Strategies to Contain and Stop the Transmission of the Corona virus Disease in Ethiopia

 Tilahun Adera, PhD;
Professor; School of Medicine,
Virginia Commonwealth University
April 10, 2020

Strategies to Contain and Stop the Transmission of the Corona virus Disease in Ethiopia

1. The Public Health Threat:  

The coronavirus disease 2019 (COVID-19) caused by the 2019 novel coronavirus (SARS-CoV-2) has continued to spread globally. The rapid spread of the virus has sparked alarm worldwide. The World Health Organization (WHO) has declared this outbreak a pandemic, and many countries are grappling with a rise in confirmed cases. According to the WHO, although the virus was relatively slow to reach Africa, infection has grown exponentially in recent weeks and continues to spread. As of April 9, 52 African countries had reported more than 10,000 cases and more than 500 deaths due to COVID-19. 

As of April 10, Ethiopia has reported 65 cases and 3 deaths from COVID-19. Despite the relatively small number of cases identified so far, Ethiopia has already began taking steps in an effort to control the pandemic: On 16 March, the office of the prime minister announced that schools, sporting events, and public gatherings shall be suspended for 15 days. On 20 March, Ethiopian Airlines suspended flights to 30 countries affected with the coronavirus. On the same date, it was announced that anyone entering the country should undergo a mandatory self-quarantine for 14 days. Night clubs in Addis Ababa are also to remain closed and boarders are ordered to be closed until further notice. On 23 March, Ethiopia closed all land borders and deployed security forces to halt the movement of people along the borders. On April 9, the Prime Minister declared a state of emergency in an effort to fight the coronavirus disease, although it is not yet clear how the state of emergency would affect disease transmission in the absence of harsher measures such as a lockdown. While these measures are steps in the right direction, more strategic steps need to be taken to protect the Ethiopian public in the absence of a vaccine or treatment. 

2. Ethiopia’s Global Health Security

Ethiopia’s Global Health Security (GHS) Index score for 2019 was 40.6%, which was approximately equal to the average score of 40.2% among 195 nations surveyed. In addition, Ethiopia was ranked 84 out of 195 nations in the survey, lagging behind neighboring Kenya (GHS=55) or Uganda (GHS=63). The GHS Index is a comprehensive effort to assess and benchmark health security and related capabilities of 195 nations based on six key factors including prevention, detection and reporting, rapid response, health system, compliance with global norms, and risk environment. Ethiopia’s relatively low GHS score reveals vulnerabilities in its health infrastructure indicating that its health capacity may be too weak and precarious to withstand a major onslaught of this vicious pandemic as it sweeps through the globe.

3. Health Capacity and Epidemic Curve 

Without speedy and coordinated public health interventions such as rapid testing, isolation of cases, “social distancing” and stay-at -home policies, the number of COVID-19 cases could rise beyond the capacity of the healthcare system to handle severe cases. This occurred in Wuhan, China and is happening now in parts of Italy and Spain. The goal is to “flatten” the curve (blue curve) – reduce the daily rate of new cases so that the number of severe cases can be handled effectively by the healthcare system. Note that public health actions taken to “flatten the curve” do not guarantee the reduction in total number of cases during a pandemic. That will be determined by additional factors such the speed by which other effective prevention measures (e.g., vaccines) are developed. The figure below demonstrates the impact of effective social distancing and other interventions on the timing and size of the peak burden of disease. The intent is to ensure the burden of disease does not exceed the capacity of the health system to manage.

4. Goal 

The overarching goal is to reach a stage where no new cases occur in Ethiopia. The path to reach this goal starts with intervention measures that would slow the progression of the outbreak and limit the burden on the health system by taking actions to reduce transmission. Transmission of COVID-19 occurs through contact with respiratory droplets containing the virus, produced when an infectious individual coughs or sneezes. Consequently, personal behavior is key to containing spread of the virus, and involves taking personal responsibility for measures, such as regular hygiene practices, early self-isolation and personal social distancing. Additional public health interventions such as rapid testing and stay-at-home policies are warranted.

5. Need for Evidence-based Decision Making 

Decision makers need to be empowered to lead and manage the pandemic more effectively by providing timely useful evidence. This evidence can be gathered through an effective coronavirus public health surveillance system for targeting and monitoring interventions. It is a tool to estimate the health status and behavior of the population. Because surveillance can directly measure what is going on in the population, it is useful both for measuring the need for interventions and for directly measuring the effects of interventions such as social distancing and rapid testing. Implementing the following measures is necessary to collect the evidence needed for decision making:  

    1. Developing rapid case-finding system
    2. Identifying and testing suspected cases
    3. Isolating and providing treatment to those who tested positive
    4. Tracing and testing contacts of cases
    5. Repeating the process until no new cases found

6. Essential Measures Proposed

    1. For health Care Workers:  Make available personal protective equipment including N95 respirators, face masks, face shields, and surgical gloves.
    2. Masks for All:  Promote the use of face masks for all people.  We recommend that 
    3. Promote social distancing, 
    4. Promote personal hygiene including handwashing with soap and warm water, use of sanitizers (to the extent possible), 
    5. Manage border measures including travel to and from other countries
    6. Temporarily suspend/manage non-essential gatherings of individuals of any size for any reason (e.g. parties, celebrations or other social events) 
    7. Avoid close contact with anyone outside of family members during outdoor activities.
    8. Consider construction and/or repurposing of temporary hospital facilities in an effort to address imminent capacity issues.

7. Specific Actions for Implementation

Protecting the health of Ethiopians in the setting of this pandemic will require: 

    1. Effective surveillance and prompt response to the pandemic;
    2. Effective diagnostic and screening tests;
    3. Rapid deployment and distribution of definitive medical countermeasures (i.e., vaccines) when they become available.
    4. Targeted and effective use of antiviral medications and other potentially scarce medical resources to treat symptomatic individuals.
    5. Judicious application of community infection control measures.
    6. Effective communication of risk reduction strategies to the private sector and to individuals.
    7. Full collaboration of the public and the private sector. A dynamic and resourceful public health and medical response has the potential to save lives by delaying the occurrence of outbreaks, decreasing the proportion of the population who develop the disease or become critically ill, and reducing the burden on critical health care facilities. For such a response to occur, Federal, Kilil, Woreda, Kebele, and Idir must ensure that all stakeholders understand their responsibilities and are adequately prepared to play their part. They must prioritize the use of scarce resources, and they must ensure the continuity of essential government, emergency, and medical services. 

Preparedness for this pandemic requires the establishment of infrastructure and capacity. This process can take a long time. For this reason, significant steps must be taken now. The Ethiopian government should use all instruments of national power to address the pandemic threat. An effective response will require the full participation of all levels of government and private institutions (Federal, Kilil, Woreda, Kebele, Idir) and all segments of society. Protecting human health is the crux of pandemic preparedness, and the goals and pillars of the Ethiopian strategy must reflect this. If we fail to protect human health, we are not likely to succeed in our secondary goals of mitigating the social and economic consequences of the pandemic.

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