By Dr. Manal Ghazzawi
FREETOWN, 10th March, 2020 – Will the novel corona virus otherwise named as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) come to Sierra Leone? Indeed, this is a question all of us might be asking ourselves in our beloved mama Salone. As it is called the novel virus, it is a new virus that we are learning about every day through rigorous studies, and through different cases that infected patients present with.
Initially, when we heard of Corona virus, we understood that the virus is being transmitted at a faster rate because of its long incubation period i.e. spreading or shedding the virus while an infected person is in the asymptomatic stage. Later, as the disease is becoming alarmingly pandemic, we learnt that the main driver of transmissibility is not its long incubation period. Confusing, right? Many public health specialists are yet to find out more about transmissibility and the disease’s severity.
Sierra Leoneans are like “Oh, this virus seems to be scarier than the Ebola virus disease (EVD)”. No, it is not, far from it. According to World Health Organisation (WHO), the case fatality rate (CFR) of EVD is 50% and has varied from 25% to 90% in past outbreaks. On the other hand, the CFR of that of the corona virus disease (COVID-19) is only about 3.4%. Let us imagine if the EVD had started in China, it would have definitely become a pandemic catastrophe that might have wiped out mankind. We have learnt that the COVID-19 presentation is mild and children are hardly being affected compared to adults, in fact, children are being infected from adults that are sick. However, there is a higher mortality rate among elderly or adults with prior existing diseases like hypertension, diabetes, cancer and heart diseases or any condition that makes your immune system compromised.
There are lots of myths going around about the virus such as it not being able to survive in hot weather, well the answer is ‘We do not know”, there is a lot to be known and studied about this virus. Most of us would have known that the SARS- CoV-2 is genetically related to that of Severe Acute Respiratory Syndrome (SARS) and Middle Eastern Respiratory Syndrome (MERS) which is also a corona virus that emerged in Saudi Arabia in 2012. David Heymann at the London School of Hygiene and Tropical Medicine, who led the global response to the SARS outbreak in 2003, points out that the MERS corona virus emerged in Saudi Arabia when it was very hot. “These viruses can certainly spread during high temperature seasons,” he says. Hence, let us not be complacent and assume that the virus may not be imported. Let us not forget that viruses undergo mutation, which is already the case with SARS-COV-2, in which there are 2 strains that have been detected in China, the L and S, the former being more aggressive and more prevalent.
Having the virus in sub-Saharan Africa or Sierra Leone might pose lots of challenges due to poor health infrastructure and an ill prepared response capacity.
However, there are lots of lessons learnt from the Ebola outbreak and the Ministry of Health is trying to put things in place. Now that the disease is pandemic, there is a lot that we can learn from China and other countries that have been affected and already developed mitigating strategies. WHO, CDC and others has come up with many guidelines that public health specialists, health care workers and the community can implement. One of these guidelines that Sierra Leone currently falls into are the following preventive and preparedness strategies:
- Activate the highest level of emergency response mechanisms.
- Test National Preparedness Plans
- Non-pharmaceutical measure
- Rapid detection
- Large scale case isolation
- Respiratory support capacities
- Rigorous contact tracing and management in national COVID-19 readiness and response plans and capacities.
- Enhance surveillance systems.
- Enhance rigorous application of infection prevention and control (IPC) measures in healthcare facilities, especially emergency departments and out-patient clinics.
- Training of Health Care Workers on IPC and patient care
- Assess population knowledge about COVID-19, adjust national health promotional materials and activities and engage clinical champions to communicate with the media.
If the ministry of health can confidently answer yes to the above then we are good to go. If not and preparedness is poor, the response will also be poor, and it will cost many lives of Sierra Leoneans. That is the saddest truth. I can attest that Sierra Leoneans here and abroad are scared of what might happen to us if COVID-19 gets imported into Sierra Leone simply due to our fragile health system. We will be glad if the Government succeeds in changing our perception for us to trust the health system and be proud of being heroes in curbing this pandemic disease.
However, with all that has been said, community engagement is key, government cannot do this on its own. Each one of us can be a pioneer in each of our communities, where we can make use some of these guidelines and teach our people about basic handwashing techniques and the importance of adhering to respiratory etiquettes i.e. sneezing or coughing into your bent elbow or a tissue to protect others. Simply the use of soap and water after every contact or touching a possibly contaminated object is key in preventing you from being infected, and of course not to touch our face, especially our eyes, mouth or nose. Also let not uninfected individuals waste essential resources like masks that should be reserved for use in the hospital by caregivers and those that become sick with respiratory illnesses. The virus is not airborne, hence the use of masks by healthy individuals is deemed unnecessary. Most of all stay informed on the latest developments about COVID-19. Follow advice given by your health care provider, your national and local public health authority or your employer on how to protect yourself and others from COVID-19.
Be empowered, let’s protect ourselves and stay informed, God protect us all.
Dr. Manal Ghazzawi is a Consultant Clinical Pharmacist, Chief Executive Officer of CitiGlobe and founder of KnowHep Foundation.