Prof. Theophilus Ben Kwofie
We are once again witnessing a major outbreak of another viral infection that is believed, like the previous viral outbreaks such as HIV, H1N1, H5N1, and H7N9-influenzas, severe acute respiratory syndrome (SARS-CoV-1), Middle East respiratory syndrome-coronavirus (MERS-CoV), Ebola, etc., to originate from animals. This new virus which is a novel human coronavirus is called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with its clinical disease known as coronavirus disease 2019 (COVID-19).
It was first identified in China in December 2019, and like the previous viruses, the evolution of SARS-CoV-2 also remains elusive. The outbreak of this SARS-CoV-2 has rapidly spread to almost all human-habiting continents of the world, including our Africa continent, and the rate of spread keeps on changing with new infections occurring daily.
The news of SARS-CoV-2 has saturated our media landscape, occupying an appreciable space on our TV and radio stations, social media, conversations, discussions and general public discourse. This has caused much concern among our citizenry, especially against the backdrop of our weak healthcare systems, low economic status, unstable and uneven distributed social services and very high illiteracy rate. This, to many of us, makes us as a nation highly vulnerable to the pandemic.
To minimize the impact of SARS-CoV-2 pandemic threats on our human health, our economic and social stability, our President, H. E. Nana Addo-Dankwa Akufo-Addo, on Wednesday, March 11, 2020 addressed the nation, assuring us about his preparedness to contain the threat and also outlying the measures he and his government have put in place to achieve the containment. Unfortunately, however, barely 24 hours after his address, Ghana recorded her first COVID-19 infected cases in two persons said to have just arrived in the country from two European affected countries. The focus now will be to mobilize all available resources to either contain the two identified cases from spreading or at worst to drastically slow down the rate of spreading. It is assuring to note that the appropriate authorities (Ghana Health Service) say they are going to undertake contact-tracing to track down any one who may have had contact with the two identified cases.
To effectively contain these two cases from spreading, it would be necessary to build on the lessons and knowledge gained during the fight against the 2014/2015 West Africa Ebola epidemic.
Targeted and segmented efficient education to the populace
During the fight against the 2014/2015 West Africa Ebola epidemic, we were told that two main factors that fuelled and accelerated the uncontrolled spread of the Ebola outbreak in Guinea, Liberia and Sierra Leone were that of the populace erratic response to authority directives and the inadequacy of laboratory diagnostic facilities. We were told the populace’s response in those countries was that of panic, anxiety, confusion, perplexity and disbelieving and not willing to readily obey directives from the authorities. That, it was found, was due to inadequate, disjointed and incoherent education from the authorities. I personally think that considering the socio-culture diversities of our people as well as the demographic differences, I believe a particular type of educational approach may not work for everyone. For example, an educational message targeting say religious institutions and organizations in the event of an outbreak occurring may not adequately apply to say market traders and their customers, commercial transport drivers and other motorists and their passengers or to others such as students (both in residence and non-residence) and their authorities, hoteliers, security agencies and even healthcare workers. In my opinion, I think we ought to break our society into segments and each segment given a specific targeted education, an approach which I termed ‘targeted and segmented education’.Through such means, I think each person or group of persons in their daily activities would then know exactly what to do and how to behave in the unlikely event of COVID-19 spreading, and this I think would help to contain and minimize the impact this outbreak may cause.
Establishing a very safe and timely laboratory diagnosis
Another reason that fuelled the Ebola outbreak in Guinea, Liberia and Sierra Leone is the mass isolation of anyone suspected of having Ebola virus infection. As we all may know, diagnosing SARS-CoV-2 infection clinically in an individual who has been infected only a few days is difficult because early symptoms are non-specific to the virus and are seen in other patients with diseases that occur much more frequently and are endemic in our sub-region. If, therefore, a person is suspected of having SARS-CoV-2 infection, then a laboratory test must be done immediately and promptly otherwise we will end up exposing people whose cases weren’t SARS-CoV-2 infection to begin with to the infection through mass isolation. Even though research institutes such as the Noguchi Memorial Institute in Accra and the Kumasi Centre for Collaborative Research (KCCR) in Kumasi have established a diagnostic facility in our country and while this is very commendable, I don’t think in the event of the outbreak spreading uncontrollably, Noguchi and KCCR alone may be able to serve the nation. I therefore think it is time for our health authorities to seriously consider equipping the laboratories of the bigger hospitals such as the teaching, regional and district hospitals to enable them to perform the laboratory diagnoses of SARS-CoV-2 infection.
Well, it is not lost on me that establishing a PCR diagnostic facility in those hospitals, as I am advocating, is quite expensive, but how much is human life?Now that we are even told that PPEs are available here and there in our country and we are also told that isolation facilities are being established and perfected, then it stands to reason that it should be possible to train and upgrade our hospital laboratories to be able to diagnose SARS-CoV-2 infection without danger.
At any rate, let us also bear in mind that as long as human activities are venturing into uncharted grounds, causing disturbances in the ecosystem into otherwise peaceful environment, then emergence or re-emergence of infections such as Ebola, SARS-CoV-2, etc, are going to come one after the other. Therefore, as part of our country’s preparedness and readiness for this and future eventualities, let us develop and institute robust response measures that can withstand and which can readily be activated any time the need arises.
The earlier, therefore, we prepare our hospitals to be able to undertake SARS-CoV-2 and any other virus infection diagnoses, the better it would for the efficient management of this and any future virus outbreak in our country.
Department of Microbiology & Immunology, School of Medicine, University of Health & Allied Sciences, Ho, Volta Region
E-mail Address: tbkwofie@uhas.edu.gh or tbenkwofie@yahoo.com