By: Barthalomew Wilson, MPH
Reports from the National Public Health Institute of Liberia regarding the fight against COVID-19 continue to exposed our vulnerability as a country.
The recent confirmation of 12 new cases outside of the contact list is very appalling and requires the immediate attention of all Liberians, government ministries and agencies trusted with the responsibility to lead this fight.
This is a clear a validation that our strategies in the fight against COVID-19 are definitely not working. We need to reconvene and evaluate our approach.
CORONAVIRUS IS NOT EBOLA
There are fundamental differences between Coronavirus and Ebola. While it’s true there are many lessons learned from Ebola, some of those are just not applicable in this context.
Ebola is transmitted from person to person through physical contact, either with an infected person or bodily fluid of an infected person.
Coronavirus on the other hand is transmitted through both physical and social contact with an infected person.
What this means is that you don’t have to touch a person to contract the virus. You could get infected from respiratory droplets produce when an infected person sneezes or coughs.
This could happen within six feet away from one who has the virus. This is why people are required to wear masks, unlike Ebola; because one could get the virus from someone they may not even remember – it could be at the bank, hospital, restaurant, in the market, bar, on the bus, on the taxi, Keke, in the yard, while playing ludo, nafo, lappa, football, at home, etc.
CONTACT TRACING ALONE IS NOT ENOUGH
The essence of contact tracing is to identify and isolate contacts of those infected with the virus before they start to transmit it to others.
By doing so, you want to break the chain of transmission from person to person, cluster to cluster or community to community.
This strategy is most effective when physical contact is the mode of transmission, where it is easy to trace and find people who came in contact with an index case like we saw with Ebola.
Unfortunately, this strategy is not very effective in the fight against COVID-19 for two reasons:
1) Because the virus spread through social contact, people may get it from someone who they may not have met physically. Also, it’s impossible for the infected person (source case) to remember those he passed by in the markets, on the street, at the bank, gas station, on the bus, taxi etc.
The territory of transmission is so wide that contact tracing becomes inefficient. Because the virus is spread undetected, it’s only a matter of days before we start to see a plethora of cases.
2) There is evidence of pre-symptomatic and asymptomatic transmission. What this means is that people may have the virus without knowing because there are no sign and symptoms.
Also, because it takes 7-14 days for one to start showing symptoms, it is possible for people in this category to transmit the virus to others before they even know or suspect that they too are infected. By the time these cases are detected, hundreds of people have already being infected.
It is indeed no surprise to me that the last 12 cases occurred outside of the contact list.
The hard truth is just like those 12 cases, there are tens if not hundreds of undetected cases out there, unfortunately majority of those people continue to spread the virus unknowingly!
IS THERE A WAY FORWARD?
Yes! There are so many things we could do. Rather than exerting all of our efforts and resources on contact tracing, I will suggest that we look more towards innovative ways for ACTIVE CASE FINDING.
The only way we can look for contact, is by first identifying the source cases. We could do this through mobile community based testing. Bring in more testing kits and deploy mobile teams in high risk communities to conduct random testing.
This will enable us to find both asymptomatic and pre-symptomatic cases before they begin infecting others. Remember in this fight, there are two things that work really well- early detection of cases and early treatment.
Once we are able to identify and isolate those cases, we can break the chain of transmission- which is all you want to do.
Also, one of the things we learned from Ebola that is very important is social mobilization. However, given the nature of this virus, interpersonal communication is not a good strategy at this time and therefore we have to revise our social mobilization strategies.
We need to invest in innovative communication, using the print and electronic media to inform our citizens. Radio jingles and drama in local vernacular will prove more effective.
Also we need to ask the GSM companies to help in this fight. We could use bulk SMS to educate people and provide periodic updates.
Lastly, we have to invest in technology and health equipment. Every district level health facility in Liberia MUST have the capacity to test for COVID-19.
Transporting specimens from Maryland to Monrovia for testing is very appalling! We cannot continue to put our health workers at risk.
Do we have the resources to do that? I think we do, if only we can set our priorities straight.
Other countries including South Korea and Ghana are using technology for contact tracing. Rather than spending thousands of dollars to quarantine government officials and VIPs, we should encourage people in this category to self-isolate and some of that money could be used on technology for contact tracing–through a mobile app.
Until we start to be innovative, until we rethink our strategy and begin to do some of the things listed above, this fight hasn’t started yet.
All I see us doing is romancing the storm. I am a Liberian, I love my country and care for my people. Unfortunately, this is the most I can do. God bless our people and heal the land.
About the Author:
Mr. Barthalomew Wilson is a public health professional with over six years of experience in Public Health Emergency Response and Clinical Research on infectious diseases.
He holds a Master’s degree in public health from the Cuttington University and is a graduate student at the Harvard university, studying Global Health and Social Medicine.