessons the WHO African Region has learned in this vein. When it comes to countries reporting a large number of cases, they started implementing aggressive testing of those without the symptoms including asymptomatic people. Mary goes on to expand this vital point to us.
“Several countries are expanding testing capacity to include those who have high-risk contact and in those hotspots. We are enhancing contact tracing because we know from past experience, we had to track the contacts at a level of 100%, especially when we responded to the Ebola outbreak in 2014 and that approach helped to curb its additional spread in countries like Nigeria, Senegal and Mali. If you can detect the cases early, then you can quickly isolate them and get people treated in the designated facilities.
“To address case management gaps, some of the WHO African Region countries expanded bed capacity for managing additional COVID-19 cases by using temporary structures and big spaces. Some are using stadia or other big spaces for bed spaces and additional ventilators for COVID-19 cases, but this differs from country to country and is informed by the number of cases experienced.
“We understand that Nigeria has now started enhanced case detection, so they identify hotspots where most of the cases are coming from and go from house to house to find out who are experiencing symptoms and test them. This is one of the strategies WHO African Region employed during the Ebola response, so when several cases are coming from outside your own contact tracing list, this house to house approach is needed to detect any cases that might not be captured early enough.
WHO: Surveillance and response
As part of the surveillance, countries have hotlines which the general public can call if they have COVID-19 symptoms and be tested to check whether or not they have it, Mary reveals. As part of the WHO’s Integrated Disease Surveillance and Response (IDSR) strategy used for detection of all types of outbreaks, they also have Community Surveillance where people in the community, health workers or volunteers can actively seek cases, and report to the nearest health facility so that that case can be investigated and appropriate testing is carried out.
On 29th June 2020, 26 of the 47 WHO African Region countries have Sentinel Surveillance sites for influenza-like illnesses (ILI) and Severe Acute Respiratory Infection (SARI) which is also being used for COVID-19 surveillance. An abnormal cluster of cases presenting with COVID-19 like symptoms, such as influenza are investigated. In this respect, it is important to carry out the testing and confirm some of those cases, Mary stresses before explaining a more on this point.
“Any person that presents with influenza-like symptoms will now also be tested for COVID-19. Testing ensures that these cases are detected early enough to avoid contamination, so isolation can take place. Once this is done, you start listing all their contacts, putting them on self-quarantine and monitoring them for 14 days. So, it is a continuous cycle, complemented by laboratory testing to confirm whether or not an individual has COVID-19 or something else.”
WHO: Utilising electronic data tools like AVADAR
Open Access Government learns how WHO is utilising electronic data tools like Auto-Visual AFP Detection and Reporting (AVADAR) and the resultant metadata that can be used. With country borders closed, electronic tools are used and when lockdown measures are lifted, for reporting and follow-up of travellers at the point of entry, Mary reveals.
“We are using the Polio as a platform, part of AVADAR, and many countries are interested in electronic contact tracing. We have experience with electronic contact tracing during the 2014 Ebola outbreak and it was first implemented in Nigeria. Even though the outbreak happened in Lagos with over 20 million people, it did not spread. With the country using an electronic platform to track those contacts at 100%, there was, therefore, no chance of the outbreak expanding in communities.
“Now, we are already deploying the same mechanism and understand from the polio team that all countries have AVADAR for polio surveillance. As of mid-April 2020, about five countries started to use the same platform for contact tracing and we will enrol more countries on that. When border restrictions are lifted, we will still use the same for electronic screening at the points of entry and follow-up of all of the contacts. It is a very good platform and, of course, is adaptable for the COVID-19 response.”
COVID-19: Closing thoughts
Scientists and manufacturers globally are estimating that a feasible vaccine will not be available to populations across the world until perhaps 2021. Open Access Government asks Mary what the timeline for the WHO African region could be. While Mary says there is no definitive answer for this, but she is happy to give her thoughts on the much-needed vaccine that the world really needs.
“We have seen that the U.S. has a candidate vaccine, but we are waiting for that to become available. I believe that once the vaccine gets to the clinical trial stage, every country in the world can try it after getting ethical approval and a nation can indicate they are interested in participating in the clinical trial.”
Globally, COVID-19 is real and preventative measures in this respect are vital, Mary underlines. This includes staying at home, washing your hands regularly with soap and water or using alcohol-based sanitiser, practising social distancing and using cough etiquette. Nobody should panic, and we all have a part to play, Mary stresses, as this interview draws to a close.
“The general public should avoid any unnecessary panic because when people do not have the correct information, they can panic and that could lead to death if they take actions that are detrimental to their health and the overall response effort. Everybody is needed; it is a whole government and society approach, including governments, communities and the private sector.
“We need to mobilise global solidarity to fight this virus, but most importantly as individuals, we must play our part to complement government efforts, because experience from the Ebola response shows that the community is very important, that is their acceptance of these preventive measures, along with other public health inventions to help halt the spread of a given outbreak, including COVID-19.
“During the lockdown, we need to let our humanity play out as much as possible. Call relatives or friends check on them virtually rather than physically to see how they are. And if we are better off in terms of our capacity to provide, then why not help the people that are less privileged around us? We could as individuals, while governments are trying to provide, give additional resources to cater to the social needs of the people.”