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What is Zambia’s COVID-19 strategy kanshi?

[By Parkie Mbozi]

ON 23RD March 2020, precisely five days after 18th March when Zambia reported a twin case of the Coronavirus (code-named COVID-19) ‘pandemic’, I authored a widely circulated article titled, What is the Science Behind Zambia’s COVID Half measures? It was a follow up to a similar article I wrote on 27th February, way before the country was hit by the virus, titled, Is Zambia Ready to Cope with And Contain the Coronavirus Outbreak?

My second article was partly focused on a hastily assembled press conference the same day that the two cases of a couple of Greek origin that had traveled to Europe were announced (18th March). At that press conference a combined team of ministers from what are considered most critical and relevant ministries to the pandemic announced a range of measures to curb the spread of the virus. The measures ranged from operations of bars and churches to wearing of facemasks and hand and market sanitation.

My first concern was on the leaders not demonstrating best practice on ‘social distancing’ during the press conferences, which was beamed live on TV. I wrote then that,

“To make matters worse, the leaders have not consistently demonstrated ‘social distance’ during their press conferences. For instance, during the press conference I watched on 18th March, the ministers were literally sitting shoulder-to-shoulder, especially as they went to the single available microphone one by one. The microphone was sandwiched between Dora Siliya and Godfridah Sumaili. Is it a case of “do what I say not what I do”? Surely, leaders ought to demonstrate best practices if they want to be believed.”

Within the said article I further questioned the efficacy of some of the measures the country had put in place to fight the pandemic. A few days after my article, most neighbouring countries went into one form of lockdown or another. Zambia avoided a total shutdown despite numerous calls for it from political parties, religious organisations, etc. Our major concern seemed to have been business rather than the now known patterns of the spread of the pandemic. I warned then that, “Only time will tell whether our trajectory and/or model is a better one.”

Just to put things into perspective, on 23rd March when I did the article Zambia had only the two cases. For a considerable period during those early days of the pandemic, from 18th March and until early April, the country had among the lowest number of cases of both infections and mortality among its neighbours and the SADC region. However, a month after the first two cases were reported, on 18th April, a pattern began to emerge that depicted Zambia overtaking most of its neighbours in cumulative cases.

For instance, on 18th April Zambia had the third highest cumulative cases among our neighbours, with 52 cases, having reported first cases on th March; Zimbabwe had 24 cases, reported first case on 20th March; Angola had 19 cases, reported first case on 21st March; Namibia had 16 cases, reported first case on 14th March; Malawi had 17 cases, reported first cases on 2nd April; and Mozambique had 34 cases, reported first case on 22nd March. Only Tanzania (147) and DRC (287) had the higher cases than Zambia, but were also the first to report first cases on 16th and 10th March respectively.

Fast-forward, today 28th July, the pattern has continued. With the ‘official’ figure of 4,481 cumulative cases as of today, Zambia is now only second to Democratic Republic of Congo (DRC), which has a total of 8,831. You can argue that with a population of 86,026,000, DRC’s per capital infection is obviously much lower. I write ‘official’ figures in our case because the recently growing number of BIDs (brought in dead) is evidence enough that the cases are a lot higher than captured in the database. Zimbabwe, for instance, has been in lockdown with a curfew and their cases are half of ours. Botswana and Angola have less than 1,000 cases each.

The big question is, what are our national strategies to contain, manage and ‘flatten the curve’? Who would have thought that four months on we would still be questioning our strategies, with so much to learn from other countries and research? Yet from how we are going about it, one would be excused to think we have our own strain of COVID-19 that we are able to negotiate with; yet Anthony Fauchi, a famous of the global fight against the pandemic, always warns that, “You don’t set the timeline, the virus sets the timeline.”

One thing, which is now universally known, is that the spread of COVID-19 follows the same pattern; it always gets worse before it gets better. How soon it gets better depends on how much you invest in ‘putting off the flames’ before they become ‘wildfires’, in the analogy of Prof Salim Abdool Karim of South Africa. Prof Karim is a world-renowned HIV scientist and infectious diseases epidemiologist and chairperson of the Ministerial Advisory Committee on COVID-19. On the night of 14th April, Prof Karim gave a wide-ranging and highly educative presentation on the pandemic in South Africa and globally that left many of us asking: 1. Where are the voices of the cream of Zambia’s public health specialists and epidemiologists? 2. What is Zambia’s model for ‘flattening the curve’?

The famous proverb, ‘You Reap What You Sow’ (Galatians 6:7-8) applies to COVID-19. Similarly, with COVID-19 the saying that ‘you can’t bake your cake and eat’ holds sway. In literal sense it means, there is no way we can have it both ways: live our lives normally but still manage to flatten the curve of infections. Ask Sweden what happened. ‘Flatten the curve’ is a buzzword and, more importantly, benchmark target for any country. For my readers who may not know, it means stopping new cases of infections and mortality from going up until the numbers stabilise, start dropping and eventually come back to ‘zero new infections, zero mortality”, to borrow from HIV and AIDS terminology. This a feat achieved by countries that have relaxed (‘unlocked’) their economies but ONLY AFTER massive investment in testing, contact tracing and treatment. New Zealand is a shining example in managing to rid itself of the virus.

For us the BATTLE HAS BEEN ON since early April when the first cases of ‘community spread’ of the virus were reported. ‘Community spread’ means cases that could not be traced to a single person. At that point we began chasing and trying to put off one ‘flame’ after another in the communities to avoid ‘bushfires’ (in Prof Karim’s analogy). The best bet for any viral pandemic is prevention; avoiding community spread. Herein lies our challenge.

Some Zambian citizens, me included, have serious concerns about our strategies for containing the pandemic. Going by the increasing numbers of cases and, more gravely, growing numbers of BIDs, one would be excused to conclude that the measures are not working. In any case, health minister Dr Chitalu Chilufya told parliament on 21st July that: “Zambia could suffer deaths of up to 1,000 daily by August.”

Below are what I consider policy gaps and inconsistencies with science.

Testing and contact tracing: while some countries are talking tens of thousands of tests daily, 55 – 60,000 for South Africa, for instance, we are still below 2,000 (for instance, Dr Chilufya announced 446 tests conducted on 24th July and 1,851 tests on 25th July, which I believe is the highest on a single day so far). Contact tracing and testing are buzzwords in the containment of COVID-19. The more you test, the more you identify and quarantine carriers of the virus before they spread the ‘flame’. Many European countries, for instance, have managed to ‘flatten the curve’ and contain the virus because of their abilities to correctly approximate and positively identify the carriers.

Surprisingly, we are not hearing alarm bells from our authorities on the need for more testing or resources thereof, which can be construed as lack goals and targets for testing.

Total lockdown: this has been the most confusing of our strategies. Lockdown is the most extreme of the wide range of measures and STANDARD DOSE to ‘flatten the curve’. It means shutting down the major economic and social activities. It is a necessary measure, which facilitates for most, if not all, the other measures to take effect: testing, contact tracing, social distancing, etc. Here we have the most bizarre lockdown whereby, for instance, professionals in formal employment are asked to stay home or report in rotation and schools partially closed while life goes on ‘normally’ at Soweto and other markets country-wide, in buses, funerals, weddings, churches and other spheres of life, including (you won’t believe it) some bars.

Surely you cannot expect to put off a ‘bushfire’ by extinguishing one flame on one corner while 100s are burning in other parts of the bush. It doesn’t work.

Similarly, within a space of a week we have heard our leaders issue contradictory statements on this measure. On 21st July, finance minister Bwalya Ng’andu said a lockdown was among “matters that are being considered.” Within days, Cabinet resolved to take other measures, but again, spared us from a lockdown. Typically, we have been progressively opening up as the cases have been going up.

Other measures have been announced, but equally so relaxed or adhered to only at the pleasure of the individual and applying only to some parts of the country. They include face coverings (masks), social distancing, hand sanitisers, etc. Their impact is highly questionable.

I will end with a quote (published in March) from anonymous based in Italy on the consequences of the business-as-usual trajectory. “The big mistake was that at the start of the first hit, people continued to lead their lives. As usual they took to the streets for work, entertainment and feeling like a vacation period. Gathering with friends and banquets abounds”….”About 200 people die here every day, not because medicine in Milan is not good (it is one of the best in the world), but rather because there are no places for everyone!”
We need to re-think what we want as a country: life or economy. What we have in place to-date are a perfect fit for half measures.

The author is a media, governance and health communication researcher and scholar with the Institute of Economic and Social Research, University of Zambia.

He is reachable on: pmbozi5@yahoo.com.

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