RE: There is possibility of a lockdown, tighter restrictions – Oppong Nkrumah

On Monday 25th January 2021, Ghanaians woke up to the above headline news item. The most important paragraph in the minister’s press briefing, as quoted by Myjoyonline.com was: “Yes, there is a possibility of some more restriction being introduced especially with regard to how this trend is going. If these numbers keep rising where the average daily increases to 210- 250 that means in five days we will be hitting about 1000 plus. So if it continues, then as the President himself articulated; then we are heading for more restrictions and if it means reviewing some of the legal instruments, we will do”.

When the Minister dropped that alarming headline, Ghana’s active case count stood at 3,525, with a total case count of 61,498. As I type these words, the Ghana Health Services Covid-19 updates’ portal shows an active case count of 3,613 and a total case count of 62, 135, meaning since the minister authored those words, over 600 Ghanaians have tested positive. An epidemiological map on the Ghana Health Service (GHS) portal also confirms that the Covid-19 virus has now spread to all 16 regions of the country, with Greater Accra, Ashanti and Western Regions – the biggest hotspots.

Given that Ghana’s Covid-19 testing efforts have largely focused on symptomatic cases seeking care at health facilities and in-coming travellers at the airport, and in the presence of evidence indicating asymptomatic transmission accounting for about 40% of new infections, the alarm bells are ringing all over and rightly so.

Thus, Mr. Oppong Nkrumah’s warning of the possibility of a lockdown and tighter restrictions ahead may be a shadow of coming events. But is a lockdown the way to go for Ghana at this moment? The good news about a pandemic is that every country in the world is struggling for solutions. So what are we learning around the world?

In April 2020, when the world was awakening to the global threat of Covid-19 and most countries implementing lockdowns as a transmission control measure, cafes and restaurants remained opened in Vietnam. In July 2020, 10,000 baseball fans attended a match in a stadium in Taiwan, sending shocking waves around the world. In August 2020, thousands packed together for a music concert at the Wuhan Maya Beach Water Park in China, the very place where this beast of a Covid-19 came from. In October 2020, rugby internationals was organised in New Zealand with stadia at full capacity.

As I type these words, daily life within these countries has largely returned to normal. Compared to other countries, they have faced minimal economic damage. In fact, Taiwan never even had a lockdown, while lockdown measures in Vietnam, New Zealand and China were early, short and sharp. Out of a population of 1.4 billion people, China has only suffered 4,636 Covid-19 deaths; Vietnam, Taiwan and New Zealand together have had 67 deaths at my last check (26-01-21), much lower than small-country Ghana. How are these countries keeping Covid-19 under control, their health systems running, and their economies and societies afloat?

That is the question we should all be asking in Ghana, instead of a myopic fixation on lockdown measures. In March 2020, the Government announced a lockdown on the Greater Accra Metropolitan Area and the Greater Kumasi Metropolitan Area. The most important benefit of a lockdown is to buy time for the health system (not only the healthcare system) to ramp up capacity to combat the virus. If the time afforded by a lockdown is squandered, a lockdown becomes a retrogressive measure, given the socio-economic implications of a lockdown. Did Ghana squander the time of the lockdown of the two high-risk locations in March 2020? The answer depends on which side of the bed one woke up this morning.

Over the course of the past few months of electioneering campaigns, the case numbers have gone up and down. At a point, Ghana appeared to have crushed the curve and brought its R number under total control. But rather than replacing harsh restriction measures with a functioning testing and tracing strategy, switching from quarantining the population to only quarantining those who had been exposed to the virus, the Government happily lifted restrictions without an effective fallback. Meanwhile, the government implemented a test-on-arrival measure at the airport that seemed to focus more on making money rather than stopping the importation of the virus into the country (based on my own experienced). In effect, new chains of infection has been going on unnoticed.

What happened in March 2020 when Accra and Kumasi were lockdown suggest that for the government, the purpose of a lockdown seemed to be simply that: lock the country down and hope the problem would go away (remember the prayer meeting at the Jubilee House?). But lockdown itself doesn’t fundamentally change the virus or its trajectory. It just buys us time and what one does with the time is what matters. What Mr. Oppong Nkrumah should note is that when a lockdown is announced, sooner than later, fatigue and anger will set in. Soon, the population will equate suppressing the virus with staying at home and shutting down businesses. The alarm bells will start ringing: folks will ask: could the cost of locked down measures be higher than the toll of the virus itself? Should the lives of millions be constrained just to prevent the deaths of thousands? Should the cure become more costly than the disease?

So, what are the strategies to deal with covid-19 before an effective vaccine arrives in Ghana? The answer cannot just be locking down and imposing stricter measures on a population where a large number depends on hand-to-mouth kind of jobs, given the large economic and social costs this involves. A recent peer-reviewed paper (Han et al., 2020) examined international lessons from easing lockdown and identified three key elements that are essential for bringing the virus under control.

Institute a robust system for testing, tracing and isolating, where test results are returned within 24 hours, at least 80% of people’s contacts are reached and there is high adherence to a rule of 14 days’ isolation for those exposed to the virus.

Continuous implementation of strong public health guidance on avoiding the virus at any age, encouraging people to get outside as much as possible, to avoid indoor, crowded and poorly ventilated spaces, and touse face coverings and physical distancing wherever possible. This strategy should include implementing specific methods to increase risk perception through a robust risk communication rather than a continuous awareness creation (in this case, knowledge is not power!).

Implement strict border measures to prevent the virus (new strains) from being reimported, instead of our current system that is lax, poorly monitored and seems to focus on making money rather than breaking the chain of transmission.

The pandemic is still in its second wave. Praying for the virus to magically disappear, allowing it to run its course through society (for the apostles of herd immunity), or imposing continual lockdown measures without a clear strategy beyond waiting for a vaccine are all suboptimal choices that will damage the health of Ghanaians, increased economic hardship and destroy the very fabric of the Ghanaian society. At what stage will the Covid-19 taskforce (or as the name applies) look towards east Asia and the Pacific and say, “We want what to do what they did”? At what point will we learn from their playbook: suppressing the virus, opening up the economy and regaining a semblance of normality in our daily lives? The answer to these questions lies at the bosom of the COVID-19 Task Force.

By John Kingsley Krugu (PhD), a senior associate Public Health Advisor/lecturer at the Royal Tropical Institute in Amsterdam and a member of the Ghana Public Health Association. Currently based in Accra.