In his keynote on day 1 of virtual event Omnia Health Live Africa virtual, African Centres for Disease Control and Prevention (Africa CDC) Director Dr John Nkemgasong highlighted research into any COVID-19 vaccine developments in Africa and what a return to normal looks like for the continent.
Presenting from Addis Ababa, his epidemiological update included the following:
- 38,000 deaths from 1.5 million cases across Africa, representing a recovery rate of 83 percent. 35 countries are reporting fewer than 10,000 cases (65 percent)
- It took the continent 123 days from when the first case was reported in Egypt to reach 500,000 cases. Then it accelerated, taking 30 days to reach 1 million cases. Thereafter it took 58 days to reach 1.5 million cases
- The pandemic peaked in July 2020. Key public health measures helped to reduce the number of new cases
- The rate of new cases have greatly differed across Africa: for example a 12% decrease in cases in Central Region of Africa and a 10% increase in the Northern Region
On public health measures, Dr John Nkemgasong explained as follows:
- a joint continental strategy was agreed to ensure better cooordination and promote evidence-based practices, underpinned by the need to limit COVID-19 transmission on the continent. More than 30 policy guidelines were distributed to member states
- a PACT strategy originally targeted 10 million tests to be completed by October. It was surpassed two months ahead of the target date
- an African Medical Supplies Platform online marketplace was launched to enable critical COVID-19 equipment in Africa
- member states were brought into Senegal to train on diagnostics (in January there was no diagnostic capability)
The search for a vaccine meanwhile has involved a “whole of Africa” approach to saving lives, economies and livelihoods that included a stakeholder roadmap. He pointed to the example of AIDS deaths in US versus Africa during the 1980s, where in the latter case deaths continued to increase relative to the US (totalling 12 million deaths), and that history shouldn’t repeat itself. Vaccinating 60% of the African population is expected to cost USD 10-15 billion.
Despite Africa's success, there have been major lessons learned. Challenges included access to diagnostics, medicines and vaccines; underfunding; inadequate human resources; a need for improved leadership in the health sector; a need for strong political commitment; and weak health infrastructure.
These present opportunities to systematically strengthen Africa's health systems to promote sustainabilty and increase resilience against future emergencies, Dr Nkemgasong concluded.
Quality and safety lessons learned from COVID in the African context
At this session, panellist Irene Ogongo, Founder and Lead Mentor, Nurses in Africa, Nairobi, Kenya, shared that when COVID-19 took centre stage, safety took over quality.
“One of the lessons I quickly learned was that quality is being viewed as something to do after everything else is said and done, which should not be the case,” she said. “Often the quality part comes in as an afterthought. Another thing COVID-19 taught us is that remote mentoring and coaching is possible in resource-restricted settings. We were able to hold virtual classes with good uptake.”
While Dr Edgar Kalimba, Deputy CEO, King Faisal Hospital, Kigali, Rwanda, highlighted that healthcare workers in his hospital were becoming COVID-19 positive from the community as well as within the hospital and that required the need to change the approach. “Before we were testing only those who showed symptoms, but we quickly changed that to testing every elective admission patient. Based on this we were admitting patients who were asymptomatic or had mild symptoms and this helped in stopping the spread to the healthcare staff,” he said.
Dr Kalimba added that his hospital also realised that there was a need to allocate teams differently. “We put the doctors and nurses into different groups and teams, and they stick to that group when they do their shifts. So, for instance, if a member of the staff becomes COVID-19 positive it will be only within that team instead of different groups. All these measures have helped reduce exposure to staff and helped to control spread within the hospital. One thing that we are looking to do is significantly step up our remote consultations.”
“We need to have strong leadership, teamwork and coordination starting from the national level but also trickling down to regional district levels,” stressed Dr Apollo Basenero, Chief Medical Officer, Namibia Ministry of Health and Social Services, Windhoek, Namibia.
Immunological response in COVID-19
Dr Mervat El Ensary, Chair - Clinical & Chemical, Pathology Department, Cairo University, Cairo, Egypt, the moderator of the session, explained that the immune response to SARS-CoV-2 infection has two phases.
Phase 1 – moderate symptoms where the cytokine response used to eliminate the virus causes inflammation.
Phase 2 – severe symptoms that cause hyper inflammation and destruction of lung tissue. This uncontrolled inflammation is called “Cytokine Storm” that can result in severe tissue damage and acute respiratory distress and death. The cause of the large-scale release of cytokines is still unknown.
Current observations indicate that coronaviruses are particularly adapted to evade immune detection and dampen human immune responses. She highlighted that this partly explains why they tend to have a longer incubation period 2-11 days on average compared to influenza, 1-4 days. The longer incubation period is probably due to their immune evasion properties, efficiently escaping host immune detection at the early stage of infection.
Panellist Prof Rudo Mutasa, Professor of Pathology, University of Zimbabwe, Harare, Zimbabwe, added: “COVID-19 has had a smaller sample of autopsies due to the fact that it is a new disease and there is the fear of catching the virus. However, the samples have shown that COVID-19 is not just pneumonia, it is a multi-system inflammatory disease. The main findings are in the lungs and the consistent finding is diffused alveolar damage, which correlates to respiratory disease.”
Going viral: How COVID-19 could transform hospital planning and design
Healthcare infrastructure experts shared their thoughts on the role healthcare planning and hospital design have in helping to prevent pandemics in the future.
Moderated by Abbott's Judy Varndell, Commercial Excellence Director, Africa, the discussion involved speakers from Western Cape Government Health; Health Access International; Deloitte; and Africa Institute of Healthcare Quality Safety & Accreditation (AfIHQSA).
- Elom Otchi from AfIHQSA commented that there were instances of PPE shortages which were partly addressed within the facility, for example the sewing of face masks. The development of an app also helped with contract tracing and testing.
- Speaking from Utretch, Health Access International consultant Dirk Joubert said of the pandemic that no one had effectively planned for it, in terms of resources, buildings and materials.
- Duncan Rendell (Western Cape Government Health) agreed that no one in South Africa was used to the scale of disaster management that the pandemic presented, and "off the shelf responses" weren't ready. He added thtat they pivoted to solutions such as shipping containers.
- Deloitte's Marco Macagnano stated "the future is now" and that the move to digital enabled capabilites wasn't as difficult as had been anticipated. Healthcare will permeate so that it forms part of other environments, such as retail and commercial.
Healthcare worker safety – In collaboration with Infection Control Africa Network (ICAN)
As of September 3, more than 7,000 health workers have died around the world by contracting COVID-19. The pandemic has exerted unprecedented pressure on healthcare systems worldwide. Dr Adebola Olayinka, National Lassa Fever Research Coordinator, Nigeria Centre for Disease Control, Abuja, Nigeria, highlighted the below factors impacting healthcare worker safety:
- Fear of being infected at work and then passing on the disease to families
- Working in inadequate environments with low capacity to apply optimal safety measures
- Lack of access to PPE
- Mental stress from watching people die
- Increased workload
- Reduced rest periods
- Increased violence and harassment from patients or colleagues
- Increased social stigma and discrimination
Dr Olayinka shared a few guidelines for administrative precautions for COVID-19:
- Establishing new healthcare facility policies on the management of COVID-19 suspects and confirmed cases.
- Development of training packages to instruct healthcare workers on how to effectively adhere to standards while caring for COVID-19 patients
- Establishment of isolation spaces