By Dr Alhaji Umar N’jai
On Tuesday 23rd June 2020, President Julius Maada Bio announced at a press conference at State House the easing of the Covid19 inter-district travel ban and pushed back the curfew time from 9PM to 11PM nationwide. This announcement came 85 days after the Covid19 index case had been recorded on 31 March.
The total number of positive confirmed cases is now well over 1,300 with 60 deaths as I write, one of the highest case fatalities in the subregion. Human-to-human transmission of the SARS-COV2 (Covid19) virus is still on exponential double-digit increase with a basic reproduction number (Ro) potentially greater than 2. Given the limited testing data, one of the lowest in the sub-region; geographic spread of Covid19 infections to nearly all districts except Karene; the fact that our surveillance is chasing the virus rather than being ahead of it, it is likely the true infection rate maybe couple orders of magnitudes higher than our current test results. As we get back to normalcy and business as usual, what lies ahead of us as citizens of the nation?
So, now it looks like our fate lies with herd immunity in Sierra Leone, given the lack of a Covid19 vaccine, and fully enforced working strategy to combat the virus. We do not seem to be winning in the battle against Covid-19; and no country has clearly won so far in the first place. However, those countries that have done well in the fight against Covid19, have done so with clear, coordinated and enforced strategies that include building trust, transparency, effective testing and surveillance, public health education and community engagement, health care services and availability of strong socioeconomic service infrastructure for quarantine, lockdowns, judicial laws appropriate for pandemic, and so on.
We started this Covid19 fight with ordinary citizens like me given the false sense of preparedness and an assurance of the systems we had in place. The nation’s preparedness assurances at the time made sense; after all we were among the very last countries to record a case. We had taken the prudent steps of quarantining all international visitors from areas hardest hit by the pandemic, closing land borders, air space, declaring a state of emergency even before registering the first case, and we had at our side a power Ebola experience that few countries in the world enjoyed. So where did it go wrong with our preparedness and assurances?
The assurances have now turned out to be no insurance against widespread community transmission of the virus. The preparedness looks more like not even getting off the ground in most places. The national strategy looks and feels simply like part knee jerk, part Falamakata (copycat), and even panic response without the requisite data to drive action. I say panic response because Sierra Leone, like as many other African countries except Tanzania, rushed to do exactly what the “big nations” were doing in response to the Covid19 virus. This sort of panic made sense because if you go to a wrestling contest and your strongest fighter is whipped by the opponent, and that individual not only runs but screams and flaps their hands in exaggerated manner, you are bound to have your heart in your mouth – panic-stricken. Yet in the middle of that panic, new Leadership did not emerge. Leadership as in think, act and do something differently with the enemy.
Sierra Leone and the African Union broadly failed to constitute a group of minds to look at the nature of the virus and the epidemiology in Africa within the global pandemic. Rather, we simply relied on apocalyptic and Armageddon projections from Western models; models which failed to factor demographics as a very young African population, differences in host-pathogen response mainly genetics, co-immunities from other pathogens and or environmental toxin exposures, and other environmental factors.
Now Sierra Leone and many other African nations are rushing to reopen, as Western nations reopen, albeit with at least a better idea of the infection curve for the latter whereas for us cases are on the rise in many countries on the continent. At this juncture, should we ask ourselves the philosophical question: why did we lock down in the first place if we were going to turn around and reopen in the middle of the crisis? Where are we in the crisis in the first place – early phase, middle phase or late phase? Why did we shut down our economies, livelihoods, and economic activity if reopening in the middle of the crisis is the result?
Somehow, it seems like we shut down without data on the presence or absence of the SARS-COV2 virus in the country; it was simply we don’t have the virus, no tests done to ascertain that at the time. The second positive case with no known travel history reported not long after the index case is consistent with the view that community transmission was well underway before the first case was declared to the nation. At this point in time, we are gradually reopening without enough data on the spread and true infection rates in the country. Luck may end up being on our side with Covid19, as most of our infections are asymptomatic in nature and case fatalities would likely be much lower due to a smaller population of vulnerable people compared to Western Europe or the United States. Nonetheless, the lapses in our response call for greater reflection beyond national partisan dogmatism and whoever yells the loudest from their treetop.
As citizens of this nation, we need few answers from government as restrictions begin to ease; First, it will be good to know where in the curve we sit presently; what data is there to inform us on the curve; are we still rising, is it slowing down, are we peaking? Second, what is our overall testing strategy? Do the test results reflect the true infection rates? If not, would we see a spike in silent unknown infections that risk the lives of health care workers and our vulnerable populations? And if human-to-human chain of transmission is not contained, would the virus now have enough time to linger around and mutate to something more potent? The US President Donald Trump said in a campaign rally recently that, more testing produces more positive cases, therefore he wanted them to halt testing. Along these lines, are we testing less to keep numbers low, and buy into the narrative that our preparedness worked? Third, it will be good to have data on impacts of the two three-day nationwide lockdowns on the spread of the infections; what was the rationale for the three-day lockdowns as opposed to other models globally; Fourth, as an extension to the second point, we would like to know the impact of the inter-district travel restrictions constituted when we had cases in Port Loko and Kenema only.
Now, we are easing with cases in every district except Karene. What went wrong? What is the best explanation for this scenario? Fifth, what has been the impact of social distancing measures on the infection curve? Sixth, there had been drastic face mask campaigns prior to easing up – but what has been the impact of the use of face masks on the infections curve? Seventh, when it comes to handwashing, what does the data suggest? Are people more likely to wash hands now than before the campaign started? Eight, with regards to social mobilization, education and risk communication, how effective have they been within the overall scheme of flattening the curve of infections; Are less and less folks in denial and adoption rates of public health measures much higher than pre- campaign? Nineth, I have seen a lot of protests around quarantine facilities and people escaping quarantines for lack of food, basic amenities and unconducive environment. What is the strategy to improve the quarantine experience and enhance adoption rates? Would investing in proper quarantines service, facilities and surveillance have made more sense than investing heavily in brand high end SUV Jeeps for district coordinators? Tenth, as we have heavily focused on Covid19 in the past three months, has there been a spike in non-Covid19 related deaths? How has our ability to handle non-Covid19 infections been impacted by the Covid19 epidemic? And, Finally, what was the rationale for the 9PM to 6AM curfew when folks mingled for the rest of the day? What impact has it had on minimizing infection rate and flattening the curve?
I believe as an ordinary citizen of this country, these are answers that will help me better understand my government’s response and how effective the measures put in place to combat the Covid19 epidemic in Sierra Leone really proved to be. I thank the government for easing restrictions and coming to the realization of the economic challenges that we face in this country. Nevertheless, we could not as a nation endure an extended two-week lockdown, simply because we lack food security (despite rich agricultural lands), potable water (despite abundantly blessed with rainfall), nationwide consistent electricity (despite being blessed with Bumbuna and other hydro potentials plus wind energy).
We are a country that also lacks finance to the extent of requiring IMF and World Bank funding (despite 100 plus years of mining an array of minerals, an enormous wealth of natural resources: forests, ocean and animals). We lack adequate health systems despite Ebola resources and structures having been put in place for future epidemics, social service infrastructure and systems for quarantine, and so on despite tremendous sociocultural communal potential of the country.
I hope as a nation we can ponder over our lapses and work on building a country that is resilient with the capability to effectively utilize our resources and respond swiftly to any changes in our environment. We must learn from the past and use that knowledge or lesson to prepare for emergencies during normal times. You cannot build a mansion in the middle of flooding.
About the author: Dr. Alhaji Umar N’jai is a Global Research & Development Senior Scientist, Research Fellow, Professor, Panafrican Scholar, Founder & Chief Strategist of Project 1808, Inc., and Freelance writer ‘Roaming in the Mountains of Kabala Republic’. #Jata #Meejoh #ThePeoplesScientist
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