From Ebola to COVID-19: West Africa must learn from the past and protect vulnerable people
Mar 31, 2020
In late February, the first case of COVID-19 was reported in Africa. Today, the new coronavirus has spread to 42 out of 54 countries on the continent.
Burkina Faso, Senegal and Cameroon, which are among the worst affected countries, have already moved to a stage of local transmission and are prepared to respond.
Dr Dorian Job, MSF West Africa Programme Manager in Dakar, Senegal, provides an update on the situation and our priorities.
With the rapid spread of the new coronavirus in recent weeks, the issue of preparedness in African countries has been in the headlines of the international press.
But one should wonder, to be honest, which country was really prepared? Let's look at the situation in Europe today, especially in countries like Italy, France and Spain, which one of them was prepared to face such a time bomb?
One also wonders whether the Ebola epidemic that affected West Africa between 2014 and 2016 has helped countries in the region to be better prepared.
This allowed at least the development of surveillance and coordination reflexes and mechanisms. It’s now just a matter of time to see how effective they were.
In the meantime, we should already get prepared for the next phase, when the chains of contamination are no longer controlled and we have many more cases to deal with.
The impact of control measures
Most countries have already taken measures to stop the spread of the virus, such as closing aerial borders, banning gatherings and closing schools, without going as far as total confinement for the moment.
If they make it possible to slow the spread, these measures will, however, affect the economies of countries and populations that often live from day to day.
They will also impact vulnerable people in countries already dealing with humanitarian crises.
In Burkina Faso, for instance, it will be very difficult for organisations to ramp up the humanitarian response as we were all calling for in response to insecurity and population displacements.
None of us is today in a position to bring in new teams and the medical supply system will be disrupted for weeks or even months.
Yet, it is imperative to strengthen not only the response to the humanitarian crisis but also hygiene and infection prevention measures, in order to stop the virus spreading in a country where access to water is largely insufficient.
Striking a balance
Each country will certainly have to adapt these measures soon, in order to strike a balance between the necessary slowdown in the spread of the virus and the economic and social impacts that control measures are likely to have.
Nevertheless, certain constants must remain regardless of the country.
First of all, what will make the difference in slowing down the epidemic is a change in individual attitudes: the respect for the 1.5-metre physical distance we are told about and the application of basic individual hygiene measures.
Another key element in dealing with the epidemics will be our ability to identify, monitor and care for those most at risk, particularly in the communities.
COVID-19 is a respiratory disease with mild or moderate symptoms for the vast majority of people who catch it, but it causes quite serious complications among those at risk, especially the elderly and people with other medical conditions.
But we still know very little about its transmission in tropical areas or the consequences of co-infection with other chronic diseases, such as diabetes or hypertension, or with more seasonal diseases like malaria or malnutrition.
Other health concerns cannot be neglected
Finding an alternative to screening is also key as the testing and diagnostic capacities are not sufficient at the moment.
We will have to set up detection mechanisms based on symptoms and to develop epidemiological monitoring and referral systems for the most critical cases as close to the communities as possible.
Nevertheless, the concentration of attention and energy on COVID-19 over the next few weeks may lead us to forget other health concerns or neglect a large part of the population.
For example, malaria and measles – for which epidemic-scale outbreaks have recently appeared in Burkina Faso and Niger – remain high mortality diseases in these countries and it’s necessary to carry out preventive activities or vaccination campaigns.
Yet, we face the risk of not being able to deploy sufficient resources.
Learning from the past
We have to draw lessons from past epidemics, including the Ebola experience in the region.
Most importantly, we must: ensure the safety of health workers; maintain confidence in the response and the organisations implementing it – this is essential to avoid panic and ensure the dissemination of the right information; and, not neglect other patients.
At the same time, one must be also cautious to not simply reproduce all the elements of an Ebola response, putting in place, for example, Ebola-type protective measures such as coveralls for a virus that is not contagious through the skin.
Previous SARS (severe acute respiratory syndrome) experience also evidenced that well-ventilated structures with natural light offer much better infection control conditions than sophisticated structures with a closed air circuit.
Take stock and innovate
In short, we’ll have to take stock of the past and innovate.
I would not be surprised if new solutions for responding to this pandemic come from the African continent.
African countries have indeed more experience in managing health emergencies and public health reflexes are more developed there than in Europe.
We are moving quickly towards simplifying medical protocols and standards, which could allow a faster response in a situation like this.