Looking at the upcoming data, Ghana is very likely to take a big hit of COVID-19 cases in the next few weeks. Our rate of increase in confirmed cases over the first 12 days exceeds that of all our continental neighbours.
Considering the significant number of positive cases that have been picked up so far, one cannot help but wonder how many asymptomatic carriers of COVID-19 may have slipped through the net in the preceding weeks, and are probably, inadvertently spreading the disease in our communities.
We are grateful for the government’s decision to compulsorily quarantine and test all travellers to Ghana through our airport from the last weekend.
The emerging trend, however, calls for an enhancement of strategy in addition to the already announced measures to avoid an out of control situation/outbreak – China, Italy and Spain on my mind.
The following suggestions should be seriously considered and acted upon quickly.
- Enhance contact tracing, identification and testing
- Make testing more available
- Review case definitions so that community-acquired cases with no history of contact with known COVID-19 patients or recent travellers can get tested
- Collaboration with private labs eg Medlab, Lancet and Institutional labs with capacity to scale up should be pursued urgently to facilitate access to testing
- Deepen education and awareness at all levels about the disease, preventive measures, social distancing etc.
- Steps should be taken to enforce these measures
- Lockdown of hot spots.
- Our health institutions have to go into disaster preparation mode NOW.
- We should identify, designate and equip more hospitals to accommodate the anticipated case influx, or each individual hospital should designate and set upwards in anticipation. ( That way other hospitals can continue to render other essential services).
- The private hospitals and the religiously affiliated health institutions must be an integral part of the overall strategy.
- Fast tracking of overdue NHIS payments would put health institutions on a better footing to support the cause.
- There has to be a quick compilation of available specialist manpower/skills relevant to COVID-19 case management including but not limited to Respiratory Physicians, Intensivists, Anaesthetists, Physician specialists, Critical Care Nurses, Physiotherapists, Microbiologists, Laboratory technologists, Infection Control specialists, Biomedical engineers, Morgue attendants, etc.
- There may have to be a temporary redistribution of manpower to deal with hardest-hit areas.
- The distribution of high dependency/intensive care beds, functioning ventilators, CT scans etc across the country should be compiled quickly. (Preventive maintenance and servicing!)
- All staff (especially doctors and nurses including those on regular leave) should be put on notice that they are likely to be recruited to augment the strength of the case management teams in the event of a large influx of cases.
It is therefore very important that institutions begin to compile this list of staff and psyche them up.
- Institutions should urgently provide live training, updates/refresher to the frontline and backup staff on how to function within a high infection environment, management of critically ill patients etc.
- Simulations should be done until it becomes second nature, else releasing unprepared staff into the fray when the storm hits will result in a disaster of unimaginable proportions.
- There should be enough PPEs for both the simulations and when we go “live”.
- The safety of health care workers cannot and should not be compromised at any point.
- Details of motivation/ insurance packages should be shared transparently to avoid unnecessary frustration and suspicions which will destroy the esprit de corps.
- Retired healthcare volunteers should be utilised in regular wards and not in high-risk areas as they are known to have a worse prognosis with respect to infection with COVID-19.
- An essential supply list for COVID-19 cases including essential medicines should be agreed on by now.
- A national stockpile of essential medical supplies should be built swiftly in collaboration with medical and pharmaceutical experts and industry. International assistance should be quickly sought where needed.
- We should know by now what treatment regime/protocol we want Ghanaian COVID19 patients to be on. This should not be left to chance.
- Approvals (FDA, Ethics) should be fast-tracked for promising treatments- Chloroquine? Hydroxychloroquine? Azithromycin? Zinc? Vitamin C? Antiviral agents? Alone? In combination? Dosage?
- Availability of Oxygen, flow meters, facemasks, airway support, ventilatory support should be confirmed
- An experienced research team should be on hand to document our experiences with the cases across the different facilities so that any valuable lessons/innovations can be disseminated rapidly to save lives.
- Arrangements should also be in place regarding how to deal with those who are unfortunate to succumb – notification of family, quarantine of close contacts, burial issues, psychological support etc
- Social welfare issues, especially for orphans etc, should be anticipated and mitigated
- Political, Social, Religious, Cultural, Financial leaders, Media, Celebrities, Telcos, Agriculture, IT services, Education, NCCE, NADMO, NACOB, Metropolitan/Municipal/District Assemblies, House of Chiefs, TUC, Professional bodies/associations/Unions, Academia, Youth groups, Charities etc should be galvanised/ mobilised into cohesive teams to support the fight in whatever way possible. (Similar mobilization has been done before for HIV/AIDS etc. Utilise existing networks, no need to reinvent the wheel)
The aforementioned groups can play a major role to ensure compliance with the tough but necessary measures, care for the vulnerable, maintain the supply chain of essential products/services, ensure that prices of items like food, water, cleaning agents, sanitizers, protective gear, transport facemasks, are not hiked up to further create dissatisfaction/ disruption in society, etc. Shylocks should be called out.
Above all treatment for COVID-19, patients should be guaranteed by the state. It will be a serious indictment on all of us if family members have to go running around to purchase medications for COVID-19 affected relatives.
This challenge is probably the most difficult we have faced in our history as a nation and our best route out is to unite behind our President, eschew selfishness/negativity and contribute our bit in our respective areas to support the government’s efforts- whether it’s by staying at home, observing social distancing, providing ideas/resources, helping a neighbour, praying, educating the ignorant……
We should also psyche ourselves up for the long haul. It’s not going to be a quick fix.
“Do not let what you cannot do interfere with what you can do”.
We sink or swim together.
The writer, Dr. O. W. Ampomah, is the Head of the Surgical and Burns Unit as Korle-Bu Teaching Hospital