It is becoming more glaring each and every passing day and with every passing address by the President that government is losing the battle and the fight against the COVID-19 pandemic in Ghana.
In as much as we expect an all-inclusive participation in the fight against the coronavirus pandemic, it is more important for government to lead by example and must focus on steering the country out of this alarming crisis instead of engaging in unnecessary economic flattery comparisons. Over the past two months, government appeared uncertain in it’s decision making, which could partly have to do with a lack of precision from the various agencies involved in this life threatening national battle.
Our cases have skyrocketed since the lifting of the lockdown which was supposedly done with the relevant scientific data, with a current case count of 5,127. Events of post-lockdown lifting has exposed serious lapses in our health systems, public health planning and policies. With the herculean jump in the number of cases, we were told of pending backlog samples which suggested that as a country we could not predict the incidence rate or infectivity rate of COVID-19.
Accordingly, the scientific curves that have been drawn to provide statistical information on our current situation was the positivity rate. In basic mathematics, positivity rate would be defined as total number of positive cases per total samples tested over a period of time. This information, although relevant does not provide enough information that can influence policy decisions in fighting this pandemic. With Ghana taking samples from both routine surveillance and enhanced contact tracing, the question then arises as to whether positivity rate of all samples lumped up and tested provides empirical information on the current infection rate on the ground. Furthermore one would wonder whether the same number of samples were collected every day over the period of calculating this positivity rate and whether samples taken were without geographical bias looking at the site map of our cases such that the positivity rate calculated will show the actual countrywide picture.
For example, if for instance we test 1000 samples in week 1 and subsequently test 500 samples in week 2, then positivity rate if calculated per samples taken within the two periods will provide different statistics. This then shows that, the positivity rate is actually dependent on the number of samples tested over a specific period of time and would not present a clear picture of our situation with COVID-19. This causes one to think of how such data will inform flattening of our curve as suggested by government.
In addition to the above concerns of using a positivity rate in making such assumptions, it is important to know what the estimated number of asymptomatic cases within the community are, which have equal potential of infecting people just as people having mild to severe symptoms. If we cannot predict for sure those figures, then it may be an error in judgment to suggest a flattening curve unless of course government decides to stop testing.
At this stage where we understandably are struggling to generate anything close to a real epi curve, due to challenges with backlog which has made us lose real time data analysis, calculating and drawing an Ro curve which will show our infectivity rate will provide a more scientifically significant data on our status as a country with the spread of COVID-19.
Simply put Ro (R naught) shows us the estimated number of people an infected person can infect/transmit the virus to. The typical Ro of COVID-19 is averagely 2.0, which suggest that an infected person will be able to infect two other people. There are some countries who have however reported an Ro of as high as 5. Calculating the Ro of Ghana after this number of months of contact tracing and testing should be able to give us an estimated infectivity rate. This would provide us with enough scientific information to help inform decision on preventive measures and how they should be enforced to curb community spread.
In addition to testing, which is important in identifying isolated cases, it is important to do a more critical epidemiological analysis of the pandemic in Ghana to help in policy planning on preventive measures and practical solutions to avert the spread in the country. A pandemic such as COVID-19 is propagative in nature. A propagative epic curve begins with an index case that infects a number of other individuals. One or more of the people infected in the initial wave then infects a group of people who become the second wave of an infection. So here,a transmission is via person-to-person. A major characteristic of a propagative curve is that when control measures are not put in place and enforced, the disease continues to spread until it has no more susceptible person/host to infect. At this point, the curve flattens and subsequently declines as already infected people begin to recover.
It is widely known that the people with a higher risk of severe morbidity and mortality from COVID-19 are people with underlying health conditions or comorbidities in particularly hypertension and diabetes patients. Ghana’s prevalence of hypertension and diabetes from various studies shows a range of 19% – 54% and 3%- 8% respectively. Actual prevalence however cannot be stated accurately considering the number of people within communities who do not know of their health status. It is therefore imperative to take the necessary actions to curb community spread to save ourselves of a likely increasing number of severe morbidities and mortalities. Without the right measures we risk having a situation that could overwhelm us as a country.
In addition to the above statistical suggestion, it is equally important that we also focus on education, employing of effective Social behavioral change communication techniques and the enforcement of control measures such as the use of face masks, social distancing and personal hygiene among others.
Let us focus on what is important and pertinent for once as a country and not compare a pandemic to an energy crisis but rather how we have progressed largely in dealing with the pandemic.
Let us get our science and statistics right to help in fighting COVID-19. We are all at risk of this looming disaster.
In togetherness and without unnecessary penchant politicking, we shall come out of this with our heads up.
Long live Ghana.
By: Kwame Asiemoah Jr.
MPH, BSc. Biochem